Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • An anxiety disorder characterized by pathologic obsessions (recurrent intrusive thoughts, ideas, or images) and compulsions (repetitive, ritualistic behaviors or mental acts) causing significant distress
  • Not to be confused with obsessive-compulsive personality disorder

Epidemiology

Incidence
  • Predominant age: mean age of onset 22 to 36 years
    • Male = female (males present at younger age)
    • Child/adolescent onset in 33% of cases 1/3 of cases present by age 15 years
    • 85% of cases present at <35 years of age
    • Diagnosis rarely made at >50 years of age
  • Predominant gender: female > males but males more commonly affected in childhood

Pediatric Considerations
Insidious onset; consider brain insult in acute presentation of childhood obsessive-compulsive disorder (OCD).

Geriatric Considerations
Consider neurologic disorders in new-onset OCD.

Prevalence
  • 2.3% lifetime in adults
  • 1–2.3% prevalence in children/adolescents (1)

Etiology and Pathophysiology

  • Exact pathophysiology/etiology unknown
  • Dysregulation of serotonergic pathways
  • Dysregulation of corticostriatal-thalamic-cortico (CSTC) path
  • Genetic and environmental factors
  • Pediatric autoimmune disorder associated with streptococcal infections (controversial)

Genetics
  • Greater concordance in monozygotic twins
  • Positive family history: prevalence rates of 7–15% in first-degree relatives of children/adolescents with OCD

Risk Factors

  • Exact cause of OCD is not fully elucidated.
  • Combination of biologic and environmental factors likely involved the following:
    • Link between low serotonin levels and development of OCD
    • Link between brain insult and development of OCD (i.e., encephalitis, pediatric streptococcal infection, or head injury)

General Prevention

  • OCD cannot be prevented.
  • Early diagnosis and treatment can decrease patient’s distress and impairment.

Commonly Associated Conditions

  • Major depressive disorder
  • Panic disorder
  • Phobia/social phobia
  • Tourette syndrome/tic syndromes
  • Substance abuse
  • Eating disorder/body dysmorphic disorder

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