Obsessive-Compulsive Disorder (OCD) is a psychiatric condition characterized by obsessive and distressing thoughts that leads compulsive rituals that may lower one’s stress level (1). The prevalence of pediatric OCD has been noted to be between 1-3% (2) and in US adults, the lifetime prevalence of OCD has been noted to be 2.3% (3). Although OCD has often been portrayed by media as excessive handwashing, the obsessive thought and associated ritual can range greatly. In a prospective study by Eisen et al., they found OCD negatively affected all aspects of quality of life (4) and another study by Overbeek et al. found depression is often present among OCD patients (5).
OCD in the pediatric population can be particularly distressing to youth and families, as otherwise-healthy children may have difficulty expressing these thoughts and compensatory behaviors to adults. Thus, some youths are at risk for going undiagnosed, particularly those who have more internalizing behaviors and obsessions with less outwardly noticeable compulsions. When diagnosing OCD in the pediatric population, it is important to consider other differentials diagnosis, including phobias and generalized anxiety disorder (6), which may occur in the presence or absence of OCD. Diagnosis of OCD should be made after an in-depth understanding of the children/adolescent’s developmental history, a clear clinical history of obsessions and compulsions, and a private one-on-one interview with the both the patient and the parents (7). Parents should be provided psychoeducation on the complexity of treating youth with OCD. Some children may require higher than usual doses of medications, and most would benefit from an exposure-based psychotherapy.
The American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues has released various evidence-based recommendations for managing pediatric OCD (8), including:
- Routine screening for repetitive behaviors, obsession and compulsion.
- Positive screening warrants comprehensive assessment with the DSM-IV-TR criteria and scalar assessment.
- Comprehensive psychiatric evaluation, history taking (medical, school, family, developmental), and assessment of co-occurring psychiatric conditions.
- In mild to moderate OCD cases, cognitive behavioral therapy is first-line treatment. In more severe cases, both cognitive behavioral therapy and medication are indicated.
- First-line medication is serotonin reuptake inhibitors and prescribing should follow the AACAP guideline.
- Consider treating the co-occurring psychiatric conditions.
With early identification and a comprehensive treatment plan, youth with OCD and their families can experience a demonstrable improvement in their quality of life.
Leo Meller, BS, is a first-year medical student at UCSD School of Medicine passionate about mental health.
Shawn Sidhu, MD, FAPA, is a child and adolescent psychiatrist at UCSD/Rady and program director of the Child & Adolescent Psychiatry Fellowship Program at UCSD.
References:
- https://iocdf.org/about-ocd/
- Walitza S, Melfsen S, Jans T, Zellmann H, Wewetzer C, Warnke A. Obsessive-compulsive disorder in children and adolescents. Dtsch Arztebl Int. 2011;108(11):173-179. doi:10.3238/arztebl.2011.0173
- https://www.hcp.med.harvard.edu/ncs/index.php
- Eisen JL, Mancebo MA, Pinto A, et al. Impact of obsessive-compulsive disorder on quality of life. Compr Psychiatry. 2006;47(4):270-275. doi:10.1016/j.comppsych.2005.11.006
- Overbeek T, Schruers K, Vermetten E, Griez E. Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect. J Clin Psychiatry. 2002;63(12):1106-1112. doi:10.4088/jcp.v63n1204
- Westwell-Roper C, Stewart SE. Challenges in the diagnosis and treatment of pediatric obsessive-compulsive disorder. Indian J Psychiatry. 2019;61(Suppl 1):S119-S130. doi:10.4103/psychiatry.IndianJPsychiatry_524_18
- Krebs G, Heyman I. Obsessive-compulsive disorder in children and adolescents. Arch Dis Child. 2015;100(5):495-499. doi:10.1136/archdischild-2014-306934
- Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2012;51(1):98-113. doi:10.1016/j.jaac.2011.09.019