CHAPTER 14
Obsessive-compulsive Disorder
Psychiatrists have long been aware that children and adolescents some-
times develop troublesome and distressing rituals and ruminations, but
until about 30 years ago these were generally considered relatively non-
specific symptoms of broad-band emotional disorders. It has since become
clear that obsessive-compulsive disorder (OCD) is a relatively distinct sub-
group of the emotional disorders in terms of symptomatology, aetiology,
treatment and prognosis.
Epidemiology
Roughly a third to a half of adults with OCD have their first symptoms
before the age of 15. Epidemiological studies suggest a prevalence of about
0.5%–2% in adolescents. The prevalence is lower in prepubertal children,
but typical OCD can occur in children aged 7 or even younger. Males
and females are equally commonly affected from adolescence onwards,
but males predominate in prepubertal OCD.
Characteristic features
Obsessions are unwanted repetitive or intrusive thoughts. Compulsions
are unnecessary repetitive behaviours (or mental activities, such as count-
ing). There are surprisingly few differences between the symptoms of a
5-year-old and a 25-year-old with OCD. The most common compulsions
involve washing, cleaning, repeating, checking and touching. The most
common obsessions focus on contamination, disasters, and symmetry,
often have aggressive or sexual themes, and religious obsessions are
prominent in some cultures. Most children and adolescents with OCD
have both obsessions and compulsions; some have just compulsions; and
relatively few have just obsessions. Although resistance to obsessions
and compulsions is a diagnostic requirement for adult OCD, both ICD and
DSM recognise that this resistance is not always present in children or
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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