Clinical features Obsessivecompulsive disorder

A number of systematic studies have been conducted over the past 10 years on children and adolescents with OCD, both in clinical settings and in the community. They have greatly increased our knowledge of the disorder in its early stage and shown that, in contrast with other forms of psychopathology, the specific features of OCD are essentially identical in children, adolescents, and adults.

Obsessions are persistently recurring thoughts, impulses, or images that are experienced as intrusive, inappropriate, and distressing, and that are not simply excessive worries about realistic problems. Compulsions are repetitive behaviours or mental acts that a person feels driven to perform according to a rigidly applied rule, in order to reduce distress or to prevent some dreaded outcome. Obsessions and compulsions are egodystonic, considered by the subject him- or herself as irrational or unrealistic, and at least partly resisted. They may be kept secret for a long time, or will only appear at home or in the presence of close family members. They are always source of psychological distress, and interfere with personal and occupational functioning, social life, and relationships to others.

The nature and frequency of obsessive-compulsive symptoms during childhood and adolescent years have been documented in various countries and various cultures. In a series of 70 young patients studied at the National Institute of Mental Health ( NIMH) in the United States,'3) obsessions dealt primarily with fear of dirt or germs (40 per cent), danger to self or a loved one (24 per cent), symmetry (17 per cent), or scrupulous religiosity (13 per cent); the major presenting ritual symptoms included washing (85 per cent), repeating (51 per cent), checking (46 per cent), touching (20 per cent), ordering (17 per cent), counting (18 per cent), and hoarding (11 per cent). Toro et aA(4) described a series of 72 children and adolescents with OCD in Barcelona, for whom the most common compulsions were repeating (74 per cent) and cleaning rituals (56 per cent). For Khanna and Srinath,(5) in India, obsessions were less frequently reported by obsessive-compulsive children than by adults, with fear of harm being the single theme which occurred most often. In a group of 61 obsessive-compulsive children in Japan, the most common obsession was dirt phobia and the most common compulsion was washing.(6)

Typically, children and adolescents with OCD experience multiple obsessions and compulsions, whose content may change over time. (3,7) However, in some community-based samples of adolescents, there are high proportions of individuals with either obsessions only or compulsions only. (89)

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