Tourette Syndrome Plus - Conditions - OCD

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Information Section: Conditions
Condition: OCD
Article: About Obsessive-Compulsive Disorder
Source: Leslie E. Packer, PhD
Page Last Updated: December 28, 2004

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HOW IS OCD DIAGNOSED?

As with Tourette's Syndrome and other conditions, the diagnosis of OCD relies primarily on reported history by reliable observers and/or the clinician's observations and judgement. In the United States, mental health professionals use the DSM-IV diagnostic criteria (opens in a new window) while in Europe, mental health professional generally use the ICD-10 diagnostic criteria.

In looking at the DSM-IV criteria for diagnosis, note that all criteria A - E have to be met, but that Criterion A specifies obsessions or compulsions (emphasis added by me). A patient does not have to have both, although many do.

If you would like to complete an online OCD screening tool, the OC & Spectrum Disorders Association has a number of screening tools on their site. Keep in mind, however, that an online screening tool is not a substitute for an actual assessment or evaluation by a qualified professional.

ONSET AND PROGNOSIS

It has been estimated that 1% of children and up to 4% of adolescents have OCD. In children, OCD appears to be more prevalent in boys, but in adulthood, the ratio of males to females is approximately the same. The age of onset is typically reported as 6 - 15 for males and 20 - 29 for females, but we know that many children (including girls) who have Tourette's Syndrome also have childhood-onset OCD. More recent research suggests that OCD may have a bimodal (two peaks) distribution of onset. About 1/3 to 1/2 of adult patients who have OCD report that the onset was in childhood or adolescence, before age 10. Those adults who had early onset experienced more sensory phenomena and had a higher rate of tic disorders than those with later-onset OCD (see the Tourette's overview for a discussion of sensory phenomena and tics). Childhood-onset OCD is also associated with a higher rate of ADHD.

In terms of long-term outcomes, Soke and Soke (1999) provided a 40 year follow-up on OCD patients. They reported that over 80% of all patients experienced improvement. Almost 50% of the sample had OCD for more than 30 years. The best predictors of both obsessive and compulsive symptoms were early age of onset, low social functioning at baseline, and a chronic course at the examinations conducted between 1954 and 1956. Magical obsessions and compulsive rituals were also correlated with a worse prognosis. In the past few years, several studies have been published that specifically look at age of onset. For a variety of measures and despite differences in methodologies and samples, early-onset OCD seems to be associated with a more severe course or worse outcome. Earlier age of onset also predicts an increased risk for Attention Deficit Hyperactivity Disorder, simple phobia, agoraphobia (fear of outdoor or public places) and multiple anxiety disorders. Mood disorders such as depression or Bipolar Disorder were not predicted by age of onset but were correlated with chronological age: older children and teens with OCD exhibited more depression and/or Bipolar Disorder than younger children.

IMPACT ON YOUTH

Since the previous update to this web site, John Piacentini and his colleagues at UCLA have published the first study to really look at psychosocial impact of OCD on youth (Piacentini, Bergman, et al., 2003).

Using children with OCD referred by a clinic, the investigators had the children and their primary caregivers completed a checklist that inquiried about school, family, and social functioning. Parents tended to report more problems than the children themselves reported, with over 40% of the parents reporting that their children had difficulty concentrating on schoolwork, doing homework, and getting ready for bed at night. Thirty percent or more of the children reported significant problems concentrating on schoolwork, doing homework, and doing household chores. Parent reports and children reports all tended to note more problems in school/academic and home/family functioning than in social functioning. Although there was considerable variability across specific problem areas, 85% of children (by their own report) experienced a significant problem in at least one of the three domains of functioning (home, school, social), and close to half of the sample reported at least one significant problem in each of the three domains.

Although parents tended to report more observed problems than the children reported, the consistency in reports in terms of homework and concentrating on schoolwork should be of special note to educators in planning for these youngsters.

SUMMARY

Children and adults who have full-blown OCD have repeated intrusive thoughts that generally produce anxiety. In the presence of the anxiety, they engage in a behavior to "ward off" some dreaded event. By performing the ritual or compulsion, they temporarily reduce their anxiety, but it will start to build again. Thus the cycle of "over and over" is enacted and re-enacted.

For many people with OCD, the symptoms can be socially and economically impairing. Thankfully, however, there are several effective treatment approaches, as are discussed in the article, "The Treatment of OCD."

Information Section: Conditions
Condition: OCD
Article: About Obsessive-Compulsive Disorder
Source: Leslie E. Packer, PhD
Page Last Updated: December 28, 2004

Page 1 2

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