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Information
Section: Conditions
Condition:
OCD
Article: About
Obsessive-Compulsive Disorder
Source: Leslie E. Packer,
PhD
Page Last
Updated: January 31, 2009
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HOW IS OCD DIAGNOSED?
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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.
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ONSET
AND PROGNOSIS
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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). In a fascinating case series, Hazen, Reichert, et al. (2008) describe children with significant intolerance for ordinary sensory stimuli. The sensory intolerance created marked distress and led to compulsive behaviors in the absence of any typical obsessive themes or thoughts. The phenomenon they are describing seems like it is on the boundary of sensory integration dysfunction, Tourette's Syndrome and OCD.
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.
More recently, Geller (2006) and his colleagues (2007) reviewed some of the similarities and differences between pediatric OCD and adult OCD, and Nestadt et al. (2008) provided preliminary data describing three subtypes of OCD based on comorbidity patterns: (1) an "OCD simplex" subtype where depression is the most frequent comorbid disorder; (2) an OCD-tic subtype, in which tics are prominent and mood syndromes are considerably rarer; and (3) an OCD-mood subtype in which panic disorder and affective syndromes are common. The investigators also found gender x subtype differences: the OCD-tic subtype is predominantly male while the OCD-affective subtype is predominantly female.
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IMPACT ON YOUTH
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John Piacentini and his
colleagues at UCLA 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.
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Information
Section: Conditions
Condition:
OCD
Article: About
Obsessive-Compulsive Disorder
Source: Leslie E. Packer,
PhD
Page Last
Updated: January 30, 2009
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Page
1 2
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Tourette
Syndrome "Plus" © Copyright 1998 - 2009 Leslie
E. Packer, PhD. except as noted.
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This page last updated January 31, 2009.
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