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Obsessive-compulsive disorder in children and adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis

Author
David Rosenberg, MD
Section Editor
David Brent, MD
Deputy Editor
Richard Hermann, MD

INTRODUCTION

Obsessive-compulsive disorder (OCD) is a severe, prevalent and most often chronically debilitating disorder characterized by repetitive, ritualistic, and distressing thoughts, ideas, and behaviors over which a person typically has very little if any control.

Research suggests approximately 50 percent of all cases have their onset in childhood and adolescence [1,2]. Obsessions and compulsions in children are more likely to change/evolve as well as wax and wane, compared to the course of the disorder in adults.

This topic reviews the epidemiology, pathogenesis, clinical manifestations, course, assessment and diagnosis of OCD in children and adolescents. The treatment of OCD in children and adolescents is discussed separately. The epidemiology, pathogenesis, clinical manifestations, course, assessment, diagnosis, and treatment of OCD in adults are also discussed separately. (See "Treatment of obsessive-compulsive disorder in children and adolescents" and "Pharmacotherapy for obsessive-compulsive disorder in adults" and "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Psychotherapy for obsessive-compulsive disorder in adults".)

EPIDEMIOLOGY

Obsessive-compulsive disorder (OCD) affects more than three million people in the United States. Estimates of the disorder’s US lifetime prevalence in both pediatric and adult populations have ranged from 1 to 3 percent [3-5]. Research suggests that approximately 50 percent of all cases have their onset in childhood and adolescence [1,2]. A US epidemiologic study of a nationally representative sample reported that 21 percent of OCD cases had onset by age 10 years [3], with a mean age of onset for pediatric OCD between 9 and 11 years in boys and 11 and 13 years in girls [6]. Pediatric OCD appears to be more common in males than in females, in contrast to adults where the male-female ratio of OCD is approximately 1:1 [7,8].

A 1999 nationwide epidemiologic study of 10,438 5 to 15 year olds in the United Kingdom estimated a weighted overall prevalence of OCD at 0.25 percent (95% CI 0.14-0.35) [9]. The children with OCD were more likely to be from lower socio-economic class and of lower intelligence compared to normal controls.

                        

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