Obsessive-Compulsive Disorder (OCD)

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Description

  • A disorder characterized by pathologic obsessions (recurrent intrusive thoughts, ideas, or images) and/or compulsions (repetitive, ritualistic behaviors or mental acts) that are time-consuming and cause significant distress
  • Not to be confused with obsessive-compulsive (anankastic) personality disorder

Epidemiology

Incidence

  • Three subtypes: child/adolescent-onset (age <18 years), adult-onset (age 18 to 39 years) and late-onset (age ≥40 years).
  • Child/adolescent-onset in 50% of cases (usually by age 18 years) (1).
  • Consider pediatric acute-onset neuropsychiatric syndrome (PANS)/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) in acute presentation of obsessive-compulsive disorder (OCD) and tics in children (2).
  • Consider neurologic or neurodegenerative disorders in new-onset OCD.

Prevalence

~2% lifetime prevalence; slight female predominance when including postpartum OCD

Etiology and Pathophysiology

  • Although the exact etiology of OCD is unknown, genetic, anatomical, neurochemical, autoimmune, and environmental factors are believed to contribute to the disorder.
  • Dysregulation of serotonergic, catecholaminergic, and glutamatergic pathways
  • Dysfunction of cortico-striatal-thalamo-cortical (CSTC) circuit, involving the orbitofrontal cortex (OFC) and anterior cingulate cortex (ACC)
  • Stressors, trauma, and learned behaviors may be contributing factors to development of OCD symptoms.

Genetics

  • First-degree relatives of individuals with child/adolescent-onset OCD have a 7–15% prevalence rate of the disorder.
  • ~45–65% of the variance of OCD is explained by genetics. To date, no specific gene has been found.

Risk Factors

  • Family history of OCD
  • Advanced paternal and maternal age
  • Coexisting psychiatric disorders, most commonly anxiety disorders and schizophrenia
  • Antipsychotics such as clozapine and olanzapine with greater serotonergic blockade may cause symptoms of OCD.
  • Brain insult (i.e., encephalitis, pediatric streptococcal infection, or head injury)
  • History of childhood traumatic events, including social isolation and physical abuse
  • Stressful life events can exacerbate OCD symptoms.

General Prevention

Although primary prevention strategies are limited, secondary prevention via early diagnosis and treatment decreases distress and impairment.

Commonly Associated Conditions

  • Major depressive disorder
  • Anxiety disorders including panic disorder/phobia/social phobia/generalized anxiety disorder
  • Tourette syndrome/tic syndromes
  • Autism spectrum disorder
  • Substance abuse/eating disorder/body dysmorphic disorder
  • Other obsessive-compulsive spectrum disorders including body-focused repetitive behaviors (trichotillomania, excoriation disorder), body dysmorphia, and hoarding disorder

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