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Abstract
Obsessive compulsive disorder (OCD) is a psychiatric disorder, which commonly begins in childhood or adolescence, and if inadequately treated, can become chronic and lead to significant functional impairments across the lifespan. Despite the severity of symptoms and impairment, oftentimes it takes years for the disorder to be appropriately identified and treated. Primary care providers (PCPs) can play an important role in identifying OCD through careful history taking and screening. While many PCPs may not feel adequately trained to provide treatment, appropriate referral to specialty providers can lead to favorable clinical outcomes. This review will provide a concise discussion of the typical presentation, assessment, and treatment of OCD in children and will include relevant information regarding its epidemiology, etiology, clinical features, and typical course.
Keywords: psychiatry, obsessive compulsive disorder, child health, adolescent health, public health
Introduction
The identification, assessment, and treatment of OCD in primary care settings is challenging on several fronts. First, children and families are often unaware of the core problem behind the symptoms which bring them into their provider's office. For example, rather than describing a child with intrusive thoughts and compulsive behaviors, parents may present seeking help for explosive tantrums or disruptive behaviors precipitated by an OCD exacerbation. Moreover, the child may intentionally hide his or her symptoms from parents and providers due to embarrassment or shame. Additionally, parents may fail to mention ritualistic behaviors that they assume are developmentally normal, consider them a phase, or they may have gotten so used to the behaviors that they no longer see them as unusual.
A second challenge is that OCD shares comorbidity with a number of other childhood psychiatric disorders, and the majority of patients with OCD have a least one of these. Therefore, unless a child is carefully screened for OCD during the assessment process, signs and symptoms of the illness may be inadvertently attributed to other causes. Lastly, while the best opportunity to identify OCD may be in the primary care setting, optimal treatment will likely require collaboration with specialists who practice in other treatment settings.
Definition
With the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), OCD is now separately classified from anxiety disorders and is, instead, grouped with several similar...