Symptom severity in childhood-onset obsessive-compulsive disorder

Introduction: Obsessive-compulsive disorder (OCD) has an international lifetime prevalence of 2-3% and is, therefore, one of the most prevalent mental disorders. Once considered to be rare in youth, epidemiological studies have found an estimated prevalence of 0.25%–4% among children and adolescents. [1] Obsessive-compulsive disorder (OCD) in childhood and adolescence is an impairing condition, associated with a specific set of distressing symptoms incorporating repetitive, intrusive thoughts (obsessions) and distressing, time-consuming rituals (compulsions). [2] Despite the high prevalence, studies show that OCD typically goes undetected for many years before an accurate diagnosis is made. Left untreated symptoms may wax and wane but typically follow a chronic course and cause marked functional impairment across multiple domains, including at home, school and socially. Several reasons for the long duration between symptom onset and diagnosis of OCD are discussed in the literature. One reason includes the rate of misdiagnosis. Often OCD is not recognized as such and patients receive a wrong diagnosis or even treatment. [3]

Objectives: The aim of this study was to assess the severity of the obsessive and compulsive symptoms in children and adolescents at the time of their first evaluation by a child and adolescent psychiatrist.

Methods: Our study is a cross-sectional study that was carried out in a clinical sample in Child and Adolescent Psychiatry Clinic, University Hospital “Mother Theresa”, Tirana-Albania. The study was conducted for 12-month. We used Children’s Yale Brown Obsessive Compulsive Scale, which is considered the gold standard questionnaire for OCD evaluation. Data analyses were done using Statistical Package for Social Science, version 21 (SPSS). The complete anonymity and confidentiality of the individual details was ensured by the research team. The study was conducted following the ethical standards and approved by Albanian Ethic Committee Nr. 303/42.

Results: Our study group consists of 55 participants who met the diagnostic criteria of OCD according to DSM-5, of which 56.4% were female. The request for specialized help from psychiatrist came later after the onset of symptoms with a severe form of OCD. 18.2% of our sample reported disability by OCD. Comorbidity was present in 56.3% of our sample and comorbidity was present at about half of the sample. It was found that more frequent and time-consuming obsession were aggressive obsessions and more frequent and time-consuming compulsion were miscellaneous compulsions.

Conclusions: Results of this first study in youth with OCD in Albania gave us a picture of the severity of the symptoms in youth with obsessive compulsive disorder, their clinical characteristics and their comorbidity. This study also showed us the increased need for studies on OCD in youth and the need to educate family doctors about early detecting and referring to a mental health specialist. Early detecting means early diagnoses, early treatment, less comorbidity.

References

1. Ziegler S, Bednasch K, Baldofski S, Rummel-Kluge C (2021) Long durations from symptom onset to diagnosis and from diagnosis to treatment in obsessive-compulsive disorder: A retrospective self-report study. PLOS ONE 16(12): e0261169. https://doi.org/10.1371/journal.pone.0261169
2. Heyman, I., & Krebs, G. (2015). Obsessive-compulsive disorder in children and adolescents. Archives of Disease in Childhood, 100(5), 495–499. https://doi.org/10.1136/archdischild-2014-306934
3. A.T. Clarke, N.A. Fineberg, L. Pellegrini, et al., The relationship between cognitive phenotypes of compulsivity and impulsivity and clinical variables in obsessive-compulsive disorder: A systematic review and Meta-analysis, Comprehensive Psychiatry (2023), https://doi.org/10.1016/j.comppsych.2024.152491