Obsessive-Compulsive Disorder (OCD)
- An anxiety disorder characterized by pathologic obsessions (recurrent intrusive thoughts, ideas, or images) and compulsions (repetitive, ritualistic behaviors or mental acts) causing significant distress
- Not to be confused with obsessive-compulsive personality disorder
- Predominant age: mean age of onset is 19.5 years (1).
- Three subtypes: child/adolescent-onset (<18 years), adult-onset (18 to 39 years) and late-onset (≥40 years)
- Child/adolescent-onset in 50% of cases (usually by age 18 years) (2)
- Diagnosis rarely made at >50 years of age
- Predominant gender: females > males
- Childhood-onset obsessive-compulsive disorder (OCD) (age <10 years) is more prevalent in males, more likely to be heritable and associated with co-morbid tic disorder.
- Adolescent-onset OCD is more prevalent in females, although OCD can be precipitated in the peripartum or postpartum period as well.
Insidious onset; consider brain insult in acute presentation of childhood OCD.
Consider neurologic disorders in new-onset OCD.
- 2.3% lifetime in adults
- 1–2.3% prevalence in children/adolescents (3)
Etiology and Pathophysiology
Exact pathophysiology/etiology unknown. Potential role of:
- Cognitive-affective dysfunction
- 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)
- Brain injury (physical trauma, stroke, etc.)
- Autoimmune insult to basal ganglia, as seen in Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS); controversial
- Polygenic disorder, with variants in serotonergic, catecholaminergic, and glutamatergic genes
- Positive family history: prevalence rates of 7–15% in first-degree relatives of children/adolescents with OCD
- Greater concordance in monozygotic twins
Combination of biologic and environmental factors:
- Family history of OCD
- Advanced paternal and maternal age
- Coexisting psychiatric disorders, most commonly anxiety disorders and schizophrenia
- Low serotonin levels (Antipsychotics with greater anti-serotoninergic mechanism, such as clozapine and olanzapine, have been associated with onset of OCD.)
- Brain insult (i.e., encephalitis, pediatric streptococcal infection, or head injury)
- Perinatal insults (birth complications)
- History of childhood traumatic events, including social isolation and physical abuse
- Early diagnosis and treatment can decrease patient’s distress and impairment.
Commonly Associated Conditions
- Major depressive disorder
- Panic disorder/phobia/social phobia
- Tourette syndrome/tic syndromes
- Substance abuse/eating disorder/body dysmorphic disorder
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Domino, Frank J., et al., editors. "Obsessive-Compulsive Disorder (OCD)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688686/all/Obsessive_Compulsive_Disorder__OCD_.
Obsessive-Compulsive Disorder (OCD). In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688686/all/Obsessive_Compulsive_Disorder__OCD_. Accessed June 1, 2023.
Obsessive-Compulsive Disorder (OCD). (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688686/all/Obsessive_Compulsive_Disorder__OCD_
Obsessive-Compulsive Disorder (OCD) [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 01]. Available from: https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688686/all/Obsessive_Compulsive_Disorder__OCD_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Obsessive-Compulsive Disorder (OCD) ID - 1688686 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688686/all/Obsessive_Compulsive_Disorder__OCD_ PB - Wolters Kluwer ET - 27 DB - 5-Minute Clinical Consult DP - Unbound Medicine ER -