Objective: Obsessive–compulsive disorder (OCD) is characterized by distressing intrusive thoughts and time-consuming repetitive rituals. High rates of comorbidity are reported in pediatric OCD, mainly with anxiety disorders, major depression, tic disorders and disruptive behavior disorders. Some comorbid neurodevelopmental problems such as tic disorders and attention deficit-hyperactivity disorder (ADHD), are among the most relevant distinctive features of pediatric OCD, compared with adult OCD. OCD is a heterogeneous disorder with possible phenotypical differences, so there has been increased interest in identifying more homogeneous subtypes with distinct patterns of comorbidities. This study aimed to examine the sociodemographic, clinical and comorbidity patterns in a large sample of pediatric OCD subjects and to examine the cross-cultural similarities and differences, if any.
Method: Participants were 110 children and adolescents, who were consecutively referred to our outpatient clinic between March 2011 and September 2013 and diagnosed as having OCD according to DSM-IV. Subjects, who have a psychotic disorder, mental retardation or pervasive developmental disorder were not included in the study. A sociodemographic and clinical data form was filled by the all authors themselves by interviewing the parents and the child. This form covers the current age of the child, the main reasons for the referral, age at onset of OCD symptoms, type of obsessions and compulsions, duration of time child spends performing obsessions and compulsions, family history of OCD and other psychiatric disorders. Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime–Turkish Version (K-SADS-PL-T) was used to assess comorbid psychiatric disorders. WISC-R was administered to assess intellectual abilities.
Results: Totally 110 children and adolescents with OCD (62 girls an 48 boys) were included in the study. The mean age of the sample was 12.17 years (SD: 3.13, range: 6–18) and the mean full-scale IQ score was 95.66 (SD: 13.73, range: 71–137). The mean age at onset of OCD symptoms was 9.14 years (SD: 3.44, range: 2–16). Ninety-two subjects (83.6%) had at least one comorbid psychiatric disorder. The most common comorbid psychiatric disorders were anxiety disorders, depression and ADHD, respectively. The most common obsession types were contamination/somatic, symmetry and religious obsessions, the most common compulsion types were cleaning, repeating and checking compulsions respectively. 94.6% of the subjects had both obsessions and compulsions at the same time. 55% of the subjects were spending more than 2 hours/day performing their obsessions and compulsions and 25% were spending more than 6 hours/day. 79.1% of the subjects were primary referred for OCD symptoms. Eighty-seven subjects (79%) had a family history for any psychiatric disorder. 44.5% of the subjects had a family history of OCD.
Conclusion: Comorbidity seems to be a rule in subjects with OCD. Therefore a detailed assessment of the other psychiatric disorders should be a routine part of the assessment of children and adolescents referred for OCD symptoms.