Psychological behavior disorders: a review of five scientific journal articles

OCD in Childhood

Obsessive-Compulsive Disorder (OCD) is a common psychological, anxiety disorder that is characterized by repetitive and intrusive thoughts and stereotypic behaviors frequently associated with dread and compulsion (Walitza). These intrusive thoughts can be scary and the behaviors are often disruptive to the development of social relationships and therefore debilitating especially to children and adolescents. OCD affects approximately 3% of the population and an early age of symptoms onset during childhood and adolescence is reported by more than half of adults with OCD (Rasmussen, 1992). OCD is a highly comorbid disorder with many children meeting diagnostic criteria for other psychological disorders. Given the early onset of the disorder and the high morbidity associated with it, extensive research has been conducted on childhood OCD. Studies have aimed to determine the genetic composition of the disorder and define the associated symptoms for more appropriate qualification and treatment of the disorder.

Previous studies suggest that obsessive-compulsive disorder is a familial disorder and may therefore have genetic predispositions. Based on these early observations, Walitza et al. conducted a review of the literature to determine if any definite genetic markers for OCD have been identified (2010). The authors looked at twin and family-based studies that trace patterns of inheritance. These indicated a significant incidence of OCD across generations of the same family. More specific analysis of linkage studies that examined molecular genetic associations with OCD found several genes of neurotransmitter systems that may contribute to the development of OCD. In particular, the glutamate transporter gene SLC1A1, was identified for its involvement in OCD. Elevated levels of glutamate in the cerebrospinal fluid of OCD patient further corroborated this finding. However, findings were tentative as the authors conclude that the pathogenesis of OCD is likely influenced by genetic as well as environmental factors. No definitive genetic map of the disease has yet been defined as genome-wide association analyses continue to be conducted.

One of the main behavioral aspects that support these genetic linkage studies is the heterogeneity of the disorder. Studies have shown that up to 80% of adults with OCD meet the diagnostic criteria for other another anxiety disorder including depressive disorder, externalizing disorder and conduct disorder. Janowitz et al. specifically looked at the relationship between age of onset and the development of comorbid psychiatric disorders (2009). The authors interviewed two hundred fifty-two patients with OCD and investigated different diagnostic evaluations of comorbid disorders between subgroups with different ages of OCD symptoms onset. The three subgroups had cut-off ages of ten, fifteen, and eighteen years. The study found that subjects with an early age of onset defined as younger than ten years were significantly more likely to have comorbid tic and Tourette's disorders. It appears that an early onset of OCD associated symptoms lead to the development of other mental disorders, making early detection and treatment especially important.

Another study that examined the correlation between OCD and anxiety and externalizing disorders in childhood confirmed these results (Langley, Lewin, Bergman, Lee & Piacentini, 2010). The authors compared three diagnostic groups of subjects for differences in demographic, psychiatric and functional status associations with OCD: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. The aim of the study was to determine if there was a relationship between these DSM-IV diagnostic profiles and associated comorbidities. The authors found no gender differences across the groups. The comorbid anxiety disorder appeared to exacerbate the OCD symptoms, while greater functional impairment was observed in the OCD plus externalizing disorder group compared to the other two. This group also reported lower family cohesion, while the OCD plus anxiety disorder showed higher family conflict than the other groups. Incidence of depressive disorders did not differ between the three groups but the presence of comorbid anxiety and externalizing psychopathology showed greater functional and family impairment.

Another study by Ivarsson, Granqvist, Gillberg and Broberg looked further at the influence of comorbid depressive disorder on attachment states of mind in adolescents with OCD (2009). In their study, the authors examined groups of people with OCD and depressive disorder (DD) to determine the contribution of attachment insecurities to OCD by looking at how states of mind relate to OCD. Four study groups were examined and compared: OCD, DD, OCD and DD, and population controls. Interviews were conducted that focused on childhood experiences and evaluated difference style of discourse. While approximately 52% of the control population adolescents exhibited a secure state of mind, the adolescents in the clinical groups displayed significantly lower state of mind security. Only 12% of the OCD group, 8% of the DD and 4% of the DD and OCD group displayed a secure state of mind. In terms of attachment profiles for the groups, 60% of the subjects in the OCD group were classified as dismissive, and 40% of subjects in the DD group were unresolved with regard to loss or abuse. In the OCD and DD group, 44% were classified as dismissive and 36% as unresolved.

These studies have major implications for the treatment of OCD in children and adolescents. Given the heterogeneous nature of the disorder and the many symptoms that are associated with it as well as the specificity of the compulsions and obsessions in people with OCD, it appears that comprehensive counseling would be the most beneficial form of treatment. It would seem that this approach would benefit especially children and adolescents immediately following the first onset of OCD symptoms. However, the most common therapy consists of serotonin-reuptake inhibitor medication therapy. This medication is meant to reduce the depressive symptoms and thereby limit the OCD symptomatology.