Summary: A new study reports obsessive and compulsive behaviors in young people may represent a red flag for other more serious psychiatric conditions. Researchers report a link between OCS and an increased risk of depression and suicidal thoughts in young people.
Engaging in repetitive and ritualistic behaviors is part of typical child development. However, behaviors that develop into obsessive and compulsive symptoms (OCS) may represent a red flag for serious psychiatric conditions. Researchers at the Lifespan Brain Institute (LiBI) of Children’s Hospital of Philadelphia (CHOP) and the Perelman School of Medicine at the University of Pennsylvania found children and young adults with OCS who also admitted to having bad thoughts were more likely to also experience psychopathology, including depression and suicide. This is the first and largest study examining OCS in more than 7,000 participants aged 11 to 21.
The findings were published online last month in the Journal of American Academy of Child and Adolescent Psychiatry.
Researchers divided OCS into four categories: bad thoughts, repeating/checking, symmetry, and cleaning/contamination. More than 20 percent of youth admitted to having bad intrusive thoughts, which included thoughts about harming oneself or others, picturing violent images, or fear that one would do something bad without intending to. These children were more likely to develop serious psychopathology beyond obsessive compulsive disorder (OCD), including depression and suicide.
“Our hope is that these results will propel both mental health professionals and non-mental health practitioners, such as pediatricians, to probe for these symptoms during their patients’ visits,” said the study’s principal investigator Raquel Gur, MD, PhD, Director of the LiBI and a professor of Psychiatry, Neurology and Radiology in the Perelman School of Medicine. “These symptoms may be vital for identifying adolescents who are on a potentially debilitating psychiatric trajectory.”
“Repetitive actions are common in young children, and are in fact a healthy part of development,” says lead author of the study Ran Barzilay, MD, PhD, child and adolescent psychiatrist and research scientist at LiBI. “It’s when these symptoms continue into adolescence and start to interfere with day-to-day activities that we really need to examine the cause and treatments available.”
OCS were common in individuals who did not seek mental health treatments (38.2 percent). Only 3 percent met the threshold for OCD. OCS were more common in females and after puberty. The researchers suggest OCS may be a window for clinicians to probe and identify serious psychiatric conditions.
Source: Camillia Travia – CHOP
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Original Research: Abstract for “Obsessive-Compulsive Symptomatology in Community Youth: Typical Development or a Red Flag for Psychopathology?” by Ran Barzilay, MD, PhD, Ariana Patrick, MSc, Monica E. Calkins, PhD, Tyler M. Moore, PhD, Daniel H. Wolf, MD, PhD, Tami D. Benton, MD, James F. Leckman, MD, PhD, Ruben C. Gur, PhD, Raquel E. Gur, MD, PhD in Journal of American Academy of Child and Adolescent Psychiatry. Published January 2 2019.
Obsessive-Compulsive Symptomatology in Community Youth: Typical Development or a Red Flag for Psychopathology?
Obsessive-compulsive symptoms (OCS) are common throughout development and often considered developmentally appropriate. We evaluated the prevalence and phenotypic heterogeneity of self-reported OCS in a large community youth sample not ascertained for seeking mental-health help. We aimed to identify patterns in OCS that are associated with serious psychopathology and may thus represent a “red flag” that merits psychiatric evaluation.
Data were analyzed from youth from the Philadelphia Neurodevelopmental Cohort (N = 7,054, aged 11−21 years, 54% female). Participants underwent structured psychiatric interviews, including screening for OCS (8 obsessions, 8 compulsions, and hoarding) and other major psychopathology domains. Factor analysis was conducted to identify clustering of OCS presentation. Regression models were used to investigate association of OCS with threshold lifetime diagnoses of obsessive-compulsive disorder (OCD), depressive episode, psychosis, and suicide ideation.
OCS were common in non−mental health−seeking individuals (38.2%), although only 3% met threshold OCD criteria. OCS were more common in females and postpuberty. Factor analyses resulted in 4 factors: F1 – Bad Thoughts; F2 − Repeating/Checking; F3 – Symmetry; F4 – Cleaning/Contamination; and Hoarding as a separate item. All OCS were associated with higher rates of OCD, depression, psychosis, and suicide ideation. However, endorsement of F1 symptoms, prevalent in more than 20% of the sample, showed the most substantial associations with major psychiatric conditions.
OCS are common in community youth. Although for most youths OCS symptoms may be benign, some patterns of OCS are associated with major psychiatric conditions. These findings may help to identify youth at risk for serious psychopathology.