The Course of Childhood OCD,Its Antecedents,Onset,Comorbidities,Remission,and Reemergence

Abstract

The precursors of obsessive compulsive disorder (OCD) and its course are described in a boy in our clinic. First seen at age 4 with choking phobia, OCD was first diagnosed at age 9, was remitted by age 12, and did not reemerge again until age 16. Consistent with Kovacs and Devlin, we propose the course is consistent with biologically driven processes for internalizing disorders for children. This 12-year case report provides for observation of the development and course of OCD. This case is unique in describing antecedent behavior to onset of OCD, which was early choking phobia or obsessions of swallowing large objects and compulsive reassurance seeking. It is unique in describing a single child patient who shows remission of OCD and later reemergence of OCD. Literature of an empirical and theoretical nature support what can be learned in terms of the course and treatment of this childhood condition.

Keywords

obsessive-compulsive disorder comorbidity symptom return childhood remission

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References

Adams, G. B. , Waas, G. A. , March, J. S. , & Smith, M. C. (1994). Obsessive compulsive disorder in children and adolescents: The role of the school psychologist in identification, assessment, and treatment. School Psychology Quarterly, 9(4), 274-294.

American Psychiatric Association . (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Berg, C. Z. , Rapoport, J. L. , Whitaker, M. , Davies, M. , Leonard, H. , Swedo, S. E. , et al. (1989). Childhood obsessive compulsive disorder: A two-year prospective follow-up of a community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 28(4), 528-533.

Calvocoressi, L. , Lewis, B. , Harris, M. , Trufan, S. J. , Goodman, W. K. , McDougle, C. J. , et al. (1995). Family accommodation in obsessive-compulsive disorder. American Journal of Psychiatry, 152(3), 441-443.

Flament, M.F , Koby, E. , Rapoport, J. L. , Berg, C. Z. , Zalen, T. , Cox, C. , etal . (1990). Childhood Obsessive Compulsive Disorder: A prospective study. Journal of Child Psychology and Psychiatry, 31, 363-380.

Flament, M. F. , Whitaker, A. , Rapoport, J. L. , Davies, M. , Berg, C. Z. , Kalikow, K. , et al. , (1988). Obsessive compulsive disorder in adolescence: An epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry, 27(6), 764-771.

Judd, L. L. (1965). Obsessive-compulsive neurosis in children. Archives of General Psychiatry, 12, 136-145.

Keller, M. B. , Lavori, P. W. , Wunder, B. A. , Beardslle, W. R. , Schwartz, C.E , & Roth, J. (1992). Chronic course of anxiety disorder in children and adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 595-599.

Kovacs, M. , & Devlin, B. (1998). Internalizing disorder in childhood. Journal of Child Psychology and Psychiatry, 39, 47-63.

10.

Last, C. G. , & Strauss, C. C. (1989). Obsessive-compulsive disorder in childhood. Journal of Anxiety Disorders, 3, 295-302.

11.

Leonard, H. L. , Goldberger, E. L. , Rapoport, J. L. , Cheslow, D. L. , & Swedo, S. E. (1990). Childhood rituals: Normal development or obsessive-compulsive symptoms? Journal of the American Academy of Child and Adolescent Psychiatry, 29(1), 17-23.

12.

Leonard, H. L. , Swedo, S. E. , & Lenane, M. C. (1993). DSM-III-R anxiety disorder in children: Sociodemographic and clinical characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 1070-1076.

13.

March, J. S. , Franklin, M. , Nelson, A. , & Foa, E. (2001). Cognitive behavioral psychotherapy for pediatric obsessive compulsive disorder. Journal of Clinical Child Psychology, 30(1), 3-18.

14.

March, J. S. , & Mulle, K. (1998). OCD in children and adolescents: A cognitive-behavior treatment manual. New York: Guilford.

15.

McNally, R. J. (1994). Choking phobia: A review of the literature. Comprehensive Psychiatry, 35, 83-89.

16.

Rasmussen, S. A. , & Eisen, J. L. (1990). Epidemiology of obsessive compulsive disorder. Journal of Clinical Psychiatry, 54(Suppl.), 10-14.

17.

Swedo, S. E. , Rapoport, J. L. , Leonard, H. , Lenane, M. , & Cheslow, D. (1989). Obsessive compulsive disorder in children and adolescents. Archives of General Psychiatry, 46, 335-341.

18.

Thomsen, P. H. , & Mikkelson, H. U. (1995). Course of obsessive compulsive disorder in children and adolescents: A prospective follow-up of 23 Danish cases. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1432-1440.

19.

Zelikovsky, N. , MacNaughton, K. , & Geffken, G. R. (2001). Choking phobia in children and adolescents: A review of background, assessment and psychological treatment. Journal of Psychological Practice, 7(1), 23-32.