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Chapter 23. Obsessive-Compulsive Disorder

Daniel A. Geller,, M.B.B.S., F.R.A.C.P.
DOI: 10.1176/appi.books.9781585623921.460691

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Excerpt

Obsessive-compulsive disorder (OCD) is characterized by the presence of either obsessions (worries is a more user-friendly term for children) or compulsions (rituals is a more user-friendly term for children). Although OCD is categorized among the anxiety disorders in DSM-IV (American Psychiatric Association 1994, 2000), especially in younger children, a variety of hidden or poorly articulated affects may drive the symptoms. There is active consideration of removing OCD from the DSM category of anxiety disorders and creating a new limited category for OCD "spectrum" disorders in DSM-V. Table 23–1 shows the current DSM-IV-TR criteria for OCD. The specifier "with poor insight" may be especially relevant to the diagnosis in youth since children's ability to explain their obsessions and the fears driving their compulsions may be quite limited.

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FIGURE 23–1. Comorbid disorders in pediatric obsessive-compulsive disorder: review of clinical studies.PDD = pervasive developmental disorder; TS = Tourette's syndrome.Source. Adapted from Geller et al. 1998.

FIGURE 23–2. Theoretical basis of cognitive-behavioral treatment (exposure and response prevention).
Table Reference Number
TABLE 23–1. DSM-IV-TR diagnostic criteria for obsessive-compulsive disorder
Table Reference Number
TABLE 23–2. Diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS)
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TABLE 23–3. Dosage range for serotonin reuptake inhibitors in children with obsessive-compulsive disorder (OCD)
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TABLE 23–4. Effect size by drug in meta-analysis of pediatric obsessive-compulsive disorder trials

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