Diagnostic Issues in Early-Onset Obsessive-Compulsive Disorder and their Treatment Implications

Abstract

There is evidence that EO might be considered the neurodevelopmental subtype of OCD. Indeed there is evidence that different clusters of symptoms and dimensions at an early stage predict different trajectories in phenotype and that distinct neurocircuit patwhays underpin the progression of the disorder. Despite the development of high refractoriness in the course of the disorder, evidence suggests that EO may be particularly treatment responsive in the early stages, thus showing the need for early recognition and additional recovery oriented studies in this subgroup. Consistent with the neurodevelopmental perspective, immunity and glutamate neurotransmission are emerging as novel pathways for parsing out the neurobiology of OCD, the EO form in particular, supporting the implementation of new multisystemic models of the OCD phenotype. Brain connectivity patterns, immune and microbiome profiles are standing out as promising areas for biomarkers with the potential for targeted personalized therapies in EO.

Symmetry Dimension in Obsessive–Compulsive Disorder: Prevalence, Severity and Clinical Correlates

“…Obsessions or subjective feelings related to symmetry and/or compulsions of ordering, repeating, and counting have been consistently associated with earlier age at onset of OCS or OCD [ 8 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 ]. Such an association can be understood from a developmental perspective, and it is possible that childhood onset OCD represents a distinct, neurodevelopment form of the disorder [ 70 , 71 ]. In a previous study with adult patients [ 33 ], symptoms of the symmetry dimension presented the earliest age of onset of all, even after adjusting for gender and comorbidity with tic disorders, two factors consistently associated with early onset of OCD symptoms in the literature.…”

Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management

“…OCD can begin in childhood, and approximately 8 in 10 of those developing OCD initiate it by 18 years of age (37). The research seeks to find various OCD subtypes based on concepts of etiology; there is, for example, OCD in children called Early Onset OCD that reflects a neurodevelopmental perspective (39).…”

From Treatment Response to Recovery: A Realistic Goal in OCD

“…Evidence shows that early diagnosis and treatment are positively related to outcome in OCD ( Burchi and Pallanti, 2018 ). However, OCD has one of the longest durations of untreated illness among psychiatric disorders with a delay between the onset of symptoms and the beginning of the first appropriate treatment in patients that eventually receive treatment that ranges from 7.75 (Italy) to 17 years (USA) ( García-Soriano et al, 2014 ) In fact, OCD is often unrecognized and undertreated ( Dell’Osso and Altamura, 2015 ).…”

“…Poor recognition of harm and taboo content were identified as reasons for underdiagnosis ( García-Soriano et al, 2014 ). Moreover, the separation of OCD from the chapter of anxiety disorders in the DSM-5 may have decreased detection of these cases, especially in pediatric patients, who present prodromally with anxiety ( Juckel et al, 2014 ; Burchi and Pallanti, 2018 ). This suggests the necessity of improving early detection of cases and sensitivity of assessment.…”