Coexisting Conditions in Pediatric OCD

Written by Bradley C. Riemann, Ph.D.

A majority of children and teens with OCD also suffer with other anxiety disorders, depression and behavior disorders.

Once thought to be a rare phenomenon, pediatric obsessive-compulsive disorder (OCD) has been found to be a fairly common condition affecting between 1% and 4% of young people. It also, more often than not, co-occurs with a variety of other disorders. Research has found that 58%-80% of children and adolescents with OCD also suffer from at least one other psychiatric diagnosis and between 30%-50% from two or more. Rates for specific comorbid disorders varies greatly from study to study. However, the rank order of diagnostic category remains fairly consistent with anxiety disorders (e.g., generalized anxiety disorder, social anxiety disorder; 26%-75%) and depressive disorders (e.g., major depressive disorder; 25%-75%) being the most prevalent followed by disruptive behavioral disorders (e.g., attention deficit hyperactivity disorder, oppositional defiant disorder; 15%-51%) and tic disorders (e.g., tics, Tourette's disorder; 15%-32%).

Examining anxiety disorders more specifically in pediatric OCD, one finds high rates of generalized anxiety disorder (20%), specific phobia (16%-36%), social anxiety disorder (7%-33%), panic disorder (18%-33%), and separation anxiety (4%-56%). In terms of depressive disorders, high rates of major depression (6%-62%) and dysthymia (8%-15%) are also found. Interestingly, several studies have found the onset of the depressive disorders followed the onset of the OCD, which could point to depression being a consequence of OCD in some cases and not a primary problem in-of-itself.

The chronological age (i.e., age when participated in the research study) of OCD sufferers has been found to effect the prevalence rates of some comorbid conditions. Within pediatric OCD, Geller and colleagues found that adolescents suffered from a much higher rate of major depression than children (62% versus 39% respectively), but had lower rates of Tourette's disorder (9% versus 25%). Rate of separation anxiety was also found to be age sensitive with adolescents experiencing a considerably high rate yet lower than in children (35% versus 56%). High rates of other anxiety disorders were seen in both children and adolescents with no significant differences found between them.

Age of onset (i.e., age when disorder started) has also been found to create different patterns of comorbidity in children and adolescents with OCD. In a different study, Geller and colleagues examined children with a childhood onset of OCD, adolescents with a childhood onset of OCD, and adolescents with an adolescent onset of OCD. Irrespective of current age, earlier age of onset of OCD increased the risk for coexisting attention deficit hyperactivity disorder, specific phobia, agoraphobia, multiple anxiety disorders, and possibly Tourette's disorder.

Pediatric OCD comorbidity is an important issue with possible treatment implications. In a third study, Geller and colleagues found that comorbidity might play a role in terms of medication treatment response and relapse rates. Whereas 75% of pediatric OCD sufferers without any coexisting conditions responded to paroxetine, response rates with comorbid attention deficit hyperactivity disorder, tic disorder, and oppositional defiant disorder were much lower (56%, 53%, and 39% respectively). In terms of relapse following discontinuation of paroxetine, increased rates were found in those having a comorbid condition. Relapse occurred in only 32% of patients with no comorbid disorders, whereas, it occurred in 46% with one comorbid disorder, and in 56% of sufferers with two or more comorbid disorders.

In summary, pediatric OCD is a common and debilitating problem. "Pure" pediatric OCD is the exception not the rule, with the majority of sufferers also having one or more additional psychiatric conditions. These comorbid disorders appear not only to increase the interference in the child's life, but in some cases may also play a role in treatment response and relapse prevention.

About the author: Bradley C. Riemann, Ph.D. is Clinical Director of The Obsessive Compulsive Disorder Center at Rogers Memorial Hospital.

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