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Obsessive compulsive symptoms common in community youth

After assessing data from a large community sample of more than 7,000 youth, researchers found a high rate of obsessive-compulsive symptoms, particularly in females and after puberty.

Furthermore, these symptoms were linked to higher rates of obsessive-compulsive disorder, depression, psychosis and suicide ideation, according to the study findings.

“No studies have been performed on large samples of interviewed community adolescents, spanning pre- and post-puberty with self-report of multiple [obsessive-compulsive symptoms] and clinical phenotyping for major psychiatric conditions,” Ran Barzilay, MD, PhD, of the Children’s Hospital of Philadelphia and the Perelman School of Medicine, and colleagues wrote. “Given the prevalence of children and adolescents who engage in some obsessions and/or compulsions but do not reach threshold criteria for an OCD diagnosis, it remains a clinical challenge to identify subsets at risk for major psychiatric conditions.”

Researchers reported patterns of obsessive-compulsive symptoms tied to serious psychopathology after analyzing data from more than 7,000 youth aged 11 to 21 years.

Participants underwent structured psychiatric interviews to determine obsessive-compulsive symptoms and other major psychopathology domains. Researchers conducted factor analysis to determine clustering of symptom presentation and used regression models to determine the connections between obsessive-compulsive symptoms and lifetime diagnoses of OCD, depressive episode, psychosis and suicide ideation.

Overall, 38.2% (n = 2,697) of the cohort reported experiencing at least one obsessive-compulsive symptom and 3% (n = 209) met criteria for lifetime OCD diagnosis. Female sex (OR = 1.3; P < .001) and puberty (OR = 1.18; P = .002) were both linked to experiencing obsessive-compulsive symptoms. Researchers also observed a higher proportion of symptoms in females post-puberty. Participants with obsessive-compulsive symptoms had higher rates of OCD, depression, psychosis and suicide ideation, according to the results.

After conducting factor analyses, four factors emerged (with hoarding as a separate item): bad thoughts (ie, thoughts about harming others/self); repeating/checking; symmetry; and cleaning/contamination.

Barzilay and colleagues found that participants most commonly experienced bad thoughts, which was prevalent in more than 20% of the sample and indicated the greatest association with major psychiatric conditions. Specifically, bad thoughts had the strongest associations with comorbid OCD (OR = 11.7), depression (OR = 4.3), psychosis (OR = 3.3) and suicide ideation (OR=4.4; all P < .001). In all four factors and hoarding, obsessive-compulsive symptoms were more prevalent among girls.

“We report a high rate of obsessive-compulsive symptoms in a large, generalizable sample of U.S. youth,” the investigators concluded. “We hope that these results will propel mental health professionals and non-mental health professionals alike (ie, pediatricians) to probe for these symptoms during clinical evaluations, as these may prove vital for identifying youth who are on a potentially debilitating psychiatric developmental trajectory.” – by Savannah Demko

Disclosure: Barzilay reports serving on the scientific board at and owning stock in Taliaz Health. Please see the study for all other authors’ relevant financial disclosures.