Many children exhibit obsessive compulsive symptoms, such as repetitive and ritualistic behaviors, but when these behaviors become disruptive to the child’s life or when intrusive thoughts emerge, it may be a red flag for serious psychiatric conditions, according to a new study published in the Journal of the American Academy of Child and Adolescent Psychiatry.

“Repetitive actions are common in young children, and are in fact a healthy part of development,” said lead author of the study Ran Barzilay, M.D., Ph.D., child and adolescent psychiatrist and research scientist from the Lifespan Brain Institute (LiBI) at the Children’s Hospital of Philadelphia (CHOP).

“It’s when these symptoms continue into adolescence and start to interfere with day-to-day activities that we really need to examine the cause and treatments available.”

For the study, researchers at LiBI and the Perelman School of Medicine at the University of Pennsylvania aimed to identify patterns in obsessive compulsive symptoms that may serve as a red flag for serious mental disorders. More than 7,000 participants ages 11 to 21 underwent structured psychiatric interviews, including screenings for obsessive compulsive symptoms and other major mental health disorders.

Obsessive compulsive symptoms were divided into four categories: bad thoughts, repeating/checking, symmetry, and cleaning/contamination.

The research team then investigated the association of these symptoms with lifetime diagnoses of obsessive compulsive disorder (OCD), depressive episode, psychosis, and suicidal ideation.

According to the findings, obsessive compulsive symptoms were common (38.2 percent) in young people who were not seeking mental health treatments, particularly in females and after puberty. Only three percent of the cohort actually met the qualifications for OCD.

All obsessive compulsive symptoms were linked to higher rates of OCD, depression, psychosis and suicidal ideation. However, intrusive bad thoughts — prevalent in more than 20 percent of the sample — showed the most substantial associations with major psychiatric conditions.

These bad thoughts include thoughts about harming oneself or others, picturing violent images, or fear that one would do something bad without intending to. Children with these types of thoughts were more likely to develop serious psychopathology beyond OCD, including depression and suicide.

“Our hope is that these results will propel both mental health professionals and non-mental health practitioners, such as pediatricians, to probe for these symptoms during their patients’ visits,” said the study’s principal investigator Raquel Gur, M.D., Ph.D., director of the LiBI and a professor of psychiatry, neurology and radiology in the Perelman School of Medicine.

“These symptoms may be vital for identifying adolescents who are on a potentially debilitating psychiatric trajectory.”

The researchers suggest that screening for obsessive compulsive symptoms during medical visits may offer a window for clinicians to identify serious psychiatric conditions.

Source: Children’s Hospital of Philadelphia