Obsessive-compulsive risks for teens.

Contrary to what many researchers and clinicians assume, youngsters who exhibit depression and substance abuse in the first few years of adolescence have a heightened likelihood of developing obsessive-compulsive disorder (OCD) by age 18, a new study finds.

Several factors have been suggested as contributing to OCD, including eating disorders, birth problems that subtly disturb brain development, and Tourette's syndrome (SN: 7/21/90, p.42). However, none of them shows a close link to OCD in the latest investigation, which tracked 930 boys and girls from birth to young adulthood.

"These findings suggest that clinicians should be aware of a risk for emerging OCD among young teenagers who have other [mental] disorders, especially depression and substance abuse," asserts Heidi M. Douglass, who directed the data analysis while a graduate student in psychology at the University of Otago Medical School in Dunedin, New Zealand.

Obsessions consist of repeated, distressing thoughts or impulses, such as the fear of getting contaminated by shaking hands with others. Compulsions are repetitive behaviors or mental acts intended to quell anxiety, such as washing one's hands over and over. Symptoms of the disorder take up 1 or more hours daily.

Douglass and her colleagues drew on an investigation of New Zealand youths that has already yielded clues to the origins of hard-core delinquency (SN: 4/15/95, p.232). Participants are mostly white and come from all social backgrounds. They have completed extensive medical and psychological testing every 2 to 3 years, beginning at age 3.

At age 18, 37 volunteers--4 percent of the total--cited symptoms of OCD that had occurred in the past year. That proportion coincides roughly with previous estimates of OCD's prevalence. The researchers compared this group to 590 teens who had had no mental disorders in the past year, 45 who had exhibited conduct disorder (frequent delinquency and violence) in that period, and 215 who had suffered from anxiety disorders or depression in the past year.

OCD cases typically involved either obsessions or compulsions but not both simultaneously. One or more mental disorders accompanied most instances of OCD, particularly depression, social phobia, and alcohol or marijuana dependence.

Only depression and substance abuse in early adolescence showed a significant elevation in the OCD group, compared to the other groups, Douglass and her coworkers report in the November Journal of the American Academy of Child and Adolescent Psychiatry.

Psychiatrists may need to devise a new diagnostic category that combines symptoms of OCD with those of mood disorders such as depression, the researchers propose.

Other proposed risk factors for OCD may apply mainly to the most severe cases, which have attracted the bulk of scientific attention to date, Douglass asserts.