Vol 11, N°1 Child and Adolescent Psychiatry
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bsessive-compulsive disorder (OCD) is a chronic and potentially disabling condition affecting from 1% to 3% of the general adult population.1,2 Similar rates have also   been   reported   for   children   and   adolescents.3-5 Frequently, patients with OCD describe the sudden intru- sion into consciousness of unwanted thoughts or unpleas- ant images.These obsessions are often accompanied by a profound sense of dread and the urge to complete specific compulsions. Compulsions are repetitive acts, typically per- formed a certain number of times or according to certain private rules, that the individual is driven to complete, even though these acts are perceived as excessive. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,Text revision (DSM-IV-TR)6 and other stan- dard diagnostic classifications, such as the International Classification of Diseases,Tenth Edition (ICD-10),7 catego- rize OCD as a unitary nosological entity.While this parsi- mony has a certain formal appeal, it is misleading. The symptoms used to define OCD are heterogeneous and include various intrusive thoughts and preoccupations, rit- uals, and compulsions.Two individuals with OCD may have totally different and nonoverlapping symptom patterns. From as far back as the earliest descriptions of OCD, investigators have attempted to dissect the phenotype into homogeneous subtypes. For example, Falret8 made the distinction between “folie du doute” (madness of doubt) and “délire du toucher” (delirium of touch) in 1869. Most commonly, investigators have distinguished “washers” from “checkers.”9-12 With a few notable excep- T r a n s l a t i o n a l   r e s e a r c h O Copyright © 2009 LLS SAS.  All rights reserved www.dialogues-cns.org Symptom dimensions and subtypes of obsessive-compulsive disorder: a developmental perspective James F. Leckman, MD; Michael H. Bloch, MD; Robert A. King, MD Keywords:   obsessive-compulsive  disorder;  tic  disorder;  early  onset;
 symptom dimension Author affiliations:  The Child Study Center and the Departments of Psychiatry, Psychology  and  Pediatrics,  Yale  University  School  of  Medicine,  New  Haven, Connecticut, USA   Address for correspondence:  James Leckman, Child Study Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06520-7900, USA (e-mail: james.leckman@yale.edu) In the absence of definitive etiological markers for obses- sive-compulsive disorder (OCD), obsessive-compulsive (OC) symptom dimensions may offer a fruitful point of orientation.  These  dimensions  can  be  understood  as defining potentially overlapping clinical features that may be continuous with “normal” worries first evident in childhood. Although the understanding of the dimen- sional  structure  of  OC  symptoms  is  still  imperfect,  a recent large-scale meta-analysis has confirmed the pres- ence of at least four separable symptom dimensions in children, as well as adults, with OCD. A dimensional approach does not exclude other methods to parse OCD. Thus far, a pediatric age of onset, the presence of other family members with OCD, and the individual’s “tic- related” status appear to be potentially useful categor- ical distinctions. Although the OC symptom dimensions appear to be valid for all ages, it is unlikely that the underlying genetic vulnerability factors and neurobio- logical substrates for each of these symptom dimensions are the same across the course of development.      © 2009, LLS SAS Dialogues Clin Neurosci.  2009;11:21-33.