When Washing Becomes a Compulsion

Obsessive-compulsive disorder is often diagnosed too late in children and adolescents. In the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108: 173-79), Susanne Walitza and her colleagues point out that appropriate early recognition and treatment can positively affect the course of the disease.

Compulsive washing, the most common obsessive-compulsive manifestation among children and adolescents, is present in up to 87 percent of all patients; other common types are compulsive repetitive behavior and checking, and obsessive thoughts of an aggressive type. Comorbidities such as attention deficit/hyperactivity disorder are present in more than 70 percent of patients. Obsessive-compulsive disorder presenting in childhood or adolescence often becomes chronic and impairs mental health onward into adulthood.

The specific manifestations of obsessive-compulsive disorder can be diagnosed early with psychodiagnostic techniques. Treatment is often highly time-consuming. Behavioral therapeutic methods have been found effective and are accordingly considered first-line treatment. In behavioral therapy, the patient is confronted with the situation that precipitates the obsessive-compulsive manifestations, but the manifestations are suppressed. Second-line treatment consists of behavioral therapeutic intervention combined with the administration of a serotonin reuptake inhibitor. The authors state that, even after a course of intensive treatment has been completed, patients still need psychotherapy or combination therapy to prevent a later recurrence.

The etiology and pathogenesis of obsessive-compulsive disorder are multifactorial, with psychological, neurobiological and genetic factors all playing a role.