Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States of America.
Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States of America; Harvard Medical School, United States of America; Royal Australasian College of Physicians, Paediatrics, Australia.
Compr Psychiatry. 2018 Oct;86:25-30. doi: 10.1016/j.comppsych.2018.07.006. Epub 2018 Jul 17.
Common symptom presentations in youth with Obsessive Compulsive Disorder (OCD) are easily recognized and are included in the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS) symptom checklist. However, some youth may occasionally present with atypical or unusual symptoms that are less readily recognized as OCD and may be confused with other disorders that sometimes overlap, such as autism spectrum disorder or even psychosis.
Case synopses which are thematically linked and exemplify and illustrate two distinct types of unusual or atypical symptom presentations are described. These symptoms are embedded in the subjects' broader clinical picture, that more correctly identifies the atypical symptoms as a variant feature of OCD rather than some other diagnostic condition.
We describe twenty-four children with OCD. Twelve children had obsessions related to adverse experiences of places, times or other people that were felt as horrific, abhorrent or disgusting. These obsessions led to contamination fears of any thoughts or actions associated with those places, events or people. In those whose OCD was a reaction to another person, the contamination obsession often took the form of fear of acquiring an unwanted trait or characteristic by association, which was then avoided. Twelve other youth had obsessions driven by a primary sensory experience that was intolerable, including tactile, olfactory, and auditory stimuli. These sensory experiences were sometimes linked to specific objects or people, driving time-consuming repetitive behaviors to avoid or alleviate the sensory discomfort.
Recognition of atypical presentations of OCD, such as fear of contamination by association with adverse experiences and primary sensory intolerance leading to OCD will help clinicians to better identify and treat these unique symptoms.
青少年强迫症（OCD）的常见症状表现容易识别，并包含在儿童耶鲁布朗强迫症量表（CY-BOCS）症状清单中。然而，一些青少年偶尔可能会出现不太容易被识别为 OCD 的非典型或不寻常的症状，这些症状可能与其他有时重叠的疾病混淆，如自闭症谱系障碍，甚至精神病。
描述了两个不同类型的不典型或非典型症状表现的主题相关案例概要，这些症状嵌入在受试者的更广泛的临床图片中，更正确地将这些不典型症状识别为 OCD 的变体特征，而不是其他一些诊断条件。
我们描述了 24 名患有 OCD 的儿童。12 名儿童的强迫观念与对地方、时间或其他人的负面经历有关，这些经历感觉非常可怕、厌恶或恶心。这些强迫观念导致对与这些地方、事件或人有关的任何想法或行动产生污染恐惧。在那些 OCD 是对另一个人的反应的人中，污染强迫观念通常采取担心通过联想获得不想要的特征或特征的形式，然后避免这种特征或特征。其他 12 名青少年的强迫观念则是由无法忍受的主要感官体验驱动的，包括触觉、嗅觉和听觉刺激。这些感官体验有时与特定的物体或人有关，导致耗时的重复行为以避免或减轻感官不适。
认识到 OCD 的非典型表现，如因与负面经历有关而产生的污染恐惧和主要感官不耐受导致 OCD，将有助于临床医生更好地识别和治疗这些独特的症状。
