Indian Journal of Private Psychiatry

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VOLUME 13 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Preschool Onset of Obsessive-compulsive Disorder: A Case Report

Shikha K Talati, Jitendra Jeenger, Varun Gupta, Sankalp Doda

Keywords : Differential diagnoses, Exposure and response prevention therapy, Obsessive-compulsive disorder, Preschool onset

Citation Information : Talati SK, Jeenger J, Gupta V, Doda S. Preschool Onset of Obsessive-compulsive Disorder: A Case Report. Ind J Priv Psychiatry 2019; 13 (2):77-79.

DOI: 10.5005/jp-journals-10067-0033

License: CC BY-NC 4.0

Published Online: 01-08-2016

Copyright Statement:  Copyright © 2019; The Author(s).


Preschool onset of obsessive-compulsive disorder (OCD) is rare with limited studies on it and with multiple diagnostic and treatment quandaries. We report a case of 5-year-old girl who had obsessive-compulsive symptoms since 4 years of age. She was diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria after eliminating other potential diagnoses. She showed good response to a combination of parent-assisted exposure and response prevention therapy and fluoxetine. This case brings into focus the distress associated with very early onset of OCD and discussion of differential diagnoses and treatment options for it.

  1. Levin AB, Piacentini J. Obssessive-compulsive disorder in childhood. In: Sadock BJ, Sadock VA, Ruiz P, ed. Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 10th ed. Philadelphia: Wolters Kluver; 2017. p. 3695.
  2. Lewin AB, Piacentini J. Obsessive-compulsive disorder in children. In: Sadock BJ, Sadock VA, Ruiz P, ed. Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th ed. Philadelphia: Wolters Kluver; 2009. p. 3671.
  3. Micali N, Heyman I, Perez M, et al. Long-term outcomes of obsessive-compulsive disorder: follow-up of 142 children and adolescents. Br J Psychiatry 2010;197(2):128–134. DOI: 10.1192/bjp.bp.109.075317.
  4. Fontenelle LF, Mendlowicz MV, Marques C, et al. Early-and late-onset obsessive–compulsive disorder in adult patients: an exploratory clinical and therapeutic study. J Psychiatr Res 2003;37(2):127–133. DOI: 10.1016/S0022-3956(02)00087-0.
  5. do Rosario-Campos MC, Leckman JF, Mercadante MT, et al. Adults with early-onset obsessive-compulsive disorder. Am J Psychiatry 2001;158(11):1899–1903. DOI: 10.1176/appi.ajp.158.11.1899.
  6. de Mathis MA, do Rosario MC, Diniz JB, et al. Obsessive-compulsive disorder: influence of age at onset on comorbidity patterns. Eur Psychiatry 2008;23(3):187–194. DOI: 10.1016/j.eurpsy.2008.01.002.
  7. Stewart SE, Geller DA, Jenike M, et al. Long-term outcome of pediatric obsessive-compulsive disorder: a meta-analysis and qualitative review of the literature. Acta Psychiatr Scand 2004;110(1):4–13. DOI: 10.1111/j.1600-0447.2004.00302.x.
  8. Kulkarni H, Sudarshan CY. Obsessive compulsive disorder in a 4-year-old child. Indian J Psychol Med 2015;37(2):230–232. DOI: 10.4103/0253-7176.155647.
  9. Tobias R, Walitza S. Severe early-childhood obsessive-compulsive disorder – case report on a 4-year-old girl. Z Kinder Jugendpsychiatr Psychother 2006;34(4):287–293. DOI: 10.1024/1422-4917.34.4. 287.
  10. Scahill L, Riddle MA, McSwiggin-Hardin M, et al. Children's Yale-Brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 1997;36(6):844–852. DOI: 10.1097/00004583-199706000-00023; Shaffer D, Gould MS, Brasic J, et al. A children's global assessment scale (CGAS) (for children 4 to 16 years of age). Psychopharmacol Bull 1985;21(4):747–748.
  11. Wechsler D. Wechsler preschool and primary scale of intelligence, 4th ed. San Antonio, TX: The Psychological Corporation; 2012.
  12. Freeston M, Kendall T, Derisley J, et al., NICE Guidelines on Obsessive Compulsive Disorder: National Clinical Practice Guideline Number 31. Northampton Shire: The British Psychological Society; 2006. Last cited on 2014 Jan 11. Available from:
  13. Garcia AM, Freeman JB, Himle MB, et al. Phenomenology of early childhood onset obsessive compulsive disorder. J Psychopathol Behav Assess 2009;31(2):104–111. DOI: 10.1007/s10862-008-9094-0.
  14. Storch EA, Milsom VA, Merlo LJ, et al. Insight in pediatric obsessive compulsive disorder: associations with clinical presentation. Psychiatry Res 2008;160(2):212–220. DOI: 10.1016/j.psychres.2007.07.005.
  15. Mohapatra S, Rath N. Atypical presentation of childhood obsessive compulsive disorder. Indian J Psychol Med 2016;38(1):67–68. DOI: 10.4103/0253-7176.175124.
  16. Swedo SE, Leonard HL, Garvey M, et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 1998;155(2):264–271. DOI: 10.1176/ajp.155.2.264.
  17. Miyawaki D, Goto A, Iwakura Y, et al. Preschool-onset obsessive-compulsive disorder with complete remission. Neuropsychiatr Dis Treat 2018;14:1747–1753. DOI: 10.2147/NDT.S169797.
  18. Mcguire JF, Piacentini J, Lewin AB, et al. A meta-analysis of cognitive behavior therapy and medication for child obsessive-compulsive disorder: moderators of treatment efficacy, response, and remission. Depress Anxiety 2015;32(8):580–593. DOI: 10.1002/da.22389.
  19. Lewin AB, Park JM, Jones AM, et al. Family-based exposure and response prevention therapy for preschool-aged children with obsessive-compulsive disorder: a pilot randomized controlled trial. Behav Res Ther 2014;56:30–38. DOI: 10.1016/j.brat.2014.02.001.
  20. Freeman J, Sapyta J, Garcia A, et al. Family-based treatment of early childhood obsessive-compulsive disorder: the Pediatric Obsessive-Compulsive Disorder Treatment Study for Young Children (POTS Jr) – a randomized clinical trial. JAMA Psychiatry 2014;71(6):689–698. DOI: 10.1001/jamapsychiatry.2014.170.
  21. Gleason MM, Egger HL, Emslie GJ, et al. Psychopharmacological treatment for very young children: contexts and guidelines. J Am Acad Child Adolesc Psychiatry 2007;46(12):1532–1572. DOI: 10.1097/chi.0b013e3181570d9e.
  22. Armstrong C. AACAP updates recommendations on diagnosis and treatment of obsessive-compulsive disorder in children. Am Fam Physician 2012;85(11):1107–1109.
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