Childhood rituals: normal development or obsessive-compulsive symptoms?

The symptoms of obsessive compulsive disorder (OCD) have been viewed as extreme variants of normal developmental rituals and superstitiousness; however, difference in timing, content, and severity argue against this continuum. In a systematic comparison of 38 children with severe primary OCD and 22 matched normal controls, parents were interviewed about their child's early developmental rituals and current superstitions. Children were asked about superstitious beliefs. Children with OCD did not differ significantly from controls in number or type of superstitions. However, parents of the OCD children reported significantly more "marked" patterns of early ritualistic behavior than did parents of normal controls. When behaviors resembling primary OCD symptoms were excluded, other rituals did not differ leaving open the possibility that such behaviors were early manifestations of the disorder. Only a prospective study can determine whether these results reflect preclinical OCD or are an artifact of biased recall.