The Maudsley's obsessional children: phenomenology, classification, and associated neurobiological and co-morbid features.

From the 1968-1983 Maudsley Hospital database of 5556 children and adolescents, 175 (3.1%) werechildren with obsessions, CWO (i. e. children of normal intelligence with obsessive-compulsive symptoms but without autism, psychosis, substance dependence, or personality or sexual deviance). Acontrolled case record study of a subgroup (100) of theseCWO showed that only 39 were given a diagnosis of OCD; the rest received co-morbid diagnoses. patients with co-morbid diagnoses resembled those with OCD on some clinical and psychosocial measures and, perhaps, should also be regarded as having OCD. Male to female ratio was 1.5∶1, no significant difference existed between the ages of boys and girls, andCWO experienced more time between discovery and presentation of symptoms than children with non-obsessional psychiatric disorders,controls. Suicidal ideation and resistance to compulsions were uncommon. Specific disorders of the basal ganglia and diffuse brain abnormalities were associated with obsessionality.CWO were more likely to come from social class I or II, and experience greater acute psychosocial, intra-familial, and treatment related stresses but not cognitive impairment thancontrols. Treatment outcome was frequently poor. Prospective studies are needed to extend these findings.