Objective: Presented is a review of the literature on the medium- and long-term course of obsessive-compulsive disorder (OCD) with onset in childhood or adolescence.
Methods: Using the data bank MEDLINE, relevant studies published since 1983 were investigated. Older studies were included if their results complemented those of recent studies.
Results: Follow-up studies point to a rather unfavorable course of childhood OCD. At the time of follow-up investigations, 30% to 70% of the patients still suffered from obsessive-compulsive symptoms or had a diagnosis of OCD. Other clinical disorders were diagnosed in 20% to 95% of them. One to two thirds of former patients had received at least one diagnosis of a personality disorder. Multicomorbidity was common. Impairment of the patients' psychosocial adjustment especially affected relationships and sexuality. Most of the variables examined in childhood or adolescence had no significant predictive power as to the course of obsessive-compulsive disorders.
Conclusions: Differences between the results of the follow-up studies can partly be explained by the different study designs employed. Results on the course of childhood OCD point to the high stability of the disorder and the accompanying rate of comorbidity. This has to be taken into account in the diagnosis (supplementary diagnosis of comorbid disorders and family diagnostics) and therapy of childhood OCD (offering long-term therapeutic advice and booster sessions, treatment of comorbid disorder, inclusion of the family).