Preschool-onset obsessive-compulsive disorder with complete remission

Area of Science:

• Child and Adolescent Psychiatry
• Neuroscience
• Psychology

Background:

• Early-onset obsessive-compulsive disorder (OCD) is often more severe and less responsive to treatment than later-onset forms.
• Complete remission in preschool-onset OCD, particularly severe cases, is rarely reported.
• Preschool-onset OCD may be misdiagnosed as separation anxiety disorder, delaying appropriate intervention.

Observation:

• A 6-year-old girl presented with severe OCD symptoms starting at age 3, including contamination fears, excessive washing, checking rituals, and refusal to eat or dress.
• Initial inpatient pediatric treatment yielded no improvement.
• The patient was transferred for specialized psychiatric care.

Findings:

• Successful treatment was achieved through family-based cognitive-behavioral therapy (CBT) combined with a short-term, low-dose course of fluvoxamine in an inpatient setting.
• The patient experienced complete remission of OCD symptoms for over 3 years.
• At age 9, she exhibits good global functioning and no longer requires treatment.

Implications:

• This case demonstrates that severe preschool-onset OCD can achieve long-term remission with intensive, family-based inpatient treatment.
• Family-based CBT is a viable and effective treatment for hospitalized preschoolers with severe OCD.
• Early detection and intervention are crucial for improving remission rates in very young children with OCD.