Anxiety and Obsessive-Compulsive-Related Disorders
This area groups the anxiety disorders and obsessive-compulsive disorder as they present in children and adolescents. These are the most common emotional disorders of childhood, sharing a core of excessive, developmentally inappropriate fear, worry, or repetitive distress that impairs everyday functioning. The grouping orients the reader to the shared developmental, phenomenological, and treatment-research themes that run across the individual conditions described in its topic pages.
Definition
A clinical area encompassing childhood and adolescent disorders characterized by excessive fear or anxiety and related behavioral disturbance (the anxiety disorders) together with obsessive-compulsive disorder, characterized by intrusive obsessions and repetitive compulsions.
Scope
The area is an orienting overview of pediatric anxiety presentations (generalized, social, separation, and panic) together with obsessive-compulsive disorder. It covers what unites these conditions developmentally and clinically and points to the dedicated topic entries; it does not provide diagnostic algorithms or treatment instructions. Following current nosology (DSM-5 and ICD-11), obsessive-compulsive disorder is classified separately from the anxiety disorders, but the conditions are presented together here because of their longstanding clinical and research links in youth.
Sub-topics
Core questions
- Which fears and worries are developmentally normative and which signal a disorder?
- How do anxiety presentations change across childhood and adolescence?
- What distinguishes obsessive-compulsive disorder from the anxiety disorders in young people?
- What is the evidence base for psychological and pharmacological treatment of pediatric anxiety and OCD?
Key concepts
- Developmentally inappropriate fear, worry, and avoidance
- Behavioral inhibition as a temperamental risk factor
- Fear conditioning and extinction learning
- Obsessions and compulsions
- Comorbidity among anxiety disorders and with depression
- Cognitive behavioral therapy and exposure
- Homotypic and heterotypic continuity into adulthood
Mechanisms
Across these conditions, normal protective fear and worry become excessive, persistent, and impairing. Temperamental behavioral inhibition in early childhood is a recognized antecedent of later anxiety, particularly social anxiety, and models of fear conditioning and impaired extinction learning are central to understanding how anxiety is acquired and maintained. Obsessive-compulsive disorder is additionally linked to cortico-striato-thalamo-cortical circuit dysfunction and has a substantial genetic and neurobiological component. The disorders frequently co-occur with one another and with depression, and many show continuity from childhood into adult mental disorder.
Clinical relevance
Anxiety disorders and OCD are among the earliest-onset and most prevalent psychiatric conditions in young people, and they are associated with academic, social, and family impairment and with later risk of depression and substance use. Understanding this area supports recognition of how these conditions are defined, studied, and treated in the literature; the material is educational and is not a substitute for individualized clinical assessment or treatment.
Epidemiology
Anxiety disorders are collectively the most common class of psychiatric disorder in childhood and adolescence, with worldwide pooled prevalence estimates for any anxiety disorder around 6-7% of children and adolescents in meta-analytic work. Onset is typically early, anxiety disorders having among the youngest median ages of onset of all mental disorders, and the conditions show high mutual comorbidity and frequent progression to depressive disorders. Obsessive-compulsive disorder is less common but typically begins in childhood or adolescence in a substantial share of lifetime cases.
Evidence & guidelines
Practice parameters from the American Academy of Child and Adolescent Psychiatry address the assessment and treatment of pediatric anxiety disorders (Connolly & Bernstein, 2007) and of obsessive-compulsive disorder (Geller & March, 2012). The Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008) is a landmark randomized trial establishing the efficacy of cognitive behavioral therapy, sertraline, and their combination for childhood anxiety. These sources frame the evidence base; they are summarized here for reference and do not constitute treatment direction.
History
Childhood fears and worries were long regarded as transient developmental phenomena, but cohort studies through the late twentieth century established that anxiety disorders in youth are common, impairing, and often persistent. Nosological revisions progressively separated obsessive-compulsive disorder from the anxiety disorders while retaining their clinical proximity, and large treatment trials in the 2000s placed pediatric anxiety and OCD on a firmer evidence footing.
Debates
- Should obsessive-compulsive disorder be classified with or apart from the anxiety disorders?
- DSM-5 and ICD-11 moved OCD into a separate obsessive-compulsive and related disorders grouping, reflecting distinct neurobiology and phenomenology, yet its strong clinical and developmental links to anxiety mean the two are frequently considered together, especially in youth.
Related topics
Seminal works
- connolly-2007
- walkup-2008
- geller-2012
- polanczyk-2015
Frequently asked questions
- Why are anxiety disorders and OCD grouped together for children and adolescents?
- They share a developmental core of excessive fear, worry, or repetitive distress, frequently co-occur, and have closely linked research and treatment literatures, even though current diagnostic systems classify OCD separately from the anxiety disorders.
- How common are anxiety disorders in young people?
- Anxiety disorders are collectively the most common psychiatric conditions of childhood and adolescence, with meta-analytic worldwide prevalence estimates of roughly 6-7% for any anxiety disorder.