8%) and compulsive nail-biting (10%); trichotillomania cooccurred in 1.4% of cases. Differential diagnosis It is important to distinguish developmental normal

repetitive behavior, such as bedtime rituals, from persistent distressing thoughts and compulsions. Recurrent thoughts occur in a number of clinical conditions. In eating disorders, the focus is one’s appearance and the fear of gaining weight, with gross distorsions of body image, and much time is devoted to thinking about food and calories. The depressed patient will ruminate over and over with negative self-denying Inhibitors,research,lifescience,medical thoughts about him- or herself and his or her future, as well as guilt. Children with separation anxiety disorder will mainly worry about leaving their caregiver, with intense fears over their parent’s health and safety. In social phobia, the main theme will be the fear of judgment by others. In generalized anxiety disorder, fear of Inhibitors,research,lifescience,medical catastrophe

and exaggeration of everyday occurrences will be the main worries. In body dysmorphic disorder, a morbid preoccupation with a flaw in physical appearance will be encountered. In pervasive developmental disorders (PDD), repetitive actions are linked to self-stimulation and stereotypical behavior, as part of the core symptoms of PDD along with specific interests. Recurrent bizarre thinking occurs in the psychotic illnesses. Trichotillomania is considered Inhibitors,research,lifescience,medical more an impulse disorder than an obsession, although both disorders can coexist. Hypochondriasis, the conviction of having a serious illness, must be distinguished from fear of contracting an illness, for example by contamination, as found in OCD. Etiology Biological factors Basal ganglia dysfunction has been associated Inhibitors,research,lifescience,medical with obsessive-compulsive manifestations. For example, Tourette’s disorder is associated with an increased rate of OCD. Von

Econome, in 1931, decribed ritualized behavior following encephalitis secondary to influenza and linked to the destruction of the basal Inhibitors,research,lifescience,medical ganglia. Many studies associate Sydenham’s chorea with OCD as a result of basal ganglia autoimmune inflammation. In a similar fashion, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are associated with sudden onset of tics and OCD following a Group A β-hemolytic streptococcal infection (GABHS) also triggering, via antibody formation, an autoimmune reaction towards the basal ganglia. Genetics In his 2006 review, Geller6 states that the estimated familial risk for adults with an OCD-suffering relative is 11% to 12%; however, recent studies on family members of affected children show a 25% relative risk. Thus, the age of onset is considered the most important factor relative to genetic penetrance. Lenane et al32 found that, in parents of children with severe OCD, 25% of the Fasudil fathers and 9% of the mothers had the illness themselves.