Differential Diagnosis of Obsessive Compulsive Disorder Among Young People in India

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Obsessive compulsive disorder is common among children and adolescents in India, including cities like Mumbai and Bengaluru. Young people with OCD may experience anxiety and distress, have lower academic performance, and be at a higher risk of other mental health conditions.

With accurate diagnosis of the condition and accessible treatment, young people can manage and recover from the disorder. However, finding accurate and reliable diagnoses isn’t always easy, especially since symptoms of OCD can be very similar to those of other disorders. This means that the process of differential diagnosis – distinguishing between multiple disorders that may have similar symptoms – is very important.

This blog offers some information about obsessive-compulsive disorder among young people in India and differential diagnosis. It also outlines the treatments available that can support lasting recovery.

What Is Obsessive Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. Young people with OCD experience unwanted and intrusive thoughts, impulses, or images that make them feel anxious or distressed. To cope with or try to resolve these thoughts, people with OCD carry out compulsions (behaviours or rituals) to attempt to stop the obsessions.

However, the obsession usually returns, sometimes in an even more distressing form. This can create a vicious cycle of obsessions and compulsions accompanied by anxiety and distress. Without effective support, OCD can make a young person’s daily life difficult or almost impossible to manage.

Researchers still aren’t sure what causes OCD in children and adolescents. Several different factors may play a role, including genetics, life events including trauma, and certain personality traits. OCD usually develops during adolescence or adulthood, but it can also begin in childhood.

How Common is OCD Among Young People in India?

While research on OCD among young people in India is limited, studies have found that it is common among adolescents. One study among over 7000 adolescents aged 12 to 18 found that 0.8% met the criteria for OCD. Taboo thoughts and mental rituals were the most common symptoms. Moreover, the study found that those with OCD had poorer academic performance, significantly more suicidal thoughts, and greater psychological distress.

Another study looking into the symptoms and clinical profile of young people in India with OCD found that the most common symptoms were:

  • aggressive, contamination-related obsessions
  • washing, checking, and repeating compulsions

Around 75% of children and adolescents had developed the condition before the age of 14.

Understanding Differential Diagnosis

Differential diagnosis is the process of distinguishing between two or more conditions that have similar symptoms. Differential diagnosis is important to ensure young people receive an accurate diagnosis and treatment that’s effective for them. 

Effective treatment can be very different for one disorder than the other, even when symptoms are very similar. This means that a false diagnosis can prevent young people from managing and recovering from symptoms.

While differential diagnosis is a process of distinguishing between disorders, mental health experts may find that a young person has two or more conditions. This is called co-morbidity or co-occurring disorders. 

Autism Spectrum Disorder and OCD

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects the way young people see the world and interact with other people. It involves a broad spectrum of traits that can affect young people in different ways. Autism is not a mental health disorder, but young autistic people may face challenges with their mental health, often because of a lack of social support and structures that recognize their needs.

Sometimes, autistic traits and symptoms of OCD can look very similar in children. For example, autistic children may show repetitive behaviours like ordering and rearranging toys that can look very like compulsions.

However, there are some important differences between these behaviours and OCD symptoms. Firstly, OCD compulsions are usually preceded by an obsession that a young person tries to cope with or resolve through their compulsion. For example, a young person with OCD may experience intrusive thoughts that something bad will happen to them unless their toys are in a certain order, and then rearrange their toys. 

Secondly, OCD behaviours usually give a young person temporary relief from their anxiety (although their obsessions typically return later). Thirdly, young people with OCD tend not to find compulsive behaviours intrinsically pleasurable. Instead, they feel compelled to engage in these unwanted behaviours even though they may be out of line with their values, goals, and needs.

Repetitive behaviours among autistic children don’t share these characteristics. Rather than being associated with anxieties and compulsions, young autistic people tend to enjoy – or are intrinsically interested in – these behaviours. 

Importantly, these behaviours are not always mutually exclusive. Some young autistic people may also have OCD: in fact, OCD is significantly more common among autistic people than among those who are not autistic. In any case, an accurate diagnosis (or none, one, or both disorders) is essential for young people to get the support they require.

OCD and Tic Disorders

Tics are sudden movements, sounds, and twitches that people do repeatedly. They are involuntary, meaning that a person cannot stop themselves from doing a tic. Tics are relatively common among children and usually begin around the age of 5. 

Complex tics can be difficult to distinguish from compulsions. For example, children and adolescents may repetitively tap or touch something – a behaviour that is identical to some OCD compulsions. 

However, while tics are mainly involuntary, compulsions are deliberate actions that young people take to cope with obsessions. Moreover, even complex tics are usually more straightforward and simple than compulsions. For example, while a tic may be a simple tapping action, a compulsion might be tapping four times with the left hand and four with the right.

As with autism spectrum disorder and OCD, tic disorders and obsessive-compulsive disorder often co-occur. Around 60% of children and adolescents with OCD may meet the criteria for a tic disorder at some time during their lives. Research also suggests that young people with both tic disorders and OCD may have an earlier average onset of OCD and different symptoms from those without tic disorders. 

OCD and Psychosis

OCD symptoms in children and adolescents can also be confused with symptoms of psychosis. This often happens when a child isn’t fully aware that their obsessions are irrational. They may have ‘transformational obsessions’ where they are afraid of turning into something or someone else. These types of obsessions can be hard to distinguish from delusions.

Other obsessions – such as paranoid obsessions – can also look similar to symptoms of psychosis, like paranoid delusions. However, in cases of OCD, these obsessions are less likely to be part of a broader schema of beliefs but instead be isolated ideas. Young people with OCD may also have more insight into the irrationality of their obsessions than people with psychosis have about their delusions. 

Treating Obsessive Compulsive Disorder in Children and Adolescents

Cognitive-behavioral therapy (CBT) is the most common treatment for OCD in children and adolescents. CBT is an evidence-based therapy that focuses on the interactions between a young person’s thoughts and behaviours, teaching skills to help change negative patterns into more positive ones. 

CBT for obsessive-compulsive disorder may be offered through group therapy or family-focused therapy, as well as individual therapy. It’s usually based on exposure-based techniques that support young people to gradually encounter and challenge thoughts, feelings, images, and worries that provoke their obsessions in a safe environment until they no longer see their obsession as a threat.

Other treatment approaches for OCD in young people include:

  • Medication (usually for young people over 18)
  • Eye Movement Desensitisation and Reprocessing (EMDR)
  • Social skills training

The Wave Clinic: Specialist Residential Care for Young People

The Wave Clinic is a specialist residential treatment space for adolescents and young adults just outside of Kuala Lumpur, Malaysia. Our programs make a difference in the lives of young people, combining exceptional clinical care with education, community responsibility, and a gap year experience.

In recent years, more and more families from Mumbai, Bengaluru, and other parts of India are traveling to the Wave for treatment. This means that we have established communities of parents within these cities to provide support to other families during and after treatment. We also have connections with trusted local therapists to offer follow-up care after a young person returns home.

At The Wave, we support young people to grow in self-confidence, discover new life paths, and gain the skills they need to follow their dreams. If you’re interested in finding out more about our programs, get in touch today. We’re here to help.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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