Patients present with an abrupt and dramatic onset of OCD. The acuity of onset and initial severity of the OC symptoms are hallmarks of the diagnosis. The OCD symptoms must be sufficiently frequent and intense to meet DSM-5 criteria for OCD and must cause significant distress and interference in the child’s activities at home, at school, and/or with peers.
Many parents describe the onset as the child waking up one day a different character. Many parents can pinpoint the exact date neuropsychiatric symptoms erupted and their child’s personality changed from baseline.
A prior history of mild, non-impairing obsessions or compulsions does not, however, rule out the syndrome, as children may have had subclinical symptoms present for an extended period prior to the sudden onset of the full disorder.
Eating Disorder Symptoms
In addition to the initial OCD symptoms, there is also usually restricted food intake and abnormal eating behaviors. In some patients, body image distortions appear to drive the weight-loss inducing behaviors; while in the majority, the body image distortions appear only after the child had lost a significant amount of weight (10-15% of starting weight) as a result of food intake restrictions that were related to obsessional preoccupations with the texture of food and a fear of choking, vomiting, or contamination from ingesting specific foods. The sudden onset of eating restrictions or anorexic behaviors can occur even in the absence of more typical symptoms of OCD.