LETTERS TO THE EDITOR

SEXUAL OBSESSIONS IN OBSESSIVE-COMPULSIVE DISORDER

Sexual obsessions occur in pediatric and adult OCD including thoughts about sexual acts with family members, sexually inappropriate behavior, or homosexual orientation. They may remain undiagnosed because of embarrassment to report thoughts that are perceived as unacceptable. Prevalence studies of sexual obsessions in pediatric populations are rare. The present study investigated prevalence of sexual obsessions and treatment outcome compared to youth with OCD without sexual obsessions in a large sample. Sexual obsessions and OCD severity were assessed with the Children’s Yale-Brown Obsessive- Compulsive Scale in all 269 participants of the Nordic Longterm OCD Treatment study (mean age 12.8 years, 48.7% boys) at baseline, after treatment and three years follow-up. Treatment consisted in individual manualized CBT with exposure and response prevention. Patients with and without sexual obsessions were compared on clinical characteristics and treatment outcomes. Sexual obsessions were reported by 18%, those with sexual obsessions were slightly older (13.5 versus 12.7 years). Both groups had no difference in treatment outcome, suggesting that if addressed, the response to CBT is similar in sexual, as in other obsessions. Clinicians need to be aware that children may need help to disclose and to identify these thoughts as obsessions to address them in treatment.

Information on the function of the hypothalamic-pituitary-adrenal (HPA) axis, the main mammalian system of stress response, in obsessive compulsive disorder (OCD) is inconsistent. In this study, nine inpatients with a DSM-IV diagnosis of OCD without comorbid major depression (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score >15; HAMD-21 total score ⩽16) and nine healthy matched controls were included. Blood of patients (seven males; 31.8 ± 9.3 years, Y-BOCS: 27.3 ± 4.3, HAMD-21: 13.3 ± 1.9) and controls (seven males, 31.6 ± 9.1 years) was drawn every 20 min between 23:00 and 7:00 h during sleep using a long catheter for later ACTH and cortisol analysis. Secretion patterns of cortisol and ACTH were similar in both groups, in OCD, however, at a higher level. Area under the curve plasma concentrations of both ACTH (p < 0.05) and cortisol (p < 0.005) were significantly greater in patients with OCD (ACTH: 674.3 ± 57.4; cortisol: 2148.4 ± 271.7) than in controls (ACTH: 460.2 ± 61.0; cortisol: 1191.2 ± 124.1). In conclusion, our findings suggest that the activity of the HPA axis in patients with OCD is increased compared to healthy controls.

This report documents emerging posttraumatic obsessive–compulsive disorder in 13 Israeli military veterans diagnosed with both obsessive–compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), for whom the onset of OCD was clearly associated with the trauma. Data presented include four detailed case reports that delineate relations between symptomatology in the two disorders. Clinical and theoretical implications of these data are discussed.