Abstract:
Children and adolescents with Obsessive Compulsive Disorder (OCD) can present in atypical and unusual ways.
We present the case of a 13 year old boy with an unusual presentation of OCD. He presented with irritability,
aggression, poor sleep, reduced attention, hyperreligiosity, social withdrawal and disinhibition (i.e. inappropriately touching females) for 1 week and was found to have obsessional thoughts and impulses related to
sex and the compulsion of seeking absolution from lord buddha. He was diagnosed as OCD after excluding
organic causes, manic episode, acute psychotic episode, drug induced psychosis and sexual abuse. He initially
responded to fluoxetine 20mg, olanzapine 2.5 and a short course of lorazepam. He was functioning well for 2
weeks and thus olanzapine and lorazapam were tailed off. A week later he presented with similar symptoms with
the added symptoms of singing, masturbating in public and talking excessively to his mother about sex. He was
found to have obsessional thoughts, impulses and images and the compulsions of reassurance seeking from his
mother and seeking absolution from lord buddha. He responded to an increase in fluoxetine to 40mg and
olanzapine 2.5mg. He has now remained in remission for 4 months with good functioning. This case shows that
in contrast to adults, children may not recognize that their obsessional thoughts are irrational and may not be
able to resist the obsessions as a result. It stresses the importance of being mindful of the atypical presentations of
OCD in children to avoid misdiagnosis.
