Childhood obsessive-compulsive disorder.

Case Example Joseph is an 11-year-old boy whose mother has brought him to the pediatrician for a concern about his hands. The skin is dry, cracked, and erythematous. Joseph is wearing gloves in the office and is unhappy about being there. He does not want to show his hands to the doctor. No other area of skin is affected. The condition has worsened gradually over several months. Joseph’s mother has noticed that he washes his hands often and consumes large quantities of hand sanitizer gel throughout the day. Joseph vehemently denies this behavior. In addition, there is a several-year history of frequent hand-washing, increasing in severity over the past several months, and avoidance of touching door knobs, handles, playing cards, books, and toys that are not his own. He wears gloves everywhere he goes outside of his house. Joseph worries about germs and getting sick, and he avoids going to other kids’ houses or eating food that has not been prepared by his mother. He also has elaborate routines when he uses the bathroom that take more than an hour before he goes to school, and he has tantrums when his mother tries to rush him when he is running late for school. He needs to use several clean towels every time he washes his hands, and his mother has had difficulty keeping up with all the laundry. Joseph disputes the history his mother provides at every turn, insisting that he is fine. Despite all of the reported concern about germs and cleanliness, his teeth are unbrushed and he is observed to be somewhat slovenly and careless about his overall personal hygiene.