The Overlap Between Obsessive-Compulsive Disorder and Psychotic Experiences in Youth: Phenomenology, Diagnostic Challenges, and Treatment Strategies

The co-occurrence of obsessive–compulsive disorder (OCD) and schizophrenia has attracted increasing attention in recent years. Among individuals with schizophrenia and co-occurring OCD, obsessive–compulsive symptoms (OCS) typically precede the onset of psychotic symptoms, and the presence of OCD is associated with an earlier onset of psychosis. Furthermore, there is a well-documented high prevalence of OCS and OCD not only in individuals with first-episode psychosis but also in those at high clinical risk for psychosis. Conversely, there is substantial evidence that children and adolescents with OCD are at increased risk of developing psychosis. However, the literature remains limited and far from providing a clear picture, particularly with regard to preventive strategies and therapeutic interventions. Indeed, the neurobiological mechanisms, clinical manifestations, implications for care, and psychopathological trajectories associated with psychotic vulnerability in this population have yet to be fully elucidated.

There is a need for a more comprehensive understanding of psychotic vulnerability in children and adolescent with OCD. The aim of this Research Topic was to gather a comprehensive body of research to clarify the current state of evidence relating the risk of psychotic onset in youth with OCD.

Topics of interest include:

• Clinical characteristics of youth with OCD and psychotic vulnerability.

• Psychosocial factors potentially associated with psychotic vulnerability in youth with OCD.

• Practical screening tools for efficiently assessing psychosis risk in youth with OCD.

• Challenges in differentiating phenomenology between obsessions and delusions in young people with OCD (i.e., OCD with psychotic features versus schizophrenia with OCD).

• Efficacy of therapeutic interventions (e.g., CBT) in youth with OCD and psychotic vulnerability.

• Potentially distinct developmental trajectories in youth with OCD, stratified by the presence or absence of psychotic vulnerability.

• Evaluation of additional comorbidities (e.g., autism spectrum disorder, ADHD, bipolar disorder) that may complicate diagnosis and/or clinical management.

• Genetic, epigenetic, and neurobiological mechanisms underlying this comorbidity.

We welcome manuscripts reporting original data, systematic reviews or meta-analyses, as well as papers with a conceptual or methodological focus.