Obsessive and compulsive phenomena are common in child and adolescent psychiatric disorders. They are part and parcel of Asperger syndrome and occur at a very high rate in Tourette syndrome, to mention but two disorders in which obsessions, ritualistic phenomena and repetitive activities comprise the clinical picture. Obsessions and compulsions in adults are usually reported to be egodystonic, i.e. they are perceived by the individual affected by them as negative phenomena which they would like to be rid of. This egodystonic quality is often reported not to be present in children and adolescents, who may well consider their ‘symptoms’ to represent normal phenomena.

It has recently been suggested that not only are autism and the other disorders on the autism spectrum associated with severe empathy deficits, but that such problems may be of crucial importance in some cases subsumed under other phenomenological diagnostic labels (Gillberg, 1992). These have been suggested to include obsessive–compulsive personality disorders and subgroups of the eating disorders.

Obsessive–compulsive personality disorder

As with all so-called personality disorders, a diagnosis of obsessive–compulsive personality disorder (OCPD) cannot be made appropriately until an individual's 18th birthday. However, the concept of ‘personality disorder’ is muddled. It is not clear to what extent some terms, such as narcissistic and histrionic personality disorder, represent ‘disorder’ rather than ‘personality constitution’. Furthermore, ‘personality’, whatever it is, can certainly be perceived long before 18 years of age (Chess & Thomas, 1977; Thomas & Chess, 1977).