OCD usually begins in adolescence or early adulthood but can begin prior to that time; 31% of first episodes occur between ages 10 and 15 years, with 75% developing OCD by age 30. In most cases, no particular stress or event precipitates the onset of OCD symptoms, and after an insidious onset there is a chronic and often progressive course. However, some patients describe a sudden onset of symptoms. This is particularly true of patients with a neurological basis for their illness. There is evidence of OCD associated with the 1920s encephalitis epidemic, abnormal birth events, and onset following head injury or seizures. Of interest are reports of new onset of OCD during pregnancy (Neziroglu et al. 1992).

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