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Obsessive Compulsive Disorder (OCD)
Source: A-Z Disorder Guide, http://www.aboutourkids.org/aboutour/disorders.html ,
New York University Child Study Center
Introduction
A child with OCD has an anxiety disorder marked by the presence
of obsessions and compulsions severe enough to interfere with
the activities of daily life. Obsessions are repeated, unwanted
thoughts often related to fears of contamination. Compulsions
are repeated, purposeless behaviors. The cause of OCD is believed
to be neurological and it runs in families. Treatment includes
a combination of behavior therapy and medication.
Real Life Stories
- Five-year-old Alex can't go to sleep until he kisses his
mother five times on each cheek after she closes his closet
in a certain way. He has no other fixed behaviors.
- Jesse, l0 years old, cleans his teeth so frequently that
he uses a box of toothpicks each week and his gums bleed
profusely. Each day he uses a half box of Q-tips to clean
his ears and a roll of toilet paper when he goes to the
toilet. When he does his homework, Jesse can spend an hour
on the same page, erasing and rewriting words because he's
sure he didn't get them right.
- Ashley, l6, reports that each time she leaves a classroom,
passes the principal's office or leaves school, she has
to imagine the number 12 on a clock and say the words "good
luck" to herself. She reports that she can't stop thinking
about the words "good luck." If she tries to stop
herself from thinking about these words, she becomes very
anxious and worries that she'll have a heart attack. In
the classroom, she is often frozen in her seat, unable to
respond. She worries that any decision she makes will result
in something dreadful happening to her parents. Before going
to sleep, she closes the bedroom door four times, turns
the lights on and off four times and looks out the window
and under her bed twelve times.
- Alex, at 5 years of age, is preoccupied with rituals appropriate
to his age. They are mild and do not affect his enjoyment
of life. Jesse and Ashley have been diagnosed as having
Obsessive Compulsive Disorder.
Childhood rituals and superstitions differ with age. At about
2 l/2, children begin to expect routines; at mealtime, bathing
and bedtime rituals are frequent and help to stabilize the
child's world. Between the ages of five and six, children
develop group rituals, during which they play games with rules
and rhymes. Older children begin to collect objects and may
become preoccupied and obsessed with hobbies. Ritualized behaviors
help children to become socialized and to master anxiety.
However, when obsessive thoughts become so frequent or intense
or rituals become so extensive that they interfere with functioning,
the diagnosis of Obsessive Compulsive Disorder (OCD) is considered.
What are the symptoms?
OCD is an anxiety disorder characterized by the presence of
obsessions and compulsions that the child feels unable to
control. Obsessions are unwanted, intrusive thoughts, ideas,
urges, impulses or worries that run through a person's mind
repeatedly. Often the obsessions are senseless, unpleasant,
distasteful, or even repugnant. The person must attempt to
ignore or suppress these obsessions or neutralize them with
some other thought or action. The person with OCD recognizes
that these thoughts arise in one's own mind and are not a
psychotic intrusion. Some common obsessions are: repeated
impulses to kill a loved family member; incessant worries
about dirt, germs, contamination, religion; recurrent thoughts
that something has not been done properly; feelings that certain
things must always be in a certain place, position or order;
thoughts of nonsense words, sounds, numbers or images. For
some children excessive rumination and rituals are the result
of their efforts to impose order on internal feelings of anxiety
and confusion.
Compulsions are repeated purposeless behaviors that are usually
performed in response to an obsession. The behavior is an
attempt to neutralize or prevent some dreaded event, situation
or thought. A person may or may not recognize that the behavior
is obsessive or unreasonable. Some common compulsions are:
excessive hand washing, showering, bathing, and checking drawers
and locks. Repeated behaviors can include putting clothes
on and then taking them off; hoarding objects; seeking reassurance
that something has or has not happened. The symptoms can wax
and wane. Often there is no logical relationship between the
obsession or compulsion and the fears it is designed to offset;
rather than reducing the anxiety the obsessions and compulsions
frequently increase it.
To warrant a diagnosis of OCD, the obsessions and compulsions
must be severe enough to be time consuming or cause marked
distress or significant impairment. For adults, at some point
during the course of the disorder the person has recognized
that the obsessions or compulsions are excessive or unreasonable.
This does not always apply to children since some do not yet
have the necessary cognitive skills to make this judgment.
Children with OCD may be successful academically and with
other school activities, but they may have difficulty completing
homework and papers as they focus on getting things perfect.
If their symptoms are severe and time-consuming, they may
cause problems with self-esteem and interfere with friendships
and family functioning.
Who is likely to have it?
OCD affects as many as 3% of the general population, roughly
one million of whom are children and adolescents. These statistics
translate into three to five youngsters with OCD per average-sized
elementary school and as many as twenty in a large urban high
school. Unlike the high female: male ratio in other anxiety
disorders, the ratio of boys to girls is 2:1.
The age of onset in more than 50% of adult cases with this
disorder is before age 15. OCD has been reported as early
as the preschool years, with a peak onset age of about ten.
Twenty percent of youngsters with OCD have another family
member with this.
Why does it happen?
OCD is believed to be neurological in origin. Evidence strongly
suggests that OCD is associated with a deficiency in serotonin
in the brain. The disorder that causes OCD runs in families;
recent studies show that 20% of youngsters with OCD have a
family member with the disorder.
How is it treated?
The recommended treatment is a combination of therapy and
medication. Behavior therapy includes exposure and response
prevention. The child is forced to confront his fears and
to work his way through the anxiety. The child may be brought
into contact with the feared object or event, and then the
obsessive-compulsive behavior may be gently thwarted. Cognitive
behavioral therapy focuses on changing the irrational beliefs
and distorted thoughts that contribute to the disorder. The
goal is to help children recognize the illogical nature of
their fears and change them. The medications prescribed for
OCD include the SSRIs: Luvox, Paxil, Prozac, and Zoloft. The
majority of children on medication improve, but may relapse
and need further treatment.
OCD Questions & Answers
What works best for a child with OCD?
A therapist working with a child with OCD must carefully
assess and document the degree and intensity of the symptom.
For the child with mild or new OCD what's been effective is
to use cognitive behavioral therapy first and that may be
sufficient.
What if cognitive behavioral therapy alone doesn't help?
If the child has had OCD for a period of time, the strategy
is to use cognitive behavioral therapy for a while and then
add medication. If a child has severe symptoms, starting on
both cognitive behavioral therapy and medication is advisable.
Are symptoms apt to change?
OCD symptoms generally change over time. Sometimes when a
child gets rid of one symptom, another may develop. For example,
a child may switch from hand washing to checking. Cognitive
behavioral therapy teaches the child to deal with the symptoms
no matter what they are. The child is taught to recognize
symptoms early and to use the same approach.
Why can't I just tell him to stop?
Parents inadvertently may get drawn into a cycle. Telling
the child to stop may accidentally reinforce the symptom;
the attention may maintain the problem. In cognitive behavioral
therapy the parent learns how to become a home-based therapist.
Parents need to learn to walk away from the behavior and then
reward the child when she copes with it appropriately.
Will it last a lifetime?
Children may always have this tendency, but treatment helps
them recognize and manage the symptoms. |
