Obsessive-Compulsive Disorder (OCD)

Parents may wonder if their child has OCD when they notice that the child seems overly occupied with worries and strange behaviors. If the parent has seen something similar in another family member who has already been diagnosed with OCD, he or she may suspect that this child may also have the disorder.  Other parents have no such frame of reference and are simply perplexed by their youngster’s behavior.

Small children are often anxious and ritualistic – they want their parents to give them 10 kisses at bedtime and stay with them the whole night! It’s very difficult for a parent to know whether such behavior is just normal childish behavior or something that requires professional attention. However, when a child starts demanding 24 kisses – exactly 12 on one cheek and 12 on the other – a parent may become suspicious. It doesn’t “feel” or “sound” right to him or her. The only way to know if the child’s feelings and actions are within the normal range is to obtain a proper assessment.

A  diagnosis  of OCD can only be confirmed or dis-confirmed by a qualified mental health professional. If you are concerned about your child, talk to your family doctor or pediatrician – this person can refer you to a psychiatrist or clinical psychologist for an assessment. OCD will not normally be diagnosed unless the symptoms are causing the child significant distress or unless they are affecting the child’s school life, social life or home life adversely. Even if the child is diagnosed with OCD, there is much to be hopeful about: there are excellent behavioral treatments for OCD. People who receive treatment have a good recovery rate.

What is OCD?
OCD involves obsessions and compulsions (also called “rituals”). Obsessions are “sticky” thoughts – thoughts that just won’t go away (at least not by themselves). A teenager might obsess about whether she remembered to lock the door. Instead of just leaving the house like others do, she thinks about that door, asking herself over and over again if she remembered to lock it. Obsessions can also be sensations – a type of feeling. For instance, a child might pull his sock up over and over again until it hits a spot on the leg that feels “just right.” His mother might say that he is obsessed with getting just the right spot and she would be correct – the youngster cannot tolerate the feeling of the sock being at the wrong spot. Compulsions are actions that a person does that either “undoes” an obsession or ends it in some way. Spending lots of time arranging the socks is a compulsion. The teenager who is obsessing about whether or not she remembered to lock the door, may go back to the house 2, 3, or more times “to make sure.” The ritual of checking is called a compulsion.

A common obsession has to do with the fear of becoming contaminated. This may involve a fear of germs. “I don’t want to touch the money because everyone else has touched the money and it probably is full of germs and germs are dangerous.” Equally common is the ritual of excessive washing in order to clean oneself of germs or contamination. “My daughter washes her hands until they bleed.” This is not normal washing that is meant to remove surface dirt; rather this is OCD washing that is meant to remove spiritual impurities that can harm a person. In fact, in order not to HAVE to wash oneself, OCD sufferers start to avoid being near problematic triggers. For instance, they might only handle money while wearing gloves (so their hands won’t touch the contaminated money and they will then not have to wash off the contamination). Or, they  may not open a door with their hand – they might use a foot or an elbow or ask someone else to open it. Avoidance actually contributes to the illness – the more a person avoids OCD triggers, the stronger the illness of OCD becomes. In fact, the major aspect of treating OCD involves teaching the sufferer to avoid avoidance! A child must be helped to confront and live with his or her worst fears.

Most obsessions center around issues of health, safety, goodness and cleanliness. As stated above, they can also center around certain “right” feelings (like the feeling of having a shoe lace tied up “just right”).

For instance, children and teens can obsess about the idea they have might have made a religious error. To “fix” it they might pray for hours on end (missing school in the process). Some people want to do things perfectly; a child may write something, erase it, write it again, erase it, write it again, over and over and over again – destroying the paper and taking hours to perform a task that other children are completing in minutes. Some people with OCD need to have everything in a certain order – for example, in order from biggest to smallest. Again, trying to get it that way can take painful hours; if the order is messed up by someone else, the person with OCD can become hysterical. These are just some of the common variations of OCD. There are many others and each person can have his or her own unique version of the disorder.

Treatment for a religious obsession might be insisting that the youngster DOES NOT pray for more than the normal few minutes that prayer takes a healthy person. In other words, the youngster must just live with the worry that perhaps she did something wrong. Instead of making that worry go away by praying excessively, she must just have the worry without doing anything to fix it or end it. This sort of treatment has the effect of stopping the worry altogether. Therefore, no more excessive praying is required. No obsession leads to no ritual which essentially is no OCD.

Obsessive-Compulsive Disorder (OCD)
People who suffer from OCD, even kids, usually know that their thoughts and actions are irrational, and they often feel distressed over their lack of control. The obsessions and compulsions, however, feel more powerful than a person’s will. The obsessive compulsive person is trapped in a vicious cycle; he or she needs to behave a certain way (perform a ritualistic behavior) to relive stress and anxiety, but the behavior itself creates more stress and anxiety. This can lead to intense attempts to avoid situations that will trigger the compulsion. For instance, if someone knows that touching a doorknob will create anxiety that can only be soothed by repeated washing of the hands, then he will try not to touch the doorknob. Instead, he might ask someone else to open the door, or he might open it with his elbow or he might wear gloves in order to open it. The time it takes to perform rituals can severely affect a person’s life and the difficulty of avoiding triggers can make a person function in a very odd way. OCD is thus very stressful. Attempts to manage OCD can sometimes lead to other mental health complications, such as clinical depression, other anxiety disorders, substance abuse and/or other impulse-control issues. OCD is sometimes found in people who have other clinical disorders like anorexia, Tourette’s Syndrome or ADD/ADHD.

What Causes  OCD?
Current thinking suggests that that OCD is a biologically- based condition, possibly the result of serotonin deficiency in the brain and other chemical conditions. It has been observed that OCD tends to run in families (that is, other family members have OCD or they may have other anxiety disorders) and therefore it is thought that a vulnerability for the condition is passed on through the genes.  OCD can also occur in a form called PANDAS  (pediatric autoimmune neuropsychiatric disorder) – when it suddenly appears following a streptococcal infection like strep throat. In this case it is believed that OCD is triggered by the same bacteria that causes scarlet fever and strep throat. Again, it might be that a person must have the vulnerable genes in order for the bacteria to have this effect.

What is the Treatment for OCD?
OCD is best treated with CBT – Cognitive Behavioral Therapy. Although some teens and adults can relieve their own symptoms with self-help by reading books on OCD (see for instance, “Overcoming Compulsive Washing” or “Overcoming Compulsive Checking” by Dr. Munford), most people will have the best results by consulting a qualified mental health professional who specializes in the diagnosis and treatment of OCD. Ask your doctor for a referral. Parents should read up on OCD and get professional counseling to know how to best help their child. Uninformed parents often accidently worsen OCD by helping the child AVOID triggers. As we saw above, EXPOSURE to the frightening element is curative – NOT avoidance! Parents need to know exactly how to help their child or teen in the home setting. The earlier OCD is treated, the easier it is to treat. On the other hand, the more one lets OCD fester, the more they will experience its symptoms. It is possible that intense stress causes certain physical conditions in the brain that then trigger the dynamics of OCD. Relieving stress may make it easier to treat the OCD. Therefore, psychotherapy may play a role in helping ease OCD by reducing overall stress and anxiety in the system (much like medication does) so that CBT can be effective.

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