11.Obsessive-Compulsive Disorder (OCD)

11.1.What Is Obsessive-CompulsiveDisorder (OCD)?

Obsessive-compulsive disorder is an anxiety disorder in which a person hasan unreasonable thought, fear, or worry that he or she may try to manage byperforming a ritual activity to reduce the anxiety. Frequently occurringdisturbing thoughts or images are called obsessions, and the repeated ritualsperformed to try to prevent or dispel them are called compulsions. Problemsarise as the behaviors interfere with daily life functioning, school or jobperformance and managing personal relationships.

During the normal growth and developmental process of children andadolescents, rituals and obsessive thoughts normally occur with a purpose andfocus based on age. Preschool children often use rituals and routines aroundmealtimes, bath and bedtime to help them stabilize their expectations andunderstanding of their world.

School-aged children normally develop group rituals as they learn to playgames, team sports and recite rhymes. Older children and teens begin to collectobjects and develop hobbies.

An individual with OCD has obsessive thoughts that are unwanted andrelated to fears (such as a fear of touching dirty objects) and uses compulsiverituals to control the fears (such as excessive hand washing).

When OCD is present, obsessive thoughts cause distress and compulsiverituals can become so frequent or intense that they interfere with activitiesof daily living (ADLs) and normal developmental activities.

11.2.Causes of Obsessive-Compulsive Disorder

The cause of OCD is not known. Research indicates that OCD is aneurological brain disorder. Evidence suggests that people with OCD have adeficiency of a chemical in the brain called serotonin.

Twenty percent of children and adolescents with OCD also have anotherfamily member with OCD. Some evidence suggests a genetic component; however,OCD may also develop without a family history of OCD.

11.3.Incidence of Obsessive-Compulsive Disorder

While symptoms of OCD do occur in children, it is recognized as arelatively common mental health disorder in adolescents. Most people arediagnosed by age 19. Current estimates suggest approximately 1-3 % of the U.S.adult population has this condition.

11.4.Signs and Symptoms

The following are the most common symptoms of obsessive-compulsivedisorder. However, each child may experience symptoms differently. Symptoms mayinclude:

An extreme preoccupation with dirt, germs, or contamination

Repeated doubts (for example, whether or not the door is locked)

Obtrusive thoughts about violence, hurting, killing someone, or harmingself

Spending long periods of time touching things, counting, thinking aboutnumbers and sequences

Preoccupation with order, symmetry, or exactness

Persistent thoughts of performing repugnant sexual acts or forbidden,taboo behaviors

Troubled by thoughts that are against personal religious beliefs

An extreme need to know or remember things that may be very trivial

Excessive attention to detail

Abnormalities with eating patterns

Excessive worrying about something terrible happening

Aggressive thoughts, impulses, or behaviors

Compulsive behaviors (the repetitive rituals used to reduce anxiety causedby the obsessions) can become excessive, disruptive, and time consuming, andmay interfere with daily activities and relationships.

Examples of compulsive behaviors may include:

Grooming rituals, including repeated hand washing, showering and teethbrushing

Checking and rechecking repeatedly (to ensure that a door is locked)

Following rigid rules of order (putting on clothes in the very samesequence every day, keeping belongings in the room in a very particular way andbecoming upset if the order becomes disrupted)

Hoarding objects

Counting and recounting excessively

Grouping or sequencing objects

Repeating words spoken by self (palilalia) or others (echolalia);repeatedly asking the same questions

Coprolalia (repeatedly speaking obscenities) or copropraxia (repeatedlymaking obscene gestures

Repeating sounds, words, numbers, or music to oneself

The symptoms of OCD may resemble other medical conditions or psychiatricproblems, including Tourette's disorder. Always consult your child's physicianfor a diagnosis.

11.5.Diagnosis Obsessive-Compulsive Disorder

Child psychiatrists, adolescent medicine physicians, psychologists orother qualified mental health professionals usually diagnose anxiety disordersin children or adolescents following a comprehensive psychiatric evaluation.

Parents who note signs of severe anxiety or obsessive or compulsivebehaviors in their child or adolescent can help by seeking an evaluation andtreatment early. Early treatment can often prevent future problems.

In order for a diagnosis of OCD to be made, the obsessions and compulsionsmust be pervasive, severe, and disruptive enough that the individual'sactivities of daily living and function (including school performance) areadversely affected.

In most cases, the activities involved with the disorder (hand washing,checking the locks on the doors) consume more than one hour each day and causepsychological distress and impaired mental functioning.

In most cases, adults realize that their behaviors are unusual to somedegree. However, often, younger individuals do not have this critical abilityto judge this type of behavior as irrational and abnormal.

11.6.Treatment for Obsessive-Compulsive Disorder

Specific treatment for OCD will be determined by a physician based on:

Age, overall health, and medical history

Extent of symptoms

Tolerance for specific medications, procedures, or therapies

Expectations for the course of the condition

OCD can be effectively treated -- usually with a combination of individualtherapy and medications. Treatment can be implemented once a comprehensiveevaluation of the individual has taken place while also giving specialconsideration to family genetics. Individual therapy usually includes bothcognitive and behavioral techniques. Cognitive therapy focuses on helpingidentify and understand their fears and learn new ways to resolve or reducetheir fears more effectively.

Individual therapy usually includes both cognitive and behavioraltechniques. Cognitive therapy focuses on helping identify and understand theirfears and learn new ways to resolve or reduce their fears more effectively.

Behavior techniques establish contracts or guidelines to limit or changebehaviors (such as establishing a maximum number of times a compulsive handwasher may wash his / her hands.)

Medications used most often to treat OCD are Anafranil, Luvox CR, Prozac,Paxil and Zoloft among others. Treatment recommendations may include familytherapy and consultation with the school. Parents, guardians and family membersplay a vital supportive role in any treatment process.

Approximately 20 percent to 40 percent of adolescents with OCD alsoexperience one or more types of eating disorders, which also require treatment.

11.7.Preventive Action

Preventive measures to reduce the incidence of OCD in children are notknown at this time. Further research needs to be conducted to better understandOCD. However, early detection and intervention can reduce the severity ofsymptoms, enhance normal growth and development and improve the quality of lifeexperienced by individuals with anxiety disorders.