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Obsessive-Compulsive Disorder
"I couldn't do anything without rituals. They invaded every aspect
of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck
number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night,
I had to set it to a number that wouldn't add up to a "bad" number.
"Getting dressed in the morning was tough because I had a routine,
and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't
do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational,
but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable
to do a lot of things that were important to me.
"I knew the rituals didn't make sense, and I was deeply ashamed of
them, but I couldn't seem to overcome them until I had therapy."
The disturbing thoughts or images are called obsessions,
and the rituals performed to try to prevent or get rid of them are called compulsions. There is no pleasure in carrying out
the rituals you are drawn to, only temporary relief from the anxiety that grows when you don't perform them.
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Obsessive-compulsive disorder, or OCD, involves anxious thoughts
or rituals you feel you can't control. If you have OCD, you may be plagued by persistent, unwelcome thoughts or images, or
by the urgent need to engage in certain rituals.
You may be obsessed with germs or dirt, so you wash your hands
over and over. You may be filled with doubt and feel the need to check things repeatedly. You may have frequent thoughts of
violence, and fear that you will harm people close to you. You may spend long periods touching things or counting; you may
be pre-occupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you;
or you may be troubled by thoughts that are against your religious beliefs.
The disturbing thoughts or images are called obsessions, and
the rituals that are performed to try to prevent or get rid of them are called compulsions. There is no pleasure in carrying
out the rituals you are drawn to, only temporary relief from the anxiety that grows when you don't perform them.
A lot of healthy people can identify with some of the symptoms
of OCD, such as checking the stove several times before leaving the house. But for people with OCD, such activities consume
at least an hour a day, are very distressing, and interfere with daily life.
Most adults with this condition recognize that what they're
doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their
behavior is out of the ordinary.
OCD afflicts about 3.3 million adult Americans.1 It strikes men and women in approximately equal numbers and usually first appears in childhood, adolescence, or early
adulthood.2 One-third of adults with OCD report having experienced their first symptoms as children. The course of the disease
is variable—symptoms may come and go, they may ease over time, or they can grow progressively worse. Research evidence
suggests that OCD might run in families.3
Depression or other anxiety disorders may accompany OCD,2,4 and some people with OCD also have eating disorders.6 In addition, people with OCD may avoid situations in which they might have to confront their obsessions, or they may
try unsuccessfully to use alcohol or drugs to calm themselves.4,5 If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities
at home.
OCD generally responds well to treatment with medications or
carefully targeted psychotherapy.
Study Finds Young Children Can Develop Full-blown OCD
A new study
by researchers at the Bradley Hasbro Children's Research Center has found that children as young as four can develop full-blown
obsessive compulsive disorder (OCD) and often exhibit many of the same OCD characteristics typically seen in older kids.
The
study, published online by the Journal of Psychopathology and Behavioral Assessment, is the largest sample of young
children with OCD published to date.
"There have been very few studies focusing on early childhood OCD, even though
we know that OCD, if left untreated, can significantly disrupt a child's growth and development and can worsen as the child
gets older," says lead author Abbe Garcia, PhD, director of the Bradley Hasbro Children's Research Center (BHCRC) Pediatric
Anxiety Research Clinic. "That's why we need to understand more about OCD in very young children, since early diagnosis and
intervention are critical to reducing the severity of symptoms and improving quality of life."
OCD is an anxiety disorder
characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors
such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or
making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them
markedly increases anxiety. According to the American Academy of Child and Adolescent Psychiatry, as many as 1 in 200 children
and adolescents struggle with OCD.
Garcia and colleagues studied 58 children with OCD between the ages of four and
eight, including 23 boys and 35 girls. All children underwent a series of clinical psychological assessments. Approximately
19 percent had been previously treated with medication and 24 percent had received some form of previous psychotherapy for
OCD. Twenty percent reported a first-degree family history of OCD. Nearly 22 percent of children had an additional diagnosis
of attention deficit hyperactivity disorder (ADHD) and about 20 percent were also diagnosed with generalized anxiety disorder
(GAD).
Common obsessions among children in the study included fear of contamination and aggressive/catastrophic fears
(involving death or harm to themselves or loved ones), and three-quarters reported having multiple obsessions. Nearly all
of the children suffered from multiple compulsive behaviors, with an average of four compulsions per child. Washing, checking
and repeating were the most commonly reported compulsions.
A data analysis revealed a number of parallels between
young children with OCD and reported samples of their older peers in terms of symptoms and severity. For example, both groups
appear to have similar types of obsessions and compulsions, multiple psychiatric diagnoses, and high rates of OCD family history.
"These similarities suggest this is a study sample involving full-blown OCD, as opposed to children who are either
in the beginning phases of the illness or only have a partial OCD diagnosis," says Garcia, who is also an assistant professor
of psychiatry (research) at The Warren Alpert Medical School of Brown University.
However, Garcia says they also discovered
some important differences between younger and older children with OCD. Although anxiety disorders seem to be a common comorbid
diagnosis in both groups, younger children were less likely to have depression, compared to older children. Also, while many
experts believe boys are more likely to present with juvenile OCD, the findings from the current study actually indicate a
lower boy to girl ratio.
"Our findings offer the first glimpse at the features and variables that emerge during early
childhood onset OCD and will hopefully lead to further studies focusing on assessment and treatment of this age group," Garcia
says.
---------------------------- Article adapted by Medical News Today from original press release. ----------------------------
The study was supported in part by a grant from the National Institutes of Mental Health. Co-authors were Jennifer
Freeman and Henrietta Leonard from the BHCRC and Alpert Medical School; Noah Berman, Alexandra Ogata and Molly Choate-Summers
from the BHCRC; Michael Himle from the University of North Dakota; and Janet Ng from the University of Oregon.
Founded
in 1931, Bradley Hospital, located in East Providence, RI, was the nation's first psychiatric hospital devoted exclusively
for children and adolescents. Today, it remains a nationally recognized center for children's mental health care, training
and research. A teaching hospital for The Warren Alpert Medical School of Brown University, Bradley Hospital offers a wide
range of services for psychological, developmental and behavioral conditions, including inpatient, outpatient, residential
and home-based treatment options. More than 30 postdoctoral residents and fellows in child psychiatry, psychology and pediatrics
receive training in Bradley Hospital's programs every year. Its research arm, the Bradley Hasbro Children's Research Center,
brings together a multidisciplinary team of investigators working to advance our knowledge of children's mental health through
federally funded research projects. Bradley Hospital also operates the Bradley School, a fully certified special education
school. A private, not-for-profit hospital, Bradley Hospital is a member of the Lifespan health system. For more information,
please visit http://www.bradleyhospital.org/
Most people have heard of OCD (obsessive-compulsive
disorder). It is the condition Jack Nicholson's character has in the movie As Good as it Gets. It's been featured on
television programs such as 60 Minutes, Dateline and Oprah. OCD is, in fact, much more common than
was previously thought, directly affecting at least one person in 40 in the general population.
What is really shocking, however, is how many children
suffer from OCD. According to Tamar Chansky, the author of Freeing Your Child from Obsessive-Compulsive Disorder and
the director of the Children's Center for OCD and Anxiety in Philadelphia, Pa., there are more than a million children in
the United States today with OCD. Chansky also reports that the condition affects at least one in 100 American children and
that the average age of onset is 10.2.
Adults with OCD usually know they have a problem.
They are able to separate their obsessive-compulsive thoughts and behaviors from normal, healthy thoughts and behaviors, which
is considered the first step on the road to recovery. Children, however, generally do not have enough life experience or self-awareness
to make this critical distinction. When they find themselves performing bizarre or repetitive rituals, such as washing their
hands over and over, they are ashamed and feel like they are going crazy.
Often, these kids are too embarrassed to tell their
parents or an adult what is going on. This is why it is so important that adults are aware of OCD and knowledgeable
enough about it to detect it in children. As a parent, you will need to guide your child through the acceptance and recovery
processes step-by-step.
OCD: Recognizing the Problem What
is OCD exactly? Chansky suggests we think of it as a "brain glitch," in which the brain sends false messages -- such as "the
stove is still on," or "there are harmful germs on the telephone" -- and the affected person needs to perform rituals to shut
off the voice delivering the message. Because OCD is a vicious cycle, though, the voice doesn't get shut off -- it becomes
louder and more insistent instead.
The good news is that OCD, in adults as well as children,
is highly treatable. Most people with OCD are able to retrain their brains to ignore the false messages until they just stop
getting sent. But how do you know if your child has OCD? Kids often become experts at hiding their symptoms because they feel
humiliated and scared.
What parents can do is make their children feel safe
and comfortable and watch them carefully for any of the following signs:
Obsessions:
Contamination -- excessive concern over germs, disease, illness, contagion.
Harm to self or others -- irrational fears such as causing a car crash, stabbing him- or herself or another person with
a knife or other sharp object, etc.
Symmetry -- need to have possessions/surroundings arranged symmetrically and/or to move in symmetrical ways.
Doubting -- becoming convinced that he or she hasn't done something he or she is supposed to do.
Numbers -- fixation on a particular number or series of numbers; performing tasks a certain number of times
regardless of sense or convenience.
Religiosity -- preoccupation with religious concerns such as the afterlife, death or morality.
Hoarding -- stockpiling of useless or meaningless objects such as old newspapers or food.
Sexual themes -- obsessive
thinking about sex; disturbing writing or doodling of a sexual nature.
Compulsions:
Washing and cleaning -- washing hands until they are red and chapped; brushing teeth until gums bleed.
Checking -- returning to check that the door is locked more than once.
Symmetry -- need to have socks at same height on each leg; cuffs of exactly equal width.
Counting -- counting of steps while walking; insistence on performing a task a specific number of times.
Repeating/redoing -- performing a mindless task repeatedly until it "feels right"; redoing a task that has already
been acceptably completed, such as erasing letters on a page until the paper wears through.
Hoarding -- hiding food under the bed; refusing to throw away soda cans or gum wrappers, for instance.
Praying -- excessive, time-consuming
repetition of protective prayers or chants.
Of course, many of us, at some point in time or consistently,
engage in one or even a few of the above obsessions or compulsions. For example, on a stressful morning, it is not abnormal
to check that you've locked the front door twice. You may hold onto old newspapers or magazines for what others consider an
excessive period of time. But if you notice your child engaged in several of these activities over a period of weeks, observe
him or her very carefully for signs of the following, which may indicate the presence of real obsessive-compulsive behavior
and possibly full-blown OCD:
stress
sleep deprivation
depression/shame
agitation
slowness in performing everyday tasks such as getting
dressed in the morning or preparing for bed
manic need to keep busy
academic difficulties, including slowness to complete
easy work
behavioral difficulties such as angry outbursts
when questioned about odd rituals or desires (like his or her need for symmetry)
social difficulties and/or a desire to spend excessive
time alone
family conflict over usually mundane details, such
as the way the table is set
Obviously, many kids have superstitions (avoiding
sidewalk cracks, wearing a lucky T-shirt), obsessions (baseball cards, 'N Sync) and compulsions (hair flipping, nail biting),
and many of the above manifestations affect non-OCD children for an infinite number of reasons. What you are looking for is
signs of the obsessions and compulsions and several of the manifestations in a child who appears to have a lot
on his or her mind.
Getting Help Talk
to your child if you think you may be on to something -- he or she may well be relieved you have noticed and could be anxious
to tell you what's going on. If not, you will still glean information based on his or her reaction. Then it's time to get
help.
For a referral, contact the OC Foundation at (203)
315-2190 or at http://www.ocfoundation.org. According to Chansky, what you want is a behavior therapist who
is also an expert in childhood OCD. Although you may eventually want to talk to a psychiatrist about SSRIs, your therapist
can help you make that decision; medication is not always necessary to treat OCD in kids.
Remember That No One's At Fault And
finally, you must know and believe that your child is not trying to aggravate you with obsessive-compulsive behavior, no matter
how annoying it may be. He or she can't help it -- OCD is a biochemical brain glitch, not a psychological condition, and the
behaviors most likely annoy your child even more than they annoy you.
OCD has nothing to do with your parenting skills,
your neurosis, or anyone's neurosis, any more than the chicken pox or the flu. And although this is especially difficult for
parents, whose instincts tell them to do all they can to ease their child's pain, understand that you are not helping your
child by participating in his or her obsessive-compulsive rituals. The best thing you can do is help your child learn to stop.
Last reviewed: On 13 Feb 2006 By John M. Grohol, Psy.D.
Enter secondary content here
the following web links are provided
for your convenience in visiting the source sites of the information displayed on this page:
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New York: The Free Press, 1991.
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Medicine. Volume 3. New York: Healtheon/WebMD Corp., 2000, Sect. 13, Subsect. VIII.
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