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Children & Obsessive Compulsive Disorder

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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."

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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.

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Study Finds Young Children Can Develop Full-blown OCD

Main Category: Psychology / Psychiatry
Also Included In: Pediatrics / Children's Health;  ADHD
Article Date: 01 Oct 2008 - 0:00 PST

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.

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Article adapted by Medical News Today from original press release.
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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/

Source: Jessica Collins Grimes
Lifespan

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When Your Child Has Obsessive-Compulsive Disorder

By Amy Wilensky
8 May 2001


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.

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Anxiety Disorders

References

1Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of anxiety disorders. One-year prevalence best estimates calculated from ECA and NCS data. Population estimates based on U.S. Census estimated residential population age 18 to 54 on July 1, 1998. Unpublished.

2Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.

3The NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998.

4Regier DA, Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry Supplement, 1998; (34): 24-8.

5Kushner MG, Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety disorders. American Journal of Psychiatry, 1990; 147(6): 685-95.

6Wonderlich SA, Mitchell JE. Eating disorders and comorbidity: empirical, conceptual, and clinical implications. Psychopharmacology Bulletin, 1997; 33(3): 381-90.

7Davidson JR. Trauma: the impact of post-traumatic stress disorder. Journal of Psychopharmacology, 2000; 14(2 Suppl 1): S5-S12.

8Margolin G, Gordis EB. The effects of family and community violence on children. Annual Review of Psychology, 2000; 51: 445-79.

9Yehuda R. Biological factors associated with susceptibility to posttraumatic stress disorder. Canadian Journal of Psychiatry, 1999; 44(1): 34-9.

10Bourdon KH, Boyd JH, Rae DS, et al. Gender differences in phobias: results of the ECA community survey. Journal of Anxiety Disorders, 1988; 2: 227-41.

11Kendler KS, Walters EE, Truett KR, et al. A twin-family study of self-report symptoms of panic-phobia and somatization. Behavior Genetics, 1995; 25(6): 499-515.

12Boyd JH, Rae DS, Thompson JW, et al. Phobia: prevalence and risk factors. Social Psychiatry and Psychiatric Epidemiology, 1990; 25(6): 314-23.

13Kendler KS, Neale MC, Kessler RC, et al. Generalized anxiety disorder in women. A population-based twin study. Archives of General Psychiatry, 1992; 49(4): 267-72.

14LeDoux J. Fear and the brain: where have we been, and where are we going? Biological Psychiatry, 1998; 44(12): 1229-38.

15Bremner JD, Randall P, Scott TM, et al. MRI-based measurement of hippocampal volume in combat-related posttraumatic stress disorder. American Journal of Psychiatry, 1995; 152: 973-81.

16Stein MB, Hanna C, Koverola C, et al. Structural brain changes in PTSD: does trauma alter neuroanatomy? In: Yehuda R, McFarlane AC, eds. Psychobiology of posttraumatic stress disorder. Annals of the New York Academy of Sciences, 821. New York: The New York Academy of Sciences, 1997.

17Rauch SL, Savage CR. Neuroimaging and neuropsychology of the striatum. Bridging basic science and clinical practice. Psychiatric Clinics of North America, 1997; 20(4): 741-68.

18Gould E, Reeves AJ, Fallah M, et al. Hippocampal neurogenesis in adult Old World primates. Proceedings of the National Academy of Sciences USA, 1999, 96(9): 5263-7.

19Hyman SE, Rudorfer MV. Anxiety disorders. In: Dale DC, Federman DD, eds. Scientific American Medicine. Volume 3. New York: Healtheon/WebMD Corp., 2000, Sect. 13, Subsect. VIII.

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