Obsessive-compulsive disorder (OCD)

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Obsessive-compulsive disorder is an anxiety disorder in which a person has an irrational thought, fear or worry and sometimes tries to manage by performing a ritual activity to reduce the anxiety. Frequently occurring disturbing thoughts or images are called obsessions and the repeated rituals performed to try to prevent or dispel them are called compulsions.

During the normal growth and development of children and adolescents, rituals and obsessive thoughts normally occur with a purpose and focus based on age. Preschool children often use rituals and routines around mealtimes, bath and bedtime to help them stabilize their expectations and understanding of their world. School-aged children normally develop group rituals as they learn to play games, team sports and recite rhymes. Older children and teens begin to collect objects and develop hobbies. These rituals help children to socialize and learn to master anxiety. A child or adolescent with OCD has obsessive thoughts that are unwanted and related to fears (such as a fear of touching dirty objects) and uses compulsive rituals to control the fears (such as excessive handwashing). When OCD is present, obsessive thoughts cause distress and compulsive rituals can become so frequent or intense that they interfere with activities of daily living (ADLs) and normal developmental activities.

Causes

The cause of OCD is not known. Research indicates that OCD is a neurological brain disorder. Evidence suggests that people with OCD have a deficiency of a chemical in the brain called serotonin. OCD tends to run in families, suggesting a genetic component. However, OCD may also develop without a family history of OCD.

Who is affected?

While symptoms of OCD do occur in children, it is recognized as a relatively common mental health disorder in adolescents, with the average age of onset around 15 years old. Within the general population, approximately 1,000,000 children and adolescents have OCD. Unlike other anxiety disorders, twice as many males have OCD as females. Twenty percent of children and adolescents with OCD also have another family member with OCD.

Symptoms

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

• 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 harming self
• 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
• Excessive worrying about something terrible happening
• Aggressive thoughts, impulses and behaviors

Compulsive behaviors (the repetitive rituals used to reduce anxiety caused by the obsessions) can become excessive, disruptive and time-consuming, and may interfere with daily activities and relationships. Examples of compulsive behaviors may include:

• Repeated handwashing (often 100 or more times a day)
• Checking and rechecking repeatedly (i.e., to ensure that a door is locked)
• Following rigid rules of order (i.e., putting on clothes in the very same sequence every day, keeping belongings in the room in a very particular way and becoming 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 (repeatedly making obscene gestures)
• Repeating sounds, words, numbers or music to oneself
• Spending long periods of time touching things, counting thinking about numbers and sequences

The symptoms of OCD may resemble other medical conditions or psychiatric problems, including Tourette's disorder. Always consult your child's physician for a diagnosis.

Diagnosis

A psychological assessment is usually recommended to diagnose anxiety disorders in children or adolescent, with therapy generally being the first line of treatment. If the patient is in danger due to suicidal thoughts or attempts and/or severe impairment in functioning, then they might need medication first to stabilize them. Parents who note signs of severe anxiety or obsessive or compulsive behaviors in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

In order for a diagnosis of OCD to be made, the obsessions and compulsions must be pervasive, severe and disruptive enough that the child or adolescent's activities of daily living and function are adversely affected. In most cases, the activities involved with the disorder (i.e., hand washing, checking the locks on the doors) consume more than one hour each day and cause psychological distress and impaired mental functioning. In most cases, adults realize that their behaviors are unusual to some degree. However, often, children and adolescents do not have this critical ability to judge this type of behavior as irrational and abnormal.

Treatment:

Specific treatment for OCD will be determined by your child's physician based on:

• Your child's age, overall health and medical history
• Extent of your child's symptoms
• Your child's tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference

OCD can be effectively treated – with individual therapy alone or with a combination of individual therapy and medications. Treatment should always be based on a comprehensive evaluation of the child and family. Individual therapy usually includes both cognitive and behavioral techniques. Cognitive therapy focuses on helping the child or adolescent identify and understand their fears and learn new ways to resolve or reduce their fears more effectively. Behavior techniques help the child or adolescent and their family establish contracts or guidelines to limit or change behaviors (such as establishing a maximum number of times a compulsive handwasher may wash hands). Medications used most often to treat OCD are classified as selective serotonin reuptake inhibitors (SSRIs), medications that selectively affect neurotransmitters mechanisms in the central nervous system. Examples of these medications include sertraline (Zoloft), fluoxetine (Prozac), and fluvoxamine (Luvox). If OCD is found to be linked to a streptococcal infection, then a series of antibiotic medications may be prescribed by your child's physician. Treatment recommendations may include family therapy and consultation with the child's school. Parents play a vital supportive role in any treatment process.

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

Prevention of obsessive-compulsive disorder:

Preventive measures to reduce the incidence of OCD in children are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the child's normal growth and development and improve the quality of life experienced by children or adolescents with anxiety disorders.