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Added November 11, 2004

Does Your Child Have

    Obsessive-Compulsive Disorder?

Introduction

Worries and doubts are part of normal everyday life. However, when these concerns affect normal functioning, it is a sign that there might be a greater problem.

Modern psychiatry classifies Obsessive-Compulsive Disorder (OCD) as one of the Anxiety disorders. Currently, 1 in 200 children and adolescents in the United States has Obsessive-Compulsive Disorder. Fortunately, there is a lot that you as a parent can do to help your child.

Symptoms

Obsessions are persistent and recurrent impulses, thoughts, or images that are unwanted and cause distress. These are usually irrational and are not the normal products of daily living. Compulsions are repetitive actions, like washing hands or hoarding things, or mental actions, like counting or repeating words silently. As the name implies Obsessive-Compulsive Disorder is characterized by both.

Typically, the person is plagued by repetitive thoughts, images, or impulses that are disturbing, illogical, and out of the person’s control. In an attempt to make these obsessions go away the person develops and performs compulsively a set of actions to relieve the discomfort caused by the obsessions.

For example, a person who is obsessed with sickness may develop compulsive hand washing. A person who is obsessed with fear of fire might continually check to make sure that the stove is off. The person gets no pleasure from doing these actions. Rather they provide temporary relieve from his unpleasant thoughts. The person may spend hours over the course of the day doing compulsive actions to relieve his obsessive thoughts.

At some point, most people realize that the anxieties are only a product of their own minds and have nothing to do with reality. However, they are unable to control the thoughts or the behaviors.

Description

Obsessive-Compulsive Disorder can start as early as preschool age. The way OCD shows itself in a child will vary with the child’s age. A younger child may have anxiety that harm will come to him or a family member. He may repeatedly check to see if the doors of his house are locked.

An older child may be afraid of germs and that his food is poisoned or that he will get AIDS. He may constantly wash his hands or food. The child may even know and can verbalize that it doesn’t make sense. However, the compulsive behavior is beyond his control.

Children with OCD frequently don't feel well physically. This may be because of the stress their anxieties cause or it may be due to lack of sleep or poor nutrition. These children often have stress related disorders such as headaches or stomach upset.

Frequently, children are angry with their parents. This usually occurs when the parents are unable to comply with their child’s behavioral quirks. These children usually have trouble keeping friends because of their behaviors make them stand out. These children often suffer from poor self-esteem.

Diagnosis

To receive the classic the diagnosis of OCD a person must have obsession and/or compulsions that cause the person anxiety or distress and cannot be attributed to another cause, such as substance abuse. The obsessions or compulsions cause a lot of distress and interfere with normal living.

The diagnosis usually goes unrecognized for a very long time. Studies show that most people don’t receive the diagnosis of OCD until 9 years after the symptoms first appear. It may take an addition 8 years before they receive adequate treatment. The reason for this is two fold. Most patients are embarrassed by their condition, so they avoid telling anybody. Secondly, many doctors are not familiar with the condition, so that they are not quick to recognize it nor do they know how to treat it.

Causes

The current research indicates that OCD is a neurologically based brain disorder. Studies show that there seems to be a communication problem between the frontal lobes of the brain and the brain’s deeper structures. These areas of the brain use the neurotransmitter, serotonin to communicate. People with OCD have lower levels of serotonin in these areas of the brain. Drugs that increase the brain serotonin levels also improve OCD.

Obsessive-Compulsive Disorder has also been linked to strep infections. Recently, a study was done giving OCD patients anti-strep antibodies. Patients showed a significant improvement in their OCD symptoms.

Related Disorders

Children with OCD commonly have other psychiatric problems. Below is a list of psychiatric conditions that frequently occur along with OCD:
  • Other anxiety disorders
  • Depression
  • ADHD
  • ODD
  • Learning disorders
  • Hair pulling

Treatment

Most children with OCD can be treated effectively with a combination of psychotherapy and certain medications, particularly serotonin reuptake inhibitors. Family support and education are also central to the success of treatment. Antibiotic therapy may be useful in cases where OCD is linked to streptococcal infection.

Psychotherapy

Cognitive behavioral psychotherapy is the psychotherapeutic treatment of choice for children, adolescents, and adults with OCD. This method helps the patient internalize a strategy for resisting OCD and has lifelong benefit. This therapy focuses on changing the persons thoughts and feelings by first changing his behavior.

This form of therapy has only moderate success. 25% of patients are unable to finish the course of the program. Of those that do finish, between half and three quarters report some degree of benefit after three to five months. These benefits last after the therapy has stopped.

Therapy usually is administered on a weekly basis for at least two months. There is an intensive form of therapy in which the person works with the therapist in 2-3 hour periods three times a week. If the person chooses the faster approach, he can complete treatment in three weeks.

Medication

The serotonin reuptake inhibitors (SRIs) are uniquely effective treatments for OCD. These medications increase the concentration of serotonin, a chemical messenger in the brain. Five SRIs are currently available by prescription in the United States:
  • Clomipramine (Anafranil)
  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)
Most people notice some benefit after 3 to 4 weeks. It takes 8-10 weeks before these medications take full effect, but most people say they are significantly better. 20% of people don’t do well on their first medication and are forced to try a different SRI.

SRI Side Effects

The most common side effects are:
  • Nervousness
  • Insomnia
  • Restlessness
  • Nausea
  • Diarrhea
Clomipramine has a broader action than the other drugs and carries with it additional side effects including:
  • Dry mouth
  • Sedation
  • Dizziness
  • Weight gain
  • Blood pressure problems
  • Irregular heart beats
Medications control symptoms, but they do not cure the disorder. When a child stops taking medication, the symptoms usually return. For this reason, the current recommendation is to use cognitive behavioral therapy in conjunction with medication.

No two children respond to anti-OCD medication in exactly the same way. Some children don’t respond to any medication. Side effects also vary from person to person. For this reason, your child may need to try more than one medication. Although we still don’t know for certain, no one has identified any long-term problems from taking these medications.

Newer Treatments

Recent studies have linked certain cases of OCD with the presence of anti-strep antibodies. In a study performed at the National Institute of Mental Health, a number of children with OCD and who tested positive for strep were given a treatment to remove circulating anti-strep antibodies. Within a few weeks some of the children’s symptoms lessen and in a few cases they disappeared completely.

Treating for circulating strep anti-bodies is still considered experimental. However, this new treatment might soon be changing the way we treat some people with OCD.

Conclusion: What You as a Parent Can Do

  1. If your child has Obsessive-Compulsive Disorder, the most important thing you can do to help your child is to learn as much as you can about the condition.

  2. Children and adolescents often feel shame and embarrassment about their OCD. Many fear it means they're crazy. Good communication between parents and children can increase understanding of the problem and help the parents appropriately support their child.

  3. Family problems do not cause OCD, but the way the family deals with the symptoms can affect the child. If your family is having difficulty dealing with a member who has OCD, you should try to consult a Family Therapist for direction.

  4. Try to be as kind your child as possible. This is the best way to reduce the symptoms of OCD. It will not work to command your child to stop the behavior. Your child is unable to stop and he will only feel even greater distress if he is reprimanded or forced to stop his rituals. Remember, as much as your child’s behavior bothers you, he is suffering even more.

  5. You have to be your child’s advocate in school. You must make sure that the child’s teacher and the school administrators understand the disorder.

  6. Use support groups. Sharing common problems with other parents is an excellent way to help you feel that you are not alone and is great support. You also might gain so practical insights about what you can do to deal with the daily problems that come up.

  7. Make time for yourself and your own life. You must not let yourself be trapped by your child’s rituals. You child does not need a martyr as a parent.



Anthony Kane, MD

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