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Obsessive-Compulsive
Disorder (OCD), usually begins in adolescence or young adulthood
and is seen in as many as 1 in 200 children and adolescents.
OCD is characterized by recurrent obsessions and/or compulsions
that are intense enough to cause severe discomfort. Obsessions
are recurrent and persistent thoughts, impulses, or images
that are unwanted and cause marked anxiety or distress. Frequently,
they are unrealistic or irrational. They are not simply excessive
worries about real-life problems or preoccupations. Compulsions
are repetitive behaviors or rituals (like hand washing, hoarding,
keeping things in order, checking something over and over)
or mental acts (like counting, repeating words silently, avoiding).
In OCD, the obsessions or compulsions cause significant anxiety
or distress, or they interfere with the child's normal routine,
academic functioning, social activities, or relationships.
The obsessive
thoughts may vary with the age of the child and may change
over time. A younger child with OCD may fear that harm will
occur to himself or a family member, for example an intruder
entering an unlocked door or window. The child may compulsively
check all the doors and windows of his home after his parents
are asleep in an attempt to relieve anxiety. The child may
then fear that he may have accidentally unlocked a door or
window while last checking and locking, and then must compulsively
check again.
An older
child or a teenager with OCD may fear that he will become
ill with germs, AIDS, or contaminated food. To cope with his/her
feelings, a child may develop "rituals" (a behavior
or activity that gets repeated). Sometimes the obsession and
compulsion are linked; "I fear this bad thing will happen
if I stop checking or hand washing, so I can't stop even if
it doesn't make any sense."
Research
shows that OCD is a brain disorder and tends to run in families,
although this doesn't mean the child will definitely develop
symptoms. Recent studies have also shown that OCD may develop
or worsen after a strep infection. A child may also develop
OCD with no previous family history.
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.
Most children
with OCD can be treated effectively with a combination of
psychotherapy (especially cognitive and behavioral techniques)
and certain medications for example, serotonin reuptake inhibitors
(SSRI's). 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.
Seeking
help from a child and adolescent psychiatrist is important
both to better understand the complex issues created by OCD
as well as to get help.
Article
#60 Updated 08/97
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