Obsessive-compulsive disorder (OCD), one of the anxiety disorders, is a potentially
disabling condition that can persist throughout a person's life. The youngster who
suffers from OCD CAN becomes trapped in a pattern of repetitive thoughts and behaviors
that are senseless and distressing but extremely difficult to overcome. OCD occurs in a
spectrum from mild to severe, but if severe and left untreated, can destroy a person's
capacity to function at school, home, or in later adulthood, at work.
For many years, mental health professionals thought of OCD as a rare disease because
only a small minority of their patients had the condition. The disorder often went
unrecognized because many of those afflicted with OCD, in efforts to keep their
repetitive thoughts and behaviors secret, failed to seek treatment. This led to
underestimates of the number of people with the illness. However, a survey conducted in
the early 1980s by the National Institute of Mental Health (NIMH)--the Federal agency
that supports research nationwide on the brain, mental illnesses, and mental
health--provided new knowledge about the prevalence of OCD. The NIMH survey showed that
OCD affects more than 2 percent of the population, meaning that OCD is more common than
such severe mental illnesses as schizophrenia, bipolar disorder, or panic disorder.
Likewise, recent studies indicate that OCD occurs in 1-2% of youth. Thus, OCD strikes
people of all ethnic groups and ages. Males and females are equally affected. The social
and economic costs of OCD were estimated to be $8.4 billion in 1990 (DuPont et al,
1994).
Although OCD symptoms typically begin during the teenage years or early adulthood,
children DO develop the illness, even during the preschool years. Studies indicate that
at least one-third of cases of OCD in adults began in childhood. Suffering from OCD
during early stages of a child's development can cause severe problems for the child. It
is important that the child receive evaluation and treatment by a knowledgeable clinician
to prevent the child from missing important opportunities because of this disorder.
Obsessions
These are unwanted ideas or impulses (more than excessive worries about real-life
problems) that repeatedly well up in the mind of the person with OCD, despite the person
trying to ignore or suppress it. Persistent fears that harm may come to self or a loved
one, an unreasonable concern with becoming contaminated, or an excessive need to do
things correctly or perfectly, are common. Again and again, the individual experiences a
disturbing thought, such as, "My hands may be dirty--I must wash them"; "My clothes
aren't clean, I must change them"; or "If I don't touch my chin to my shoulder, something
terrible will happen." These thoughts are persistent, intrusive, unpleasant, produce a
high degree of anxiety, or may subject the parents or other family members into
situations where they must accommodate the child's unreasonable demands. Sometimes the
obsessions are of a violent or a sexual nature, or concern illness.
Compulsions
In response to their obsessions, many youth with OCD resort to repetitive behaviors
called compulsions. The most common of these are washing and checking. Other compulsive
behaviors include counting (often while performing another compulsive action such as hand
washing), repeating, hoarding, touching, or endlessly rearranging objects in an effort to
keep them in precise alignment with each other. Mental problems, such as mentally
repeating phrases, list-making, or checking are also common. These behaviors generally
are intended to prevent or reduce distress or some dreaded event, ward off harm to the
person with OCD or others. Some children and adolescents with OCD have regimented rituals
while others have rituals that are complex and changing. Performing rituals may give the
person with OCD some relief from anxiety, but it is only temporary. At times, the child
may demand that other family members never touch or move the child's personal belongings,
or may insist upon special care to ensure that the child's kitchen utensils or clothes
are extra clean before the child is willing to use them.
Insight
Youngsters with OCD show a range of insight into the senselessness of their obsessions.
Sometimes, especially when they are not actually having an obsession, they can recognize
that their obsessions and compulsions are unrealistic. At other times they may be unsure
about their fears, believe strongly in their validity, or even resist any suggestions
that their fears or rituals are unreasonable.
Resistance
Children and adolescents with OCD may struggle to banish their unwanted, obsessive
thoughts and to prevent themselves from engaging in compulsive behaviors. Many are able
to keep their obsessive-compulsive symptoms under control during the hours when they are
at school, but over the months or years, resistance may weaken, and when this happens,
OCD may become so severe that time-consuming rituals take over the sufferers' lives,
making it hard for them to continue activities outside the
home.
Shame and Secrecy
OCD sufferers often attempt to hide their disorder rather than seek help. Often they are
successful in concealing their obsessive-compulsive symptoms from friends and even family
members. An unfortunate consequence of this secrecy is that youth with OCD usually do not
receive professional help until years after the onset of the disorder. By that time, they
may have learned to work their lives--and family members' lives--around the
rituals.
Long-lasting Symptoms
OCD can last for years, even decades. The symptoms may become less severe from time to
time, and there may be long intervals when the symptoms are mild or seem to disappear
altogether. But for manyindividuals with OCD, the symptoms are
chronic.
What causes it?
The specific cause of OCD has not been determined. There have been, and continue
to be, many studies being conducted to determine the cause(s) of this
disorder.
Genetic. Many genetic studies published over the past
twenty years have repeatedly shown that OCD is hereditary. Early age of onset of OCD may
present a significant increase in the risk among the first-degree relatives. However, it
is important to note that not all studies demonstrate that it runs in
families.
Auto-immunity. It has been theorized that
post-streptococcal auto-immunity may be a factor in some cases of OCD. Criteria have been
developed to characterize this subgroup, designated by the acronym PANDAS, Pediatric
Auto-Immune Neuropsychiatric Disorder Associated with Streptococcal Infections. The
criteria, based on knowledge of Syndenham's Chorea and clinical observations of the first
group of youth with Streptococcal-triggered OCD, are: 1) prepubertal symptom onset; 2)
presence of tics and/or OCD; 3) episodic clinical course of symptom severity; 4)
association with group A-Beta-hemolytic streptococcal infection; and 5) association with
neurological abnormality. Also, the occurrence of the antibodies, D8/17 positive B-cells,
has been found to be significantly higher in patients with childhood-onset
OCD.
Neurological. Much research has centered on certain
areas of demonstrated brain dysfunction, notably in the frontal-lobe-limbic-basal-ganglia
circuits. There have been observations of increased rates of obsessive and compulsive
symptoms in neuropsychiatric disorders resulting primarily from basal ganglia disease,
such as Sydenham Chorea and Tourette Syndrome. Neuroimaging studies of young OCD patients
have shown smaller striatal volumes and disturbances in the structure and the function of
the corpus callosum. In addition, functional neuroimaging studies have demonstrated
increased metabolic rates in the ventral prefrontal cortical regions. Lastly, one brain
chemical (a neurotransmitter called serotonin) has been implicated as having a role in
OCD, and this is evidenced by the success of specific medications, the Selective
Serotonin Reuptake Inhibitors (SSRI's) in the treatment of
OCD.
How is it diagnosed?
To assess whether a child or adolescent has OCD, a mental health practitioner
must ascertain that the patient is exhibiting obsessions, compulsions, or both as defined
above. In addition, several questions must be asked: Are the obsessions-compulsions time
consuming, i.e. more than an hour a day? Do they create distress and significantly
interfere in the person's normal routine/activities/relationships? If the answers to
these two questions are positive, the diagnosis of OCD may be considered.
In addition, the practitioner must also ascertain that there is not another
disorder present to which the obsession-compulsion may be related, and that the
obsession-compulsion is not an effect of a substance or general medical
condition.
If all of these conditions are met, a youngster may be given a diagnosis of OCD,
and the appropriate treatment or combination of treatments may then be tailored to his or
her needs.
Publications
Books for Further Reading
For Children:
Foster CH. Polly's Magic Games: A Child's View of Obsessive-Compulsive
Disorder. Ellsworth, ME: Dilligaf Publishing, 1994.
Rapoport JL. The Boy Who Couldn't Stop Washing: The Experience and Treatment
of Obsessive-Compulsive Disorder. New York: E.P. Dutton, 1989.
For Parents:
DeSilva P and Rachman S. Obsessive-Compulsive Disorder: The Facts.
Oxford: Oxford University Press, 1992.
Gravitz, HL. OCD New Help for the Family. California: Healing Visions
Press, 1998.
For Professionals:
Johnston, HF and Fruehling, JJ. Obsessive-Compulsive Disorder in Children
and Adolescents: A Guide. Dean Foundation, 1997.
March, J and Mulle, K. OCD in Children and Adolescents: A
Cognitive-Behavioral Treatment Manual. New York: Guilford Press, 1998.
Jenike, M; Baer, L.; and Minichiello, W. Obsessive-Compulsive Disorder:
Practical Management. Third Ed., Mosby-Yearbook, 1998.
For more reading materials, visit the Obsessive-Compulsive
Foundation's website: www.ocfoundation.org/ocf1110a.htm#Group3
Scientific Publications
Pallanti S, et al.: "Citalopram for treatment-resistant obsessive-compulsive
disorder." Eur Psychiatry. 1999 Apr;14(2):101-106.
Szeszko PR, et al. "Orbital frontal and amygdala volume reductions in
obsessive-compulsive disorder." Arch Gen Psychiatry. 1999
Oct;56(10):913-9.
Simpson HB, et al. "Cognitive-behavioral therapy as an adjunct to serotonin
reuptake inhibitors in obsessive-compulsive disorder: an open trial." J Clin
Psychiatry. 1999 Sep;60(9):584-90.
Fitzgerald KD, et al. "Neurobiology of childhood obsessive-compulsive disorder."
Child Adolesc Psychiatr Clin N Am. 1999 Jul;8(3):533-75, ix. Review.
For further research: www.ncbi.nlm.nih.gov/PubMed/
On The Web
http://www.nimh.nih.gov/publicat/ocd.htm
http://www.nami.org/disorder/ocd-adol.html
http://ocfoundation.org
Support Groups and Organizations
Anxiety Disorders Association of America
11900 Parklawn Drive, Suite 100
Rockville, MD 20852
Telephone: 301-231-9350
http://adaa.org
Makes referrals to professional members and to support groups. Has a
catalog of available brochures, books, and audiovisuals.
Association for Advancement of Behavior Therapy
305 Seventh Ave.
New York, NY 10001
Telephone 212-647-1890
http://server.psyc.vt.edu/aabt/
Membership listing of mental health professionals focusing on behavior
therapy.
Madison Institute of Medicine
Obsessive Compulsive Information Center
7617 Mineral Point Road, Suite 300
Madison, WI 53717-1914
Telephone: 608-827-2479
http://healthtechsys.com/mimocic.html
Computer data base of over 13,000 references updated daily. Computer
searches done for nominal fee. No charge for quick reference questions. Maintains
physician referral and support group lists.
Freedom From Fear
308 Seaview Ave.
Staten Island, NY 10305
Telephone: 718-351-1717
http://www.freedomfromfear.org
Offers a free newsletter on anxiety disorders and a referral list of
treatment specialists.
Obsessive-Compulsive Foundation
P.O. Box 70
Milford, CT 06460-0070
Telephone: 203-878-5669
Fax: 203-874-2826
InfoLine: 203-874-3843
http://ocfoundation.org
Offers free or at minimal cost brochures for individuals with the
disorder and their families. In addition, videotapes and books are available. A bimonthly
newsletter goes to members who pay an annual membership fee. Has over 250 support groups
nationwide. Can refer to mental health professionals and treatment facilities in your
area with experience in treating OCD by mail.
Tourette Syndrome Association, Inc.
42-40 Bell Boulevard
New York, NY 11361-2874
Telephone: 800-237-0717
http://ba.mgh.harvard.edu
Publications, videotapes, and films available at minimal cost.
Newsletter goes to members who pay an annual fee.
Trichotillomania Learning Center
1215 Mission Street, Suite 2
Santa Cruz, CA 95060-3558
Telephone: 831-457-1004
E-mail:
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
http://trich.org
Membership fee includes information packet and bimonthly
newsletter |
