OBSESSIVE-COMPULSIVE DISORDER (OCD)
WHAT IS OBSESSIVE-COMPULSIVE DISORDER (OCD)?
All children suffer from fears at one time or another, this is normal. But when a fear or obsessive behavior creates feelings of overwhelming danger that are disproportionate to the actual situation, the child is most likely suffering from an anxiety disorder.
OCD is an excessive fear that creates unwanted recurring thoughts that drives a child to compulsive behaviors. In order to control the fears, the child creates rituals that are usually excessive and time consuming, such as repeatedly having to wash his hands or clean things. If the child is unable to complete the ritual, it can cause great distress and anxiety which further engrains the ritual. Children with this disorder find it difficult to control their anxiety and stay focused.
Ritualistic behaviors (compulsions) may include:
· washing hands repeatedly and excessively
· continually rechecking things
· putting things in a particular order, such as books or clothes
· counting the same things repeatedly
· repeating phrases, words, or sounds
· separating foods on a plate so they don’t touch
SYMPTOMS
Emotional symptoms of a child with OCD may include:
· ongoing worry or fear over having things in a particular order
· extreme fear of germs, dirt, bodily waste
· ongoing doubts about whether something is done, like having homework in book bag or locking a door
· ongoing fear that something bad will happen
· strong need to have things done perfectly
· strong need to touch or count things
· strong need to remember things, even if insignificant
· destructive thoughts
· lack of confidence
· difficulty concentrating
· a sense of panic if not able to perform rituals
Physiological symptoms may include:
· a racing heart
· headaches
· stomachaches
· trembling
· difficulty breathing
· feeling weak
· sweating
· fatigue
· difficulty sleeping
When OCD interferes with the child’s sleep, concentration, ability to have fun or function normally, intervention from a mental health professional is needed.
CAUSES
Predisposition - Some children are prone to being more anxious than others and are less capable of handling stress.
Genes - If the child comes from a family with a history of OCD, chances are that the child will develop the disorder.
Environment - Situations that may be a factor in developing OCD in a child include:
· parents going through a divorce
· losing a family member or friend
· birth of a sibling
· living with an ill or disabled family member
· living in a volatile home
· moving
· attending a new school
· going through a traumatic experience or event
Biological processes - An imbalance of serotonin in the brain may cause OCD. Another possibility is that a strep infection may activate the disorder in children who are predisposed to it.
TREATMENT
Cognitive Behavioral Therapy (CBT)
CBT helps children recognize their thought patterns and identify where and when those patterns help and where they hurt. In other words, how we think and act affects how we feel. The CBT therapy of choice for OCD is Exposure Response Prevention (ERP). It helps children face their fears while refraining from compulsive behaviors. Using a graded stepladder approach and repeated exposure as part of treatment, the child slowly and systematically faces his fears and reduces the symptoms of his anxiety along with his compulsive behavior.
Dr. Madeleine Vieira's Anxiety Disorder Series, I’M AFRAID, introduces CBT techniques to help children overcome their anxiety disorders.
Khloe Kitten Is Afraid of Germs! focuses on OCD. In this book, Khloe Kitten wants to go down a tube slide like her friends, but she’s afraid of germs. To overcome her fear, she uses a stepladder process (i.e., Graded Exposure) to gradually expose herself to germs while controlling her obsessive behavior. She starts with small steps and gradually builds up to more fearful situations.
In treatment, mental health professionals help children to control their OCD and uncomfortable feelings using specific techniques such as:
· Understanding that the imagined outcome associated with the anxiety isn’t realistic.
· Using self-talk to ‘fight’ the fear. The child might tell himself that what he thinks will happen won’t actually happen.
· Using relaxation techniques. The child is taught to use controlled breathing exercises to help lessen anxious feelings.
· Using role-playing techniques, such as practicing worst-case outcomes. The mental health professional will help the child realize that the outcomes are not possible or highly unlikely.
· Teaching the child that he can manage his uncomfortable feelings successfully without avoidance. This takes time, repetition, and practice!
Anti-Anxiety Medication
When a child’s OCD doesn’t fully respond to CBT, anti-anxiety medication prescribed by a child & adolescent psychiatrist may be beneficial.
Additional Help
Based on the therapeutic technique of Exposure Response Prevention (ERP), a component of Cognitive Behavioral Therapy (CBT), Khloe Kitten Is Afraid of Germs! demonstrates that it is possible for children to manage their anxiety. The story guides children through steps that research shows help them overcome the harmful habits and patterns they’ve developed while struggling with their fears. Along with the story, there is an About Anxiety page, a Coping Strategies page, and a Stepladder page. These additional tools can help alleviate anxiety symptoms.
REFERENCES
https://www.mdedge.com/psychiatry/article/59075/neurology/obsessive-compulsive-symptoms-can-manifest-through-adhd
https://adaa.org/sites/default/files/How-to-Help-Your-Child-A-Parents-Guide-to-OCD.pdf
https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/o/obsessive-compulsive-disorder-ocd-in-children.html
https://childadolescentpsych.cumc.columbia.edu/professionals/research-programs/y-team/ocd
https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder