FAQs ABOUT OCD
1. How can you tell the difference between superstitions/developmental rituals and OCD?
Children are able to control their superstitions and developmental rituals whereas children with OCD feel that they lack the ability to regulate their obsessions and compulsions. Additionally, children are comforted by their superstitions and developmental rituals while OCD engenders anxiety and fear.
2. What is Obsessive-Compulsive Personality Disorder (OCPD)? How is it different from OCD?
People with OCPD are preoccupied with orderliness, perfectionism, mental/interpersonal control at the expense of flexibility, openness, and efficiency. If a child has OCPD, he is careful and compulsive about everything in his life. You may find that your child must arrange his toys in a certain manner, clean his room every day, adhere to the same bedtime ritual, and follow rules precisely. In contrast, OCD usually involves a narrow spectrum of concerns and behaviors: for example, the fear of contamination and repeated handwashing. Additionally, children with OCD are greatly distressed by their thoughts and actions while children with OCPD are comfortable with their behavior. While children with OCPD may not be bothered by their rigid habits, it should be noted that OCPD is a disorder that can significantly impair a child. Children with OCPD can become so preoccupied with small details that they are unable to complete tasks or homework assignments. Making simple decisions, such as what to eat or wear, can be particularly difficult for children with this disorder. A concern with perfectionism can be particularly impairing - nothing gets done because it is not ever good enough. OCPD can be treated with behavioral therapy and anti-OCD medications.
3. How can you tell the difference between a tic disorder/Tourette Syndrome and OCD?
It can be difficult to make a distinction between tics and OCD. Common tics include tapping, eye-blinking, throat clearing, spitting, nose-twitching, shoulder shrugging, and licking. These behaviors can also occur in a child with OCD; however, the child with OCD performs these behaviors for a different reason than the child with a tic disorder. If the behavior is caused by OCD, an unpleasant thought will have most likely preceded it (for example, the child may tap his knee four times to decrease the fear of shouting out a swear word - the tapping decreases the anxiety associated with the fear of swearing.) A young child with a tic disorder may not be aware of her movement abnormalities or the child may experience a feeling of increased tension or physical discomfort before the tic. This feeling, often described as an “itch or tickle”, is called a premonitory urge, and it warns the child that she is about to have a tic.
4. How is OCD Treated?
For the majority of children, OCD can be treated effectively with either cognitive behavioral therapy or
medications or both. You will need to consult a physician, psychiatrist, or psychologist to tailor the
therapy to meet your child's needs.
Cognitive behavioral therapy (CBT) is based on the idea that children with OCD perform repetitive behaviors/compulsions to alleviate the anxiety associated with a bad thought/obsession. When a child is exposed to a feared object, like a dirty toilet seat, anxiety is experienced. However, this anxiety will disappear fairly quickly. Children with OCD do not wait for the anxiety to disappear; they cannot stand feeling uncomfortable even for a few seconds, and so they wash their hands in order to decrease their anxiety level. However, hand washing actually increases the anxiety. This sets up a vicious cycle, and the child becomes stuck. In CBT, children are slowly exposed to objects that cause anxiety and are taught to resist the urge to perform a compulsion. Through the exposure with response prevention, the child becomes desensitized to the feared object. CBT is not suitable for every child. Young children may not have the insight or cognitive capabilities to participate in this type of therapy. Additionally, some children have symptoms that are resistant to CBT (this includes children who only have obsessions or children with mental compulsions.)
The selective serotonin reuptake inhibitors (SSRIs) are the medical treatment of choice for OCD. They work by increasing the amount of serotonin in the brain, which corrects the chemical imbalance that is causing the childs symptoms. There are a number of SSRIs that have been approved for use in children by the Food and Drug Administration: sertraline (Zoloft), fluvoxamine (Luvox), and fluoxetine (Prozac.) Each one of these drugs has a slightly different formula; therefore, if one medication does not help your child, it is a good idea to try another one.
However, it is important to keep in mind that these medications can take 8 to 10 weeks to have an effect; it is preferable to avoid switching medications before this point. The tricyclic antidepressant clomipramine (Anafranil) has also been found to treat OCD effectively. However, this drug has more side effects than the SSRI’s, and therefore, the SSRIs are usually tried first. Many children with OCD will respond to clomipramine or SSRI treatment with a reduction in symptom severity.
5. How prevalent is OCD is children and adolescence?
Epidemiological studies have indicated that by late adolescence 2% to 3% of children will be affected by OCD. The number of children that develop the disorder peaks at puberty and then again during early adulthood, and boys tend to have an earlier age of onset than girls.
6. Is childhood onset OCD a chronic condition that my child will have to deal with for the rest of her life?
According to a comprehensive review of literature on OCD, 10% to 50% of children with pediatric OCD have a complete remission of symptoms by late adolescence. A majority of children that continue to experience OCD are able to manage their symptoms with medications and behavioral therapy.
7. What is PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections?)
The children that fit the PANDAS criteria must be diagnosed with OCD and/or a tic disorder, have a prepubertal symptom onset, an episodic clinical course tied to group A b-hemolytic streptococcal infections (GABHS/strep. throat infections), and the presence of other neurological abnormalities.
The typical PANDAS child will contract a strep. infection and shortly thereafter develop sudden onset OCD and/or tics. These children may also develop separation anxiety, sleep problems, an increase in urinary frequency, a sudden onset of bed-wetting, hyperactivity/inability to pay attention, difficulties with fine motor control, and a marked increase in irritability. Eventually, these symptoms will remit until the child has another strep. infection, and then the cycle will begin again.
8. What causes OCD?
Different parts of the human brain are connected to each other by neurons to create pathways. These pathways are much like the circuits in your home that connect electrical appliances to the main power grid via wires. Sometimes the pathways in the brain can work improperly just like the wiring in your home can short circuit. It is hypothesized that the brain pathway connecting the orbitofrontal cortex and the caudate nucleus malfunctions in children with OCD. In addition, many scientists believe that people with OCD have a chemical imbalance in the brain involving the neurotransmitter serotonin.
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