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Re: Obsessive/compulsive?

Posted By Cathi on January 19, 1999 at 14:06:57:

In Reply to: Re: Obsessive/compulsive? posted by HVM Ph.D. - KDK on January 18, 1999 at 12:27:34:

I am the mother of 4 children ages 16, 14, 4 and 9 months.  My
two teenagers are both ADHD adn are medication for this and
depression.  I wonder where I went wrong?  All of my children are
loved dearly.  To put it bluntly problems and all they are the
light of my life.  I feel bad enough that the older two have
difficulties (actually one just enjoys pushing my buttons; while the
other has learning disabilities in reading and writint)  Maybe now you can
understand why I'm worried when I see odd behavior in my 4
year old.  By odd, I mean if she gets one speck of food or
liquid on her clothing, off they come sometimes as many as 2 or 3
times per mealtime. I have to give her 3 or 4 spoon to eat with
because she won't use one if the food gets on the handle.  She will
not allow her baby brother in her room because he bothers her stuff
and she cannot tolerate change of any kind very well.  Such as re-
arranging her room or moving around her toys, etc. Please advise.


: Dear Cathi,
As you may already know, Obsessive-Compulsive Disorder (OCD) involves recurrent obsessional ideas or compulsive actions. Obsessions are persistent ideas, thoughts, etc. that are experienced as intrusive and that cause anxiety or distress. The most common obsessions involve thoughts about contamination, repeated doubts, a need to have things in a particular order, aggressive impulses and sexual imagery. Compulsions are repetitive behaviors which have as their 'goal' the prevention or reduction of anxiety or distress (brought on by the obsessions). The most common compulsions involve washing and cleaning, counting, checking, requesting or demanding assurances, repetitive actions (verbal or physical) and ordering. Probably 2.5% of the population experience OCD at some point during their lives. The prevalence of OCD is generally the same in both males and females. However, the symptoms appear an average of 5 years earlier in males. Age at onset in males is usually between ages 6 and 15; in females, between ages 20 and 29. It is unusual to see OCD in a child of 4 years, but the condition can develop as early as the age of 3. The forms of the disorder in adults and children are similar, though compulsive behaviors in children may occur without any obsessional thoughts that the child can identify. A criterion of the condition in adults is that, at some point, the person recognizes that the obsessions or compulsions are excessive or unreasonable. With children, this criterion does not apply - children often lack sufficient cognitive awareness to make such a conclusion.
Your daughter's preoccupation with, and distress around, cleanliness and ordering may well indicate the emergence of OCD. Some support for this possibility is the presence in the family of a number of conditions (depression, ADHD, learning disability) which have a strong hereditary basis. OCD, like many of the anxiety disorders of which the condition is one type, has a strong genetic basis and is linked to the biochemistry of the brain, in particular to the neurotransmitter serotonin. At the same time, it is also true that perfectly normal 4-year olds can be notoriously finicky and sensitive in relation to order and cleanliness as they learn to tame their impulses in response to the requirements of the social world. In addition, some children are more sensitive and reactive to these issues due to their fundamental nature or temperament - they come into the world 'packaged' in this way. I'm sure you've noticed quite different temperaments among your four children.
Given the family history and the fact that these behaviors in your daughter appear to cause her distress, it would be judicious to seek an evaluation by a child mental health clinician. These days, people can offer refer themselves (or their children) for such assessment, without a referral from a primary care physician. If you do need a referral, your daughter's pediatrician can probably help you. Have you discussed her situation with the pediatrician? An important determination is whether your daughter's behavior is 'located' somewhere along the spectrum (which can be quite broad)of normalcy or is reflective of an emotional disorder.
By way of a practical suggestion, you might try having your daughter wear a smock, large bib or apron at mealtimes (and have several available) and save a bit of the inconvenience of making entire changes of clothing.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
*Keyword: obsessive-compulsive disorder
Thank you for your information.  I will definitely try the bib suggestion and if my daughter's problem
persists I will also take your advise about speaking with her doctor about a referral.  Again Thanks

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