Obsessive Compulsive Disorder
Obsessive-compulsive disorder is an anxiety disorder characterized by involuntary thoughts, ideas, urges,
impulses, or worries that run through the child’s mind and/or useless repetitive behaviors. Sometimes the
obsession and compulsion are linked. Those with obsessive-compulsive disorder (OCD) experience
undesired obsessions and/or compulsions which interfere significantly with a child's ability to function
normally and become excessive, disruptive, and time-consuming. In many children with OCD schoolwork,
home life, and friendships are often affected.

Approximately one in 200 children suffers from OCD, an anxiety disorder. Children as young as five or six
have been diagnosed with OCD. The onset of OCD symptoms may occur as early as age three or four,
but very young children and parents may not recognize the symptoms. In OCD, the obsessions or
compulsions cause significant anxiety or distress, and they interfere with the child’s normal routine,
academic functioning, social activities, and relationships.

Children do not usually reveal their obsessions or meddlesome thoughts because frequently they are
unrealistic or irrational. OCD affects children and adolescents during a very important period of social
development. Some children with OCD are too young to realize that their thoughts and actions are
unusual. They may not understand or be unable to explain why they must go through their rituals. Fearing
ridicule, children may hide their rituals when in front of friends at school or at home and become mentally
exhausted from the strain.

Symptoms

Some of the most common obsessions are fear of contamination or a serious illness, fixations, fears of
danger, a need for symmetry or exactness, and excessive doubt. Some of the most common compulsions
are repetitive rituals such as cleaning or washing, touching, counting, repeating, arranging or organizing,
checking or questioning, and hoarding. The compulsive mental acts may include (counting, repeating
words silently, avoiding) these can be easily observed.  The symptoms can start gradually and parents
may have difficulty recognizing them as abnormal.  
The following are the most common symptoms of obsessive-compulsive disorder. However, each child may
experience symptoms differently. Symptoms may include:

∙        an extreme preoccupation with dirt, germs, or contamination

∙        repeated doubts (for example, whether or not the door is locked)

∙        obtrusive thoughts about violence, hurting, killing someone, or harming self

∙        spending long periods of time touching things, counting, thinking about numbers and sequences

∙        preoccupation with order, symmetry, or exactness

∙        persistent thoughts of performing repugnant sexual acts or forbidden, taboo behaviors

∙        troubled by thoughts that are against personal religious beliefs

∙        an extreme need to know or remember things that may be very trivial

∙        excessive attention to detail

∙        excessive worrying about something terrible happening

∙        aggressive thoughts, impulses, and/or behaviors

Examples of compulsive behaviors may include:

∙        repeated hand washing (often 100 or more times a day)

∙        checking and rechecking repeatedly (i.e., to ensure that a door is locked)

∙        following rigid rules of order (i.e., putting on clothes in the very same sequence every day,
keeping belongings in the room in a very particular way and becoming upset if the order becomes
disrupted)

∙        hoarding objects

∙        counting and recounting excessively

∙        grouping or sequencing objects

∙        repeating words spoken by self or repeatedly asking the same questions

∙        repeating sounds, words, numbers, and/or music to oneself

Possible Causes

The cause of OCD is not known. Research indicates that OCD is a neurological brain disorder. Evidence
suggests that people with OCD have a deficiency of a chemical in the brain called serotonin. In order to
send chemical messages, serotonin must bind to the receptor sites located on the neighboring nerve cell.
It is hypothesized that OCD sufferers may have blocked or damaged receptor sites that prevent serotonin
from functioning to its full potential.

OCD tends to run in families, suggesting a genetic component. Various studies on this topic are still being
conducted and the presence of a genetic link is not yet definitely established. However, OCD may also
develop without a family history of OCD. Recent studies suggest that streptococcal infections may trigger
the onset or increase the severity of OCD, in some cases. Studies also suggest that environmental factors
play a role in how these anxiety symptoms are expressed. There are many different theories about the
cause of obsessive-compulsive disorder. Some research has discovered a type of size abnormality in
different brain structures.

Treatments

A pediatrician, teacher, principal, or a guidance counselor  may refer parents to a child psychiatrist who
will review the child's behavior with the child, parents, siblings and use a specially designed interview to
diagnose OCD.

At school, children with severe OCD symptoms may repeatedly check, erase, and redo their assignments,
which can result in late and incomplete schoolwork. Classroom concentration and participation may be
limited by fears and rituals. Teachers can be very helpful in supporting a child's treatment of OCD once
parents inform them about the disorder. Parents may share information about their child's OCD medication
with teachers and provide occasional progress reports. Even if a child's OCD is not active at school,
teachers should be informed that treatment for OCD can improve the child's ability to learn.

OCD can be treated with Behavioral therapy, Cognitive therapy, medications, or any combination of the
three. Children and adolescents with OCD should receive behavioral psychotherapy. Some physicians
and patients will choose medication first, trying to avoid the time, effort, and anxiety associated with
behavior therapy, especially with younger children. Others will choose behavior therapy in preference to
medication and the chance of aversive side effects. Most will prefer to combine the two approaches.
Although these treatments are not a cure, their application will provide relief for the majority of patients
with OCD.
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