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Obsessive-Compulsive Disorder (OCD) in Children and Adolescents

What is Obsessive-Compulsive Disorder in Children?
All children have little worries and doubts, but when they can’t stop thinking about them and it starts to affect their daily functioning it becomes a problem. OCD is a type of anxiety disorder which is characterized by obsessions and compulsions. Sometimes OCD kids will become worried by certain thoughts or images; these are called obsessions. 

Other OCD children might feel compelled to do certain actions over and over again; these are called compulsions or rituals. Even though the child or teen might be aware that what they are doing ‘doesn’t make sense’, they feel extremely anxious if they don’t follow through with the action. 

Sometimes these compulsions are thought to prevent a terrible imagined event or outcome. In this case the child feels personally responsible for doing the action so that nothing bad happens. 

While some might think this is just a case of superstition, with OCD ritualistic behavior has great psychological impact. In other instances these actions can serve to counter-act a disturbing obsessive thought.

How Prevalent is Obsessive-Compulsive Disorder in Children and Adolescents?
The National Institute of Mental Health estimates that around 500,000 children and teens in the United States have OCD. OCD is about as equally common in boys and in girls. Age of onset is between ages 8 and 12 or between the late teens and early adulthood. 

What Causes Obsessive-Compulsive Disorder in Children?
There is no definite theory as to what causes OCD in children. The matter is mainly separated into two schools of thought.

Possible Causes of OCD in Children

Biological Causes: 

• Genetics - studies suggest that a tendency towards anxiety may be hereditary.

• Brain chemistry abnormalities - Brain imaging studies have shown that people with OCD sometimes show different neuro-chemical brain activities than those without OCD.

Psychological Causes: 

• Some children feel that thinking something bad is morally just as bad as doing it. "If I think of hitting you, it’s morally the same as actually hitting you and so I must be a terrible and violent person."

• Some children feel overly responsible for what happens around them and think certain thoughts are dangerous. "If I think that, it might actually happen and then I will be to blame."

OCD in childhood frequently occurs after exposure to the streptococcal virus.   PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) are a proposed kind of OCD that occurs in childhood following the body’s reaction to infection.    Treatment of PANDAS is with early antibiotic treatment for strep infections, followed by the more common methods of treatment (see below).

Individuals with OCD may also present with depression, eating disorders, ADHD or other anxiety disorders.  

What Are Some of the Signs and Symptoms of Obsessive-Compulsive Disorder in Children and Adolescents? 

The symptoms of OCD in children vary and are often personal and unique to each child.  Some common obsessions and compulsions that you might recognize in your child or adolescent are:

Common obsessions include but are not limited to:  Fear of dirt or germs; need for symmetry and order; fixation with body waste; lucky and unlucky numbers; aggressive or sexual thoughts that are seen as "bad" or "immoral; fear that something terrible will happen to a loved one.

Common compulsions include but are not limited to: chronic coughing or throat clearing; washing hands over and over; eye twitching; collecting and hoarding specific items; rearranging things to create order or ‘balance”; repetitive and lengthy teeth-brushing or showering; repetitive checking of doors and switches; counting items over and over; repeating specific words and phrases in a particular order; having a strict ritual before going to bed that has to be followed exactly; rituals to ‘undo’ a thought or to prevent an unwanted event. 

 How Do You Know If Your Child or Teen Needs Help?
At times, children may be prone to ‘magical thinking’ (e.g. don’t step on the cracks or the bears will get you!) and some of the symptoms listed above can be perfectly normal – especially in the toddler or older child with an active imagination.

However, you know you have a problem when your child is constantly distressed by these thoughts or behaviors or when they interfere significantly with functioning.  If this is occurring, it is important for you to get help for your child or teen as quickly as possible. 

Here are some warning signs that may indicate OCD in children and teens: fatigue, stemming from staying up late at night obsessing or performing bed-time rituals; sore, dry hands from constant hand-washing; constant concern about germs; a sudden drop in test grades; avoidance of activities that would make the child get dirty; often being late for school; taking a very long time getting ready for bed or school; a constant worry about the well-being of family members.

Getting the Help You Need
Treatment for OCD typically includes medication (anti-depressants) and counseling in order to learn new ways to manage symptoms. Anti-depressant medication may cause extreme side effects in children and must be very closely monitored.  Cognitive Behavioral Therapy has proven quite successful in treating OCD in children.  CBT or other forms of counseling can help manage the underlying anxiety and learn to challenge the obsessive thoughts and stop the repeated behaviors common in OCD. Families may benefit from counseling as well to help them better understand OCD and teach them how to help their children or teens overcome this controlling illness. 

Used alone or in conjunction with psychotherapy, herbal and homeopathic remedies can be used in OCD treatment for children to help bring your child peace of mind in a gentle, natural way. Some commonly recommended remedies include Hypericum perforatum (St John’s Wort), Passiflora incarnata, Scuttelaria laterifolia (Scullcap) and Valerian. 

The diagnosis and treatment of OCD in children and adolescent must be done by a licensed mental health professional or by a licensed psychiatrist.  The competent mental health professionals at OHEL can provide the help needed to empower children and teens impacted by OCD and allow them to regain control and improve their quality of life.

Remember, at OHEL, we are only a phone call or a click away from your road to recovery.

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