Taking it too far
Author: Sara Rider

We all have our little peculiarities. We may have a lucky number, or a lucky dress or shirt. And many of us have rituals. We may wear our lucky jersey to an important football game or always swing the bat three times before stepping to the plate in softball. But for some children, adolescents and teens, rituals can tip over into a pattern of behavior that can be truly debilitating.

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. According to the Mayo Clinic, it is characterized by unreasonable thoughts and fears (obsessions) that lead someone to perform repetitive behaviors (compulsions).

Kevin Stark, Ph.D., is the director of the Texas Child Study Center (TCSC) and a professor at the University of Texas (UT). The TCSC is the result of a partnership between Dell Children’s Medical Center and the department of educational psychology at UT to provide mental health services for children. Some of the children treated at TCSC have OCD.

“The main thing parents need to understand is how incredibly powerful the disorder is,” suggests Stark. “People don’t understand that. They watch ‘Monk’ on TV and they think it’s kind of funny. But OCD is incredibly debilitating and the level of anxiety that goes along with it is extraordinarily high.”

What is OCD?
A child or teen with OCD will have an obsession, “a thought that is especially disturbing to them, some sort of really frightening thought,” explains Stark. “And the thought keeps recurring over and over for an extended period of time.”

The reaction to the disturbing thought includes all of the typical symptoms of anxiety such as a racing heart and increased blood pressure.

“They become extremely uncomfortable, and then they do the compulsive behavior in order to bring the anxiety down and get rid of the obsession,” says Stark. Often, however, the obsession comes back and so the compulsive behavior has to be repeated. Or they may do the compulsive behavior and the anxiety doesn’t go away, so the compulsive behavior is repeated over and over.

Who’s at risk?
Although OCD occurs less frequently in children, adolescents and teens than it does in adults, it is a very debilitating condition. Causes of OCD are unclear.

“We see an increased possibility of having OCD if you have other brain disorders,” reveals Stark. “For example, kids who have autism or Asperger’s are much more likely to have OCD. Kids with attention deficit or any brain-based disorder seem to also be at risk for having OCD.”

Continues Stark, “There probably are multiple causes, but there is a genetic link. So if the parent has OCD or an anxiety disorder or both parents have anxiety disorder, then there is a greater likelihood that the kids will have OCD.”

Watching for symptoms
You might begin to suspect that your child or teen has OCD if you see behaviors that are highly repetitive, or behaviors that are complex, long sequences of actions.

In preparation for bed, a child would come into the room and have to wind up the stuffed animals in a specific way, followed by a specific sequence for getting ready for bed, followed by a specific sequence for how the bed is turned down and then a specific sequence for how the child gets into bed.”

If the child can’t do the repetitive sequence, it results in extreme distress. “So it’s not the behavior alone, it’s the reaction they have when they are not able to do the behavior that tells you they have OCD,” explains Stark.

Other signs parents can look for include a constant need for reassurance. According to Stark, this can literally mean asking for reassurance hundreds of times a day. “A child may repeatedly ask, ‘Am I okay? Am I going to get sick? Did I touch something that is full of germs?’ So this type of reassurance-seeking is another sign of kids who have OCD.”

When a child or teen has OCD, there will be four major symptoms: the obsession, the compulsion, the need for reassurance and then extreme avoidance.

“They know that something might set-off the obsession or compulsions, so they will avoid that particular thing,” he says. A fear of germs is one of the most common obsessions, so someone with that obsession would worry about door handles. “A child may never touch a door handle with [his] hands. [He] may wait for someone else to open the door, or may figure out how to use [his] feet to open the door. When you have all of those four things together, that is pretty indicative of OCD.”

Treatment options
OCD can be treated, and if parents suspect that their child might have OCD they should seek professional help. OCD is treated with a combination of psychotherapy and medication. According to the Mayo Clinic, the most common medications are antidepressants, which may help because they increase levels of serotonin that can be lacking in someone with OCD. Medication can also be combined with cognitive behavioral therapy (CBT), a process in which the TCSC specializes.

“With medication – even when it’s working well – most often it will reduce the severity of symptoms by about 50 percent after six months to a year,” says Stark. “In more mild and moderate cases, CBT alone can be effective in eliminating the disorder. For more severe cases, you combine the two and you have about an 80 percent chance of getting the disorder effectively treated so that it is manageable or it is eliminated.”

Cognitive behavioral therapy teaches the child skills for managing anxiety. Stark emphasizes that the key to CBT is exposure and response prevention. In exposure and response prevention, a person with OCD is gradually exposed to the feared object or obsession and is taught healthy ways to cope with his anxiety. But the process takes time.

“You expose [him] to one thing he fears, and then prevent [him] from doing the compulsive behavior. And while he is exposed to those things, the child is applying his coping skills, managing his anxiety and he’s trying to think of it in a more realistic way – that it’s not true that something bad is going to happen to him.

That he is safe. That everything is fine.”

If it all seems like a rather long and laborious treatment process, Stark emphasizes that patients are trying to overcome “a very powerful psychiatric disorder. Of course it varies between people who have it – from a minimal impact on their lives to a life-changing severity. But if a parent suspects OCD, what [she] should do is seek psychological and psychiatric help, because there are very effective treatments for OCD. And if you get the treatment earlier, it seems as though it’s more effective and it takes less time to [see] improvement.”

Sara Rider is a native Austinite who has worked with physicians and hospitals throughout Texas. She frequently writes freelance articles on health topics for newspapers and magazines.

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