OCD In Children

What Is Life Like For Children Who Have OCD?

OCD can make daily life very difficult and stressful for children. OCD symptoms often take up a great deal of a child’s time and energy.  This makes it difficult to complete tasks such as homework or household chores. Children worry that they are “crazy” because they are aware their thinking is different than their friends and family. A child’s self-esteem can be negatively affected because the OCD has led to embarrassment or has made the child feel “bizarre” or “out of control.”

Mornings And Evenings Can Be Especially Difficult For Children With OCD

In the morning, they feel they must do their rituals right, or the rest of the day will not go well. Meanwhile, they are rushed to be on time for school. This combination of factors leads to feeling pressured, stressed, and irritable. In the evenings, they feel compelled to finish all of their compulsive rituals before they go to bed. They know they must get their homework done and take care of any household chores and responsibilities. Some children stay up late because of their OCD, and are often exhausted the following day.

Children with OCD frequently don’t feel well physically. This may be due to the stress of having the disorder, or it may be poor nutrition or the loss of sleep.  Obsessions and compulsions related to food are common, and these can lead to irregular or “quirky” eating habits. [Eating food s in certain order, only one type foods, only one food at a time on plate, not touching]

Eating disorder and obsessive-compulsive disorder: neurochemical and phenomenological commonalities.

J L Jarry and F J Vaccarino Department of Psychology, University of Toronto, Ontario, Canada.

This paper explores a possible connection between neurochemistry and cognitions in eating disorders (ED). Cognitions play an important role in ED. However, a possible neurochemical origin of these cognitions has not been explored. Obsessive-compulsive disorder (OCD) is known as a disorder of thinking. Extensive neurochemical research conducted on this disorder indicates a connection between serotonin (5-HT) dysregulation and cognitions in OCD. This study used research done on OCD as a template to interpret the available research findings in ED and their possible meaning in terms of neurochemical origin of cognitions in ED. This paper suggests that the neurochemical and behavioral expression of both ED and OCD occur on a continuum. At one end of the continuum, ED and OCD are expressed through constrained behaviors of an avoidant quality. This pole is also characterized by high levels of serotonin markers. At the other end, both disorders are characterized by disinhibited approach behavior. This end of the continuum is characterized by low levels of 5-HT markers. It is suggested that these levels of 5-HT generate cognitions that may in turn promote specific behaviors.

Many children with OCD are prone to stress-related ailments such as headache, or an upset stomach.

Children with OCD have episodes in which they are extremely angry with their parents. This is because the parents have become unwilling (or are unable!) to comply with the child’s OCD-related demands. For example, children with obsessions about germs may insist that they be allowed to shower for hours, or demand that their clothes be washed numerous times or a particular way. Even when parents set reasonable limits, children with OCD can become anxious and angry. However, this anger does not justify physical or verbal abuse between parent and child. If violence or abuse occurs within the home, it should not be tolerated.  Professional help should be sought.

Friendships and peer relationships are stressful for those with OCD because they  try  hard to conceal their rituals from peers. When the disorder is severe, this becomes impossible, and the child may get teased or ridiculed. Even when the OCD is not severe, it affects friendships because of the time spent preoccupied with obsessions and compulsions, or because friends react negatively to unusual OCD-related behaviors.

Children with OCD appear more likely to have additional psychiatric problems than those who do not have the disorder. Comorbidity means having two (or more) separate psychiatric diagnoses at the same time.

Below is a list of psychiatric conditions that frequently occur along with OCD:

• Additional anxiety disorders (such as panic disorder or social     phobia)
• Depression/dysthymia
• Disruptive behavior disorders (such as oppositional defiant disorder, or attention-deficit hyperactivity disorder)
• Learning disorders
• Tic disorders/Tourette’s syndrome
• Trichotillomania (hair pulling)
• Body dysmorphic disorder (imagined ugliness) Sometimes comorbid disorders can be treated with the same medication prescribed to treat the OCD. Depression, additional anxiety disorders, and trichotillomania may improve when a child takes anti-OCD medication.

On the other hand, ADHD, tic disorders, and disruptive behavior disorders usually require additional treatments, including medications that are not specific to OCD. A booklet of this size cannot address all the possible comorbid conditions a child with OCD could have, nor all the possible medication approaches used for these comorbid disorders.

In general, using the smallest amount of medication effective in controlling symptoms, starting low and going slow  are common sense approaches. In unusually complicated situations, or in situations where the OCD appears resistant to drug treatment, a consultation with an expert in the area of childhood OCD is warranted.

What Are The Chances That My Child Will Inherit OCD?

OCD often runs in families. However, it appears that genes are only partially responsible for causing the disorder. If the development of OCD were completely determined by genetics, pairs of identical twins would both have the disorder, or both not have it. For example, eye color is entirely determined by genes and identical twins always have the same color eyes. If one identical twin has the disorder, there is a 13 percent chance that the other twin will not be affected. This supports the idea that genes are only part of the cause of OCD. Other factors are also important. No one really knows what that other factor might be, although some have suggested that it may be a viral infection that occurs at a critical point in a child’s development, or perhaps an exposure to an environmental toxin.

Some experts speculate that there may be different types of OCD. Some types are inherited while other types are not. There is evidence that OCD that begins in childhood may be different from OCD that begins in adulthood. Individuals with childhood-onset OCD appear more likely to have blood relatives that are affected with the disorder than are those whose OCD first appears when they are adults.

If a parent is affected with OCD we can estimate how likely it will be that their child will also have the disorder. If one parent has OCD, the likelihood the child will be affected is about 2 to 8 percent. It is important to remember that this statistic is an approximation. Several other factors should be considered when attempting to estimate the risk of a child developing OCD. One factor is whether or not the parents themselves have a family history of OCD. If a parent who has OCD has blood relatives with the disorder, the risk for the child increases. Conversely, if a parent has OCD but none of their blood relatives are affected, then the risk decreases. Another factor is whether the parent has OCD that began when they were an adult or began when they were a child. If the parent’s OCD did not start until adulthood, there is probably a decreased likelihood that his or her offspring will be affected. Conversely, if the parent’s OCD is the “variety” that starts in childhood, the chances of passing the disorder on are increased.

Another factor is the family history of tic disorders (such as Tourette’s syndrome) or other anxiety disorders. If a child has parents or other blood relatives with tic disorders or anxiety disorders, then the child is probably at increased risk for OCD. Besides, having blood relatives with OCD means that not only does the child have increased risk for OCD, but may also have an increased risk for developing a different anxiety disorder or a tic disorder. In summary, having blood relatives with OCD, anxiety disorders, and tic disorders all increase a child’s risk of developing any of these same disorders.

As the above information indicates, it is difficult to estimate the chances that a parent will pass OCD on genetically to their child. This is an area of active research, and new developments appear frequently. Prospective parents may wish to consult with a genetics counselor prior to attempting to conceive a child. This can help assure that they have the most up-to-date information available.

This information was compiled by J. Jay Fruehling, M.A. Information Specialist and The Child Psychopharmacology Information Service University of Wisconsin-Madison, Department of Psychiatry [www.psychiatry.wisc.edu] and was edited by Hugh F. Johnston, M.D., University of Wisconsin, Madison and John S. March, M.D., Duke University, Durham, North Carolina and was funded in part by donations from the Daphne Seybold Culpepper Memorial Fund, Ticking Hearts, Mr. and Mrs. Irwin Lancer, The Andrade family, Meryl and Christoper Lewis, Annoymous, Robert Selig, and Stephen Josephson, Ph.D.

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