Obsessive-Compulsive Disorder is likely to affect 2% of the child and adolescent population at some point in their life. The disorder is equally common in males and females.
Adapted from the Diagnostic and Statistical Manual of Mental Disorders – IV-TR.
Obsessions are distressing and persistent thoughts that are associated with anxiety. Obsessive thoughts frequently have a theme of contamination (germs or dirt), or doubts over something that was said or done. Many children have obsessive thoughts that have to do with rules and fairness, and contain magical or unrealistic thinking.
Compulsions, on the other hand, are behaviors or actions that are designed to reduce the anxiety associated with the obsessive thought. Compulsive behaviors are repetitive actions (behaviors) that are also designed to prevent a dreaded consequence from occurring. Compulsive behaviors include repetitive washing or cleaning, showering or doing some other activity in a particular order, checking, double-checking and triple-checking, etc., repeating phrases or thoughts or redoing actions. Compulsive behaviors frequently result in a reduction of anxiety and a temporary sense of feeling good. The most common compulsive behaviors are washing and checking.
Treatment of Obsessive Compulsive Disorder
The behavioral treatment of Obsessive-Compulsive Disorder consists of three components – exposure, response prevention and cognitive (thoughts and beliefs) therapy. Exposure involves systematic, gradual contact or exposure to events in which the obsessive thoughts and -compulsive behaviors are likely to occur. For example, a child with a fear of contamination from germs would be helped (by parents, teachers and therapist) to gradually come in contact with germs via petting a dog or a cat. This could be combined with the response prevention component of the treatment which is to not engage in the usual compulsive activity which, in this example, may be hand washing. Variations on response prevention include response delay or response restriction. Response delay means delaying immediately washing the hands for longer and longer periods of time. Response restriction, means limiting the amount of time that the hands are washed. One of the purposes of the exposure and response prevention is to see if the fear or anxiety diminishes with time and without the compulsive behavior.
The cognitive (thoughts and beliefs) component of treating OCD involves assessing and understanding the result of the exposure and response prevention exercises described above. For example, how does the child explain the fact that no disease was contracted despite touching the dog or cat, and not washing for a significant period of time? Does this new experience cause the child to rethink their assumptions about their vulnerability and the purpose of their compulsive behaviors? The cognitive therapy component of treating OCD is also designed to teach children and their caretakers’ new thinking methods and strategies that can help the child identify and alter the interpretations that they have of their obsessions.
Treatment of OCD also involves learning, practicing and implementing anxiety management strategies including progressive muscle relaxation, mental imagery or deep breathing. Becoming proficient in these relaxation strategies can make it easier for the child to approach feared and anxiety producing situations.
Cognitive behavioral therapy has shown to be effective in the treatment of Obsessive-Compulsive Disorders in children and adolescents.