The essential features of Obsessive Compulsive Disorder (OCD) are recurrent
obsessions (intrusive thoughts) and compulsions (repeated behaviors) that
are time consuming and cause marked distress or significant impairment in
daily functioning. Obsessions are persistent ideas, thoughts, impulses or
images that are experienced as intrusive and inappropriate and cause marked
anxiety or distress. Most common obsessions are repeated thoughts about contamination,
doubting oneself, needing to have things in a particular order, or aggressive
impulses. Usually, the child with obsessions tries to neutralize these disturbing
thoughts with some other thought or action (a compulsion). Compulsions are
repetitive behaviors or mental acts (e.g., hand washing, ordering, checking,
praying, counting, repeating words silently), the goal of which is to prevent
or reduce anxiety or distress, not to provide pleasure. In most cases, the
person feels driven to perform the compulsion to reduce the feelings of distress
that accompanies an obsession or to prevent some event from occurring.
Typically, the obsessions and compulsions cause marked distress, are time
consuming, and may significantly interfere with the child’s functioning at
home, school, or in social activities. Also, because obsessive intrusions
can be distracting, kids may show poor performance on tasks that would require
concentration, such as schoolwork. In addition, many kids may avoid objects
or situations that provoke obsessions and compulsions.
Treatment strategies commonly used to treat OCD in children include “exposure
and response prevention”, in which children are taught to face the fear
that triggers the obsessive thoughts or anxiety. By facing the feared
situation, anxiety is triggered, and through repeated exposure over repeated
trials, the anxiety decreases or “habituates”. The principle of “response
prevention” means that children are taught to stop the performance of
the ritual that decreases their anxiety (e.g., washing hands to feel less
anxious, checking the door, etc.) Early in treatment, this may involve
partial prevention (i.e., washing the hands 10 times rather than 20 times),
or altering ritualistic behaviors. Particularly during this phase, allies
such as parents need to be included to assist children in carrying out
this treatment effectively. As treatment progresses, complete response
prevention is introduced. Exposure and response prevention appears to
be the treatment of choice for children with OCD. Other strategies employed
are teaching children to challenge and change their obsessive thinking,
and to learn new adaptive ways of coping with anxiety. Further, rewards
are often included to praise children for their successes. Because children’s
OCD symptoms have been found to have a significant impact on the family,
many clinicians incorporate family therapy into their treatment protocol.
© 2001 The Child Anxiety Network. All Rights Reserved.
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