Obsessive Compulsive Disorder:
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.

Primary Symptoms:
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.

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Last Updated
May 5, 2015