Obsessive - Obsessive-Compulsive Disorder in Children and Adolescents

A Review of Literature

Galaunda J. Pee

Professor Shirley McClerklin - Motley

“Using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR)”

Coker College, Hartsville South Carolina

Abstract

Obsessive-Compulsive Disorder or OCD, is a medical disorder that causes repetitive, unpleasant

thoughts (obsessions) or behaviors (compulsions) that are difficult to control (Stewart et

al.2007). Unlike ordinary worries or habits, these obsessions and compulsions may consume

significant amounts of time, more than an hour per day, may interfere with a person’s daily

schedule. OCD may cause significant distress, and affects approximately one percent of children

and adolescents. It was once considered a rare condition, but is now viewed as not only one of

the more prevalent psychiatric disorders, but also one the most disabling medical disorders.

Obsessive-compulsive disorder has a significant impact on humans and social functioning,

quality of life, family, Relationships socio-economic status. Think of OCD as an “overactive

alarm system.” Obsessive compulsive disorder (OCD), is a debilitation neuropsychiatry disorder

with a lifetime prevalence of two to three percent and is estimated to be the tenth leading cause

of disability in the world (Abramowitz, J.S. (2006).

Obsessive - Compulsive Disorder in Children and Adolescents

Obsessive-compulsive disorder is a medical disorder. Children and Adolescents with OCD

become preoccupied with whether something could be harmful, dangerous or wrong. Although

Children may not recognize the excessiveness of their symptoms. Recognizing the symptoms

may be very challenging, as they can easily be misinterpreted as willful disregard,

compositionality or meaningless worry. Children may also suffer with low self-esteem, shame

or embarrassment about what and how they think and feel.

The most frequent symptoms in obsessive-compulsive disorder are contamination concerns with consequent washing, or concerns about harm to self or others. OCD symptoms have varied little by time, and differ in patients. Since patients frequently conceal their symptoms, it is important to be aware of the possible presentation of obsessive-compulsive disorder in many medical settings, and to screen patients using questions for obsessions. For example, “Do you have to do things over and over, even though you don’t want to?” To assess obsessive-compulsive disorder, a thorough psychiatric history and examination

should be taken to investigate symptoms, and to allow a differential diagnosis from other

anxiety, mood, and psychotic disorders. A general medical history and examination should also

be obtained. Doctors and scientists don’t know what causes OCD, thru recent research has led to

better understanding of it and its potential causes. Experts believe OCD is related to levels of a

neurotransmitter called Serotonin. Neurotransmitters are chemicals that carry signals in the brain

(Janowitz D, Grabe HJ, Ruhrmann S, Ettelt S, Buhtz F,

Hochrein A, Schulze-Rauschenbach S, Meyer K, Kraft S, Ferber C, Pukrop R, Freyberger HJ,

Klosterkötter J, Falkai P, John U, Maier W, Wagner M (2009).

The DSM-IV criteria for obsessive-compulsive disorder state that symptoms should not be due to a general medical disorder or a substance. Strong possibility that obsessive compulsive disorder runs in families. Many people with OCD have one or more family members who also have it or other anxiety disorders influenced by the brain’s serotonin levels. Because of this, scientists have come to believe that the tendency for someone to develop a serotonin imbalance that causes OCD can be inherited (Kessler JL, Nikizad H, Shea KG, Jacobs JC Jr, Bebchuk JD, Weiss JM (2013). OCD is more common than many other childhood disorder or illnesses. Often times it will remain undiagnosed, unnoticed and untreated. Children and adolescents tend to keep the symptoms hidden from families and friends because they’re embarrassed. Between the ages of seven and twelve, in recent studies acute episodes have been documented, the illness is generally chronic (Abramowitz, J.S. 2006). As with any unusual behavior seek the assistant of health professional. Some possible signs of OCD are sudden drop in test grades, increase in dirty laundry, chapped hands from constant washing, reluctance to leave home at the same time as other family members. Other disorders often occur include other anxiety disorders, depression, attention deficit hyperactivity disorder (ADHD), learning disorder. Treatment for OCD includes cognitive behavioral therapy (CBT) and medication management. The combination of the two treatments are more effective than either alone.
Efficacy of behavioral and cognitive-behavioral therapies in the treatment of OCD has been validated in more than thirty studies. Exposure and response prevention (ERP) therapy is the best-proven behavioral strategy (Fornaro 2011). Psychoanalytical treatment for obsessive compulsive disorder was suggested by Freud, and for a long time was thought to be an effective approach to management. A doctor’s recommendation to use medication often raises many concerns and questions in both the parents and the child. Each child is different and may have individual reactions to medication, close contact with the treating physician is a must. OCD is treatable through ongoing interventions provided by a child’s medical practitioners, therapists, and family (Mayo Clinic 2012). Cognitive interventions also have a role in treatment of obsessive-compulsive disorder. Usually recommended for children and adolescents with OCD. During this therapy a young person is helped to become aware of problem behaviors or thoughts. Cognitive behavior therapy focuses on changing behaviors and on developing more positive thinking patterns as alternatives to the negative thoughts that cause symptoms. It’s often used, administered individually or in groups. Symptoms of obsessive compulsive disorder can greatly affect the patient’s family. Individual psychotherapy may also be helpful for younger children. Everyone have ongoing stressors in their lives that make symptoms worse. This plays an important part of their self-esteem. Group psychotherapy can be valuable to a child. Working as a safe place to speak with other in the same age group, who face adversity and allow them to practice social skills. All would be effective for obsessive-compulsive disorder, but that also have a better safety and tolerability profile. The U.S. Food and Drug Administration (FDA) has approved Anafranil, Luvox, Prozac (flextime), and Zoloft for treating children and adolescents with OCD. Antidepressants Celexa, Lexapro and Paxil, are also commonly used to treat symptoms of OCD. With these medications comes warnings. Careful monitoring is highly recommended for any child using or starting medicine. Adverse reactions may occur, months after medicines are introduced. Agitation, restlessness, increased irritability, or most comment. No one is sure of what causes OCD, with continuing research we will have a better understanding of its potential cause. Scholars generally agree that both psychological and biological factors play a role in causing the disorder, although they differ in their degree of emphasis upon either type of factor (More importantly is to understand that obsessive-compulsive behavior is not something a child can stop by trying harder. OCD is a disorder, just like any physical disorder such as diabetes or asthma, is not something kids can control or have caused themselves. Children and adolescents may feel frustrated or guilty for not being able to control their own thoughts or actions. embarrassment about how and why they are thinking and feeling. Gaining knowledge about childhood OCD and its treatment has progressed. Research, clinical attention are now better able to provide children and families with symptom relief as well as the skills to manage OCD in the long term and lead productive lives. We must attempt to implement interventions that present a logically consistent and compelling relationship between the disorder, the treatment, and the specified outcome. Despite obsessive-compulsive disorder being one of the more common serious mental illnesses, it continues to be shrouded in shame and secrecy. Within children and adolescents 80 percent have a co-morbid psychiatric disorder such as ADHD, depression, tics, developmental disabilities, oppositional defiant disorder and anxiety disorders (Ruck, C et a; 2008). OCD does not have a higher affinity for a specific gender. The most likely differential diagnoses are other conditions with repetitive behaviors

such as autism spectrum disorders and Tourette syndrome, although both of these groups may

co-occur with OCD. A subgroup of children with obsessive-compulsive disorder may fall into

the PANDAS category. PANDAS (Pediatric Acute-onset Neuropsychiatric Syndrome, a rare

disease that usually appears in children. It describes a hypothesis that there exists a subset of

children with rapid onset of obsessive-compulsive disorder(OCD) and or tic disorder (Moretti G,

Pasquini M, Mandarelli G, Tarsitani L, Biondi M 2008). PANDAS is caused by the body’s

immune reaction to strep, not the infection itself (Swedo & Grant, 2005).

In conclusion Obsessive compulsive disorder sometimes is left unnoticed and untreated.

Based on several different studies there is no known cure, but is treatable. OCD may lead up to

other types of diagnosis. It is a very common psychiatric illness with a lifetime prevalence in the

general population. Once considered a rare condition, now viewed as one of the more prevalent

psychiatric disorders, also one of the most disabling medical disorders. If a friend or family

member has obsessive-compulsive disorder, our most important job should be to educate

ourselves and others about the disorder. Simply knowing that OCD is treatable can sometimes

provide enough motivation to seek help. Obsessive-compulsive disorder(OCD) is an anxiety

disorder of unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform.

Like a needle getting stuck on an old record, obsessive-compulsive disorder causes the brain to

get stuck on a particular thought or urge.

Psychological interventions such as behavioral and cognitive-behavioral therapy as well

as pharmacological treatment can lead to substantial reduction of OCD symptoms for the average

patient. However ,OCD symptoms persist at moderate levels even following adequate treatment

course and a completely symptom free period is uncommon (Eddy KT, Dutra L. Bradley 2004).

References

Janowitz D, Grabe HJ, Ruhrmann S, Ettelt S, Buhtz F, Hochrein A., . . . Wagner, M. Depress Anxiety. 2009;26(11):1012-7. doi: 10.1002/da.20597.
Eddy KT, Dutra L. Bradley R. Westen D. A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder. Clin Psychol Rev. 2004 Dec;24(8):1011-30.
Kessler JI, Nikizad H, Shea KG, Jacobs JC Jr, Bebchuk JD, Weiss JM. Am J Sports Med. 2013 Nov 22.
Abramowitz, J.S. (2006). The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry, 51(7), 407-16
Heymans, I., Mataix-Cois, D., Fineberg, N. A. (2006). Obsessive-compulsive disorder. BMJÂ 333:424-429, doi: 10.1136/bmj.333.7565.424
Moretti, G. Pasquini, M. Mandarelli, G. Tarsitani, L.& Biondi M (2008). What every psychiatrist should know about PANDAS: a review. Clinical Practice in Epidermal Mental Health 4 (1): 13. doi[->0]:10.1186/1745-0179-4-13[->1]
Mayo Clinic. (n.d.). Depression (major depression). Retrieved April 23, 2012, from http://www.mayoclinic.com/health/antidepressants/MH00071 National Institute of Mental Health. (n.d.). Antidepressant medications.Retrieved April 25, 2012, from http://wwwapps.nimh.nih.gov/health/publications/medications/antidepressant-medications.shtml Nice (2005). Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder.
Ruck, C. et a; (2008). Capsulotomy for Obsessive-Compulsive Disorder: Long-term Follow-up of 25 Patients. Arch Gen Psychiatry. 2008;65(8):914-921.
Whittal, M.L., & O'Neill, M.L. (2003). Cognitive and Behavioral Methods for Obsessive-Compulsive Disorder. Brief Treatment and Crisis Intervention
Stewart et al. 2007. Principal Components Analysis of Obsessive Compulsive Disorder Symptoms in Children and Adolescents. Biological Psychiatry. 61. pp285-291

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