Obsessive Compulsive Disorder (OCD)
obsessions; obsessive; compulsions; obsess; compulsive; rituals; anxiety; disorder;
All children worry, but some children can't stop worrying, no matter how much they want the worry to go away. About 2% of the adult population have Obsessive Compulsive Disorder (OCD), and it can start as early as about 7 years of age.
OCD is an anxiety disorder.
- There is a problem with the way the brain deals with worrying thoughts.
- Children and adults with OCD worry a lot and they feel afraid that bad things will happen if they do not take a great deal of care to prevent them happening.
People with OCD have obsessions and compulsions which cause them great distress.
- The obsessions and compulsions are time-consuming and interfere with their normal life
- They can go on for a long time, although there will be times when the thoughts and compulsions are less of a problem than they are at other times.
Obsessions are unwanted thoughts, impulses or images which keep coming back.
- The obsessions of OCD are not just worries about every day problems.
- Some examples of obsessions are:
- fears of being contaminated with germs or dirt
- thoughts that they are going to hurt somebody
- thoughts that some harm will come to their parents, even when they know that such thoughts are not realistic.
- A person with OCD cannot get these thoughts out of his mind.
Everyone worries at some time, such as worrying about getting lost, or sick, but these normal worries go away when they start thinking of other things or doing things they enjoy. With OCD the worries do not go away.
Some children will worry that they must be going crazy because of all these thoughts.
Compulsions are behaviours or rituals which the person has to do over and over again to try to lower the feelings of anxiety or to prevent something bad from happening.
- When the person carries out the ritual, the worrying thoughts might go away for a while, but they come back.
- They do not want to do the ritual but they have to do it.
Some compulsions are:
- excessive hand washing, teeth cleaning or cleaning of parts of the house to try to control the anxiety about germs or dirt - the person's hands may become red and sore with so much washing, but even then the person does not feel that she is clean enough
- checking something over and over (such as whether a door is locked) - even when she has already checked it many times
- checking and rechecking school work so much that it often is not finished on time, even though the child knows how to do the work
- having to touch or count things
- doing things a certain number of times, such as touching something 5 times before she can move on to something else
- keeping useless things just in case they could be useful sometime
- arranging things in exactly the right position
- asking the same question over and over
- counting, or repeating words over and over, silently in her mind.
They will try to hide the rituals, as they know that they are not 'reasonable'. Children may even hide them from their family for a long time because they are embarrassed about them.
Most of us have some little rituals that we include in our lives, such as putting clothes on in the same order, or brushing hair or teeth. Athletes often have little rituals before participating in sport.
- It is when these rituals take up so much time that they stop the person from leading an ordinary life that they become a problem.
- We do not know the exact cause of OCD, but we believe that part of it is genetic. OCD is more common if there is someone else in the family who has it.
- It seems that there is a difference in the chemicals that carry impulses from one nerve to another in the brain. A chemical called serotonin is involved in this nerve transmission. In OCD, the level of this chemical may be lower than usual.
- OCD is not caused by family problems or attitudes learnt in childhood (eg. about being excessively clean), but stressful events may trigger an episode of the disorder.
Recognising OCD can be difficult because a child can become skilled at hiding what he is feeling and needing to do. It is not uncommon for a child to be having obsessions and rituals for months or even years before parents know about them.
Some signs can be:
- red and sore hands from constant washing
- unusually large use of soap or toilet paper
- sudden drop in school test grades
- hours spent trying to do homework
- asking the same questions repeatedly
- a fear of illness for self or others in the family
- taking a very long time getting ready for sleep
- difficulty leaving the house because of things that need to be checked.
- For older teenagers and adults, antidepressant medication, which acts on the level of serotonin in the brain, seems often to be of use. However, while it can help control the feelings, it does not make the problem go away, and the feelings can return if the medication is stopped. Doctors may be reluctant to prescribe this medication for children.
- Cognitive behaviour therapy (CBT) helps people to change their reactions to the obsessive thoughts and compulsions. This can be very useful for children. CBT is usually provided by psychologists. In South Australia there are psychologists at CAHMS (Child and Adolescent Mental Health Services) and at community health centres, as well as private psychologists. Some psychiatrists are also able to help with CBT.
There is no cure for OCD, but treatments can make a big difference to a person's life.
Clinical Research Unit for Anxiety and Depression, University of New South Wales. '4.7 Obsessive Compulsive Disorder'
MayoClinic.com. 'Obsessive-Compulsive Disorder'
National Institute of Mental Health. 'Obsessive-Compulsive Disorder'
Nemours Foundation: KidsHealth for kids. 'Obsessive-Compulsive Disorder'
Nemours Foundation: KidsHealth for parents. 'Obsessive-Compulsive Disorder'
Nemours Foundation: TeensHealth. 'Obsessive-Compulsive Disorder'
Parmet S, et al. 'Obsessive-Compulsive Disorder'. Journal of the American Medical Association (JAMA) Vol 292, No16, October 27, 2004
The Pediatric OCD Treatment Study Team. 'Cognitive-Behaviour Therapy, Sertraline, and their combination for children and adolescents with Obsessive-Compulsive Disorder'. Journal of the American Medical Association (JAMA), Vol 292, No16, October 27, 2004
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your child's sex.