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What Is OCD?
OCD is an anxiety disorder in which the brain gets stuck on a particular thought or urge and can't let go. OCD manifests itself in obsessive thinking or beliefs that tell a child: "If you don't do X, then something uncomfortable or even life-threatening will happen." (In younger children, compulsive behaviors may be evident without the "if...then" thinking.) The rise in anxiety or worry is so strong that the child must perform the task or dwell on the thought, over and over again, to the point where it interferes with everyday life. OCD can become extremely embarrassing and overwhelming for both the child and his family.
Experts aren't sure how OCD gets started, but it should never be viewed as the child's fault or something he can stop if he just tries harder. OCD is a disorder, just like a sleep disorder or dyslexia - it's not something the child can control. Experts do know that OCD tends to run in families, and just like in children, OCD in adults is often kept private so that most families are not aware of this disorder in their family histories.
OCD is best viewed as a "short circuit" in the brain's "worry computer," says John March, MD, author of OCD in Children and Adolescents: A Cognitive Behavioral Treatment Manual. This worry computer inappropriately and repeatedly cues the child to fear that something will happen. These cues are commonly called obsessions.
Obsessions are repeated thoughts or impulses that are out of place - they cause the child to experience anxiety or distress. They are out of the child's control, and they are different from normal thoughts. A child with these thoughts usually attempts to ignore or suppress obsessive thoughts or impulses by neutralizing them with another thought or action - a compulsion. For example, a child who is plagued with doubts about having turned off the stove might compulsively check the stove, again and again, to ensure that it is off.
Compulsions, or rituals, are the deliberate and repeated behaviors a child with OCD performs to relieve the anxiety caused by the obsessive thoughts. For example, a child who has a fear of germs may repeatedly wash his hands until the skin becomes raw; a child who has an obsession with neatness will redo her test paper so many times that she may tear a hole in it from constant erasing. Other times, compulsions might seem less clearly related to the obsessive thought.
Common OCD Behaviors in Children
OCD can make daily life difficult for children and families. The OCD behaviors often take up a great deal of time and energy, making it more difficult to complete tasks such as homework or chores or enjoy life. In addition to feeling frustrated or guilty for not being able to control their own thoughts or actions, children with OCD also may suffer from low self-esteem because the disorder can lead to shame or embarrassment. Children often involve their parents in their rituals (for example, asking about a potential illness they think they have), leading to increases in family stress.
Children with OCD may feel pressured because they don't have enough time to do everything. They might become irritable because they have to stay awake late into the night or miss an activity or outing to complete their rituals. They might have difficulties with attention or concentration because of the intrusive thoughts.
In addition, obsessions and compulsions related to food are common. These can lead to abnormal eating habits (such as eating only one kind of food), thus compromising nutrition.
Studies of children and adolescents with OCD have revealed that the most common obsessions include:
- fear of dirt or germs
- fear of contamination
- a need for symmetry, order, and precision
- religious obsessions
- preoccupation with body wastes
- lucky and unlucky numbers
- sexual or aggressive thoughts
- fear of illness or harm coming to oneself or relatives
- preoccupation with household items
- intrusive sounds or words
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