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Ask an Expert: Obsessive Compulsive Disorder
The Pediatric Anxiety Research Center specializes in anxiety disorders and behavioral therapy. Psychologists Jennifer Freeman, PhD and Abbe Garcia, PhD, offer information about Obsessive Compulsive Disorder (OCD).
OCD is a disorder of the brain and behavior. It involves both obsessions and compulsions, which take a lot of time and get in the way of important activities.
Research suggests that OCD runs in families. Having a first degree relative with OCD and/or a tic disorder places one at higher risk of having OCD. Kids as young as 4 or 5 years of age can develop OCD. Research suggests that age 10 is a particularly common time for OCD symptoms to begin. Among those people who are genetically predisposed, stressful life events are often associated with the onset and/or worsening of symptoms.
OCD can only be diagnosed by trained professionals. They will look for three things:
- The person has obsessions.
- He or she does compulsive behaviors.
- The obsessions and compulsions take a lot of time and get in the way of important activities the person values (working, going to school, etc.)
Obsessions and Compulsions
Obsessions are thoughts, images, or impulses that occur over and over again and feel out of a person’s control. Abbe Garcia, PhD, describes obsessions as "unwanted, repetitive thoughts, images or impulses that come with uncomfortable feelings, such as fear, disgust, doubt, or a feeling that things have to be done in a way that is "just right."
Compulsions are repetitive behaviors or thoughts that a person engages in to neutralize, counteract, or make their obsessions go away. "People with OCD realize this is only a temporary solution," says Jennifer Freeman, PhD, "but without a better way to cope, they rely on the compulsion as a temporary escape."
Not all repetitive behaviors or “rituals” are compulsions. Bedtime routines, religious practices, and learning a new skill involve repeating an activity over and over again, but are usually a welcomed part of daily life. A person suffering from OCD finds obsessive thoughts disturbing and unwanted, and they usually know they don't make sense.
- Fears about germs and/or contamination
- Worries about harm coming to self or loved ones
- Worries about losing things
- Avoidance of situations that trigger obsessions
- Excessive washing of hands and arranging objects
- Repeating routine activities
- Reassurance seeking
Effective Treatments for OCD
"Cognitive behavior therapy (CBT) and medication treatment with a class of medicines called serotonin reuptake inhibitors (SRIs) have empirical support as efficacious treatments for pediatric OCD," says Garcia. "For mild to moderate symptoms, starting with CBT alone is a good first step. For moderate to severe illness CBT in combination with medication is likely to produce the best results."
CBT is made up of a large group of therapy strategies. The most effective strategy for OCD is called “exposure and response prevention”. This is the same type of treatment used for adults with OCD. “Exposure” refers to facing the thoughts, images, objects and situations that make the child anxious. Response prevention is the part of the treatment in which the child makes a choice to not engage in the compulsive behavior and to continue to make the commitment to not give in and do ritual until there is a drop in the child’s anxiety. The drop in the anxiety that happens when a person stays exposed and prevents the compulsive response is called habituation.
"There have been three large, randomized, controlled efficacy studies of treatments for youth with OCD, which is where the treatment recommendations just mentioned derive from," says Freeman. "In addition to treatment studies, there are also ongoing studies of the brain circuitry involved in OCD as well as studies to identify the specific genes that are involved in OCD transmission."