1. How can you tell the difference between superstitions/developmental rituals and OCD?
Children are able to control their superstitions and developmental rituals whereas children with OCD feel that they lack the ability to regulate their obsessions and compulsions. Additionally, children are comforted by their superstitions and developmental rituals while OCD engenders anxiety and fear.
2. What is Obsessive-Compulsive Personality Disorder (OCPD)? How is it different from OCD?
People with OCPD are preoccupied with orderliness, perfectionism, mental/interpersonal control at the expense of flexibility, openness, and efficiency. If a child has OCPD, he is careful and compulsive about everything in his life. You may find that your child must arrange his toys in a certain manner, clean his room every day, adhere to the same bedtime ritual, and follow rules precisely. In contrast, OCD usually involves a narrow spectrum of concerns and behaviors: for example, the fear of contamination and repeated handwashing. Additionally, children with OCD are greatly distressed by their thoughts and actions while children with OCPD are comfortable with their behavior.
While children with OCPD may not be bothered by their rigid habits, it should be noted that OCPD is a disorder that can significantly impair a child. Children with OCPD can become so preoccupied with small details that they are unable to complete tasks or homework assignments.
Making simple decisions, such as what to eat or wear, can be particularly difficult for children with this disorder. A concern with perfectionism can be particularly impairing – nothing gets done because it is not ever good enough. OCPD can be treated with behavioral therapy and anti-OCD medications.
3. How can you tell the difference between a tic disorder/Tourette Syndrome and OCD?
It can be difficult to make a distinction between tics and OCD. Common tics include tapping, eye-blinking, throat clearing, spitting, nose-twitching, shoulder shrugging, and licking. These behaviors can also occur in a child with OCD; however, the child with OCD performs these behaviors for a different reason than the child with a tic disorder.
If the behavior is caused by OCD, an unpleasant thought will have most likely preceded it (for example, the child may tap his knee four times to decrease the fear of shouting out a swear word – the tapping decreases the anxiety associated with the fear of swearing.) A young child with a tic disorder may not be aware of her movement abnormalities or the child may experience a feeling of increased tension or physical discomfort before the tic.
This feeling, often described as an “itch or tickle”, is called a premonitory urge, and it warns the child that she is about to have a tic.
4. How is OCD Treated?
For the majority of children, OCD can be treated effectively with either cognitive behavioral therapy or medications or both. You will need to consult a physician, psychiatrist, or psychologist to tailor the therapy to meet your child’s needs.
Cognitive behavioral therapy (CBT) is based on the idea that children with OCD perform repetitive behaviors/compulsions to alleviate the anxiety associated with a bad thought/obsession. When a child is exposed to a feared object, like a dirty toilet seat, anxiety is experienced. However, this anxiety will disappear fairly quickly.
Children with OCD do not wait for the anxiety to disappear; they cannot stand feeling uncomfortable even for a few seconds, and so they wash their hands in order to decrease their anxiety level. However, hand washing actually increases the anxiety. This sets up a vicious cycle, and the child becomes stuck. In CBT, children are slowly exposed to objects that cause anxiety and are taught to resist the urge to perform a compulsion.
Through the exposure with response prevention, the child becomes desensitized to the feared object. CBT is not suitable for every child. Young children may not have the insight or cognitive capabilities to participate in this type of therapy. Additionally, some children have symptoms that are resistant to CBT (this includes children who only have obsessions or children with mental compulsions.)
The selective serotonin reuptake inhibitors (SSRI’s) are the medical treatment of choice for OCD. They work by increasing the amount of serotonin in the brain, which corrects the chemical imbalance that is causing the child?s symptoms. There are a number of SSRI’s that have been approved for use in children by the Food and Drug Administration: sertraline (Zoloft), fluvoxamine (Luvox), and fluoxetine (Prozac.)
Each one of these drugs has a slightly different formula; therefore, if one medication does not help your child, it is a good idea to try another one. However, it is important to keep in mind that these medications can take 8 to 10 weeks to have an effect; it is preferable to avoid switching medications before this point.
The tricyclic antidepressant clomipramine (Anafranil) has also been found to treat OCD effectively. However, this drug has more side effects than the SSRI’s, and therefore, the SSRI?s are usually tried first. Many children with OCD will respond to clomipramine or SSRI treatment with a reduction in symptom severity.
The Pediatric Obsessive Compulsive Disorder Research Program is an element of The NIMH Division of Intramural Research Program. The National Institute of Mental Health (NIMH) is a part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services.