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What Is Life Like For Children Who Have OCD? |
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| OCD can make daily life very difficult and stressful for children. OCD symptoms often take up a great deal of a child's time and energy. This makes it difficult to complete tasks such as homework or household chores. Children worry that they are "crazy" because they are aware their thinking is different than their friends and family. A child's self-esteem can be negatively affected because the OCD has led to embarrassment or has made the child feel "bizarre" or "out of control." |
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Mornings And Evenings Can Be Especially Difficult For Children With OCD |
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In the morning, they feel they must do their rituals right, or the rest of the day will not go well. Meanwhile, they are rushed to be on time for school. This combination of factors leads to feeling pressured, stressed, and irritable. In the evenings, they feel compelled to finish all of their compulsive rituals before they go to bed. They know they must get their homework done and take care of any household chores and responsibilities. Some children stay up late because of their OCD, and are often exhausted the following day.
Children with OCD frequently don't feel well physically. This may be due to the stress of having the disorder, or it may be poor nutrition or the loss of sleep. Obsessions and compulsions related to food are common, and these can lead to irregular or "quirky" eating habits. Many children with OCD are prone to stress-related ailments such as headache, or an upset stomach.
Children with OCD have episodes in which they are extremely angry with their parents. This is because the parents have become unwilling (or are unable!) to comply with the child's OCD-related demands. For example, children with obsessions about germs may insist that they be allowed to shower for hours, or demand that their clothes be washed numerous times or a particular way. Even when parents set reasonable limits, children with OCD can become anxious and angry. However, this anger does not justify physical or verbal abuse between parent and child. If violence or abuse occurs within the home, it should not be tolerated. .
Friendships and peer relationships are stressful for those with OCD because they try hard to conceal their rituals from peers. When the disorder is severe, this becomes impossible, and the child may get teased or ridiculed. Even when the OCD is not severe, it affects friendships because of the time spent preoccupied with obsessions and compulsions, or because friends react negatively to unusual OCD-related behaviors.
Children with OCD appear more likely to have additional psychiatric problems than those who do not have the disorder. Comorbidity means having two (or more) separate psychiatric diagnoses at the same time. Below is a list of psychiatric conditions that frequently occur along with OCD |
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Additional anxiety disorders (such as panic disorder or social phobia) |
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Depression/dysthymia |
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Disruptive behavior disorders (such as oppositional defiant disorder, or attention-deficit hyperactivity disorder) |
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Learning disorders |
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Tic disorders/Tourette's syndrome |
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Trichotillomania (hair pulling) |
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Body dysmorphic disorder (imagined ugliness) Sometimes comorbid disorders can be treated with the same medication prescribed to treat the OCD. Depression, additional anxiety disorders, and trichotillomania may improve when a child takes anti-OCD medication. |
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On the other hand, ADHD, tic disorders, and disruptive behavior disorders usually require additional treatments, including medications that are not specific to OCD. In general, using the smallest amount of medication effective in controlling symptoms, starting low and going slow are common sense approaches. In unusually complicated situations, or in situations where the OCD appears resistant to drug treatment, a consultation with an expert in the area of childhood OCD is warranted. |
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| What Are The Chances That My Child Will Inherit OCD? |
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OCD often runs in families. However, it appears that genes are only partially responsible for causing the disorder. If the development of OCD were completely determined by genetics, pairs of identical twins would both have the disorder, or both not have it. For example, eye color is entirely determined by genes and identical twins always have the same color eyes. If one identical twin has the disorder, there is a 13 percent chance that the other twin will not be affected. This supports the idea that genes are only part of the cause of OCD. Other factors are also important. No one really knows what that other factor might be, although some have suggested that it may be a viral infectionthat occurs at a critical point in a child's development, or perhaps an exposure to an environmental toxin.
Some experts speculate that there may be different types of OCD. Some types are inherited while other types are not. There is evidence that OCD that begins in childhood may be different from OCD that begins in adulthood. Individuals with childhood-onset OCD appear more likely to have blood relatives that are affected with the disorder than are those whose OCD first appears when they are adults.
If a parent is affected with OCD we can estimate how likely it will be that their child will also have the disorder. If one parent has OCD, the likelihood the child will be affected is about 2 to 8 percent. It is important to remember that this statistic is an approximation. Several other factors should be considered when attempting to estimate the risk of a child developing OCD. One factor is whether or not the parents themselves have a family history of OCD. If a parent who has OCD has blood relatives with the disorder, the risk for the child increases. Conversely, if a parent has OCD but none of their blood relatives are affected, then the risk decreases. Another factor is whether the parent has OCD that began when they were an adult or began when they were a child. If the parent's OCD did not start until adulthood, there is probably a decreased likelihood that his or her offspring will be affected. Conversely, if the parent's OCD is the "variety" that starts in childhood, the chances of passing the disorder on are increased.
Another factor is the family history of tic disorders (such as Tourette's syndrome) or other anxiety disorders. If a child has parents or other blood relatives with tic disorders or anxiety disorders, then the child is probably at increased risk for OCD. Besides, having blood relatives with OCD means that not only does the child have increased risk for OCD, but may also have an increased risk for developing a different anxiety disorder or a tic disorder. In summary, having blood relatives with OCD, anxiety disorders, and tic disorders all increase a child's risk of developing any of these same disorders.
As the above information indicates, it is difficult to estimate the chances that a parent will pass OCD on genetically to their child. This is an area of active research, and new developments appear frequently. |
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OCD Medication: Children |
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When Should Medication Be Considered For Children With OCD?
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Medication treatment should only be considered when children are experiencing significant OCD impairment or distress. Also when cognitive-behavioral therapy is unavailable or only partially effective.
The following are some general principles : |
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Anti-OCD medications work because they affect the brain chemical serotonin. Serotonin is used by certain nerve cells in the brain to communicate with other brain cells. These nerve cells (called neurons) release serotonin, which then affects neighboring cells. After the serotonin is released, the serotonin is taken back up into the cell so that it can be used again. Each of the anti-OCD drugs interferes with serotonin being recycled once it has been released. This allows serotonin to spend more time outside of the cell, where it continues to affect neighboring cells. How or why this reduces obsessions and compulsions is still unknown. |
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The best dose of anti-OCD medication should be determined on an individual, case-by-case basis. It is always best to use the smallest amount of medicine that effectively treats the child's OCD. Most children metabolize medications quite rapidly, and relieving the child's OCD symptoms often necessitates the use of higher, adult-sized doses. |
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Anti-OCD medications control symptoms, but do not "cure" the disorder. This means that the positive effects of an anti-OCD medication occur as long as the drug is being taken. That some symptoms often remain, but with lower severity. When the child stops taking the anti-OCD medication, symptoms usually return. At this point, there is no known cure for OCD. |
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Each of the anti-OCD medications is also an antidepressant. With clomipramine (Anafranil ®), it was discovered that certain antidepressant medications helped control OCD symptoms. Not all antidepressant medications have anti-OCD effects, only those that strongly affect serotonin. |
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Each of the anti-OCD medications is also an antidepressant. With clomipramine (Anafranil ®), it was discovered that certain antidepressant medications helped control OCD symptoms. Not all antidepressant medications have anti-OCD effects, only those that strongly affect serotonin. |
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All anti-OCD medications work slowly. Medication is often considered when the child's OCD is severe. Both the child and family are in distress. These drugs are not "quick fixes." It takes two to three months to see improvement in the OCD! Recent studies show that ongoing improvement of OCD continues between twelve weeks and one year after starting medication. |
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No two children respond to anti-OCD medication in the same way. An occasional child will not respond to any medication. It is common for children to respond individually to each of the anti-OCD medications. Some work well for a particular child, and some not at all. The occurrence of side effects varies greatly. It is impossible to pick which medication will work best for a particular child. It is important to understand that if the first medication does not improve OCD, another one should be tried. The child may need a trial of each of the seven available anti-OCD medications to find the one that works best. The drug clomipramine is likely to cause bothersome side effects. Physicians often reserve prescribing it until several of the other anti-OCD drugs have been tried and failed. . An individual child's response to these medications, as well as the occurrence of side effects, varies greatly from drug to drug. |
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Not all the anti-OCD drugs have the Food and Drug Administration (FDA) approval for use in children and adolescents. Presently, four anti-OCD medications have been approved by the FDA for use in children. They are clomipramine (Anafranil ®), fluoxetine (Prozac ®), fluvoxamine (Luvox ®) and sertraline (Zoloft ®). |
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