OCD

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Childhood OCD

• Yvette Zuppiger
• I M.Sc. (2nd Sem) Clinical Psychology

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• Obsessive-compulsive disorder (OCD) is an anxiety
  disorder marked by recurrent intrusive thoughts
  (obsessions) accompanied by repeated attempts to
  suppress these thoughts through the performance
  of certain ritualistic mental or physical actions
  (compulsions)
• Majority of OCD cases begin in childhood /
  adolescence
• Usually diagnosed between ages 7 12
• Difficulties with attention and concentration
  because of intrusive thoughts

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• Low self esteem, shame and embarrassment
• Feel pressured because of time constrains posed
  by compulsions / rituals
• Frustration, guilt, irritable
• Children are adept at hiding the behaviors from
  elders, so OCD can go unnoticed for months or
  even years.
• Symptoms wax and wane in severity
• Specific content of obsessions and compulsions
  may change over time

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• Aware of lack of reasonableness of obsessions /
  compulsions
• Indecision, doubt and slowness in completing
  tasks
• Obsessions and compulsions take more than 1 hour
  a day and interfere with persons normal routine
• Makes daily life difficult for affected children
  and their families. The behaviors often take up a
  great deal of time and energy, making it more
  difficult to complete tasks, such as homework, or
  to enjoy life.
• Y-box checklist for OCD developed by Yale Brown

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Common Obsessions

• Fear of dirt or germs
• Fear of contamination
• Religious obsessions
• Intrusive sounds or words
• Lucky and unlucky numbers
• Sexual or aggressive thoughts
• Need for symmetry, order, and precision
• Preoccupation with body wastes
• Fear of illness or harm to oneself or relatives
• Preoccupation with household items

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Common Compulsions

• Washing/cleaning
• Counting
• Hoarding
• Checking
• Repeated actions
• Putting objects in a
• certain order
• Repeated "confessing"
• or asking others for
• assurance

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How To Spot Children With OCD

• Raw, chapped hands from constant washing
• Unusually high rate of soap or paper towel usage
• High, unexplained utility bills
• Sudden drop in test grades
• Unproductive hours spent doing homework
• Holes erased through test papers and homework
• Requests for family members to repeat strange
  phrases or keep answering the same question
• Persistent fear of illness

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• Dramatic increase in laundry
• Exceptionally long amount of time spent getting
  ready
• Continual fear that something terrible will
  happen to someone
• Constant checks of the health of family members

• Avoidance of scissors or other sharp objects
• Chronic lateness
• Daydreaming or preoccupation
• Hair loss due to frequent hair pulling
• Skin lesions due to frequent skin picking

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Epidemiology

• Point prevalence 0.5
• Lifetime rate 1-3
• Slight male predominance, which diminishes with
  age
• Fourth most common psychiatric illness (after
  phobias, substance use disorders, and major
  depressive disorders)

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Etiology

• Genetic Factors
• Tends to run in families
• Molecular genetic studies show linkage to
  chromosomes 2 9
• Supported by family studies, twin studies and
  pedigree studies
• Neuroimmunology
• Exposure to Group A beta-hemolytic streptococcus
  ("strep" throat and Sydenham's chorea) can lead
  to the onset of the OCD symptoms

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• OCD due to infection is termed Pediatric
  Autoimmune Neuropsychiatric Disorders Associated
  with Streptococcus (PANDAS)
• Bacteria activates immune system, leading to
  inflammation of basal ganglia and disruption of
  cortical-striatal-thalamocortical function
• Minority cases

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• Neurochemistry
• Serotonin system and dopamine system play a role
• Abnormalities in serotonin metabolism
• Increased glucose metabolism in left orbital
  frontal, right sensorimotor, and bilateral
  prefrontal and anterior cingulate regions (Swedo
  et al, 1989)

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• Neuroimaging
• PET scans indicate brain activity different from
  normal pattern
• MRI scans show OCD patients have significantly
  less white matter in their brains than normal

• CT MRI scans show smaller than normal basal
  ganglia segments
• Hypermetabolism in frontal cortical-striatal-thala
  mo-cortical networks

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Comorbidity

• Tourettes syndrome
• Anxiety disorders (Social phobia, specific
  phobia, panic disorder)
• Depression
• Disruptive behaviors (ADHD)
• Learning disorders
• Trichotillomania (compulsive hair pulling)
• Non-verbal learning disorders
• Habit disorders (nail biting, skin plucking)
• Body dysmorphic disorder (BDD)

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Differential Diagnosis

• Anxiety disorders (Generalized anxiety disorder,
  separation anxiety disorder, social phobia)
• Pervasive developmental disorders
• Tic disorders (Tourettes syndrome)
• Psychosis

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Course Prognosis

• Childhood onset OCD has poorest prognosis
• It is chronic, waxing and waning in intensity
• Best prognosis is for those without comorbid
  disorders
• Up to 50 experience recovery with minimal
  remaining symptoms
• In children with subthreshold symptoms, high risk
  of developing OCD within 2 years

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Treatment

• Administration of Selective Serotonin Reuptake
  Inhibitors (SSRIs), which affect the body's
  reabsorption of serotonin (Sertraline,
  Fluoxetine)
• Cognitive behavior therapy (CBT) change
  thoughts and feelings by first changing behavior
• Combination of both results in superior outcome

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