We described Obsessive-Compulsive Disorder (OCD) in part 1 of this series as being a mental disorder characterized by persistent, anxiety-triggering images (referred to as obsessions) that elicit repetitive and ritualized behaviors (known as compulsions). It is estimated that OCD affects roughly 2.5% of the populations of the West, and it often first appears in children in the 4 to 6 age-bracket.
The confounding nature of OCD
OCD is a particularly confounding disorder, acquiring different bents and severities in the same person over time. For example:
- The disorder is not always completely debilitating, as demonstrated by many famous people who were sufferers and yet attained pinnacles in their careers (Charles Darwin, Albert Einstein, Donald Trump, Michael Jackson, Harrison Ford, and many others).
- At the more extreme end of the spectrum, the rituals are more rigid. For example, some patients conduct tasks every day in the exact same order, going into a tizzy if anything or anyone interrupts their routines.
- Diagnosing the disorder is complicated by the high prevalence of alcohol and drug abuse in sufferers (it is thought that upwards of 20% of sufferers indulge in substance abuse in a quest to appease their obsessions.
- Add the fact that there are usually other mental disorders that co-exist (comorbid)¹ with OCD -e.g. depression, different phobias, panic disorder, Tourette’s, Attention Deficit Hyperactivity Disorder (ADHD), eating disorders, and hypochondriasis (excessive fear of illnesses).
- In children, the prevalence of co-existing disorders with OCD is high: examples would include separation anxiety, mood disorders, repetitive body or facial tics, social phobia, and ADHD. Therapists also have to recognize and rule out simple eccentric behavior that will fade in time.
Diagnosing OCD and self-screening tests
Mental health professionals frequently use diagnostic interviewing tools such as the Anxiety Disorders Interview Schedule for DSM-IV (child and parent version) or the Schedule for Affective Disorders and Schizophrenia for School-Age Children (present and lifetime version)² to assist in diagnosing OCD and identifying the co-existence of other disorders. A complete physical exam is usually also included as part of the evaluation, and when a child is being assessed, records of immunizations as well as school reports are examined. Additional tests exist to measure the severity of the disorder and the level of distress experienced by the patient, notably the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for adults, and the (CY-BOCS)³ for children.
Self-screening tests exist that help in determining if one has symptoms similar to those of OCD. It has to be emphasized however that those do-it-yourself tests do not rise to the level of a professional evaluation, and that they should be used only as a preliminary step to being tested by a mental health professional.
Causes of Obsessive-Compulsive Disorder (OCD)
Despite a large volume of scientific investigation that has been carried out into OCD, researchers have not as yet been able to pinpoint the exact cause of the disorder. The best that they have been able to achieve is to narrow it down is to the following determinants:
- Genetic and neurological factors– Although no specific genes have been linked to OCD, researchers have uncovered evidence that suggests that the disorder runs in certain families. The incidence of OCD is 4 times greater in a family where OCD already exists. In addition, families where OCD runs have an increased incidence of brain abnormalities, tics, and a lack of the chemical serotonin. Serotonin is a neurotransmitter of impulses, and its deficiency in the brain area also explains the high co-existence of depression, anxiety and other neurological complications.
- Behavioral factors – Although stress is known not to cause OCD, it definitely exacerbates the symptoms of the disorder. Someone in the family passing away, or parents separating may trigger OCD, particularly in people who are predisposed as a result of genetic factors. Fear and anxiety may conceivably slip into obsession –for example, if the death of a loved one brings on guilt and the fear that more detrimental harm will ensue.
- Environmental factors – “Strep” infections, which afflict growing children more so than adults, are caused by a type of bacteria called streptococcal. Doctors usually prescribe antibiotics to help the body fight off the infections, and there have been incidents where young individuals have developed obsessive-compulsive behavior following an acute infection. Like stress, it is thought that the infection itself does not produce OCD, although it triggers OCD in young individuals who have that predisposition. When that happens, symptoms of OCD will show up promptly after the infection. The term “sudden onset of OCD” resulted from cases of infection triggering OCD almost overnight. In addition, non-strep diseases such as Lyme disease and the flu could also cause similar symptoms in predisposed children, although to a lesser incidence.
How to recognize and help a child with OCD
Approximately 1 million children (1 in 100 school-aged children) are afflicted with the disorder. Parents should be on the lookout for excessive hoarding, washing, disturbing images and fears, new religious rituals, and other seemingly uncontrollable urges or practices. It is important for parents as well as afflicted children to realize that:
- No one is to blame; OCD is not caused by a parenting style
- This is a medical condition, much like asthma
- OCD has a scientific basis; it has to do with the way the brain processes certain chemicals
- There are nowadays effective treatments (discussed in Part 3 of this series)
- Like asthma, a determined effort between parent and child can overcome OCD
OCD ranks fourth among psychiatric diagnosis. First are phobias, then substance abuse, and then major depression. OCD is more common than juvenile diabetes, but because children are embarrassed, and because they fear it, they tend to hide its symptoms, and it frequently remains undiagnosed.
Part 3 will deal with
psychotherapy and pharmacological treatments.
¹ Stanford School of Medicine “Obsessive-Compulsive and Related Disorders”
², ³ Beyond OCD – “OCD Facts: Diagnosing OCD”
4 NHS- CHOICES “Your health, your choices”
About Mike Takieddine, the author:
Mine has been a privileged life, first for having traveled all over as son of a diplomatic family, then for having had the opportunity to study at Oxford, and finally for a gratifying career in business, in geriatric home care, and in writing about health issues. I look forward to using this wonderful medium to discuss the various aspects of health that are of interest to my readers.