Obsessive Compulsive Disorder is a neuropsychiatric disorder characterized by intrusive thoughts that fuel fear, leading to increased anxiety and eventual compulsive reactions. Both adults and children that suffer with OCD, are often aware that their thoughts and behaviors are irrational, however, the impulse to perform the compulsive ritual to relieve the anxiety of the obsessive thought, is too powerful for them to ignore.
The cycle of anxiety, obsessive thoughts, and compulsive reactions, becomes crippling as it interrupts daily life activities leaving sufferers trapped in repetitious cycles for hours at a time before they feel safe to move to another activity or chore. This dysfunctional pattern of paralyzing fear and dread becomes unmanageable without behavior and medicinal therapy interventions. Signs & Symptoms A patient with OCD may display either obsessive thoughts or compulsive actions individually, but it is more common for a patient to suffer from a combination of the two.
Obsessions are classified as reoccurring, unwanted thoughts and images that increase anxiety and cause physical and emotional stress to the point in which the patient is unable to ignore them. These images and thoughts are often disturbing, and leave patients riling with a sense of imminent danger. This distorted perception cascades and patients feel they will be responsible for causing injury, illness, harm or death to another individual if they do not do something to counteract the obsessive thought.
Compulsions are the repeated, often extreme and irrational, behaviors or rituals that an individual performs to alleviate the stress and anxiety caused by the obsessive thoughts. Though illogical, patients get trapped into repetitious sequences of counting, fixing, handwashing, chanting, and checking things time after time. Without early recognition, diagnosis, and interventions, the illness progresses and patients continually add more restrictions and rituals to their compulsive routines. This further isolates the OCD patient and affects their ability to work, attend school or participate in any other social activities (www. dc. gov, 2017).
Incidence & Diagnosis Obsessive Compulsive Disorder affects between 1% – 3% of youth and adolescent populations. Often, diagnosis is made before the age of nineteen and some as early as the age of three. In youth, it affects boys with a greater ratio than girls. Most of these children also have one or more additional psychological conditions. Comorbid tic disorders, ADHD, anxiety, and depression increase the severity of the obsessive-compulsive symptoms, further isolating patients within their ritualistic world.
Parents and teachers are often the first to recognize when a child is showing signs of obsessive thoughts and developing compulsive tendencies; however, diagnosis takes time as practitioners must rule out other medical or psychological conditions that are potential contributing factors. Lab tests, such as a CBC, a thyroid panel, drug and alcohol screenings, and a thorough physical examination, together with an extensive mental health evaluation, aid practitioners in identifying obsessive compulsive disorders.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the current standard that clinicians measure behaviors against before concluding an OCD finding. Clinicians also must determine if a patient believes that their obsessive thoughts are realistic and note any history of a tic disorder to warrant their conclusion (Harvard Mental Health Letter 2012; & Weidle, Ivarsson, Thomsen, Lydersen, & Jozefiak, 2015). Treatment With overlapping symptoms from co-conditions, childhood OCD is often overlooked leaving children untreated or improperly treated.
Eighty percent of the adult OCD population report that they developed the condition during childhood, yet many went undiagnosed for years. This delay in accurate identification and effective treatment leads to chronic unrelenting symptoms that are extremely difficult to overcome. A combination of cognitive behavioral therapy and the use of selective serotonin reuptake inhibitors, (SSRIs) have demonstrated success for symptom management in young patients with obsessive compulsive disorder.
Cognitive behavioral therapy, (CBT), using an “exposure and response prevention” (Jacob & Storch, 2013, p. 142) model, is recommended prior to the addition of pharmaceuticals for pediatric patients with mild to moderate OCD. Patients are gradually introduced to situations or stimulants that create feelings of fear and anxiety. The therapist then prevents the patient from performing the habitual compulsive behaviors in response to those feelings. The process is slow and patients are introduced to each new stimulant based on the severity of their reactions.
Exposure begins with the patient’s least frightening object or scenario and gradually increases towards the most feared as treatment progresses. Several studies show that through habitual exposure, anxiety and reactions decrease considerably among the pediatric population with encouraging trends towards remission. Pharmacologic adjunct therapy is indicated for patients with more severe OCD or for those that display clinically significant behaviors after undergoing extensive cognitive behavioral therapy alone (www. cdc. gov, 2017 & Jacob & Storch, 2013).
Antidepressants are generally safe for use in the youth and adolescent population, however, increased suicidal thoughts and tendencies have been associated with the drug class. Continual patient assessment is necessary to prevent potentiating risks from developing while undergoing psycholeptic drug therapy. “Four medications, currently have FDA approval for treating pediatric OCD. Clomipramine, sertraline, fluoxetine, and fluvoxamine” (Jacob & Storch, 2013, p. 142). These medications act to prevent serotonin from being reabsorbed by nerve endings after its release by the central nervous system.
Once released, serotonin works to stabilize a person’s impulse control, obsessive thinking, and mood, thus decreasing OCD symptoms. Clomipramine provides greater symptom relief than the other three approved medications, however, due to greater side effects, clomipramine is not the first pharmacologic choice for treatment. “Though not approved by the FDA, antipsychotics, benzodiazepines, serotonin and norepinephrine reuptake inhibitors are also commonly prescribed to treat OCD or as augment therapy when used with serotonin reuptake inhibitors, (SRIs)” (Jacob & Storch, 2013, p. 42).
In combination, cognitive behavioral therapy together with pharmaceutical interventions provide the best opportunity to restoring quality of life for the OCD patient (Jacob & Storch, 2013; & Weidle et al. , 2015). Genetics & Etiology The prevalence of childhood OCD and other tic, anxiety, and hyperactivity disorders remained relatively unknown until causative studies uncovered the problem over 25 years ago. Research now suggests an inherent predisposition to the development of OCD exists among first generation relatives.
This genetic susceptibility does not guarantee the onset of symptoms; however, the biological connection increases the chances of a patient developing OCD or other anxiety disorders especially during traumatic or difficult life events (http://www. jaacap. org, 2012). Brain imagining results show abnormal activity within the cerebral cortex and the basal ganglia regions of the brain of affected individuals. Scientists theorize an additional connection to a chemical imbalance of the CNS neurotransmitters serotonin, dopamine and glutamine as probable influences.
Investigation also continues into environmental factors and an association with a sporadic form of OCD. Specifically, a link between A Beta-hemolytic streptococcal infection and an abrupt onset of symptoms. Patients that develop signs of OCD immediately after they had a strep infection fall into the classification of “Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, (www. nimh. nih. gov, 2017). ” also known as PANDAS. Often symptoms of PANDAS resolve once the strep infection has been identified and appropriately treated with antibiotics (Harvard Mental Health Letter, 2012 & www. imh. nih. gov, 2017).
Conclusion As investigators continue to work towards unlocking this psychological puzzle, factors that influence individual susceptibility to obsessive compulsive disorder, are not definitive. Though evidence-based interventions currently offer the best hope at restoring normality of life to sufferers, a large amount of OCD patients continue to remain clinically symptomatic years after initial treatments. The scientific challenge of increasing long term remission rates and breaking the ritualistic cycle of anxiety, fear, obsessions and compulsions remains.