Obsessive-compulsive disorder is an anxiety disorder characterized by involuntary thoughts, ideas, urges, impulses, or
worries that run through the child’s mind and/or useless repetitive behaviors. Sometimes the obsession and compulsion
are linked. Those with obsessive-compulsive disorder (OCD) experience undesired obsessions and/or compulsions
which interfere significantly with a child's ability to function normally and become excessive, disruptive, and time-
consuming. In many children with OCD schoolwork, home life, and friendships are often affected.

Approximately one in 200 children suffers from OCD, an anxiety disorder. Children as young as five or six have been
diagnosed with OCD. The onset of OCD symptoms may occur as early as age three or four, but very young children
and parents may not recognize the symptoms. In OCD, the obsessions or compulsions cause significant anxiety or
distress, and they interfere with the child’s normal routine, academic functioning, social activities, and relationships.

Children do not usually reveal their obsessions or meddlesome thoughts because frequently they are unrealistic or
irrational. OCD affects children and adolescents during a very important period of social development. Some children
with OCD are too young to realize that their thoughts and actions are unusual. They may not understand or be unable
to explain why they must go through their rituals. Fearing ridicule, children may hide their rituals when in front of friends
at school or at home and become mentally exhausted from the strain.

Symptoms

Some of the most common obsessions are fear of contamination or a serious illness, fixations, fears of danger, a need
for symmetry or exactness, and excessive doubt. Some of the most common compulsions are repetitive rituals such as
cleaning or washing, touching, counting, repeating, arranging or organizing, checking or questioning, and hoarding. The
compulsive mental acts may include (counting, repeating words silently, avoiding) these can be easily observed. The
symptoms can start gradually and parents may have difficulty recognizing them as abnormal.

The following are the most common symptoms of obsessive-compulsive disorder. However, each child may experience
symptoms differently. Symptoms may include:

∙ an extreme preoccupation with dirt, germs, or contamination

∙ repeated doubts (for example, whether or not the door is locked)

∙ obtrusive thoughts about violence, hurting, killing someone, or harming self

∙ spending long periods of time touching things, counting, thinking about numbers and sequences

∙ preoccupation with order, symmetry, or exactness

∙ persistent thoughts of performing repugnant sexual acts or forbidden, taboo behaviors

∙ troubled by thoughts that are against personal religious beliefs

∙ an extreme need to know or remember things that may be very trivial

∙ excessive attention to detail

∙ excessive worrying about something terrible happening

∙ aggressive thoughts, impulses, and/or behaviors

Examples of compulsive behaviors may include :

∙ repeated hand washing (often 100 or more times a day)

∙ checking and rechecking repeatedly (i.e., to ensure that a door is locked)

∙ following rigid rules of order (i.e., putting on clothes in the very same sequence every day,
keeping belongings in the room in a very particular way and becoming upset if the order becomes disrupted)

∙ hoarding objects

∙ counting and recounting excessively

∙ grouping or sequencing objects

∙ repeating words spoken by self or repeatedly asking the same questions

∙ repeating sounds, words, numbers, and/or music to oneself

Possible Causes

The cause of OCD is not known. Research indicates that OCD is a neurological brain disorder. Evidence suggests that
people with OCD have a deficiency of a chemical in the brain called serotonin. In order to send chemical messages,
serotonin must bind to the receptor sites located on the neighboring nerve cell. It is hypothesized that OCD sufferers
may have blocked or damaged receptor sites that prevent serotonin from functioning to its full potential.

OCD tends to run in families, suggesting a genetic component. Various studies on this topic are still being conducted
and the presence of a genetic link is not yet definitely established. However, OCD may also develop without a family
history of OCD. Recent studies suggest that streptococcal infections may trigger the onset or increase the severity of
OCD, in some cases. Studies also suggest that environmental factors play a role in how these anxiety symptoms are
expressed. There are many different theories about the cause of obsessive-compulsive disorder. Some research has
discovered a type of size abnormality in different brain structures.

Treatments

A pediatrician, teacher, principal, or a guidance counselor may refer parents to a child psychiatrist who will review the
child's behavior with the child, parents, siblings and use a specially designed interview to diagnose OCD.

At school, children with severe OCD symptoms may repeatedly check, erase, and redo their assignments, which can
result in late and incomplete schoolwork. Classroom concentration and participation may be limited by fears and rituals.
Teachers can be very helpful in supporting a child's treatment of OCD once parents inform them about the disorder.
Parents may share information about their child's OCD medication with teachers and provide occasional progress
reports. Even if a child's OCD is not active at school, teachers should be informed that treatment for OCD can improve
the child's ability to learn.

OCD can be treated with Behavioral therapy, Cognitive therapy, medications, or any combination of the three.
Children and adolescents with OCD should receive behavioral psychotherapy. Some physicians and patients will
choose medication first, trying to avoid the time, effort, and anxiety associated with behavior therapy, especially with
younger children. Others will choose behavior therapy in preference to medication and the chance of aversive side
effects. Most will prefer to combine the two approaches. Although these treatments are not a cure, their application will
provide relief for the majority of patients with OCD.
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