The number of children diagnosed with Obsessive Compulsive Disorder
Daily, the number of children diagnosed with Obsessive Compulsive Disorder (OCD) is on the increase. OCD has been shown to affect at least 2% of young people (OCF 2009). As defined by the NHS clinical guide 2005, “obsessive compulsive disorder (OCD) is characterized by the presence of either obsessions or compulsions and most commonly both” The NHS further describe an obsession as any thoughts, imagery or urge which is unwanted and intrusive, repeatedly bogging someone’s mind. Also compulsion, are behaviors or mental activities repetitive in nature which a person feels need or is driven to perform. These definitions embody the reality encompassing people suffering with OCD. The symptoms which cause significant functional impairment and distress coupled with the fact that it can either be overt and observable by others (for example, checking that a door is locked repeatedly) or covert mental act like repeating a particular phrase in ones mind tend to affect sufferers, physically, psychologically, socially and academically as would be expounded in this study. Obsessions or compulsions can negatively impact on the lives of young people within their family environment, school and with friends. Nearly all children have little worries or fears as a normal part of growing up (Pridmore, 2010). This then makes OCD in children difficult to diagnose thus removing early identification and treatment in effect leading to a more developed situation in adult hood. Research into the early diagnosis forms the crux of this study.
AIMS AND OBJECTIVES
This research is aimed at scaling more light on ways of early detection of OCD in children with a view to early diagnosis and early treatment by way of research to investigate the relationship between OCD in children, adolescents and adult, thus ensuring translating the cognitive processing of threat across age groups, magnitude of symptom and how this is usually shown by sufferers with age.
Furthermore it also aims to add knowledge to what is currently known about the import of age on OCD and the best approach in detecting and treating OCD early in life.
Interpret how OCD symptoms begin and are displayed across age groups.
Assess level of symptom in sufferers across different age groups.
Analyze critically the best practice for early detection and best approach to treatment.
Make recommendation based on research finding into OCD across varied age groups.
Important to this research are the following questions, which make up the body of the research:
How are the symptoms of OCD exhibited in children
What role does age play in the repression or otherwise of OCD in children
How does comparism of OCD symptoms across age groups affect current knowledge of OCD in Children
What conditions affect the repression of OCD symptoms across the test age groups
Can the success of repression across any of the age groups be used as tool to treat OCD in children
These questions would form the building blocks of the research, as the findings would formulate points of discussion.
Previously, OCD was thought to be a rare psychiatric illness (Paige, 2007), however, research into the causes and symptoms into the condition, points out that the condition or disorder clearly characterized by cycles of obsessions and ‘rituals’ or compulsions causing extreme malfunction, fear and distress to its sufferers.
It is proposed and more likely that in the near distant future, OCD would be grouped in a field of disorders with various treatments. The proposed OC spectrum disorders might include OCD, body dysmorphic disorder (Bjornsson et al, 2010), hoarding (Pertusa et al, 2010), pathological gambling (Black et al, 2010), certain eating disorders, and autism. The current position of OCD differs in the two major diagnostic systems. OCD is perceived as an anxiety disorder In the DSM-IV, while ICD-10 lists it as an entity, which is separate from the anxiety, disorders. As stated above, proposals for the removal of OCD from the anxiety disorders and placed in an independent grouping of “OC spectrum disorders” is currently under discussion (Bartz & Hollander, 2006).
OCD is yet to be fully understood thus various theories flourish which link it to different conditions such as a connection to disgust which is a basic human emotion, which may have an evolutionary function that encourages the avoidance of contamination and disease. Husted et al, (2006), explained that functional imaging indicates that the neurocircuitry of OCD and disgust are similar conceiving OCD as a malfunction in an appraisal process. This would fit with OCD in which there are contamination concerns. However, this ideology does not tally with another theory that observes indecision as a feature of OCD and proposes the disorder is a result of disturbed decision-making strategies, which has been discussed by (Sachdev, et al, 2005). In another instance, functional imaging supports the theory that decision making involves the dorsolateral, orbitofrontal and anterior cingulate cortices (CHANGE THE WORDS) which interact with limbic structures to retain memory of emotional rewards, and the basal ganglia which is involved in behavioral execution, the same structures that appear to be involved in OCD. These are shrouded with other theories that include “not just right experiences” (Coles et al, 2010), inability to terminate improbable but grave danger concerns (Woody and Szechtman, 2010) and “an inflated sense of responsibility” (Smari et al, 2010)
OCD involves obsession that are involuntary, leading up to thoughts that are unwanted and recurring result in feelings of anxiety and many at times dread hence they are not simply cases of meticulousness or over worry. There tend to be much worse, they make the sufferer seem irrational, interfere with normal thinking and are time consuming in some cases taking up to two hours per day (Fruehling J, 1999).
They compel sufferers to make repeated attempts to try and control arising obsessive thoughts all to no avail. The ‘rituals’ performed by sufferers tend to bring temporary relief from the anxiety brought about by the thoughts as there exist a clear the relationship between most obsessions and the compulsions that follow. for example, contamination and washing. Sometimes the opposite is the case as not clear relationship can be attributed to (WHAT)for example, counting behaviors in a bid to prevent harm to others (Paige, 2007). The symptoms of OCD have been shown to grow stronger over time in cases where certain performed compulsions appear less effective in bringing relief. More elaborate measures could be taken to provide a sense of relief effectively ensuring that these become time consuming and thus interfering with everyday functioning. There have been cases of delayed indulgence so as not to appear abnormal socially, but this is nearly very difficult and the urge to perform the rituals always tends to grow. For example, students who tend to and are able to delay their compulsions while in class often tend to go to private places later on to perform set rituals during school hours. The concept of delusion cannot be attributed to sufferers of OCD, more adult sufferers often tend to recognize that such thoughts and behaviors that follow are unreasonable, however, that lack the will or ability to control them. In the face of illness or stress, OCD symptoms worsen.
The causes of OCD border around three major areas, psychological, biological and the roles of neurotransmitters.
Biologically – Studies have linked patients with childhood onset OCD to first-degree relatives, than among patients with later onsets to first-degree relatives (Starcevic, 2005). However, statistical inconsistencies have been shown to exist among twins demonstrating a higher concordance among dizygotic pairs. Upon statistical analysis further more, Grootheest et al, 2005 explained that if a dimensional approach is employed, studies amongst twins suggest heritability of obsessive compulsive symptoms. Early onset of OCD is traceable to strong genetical contributions however, this is not definitive (Pridmore, 2010).
Role of Transmitters – In another study, neurological images implicate disturbances in pathways between the cerebral cortex and thalamus as pathogenesis of obsessions while pathogenesis of compulsion along with repetitive motor acts results from abnormalities in the striatum (Insel, 1992). When comparing sufferers of OCD and other anxiety disorders, Ruda et al, (2010) observed common and distinct neural substrates as both showed a decreased level of bilateral grey matter volume in the brain. OCD like disorders caused by childhood streptococcal infections has been termed Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. It has been observed that a large percentage of children who have suffered this complication of rheumatic fever have antibodies directed against the caudate (Swedo et al, 1994).
Psychologically – OCD are shown by the symptoms explained upon earlier in this study.
OCD UK STATISTICS
Torres et al reported in 2006 that the survey of British National Psychiatric Morbidity revealed the prevalence within the general population of OCD was 1.1%. The same statistics also showed that the percentage decreased with increasing age (1.4% within 16-26years and 0.2% within 65-74 years). These statistics also revealed that the condition was slightly higher in females than males. Amongst sufferers of the condition, it has been identified that 55% suffer from only obsessions while 11% have only compulsions with 34% having both obsessions and compulsions (Pridmore, 2010). Further statistics show that 62% patients suffer from mental disorder in particular depression and anxiety, with 20% having alcohol dependence, 13% on drug dependence and 25% with a history of attempted suicide. The above statistics points to the prevalence of OCD in children who very often are ignorant of the existence of the condition and or where conscious are often very afraid to inform parents. In a 9 year survey where 142 adolescents and children where followed, Heyman et al, 2010 revealed that 41% of this population had persistent OCD, a very considerable number of those without the condition showed signs of other psychiatric conditions. This reveals that OCD is a chronic disorder amongst the younger generation with a guided prognosis.
CHILDREN LIVING WITH OCD
Childhood onset of OCD may result in children demonstrating washing; checking rituals, and preoccupation with disease, danger, and doubts inter alia (Swedo et al 1989), with an approximate 2%–3% of people (including adolescents) having OCD. Notwithstanding this may be an underestimate because many symptoms are kept secret, OCD can emerge as early as preschool. During puberty and early adulthood, the number of children who develop the disorder peaks (National Institutes of Mental Health, Pediatric Obsessive- Compulsive Disorder Research, 2006). Studies by Paige, 2007 show that one-third of adults have OCD developed from childhood. As stated earlier, children and adolescents often tend to hide the symptoms of OCD for fear of being tagged ‘crazy or weird’ this often takes its toll on the severity of the condition in sufferers later on in life. The stigma often associated with OCD come to the full understanding of most adolescents who go through extreme lengths to avoid showing the symptoms. These steps could see them seek ways to avoid situations, which tend to trigger symptoms or young sufferers become clever in devising explanations for their behaviors. Snider et al, 2000 preach that compulsive behavior begins very often gradually and the trend is inadvertently supported by unsuspecting parents at the outset, for example, in cases where children and adolescents show rituals or compulsions that tend to be developmentally appropriate such as wearing a lucky shirt to a game or lining up stuffed animals in a particular way or show healthy behavior such as appear healthy washing of hands after bathroom use, parents may not initially be concerned by such OCD symptoms thus resulting in not seeking medical treatment at the outset until behaviors have become disruptive. Study by Zohar (1999) reveal that following childhood onset, OCD has a complete remission rate of 10 to 50 percent by late adolescence and without treatment tends to become chronic affecting normal function adversely. Considerable effects on adolescents include decreased performance qualities, impaired relationships, depression, problems associated with poor academic performance and so on (Paige, 2004). Expounding further on the effect of OCD on child or adolescent school performance, OCD often at times has a considerable and significant effect on child or adolescent learning; this tends to worsen if left untreated at the earlier stages. Academic problems associated with OCD in children or adolescent include poor attendance often similar to school avoidance, perceived weird behavior as young sufferers tend to avoid situations and places that increase obsessive thoughts as they may spend more time in secret places where rituals or compulsions are performed, this often results in increased social isolation and missed learning. Other problems may include loss of concentration, which is similar to symptoms associated with Attention Deficit Disorder (ADD) as a direct result of obsessive. The consequences of such behaviors often result in victimization or bullying of students suffering from OCD while obsessive thoughts create social problems.
COMPARISON OF CHILDREN AND ADULTS LIVING WITH OCD
In a study to unearth the developmental differences in the cognitive processing of threat across children, adolescent and adult groups of individual sufferers of OCD by Farrell et al in 2006, some evidence showed that age accounted for differences in the cognitive processing of threat associated with OCD. As this study was the first to examine this relationship, it demonstrated that children suffering from OCD experienced lower anxious and intrusive thoughts in direct comparism to both adolescents and adults. Children experienced lower levels of sadness, worry, disapproval and removal strategies associated with OCD as determined by Farrell et al, (2006) when compared to adolescents and adults. The research also pointed that the intrusive and depressive thoughts experienced by children with OCD was less distressing and less difficult to resist in comparison to the other two groups. These finding where consistent with reports by Salkovskis (1985, 1989) and others (Freeston et al., 1996; Rachman, 1993). Similar results were obtained when responsibility was the factor being tested for. The results showed that children report significantly less responsibility on a self-report responsibility attitude measurement in comparison to the other two groups. This suggested effectively that by adolescent, sufferers ten to have increased attitudes regarding personal blame for harm as is also in the case of adults suffering with OCD.
CONCLUSION AND RECOMMENDATION
The cognitive theory of OCD has in the past been heralded as the most widely accepted account of maintenance of the disorder in adults however; it remained to be seen if evaluation across children, adolescent and adult comparison portends any trend. To this end, research was undertaken to investigate developmental differences in symptoms displayed by OCD sufferers across the age range, the results obtained demonstrated that symptoms evinced increased across the grouping (children – adolescent – adult). This therefore suggests adoption of strategies for treatment of the condition. Importance is placed of the early discovery of the condition in an individual so as to ensure that whatever treatment is required is provided to stem increased conditions as the individual matures. Furthermore, in managing and ensuring recovery from OCD, early identification and requisite treatment remain imperative. Various strategies to manage and control the condition amongst children within the school environment and at home have to be employed. At schools, staff should be alert as to the symptoms of the disorder in any pupil and to achieve this there is need for adequate enlightenment of staff about the disorder. Advice should the sought from the school counselor as unexplained agitation in pupil, prolonged and or frequent absence from class etc could be pointers to the condition in a pupil. Also, indirect observation such as raw or bleeding hands could give required clues. Stigmatization should also be eliminated. Conclusively, parental involvement remains utmost in the management and recovery process. Some parents may require education on how to identify and support children suffering with OCD.
More research is required to fully grasp the role of responsibility, life experiences and exposures on the display and repression of OCD symptoms. This research study however, recommends a more details research into the symptoms showed by sufferers across different age groups and the roles which various factors would play.
Bartz J., and Hollander E., (2006) ‘Is obsessive-compulsive disorder an anxiety disorder?’ Progress in Neuropsychopharmacology and Biological Psychiatry, vol. 30. pp. 338-352.
Bjornsson A, Didie E, Phillips K., (2010) ‘Body dysmorphic disorder’ Dialogues in Clinical
Neuroscience, vol. 12, pp. 221-232.
Coles M., Heimberg R., Frost R., and Steketee G., (2005) ‘Not just right experiences and obsessive compulsive features: experimental and self-monitoring perspectives’ Behavior
Research and Therapy, vol. 43, pp. 153-167.
Freeston, M. H., Rheaume, J., & Ladouceur, R. (1996) ‘Correcting faulty appraisals of obsessional thoughts’ Behaviour, Research and Therapy, vol. 34, pp. 433–446.
Insel T., (1995) ‘Toward a neuroanatomy of obsessive-compulsive disorder’ Archives of
General Psychiatry, vol. 49, pp. 739-744.
National Institutes of Mental Health, Pediatric Obsessive-Compulsive Disorder Research. (2006) FAQs about OCD. Retreived May 31, 2007, from http://intramural.nimh.nih.gov/pocd/ pocd-faqs.htm#FAQ-1
National Health Scheme NHS (2005) ‘Obsessive-compulsive disorder Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder’ National Institute for health and clinical excellence. www.nice.org.uk.
Obsessive Compulsive Foundation (OCF) (1999) ‘OCD in Children’
Obsessive-Compulsive Foundation. (2006) ‘What is OCD?’ Retreived June 1, 2007, from www.ocfoundation.org/what-is-ocd.html
Paige L. Z., (2004) ‘Obsessive-compulsive disorder: Information for parents and educators’ In Canter, A. S., Paige, L. Z., Roth, M. D., Romero, I., & Carroll, S. A. (Eds.), Helping children at home and school II: Handouts for families and educators.
Bethesda, MD: National Association of School Psychologists.
Pertusa A, Frost R, Mataix-Cols D., (2010) ‘When hoarding is a symptom of OCD: a case
series and implications for DSM-V. Behavioral Research and Therapy 2010; in press.
Pridmore S., (2010) ‘OCD – download of Psyciatry’ Chapter 13
Rachman S., (1993) ‘Obsessions, responsibility, and guilt. Behaviour Research and Therapy, vol. 31, pp. 149–154.
Radua J., van den Heuvel O., Surguladaze S., and Mataix-Cols D., (2010) ‘Meta-analytical; comparison of voxel-based morphometry studies in obsessive-compulsive disorder vs other anxiety disorders’ Archives of General Psychiatry, vol. 67, pp. 701-711.
Smari J, (2010) ‘Pathways to inflated responsibility beliefs, responsibility attitudes and
obsessive-compulsive symptoms: factor structure and test of mediational model’
Behavioral and Cognitive Psychotherapy, vol 38, pp. 535-544.
Snider L. A., and Swedo S. E., (2000) ‘Pediatric obsessive-compulsive disorder. The Journal of the American Medical Association, vol. 284, pp. 3104–3106.
Starcevic V., (2005) ‘Anxiety Disorders in Adults’ Oxford University Press: Oxford. 2005.
Swedo S. E., Rapoport J. L., Leonard H. L., Lenane M., and Cheslow D., (1989) ‘Obsessivecompulsive disorder in children and adolescents: Clinical phenomenology of 70 consecutive cases. Archives of General Psychiatry, vol. 46, pp. 335–341.
Salkovskis P. M., (1985) ‘Obsessional compulsive problems: A cognitive-behavioural analysis’ Behaviour Research and Therapy, vol. 23, pp. 571–583.
Salkovskis, P. M. (1989) ‘Cognitive behavioural factors and the persistence of intrusive thoughts in obsessional problems’ Behaviour Research and Therapy, vol. 27, pp. 677–682.
Zohar A. H., (1999) ‘The epidemiology of obsessive-compulsive disorder in children and adolescents’ Child and Adolescent Psychiatry, vol. 8, pp. 445–460.