Some kids like to wash their hands, but Sarah does it too much.
She wants to stop, but her hands just don't feel clean enough
and she can't make herself turn off the water. Sometimes she
scrubs her hands until they are red and raw. After eating, she
feels she has to wash again.
Because she spends so much time washing, Sarah has to rush to
get to school on time. At school, she tries not to touch doorknobs
or handrails, worrying that if she does she may catch a serious
disease. Sometimes, Sarah gets behind in her classwork because she
feels that she needs to keep checking it over and over.
During a quiz or test Sarah checks and rechecks every answer and
erases anything that isn't perfectly straight or neat.
Sometimes she erases so hard it tears the paper, but she can't
help it. Sarah gets a bad feeling that if everything isn't
exactly right, something terrible may happen. All this worrying,
checking, and fixing takes so long that Sarah hardly ever finishes
the test before time is up. So even though she knows the work, she
often gets an incomplete mark or even fails.
Sarah tries so hard to hide her habits. She worries that she
might be going crazy or that people would think she's weird if
they knew what she was doing. Sarah knows that the time she spends
washing and checking could be spent having fun with friends or
doing her schoolwork, but she can't seem to stop herself.
That's because Sarah has
obsessive-compulsive disorder
(OCD)
.
What Is OCD?
OCD is a type of
anxiety
(say: ang-
zye
-uh-tee) that happens when there is a problem with the way the
brain
deals with normal worrying and doubts. Kids with OCD worry a
lot
. Sometimes they feel afraid that bad things could possibly happen
to them, sometimes they feel that something bad could happen to
people they love, or sometimes they feel like they have to get
things "just right" and have to check to make sure.
Like Sarah, some kids with OCD are afraid of getting dirty or
catching
germs
. Others always worry that their parents will get sick or hurt.
Some kids feel that they have to say things a certain number of
times, ask questions over and over again, or keep things
super-clean as a way to keep bad things from happening.
Some kids even worry about thinking bad thoughts. They sort of
believe that thinking bad things could make them come true.
Some kids may also worry about things being out of
"order" or not "just right" and they may worry
about losing "useless" items or feel the need to collect
them.
People with OCD worry so much that they can spend many hours, or
even the whole day, worrying about things and trying to make sure
the bad things they worry about don't happen.
Normal Worry or OCD?
Of course, it's normal to worry now and then. Everyone does.
Kids may
worry about
getting lost or that something will happen to their parents. They
may sometimes feel afraid that they will get sick or hurt. It's
normal for kids to worry once in awhile about burglars,
fires
, or earthquakes. Sometimes, worrying can help kids learn how to be
safe and careful. Normal worries come and go without causing too
much of a problem.
But OCD is much more than normal worry. Instead, the worry is
really intense and it can happen over and over again. With OCD, the
brain replays the worry thoughts and if nothing is done, the worry
feeling can get worse and worse.
These frequent worry thoughts are called
obsessions
(say: ob-
sesh
-unz), and the behaviors people do to try to make the worry
thoughts go away are called
compulsions
(say: kum-
pul
-shunz).
What Are Obsessions?
A kid who has OCD might have obsessions about illness or injury
or cleanliness. And these obsessive worries just don't quit.
The brain keeps repeating them instead of moving on to something
else. It can be a lot like that awful song you hear that gets stuck
in your head. No matter how much you don't want to hear it,
your brain just keeps playing it back. The difference is that the
obsessive thoughts come with anxiety.
Having upsetting thoughts that you can't get rid of can feel
terrible and scary. And having so many worry thoughts can make it
hard to concentrate on anything else. OCD can take the fun out of
almost anything.
With OCD, someone may have obsessions about:
- germs or dirt
- illness or injury (involving the person or someone else)
- coming across unlucky numbers or words
- things being even or straight
- things being perfect or just right in a certain way
- making mistakes or not being sure
- doing or thinking something bad
What Are Compulsions?
Compulsions are the behaviors, or actions, that someone with OCD
does to try to shut down the worry thoughts. Another name for
compulsions is rituals. By doing compulsions, people with OCD hope
to keep bad things they worry about from happening. They believe
that doing a certain ritual will make the bad feeling go away and,
for a while, it often does. They feel scared that if they don't
do the ritual something bad will happen. Some kids may have a
difficult time explaining a reason for their rituals and they do
them "just because." But in general, by doing a ritual,
someone with OCD is trying to feel absolutely certain that
something bad won't happen.
Of course, plenty of people who
don't
have OCD have rituals or actions that are important to them. Maybe
you tap your pencil three times before starting a tough test or
sing a certain song just before diving off the high dive. Perhaps
you have a lucky number or even a lucky pair of socks. But OCD
compulsions are much more than doing something just for luck.
Kids with OCD feel they
have
to do certain things over and over to feel protected from unlucky
events or make the anxiety go away. Kids with OCD don't really
want
to be doing rituals. But when you have OCD, performing the rituals
seems like that's the only way to feel safe from bad things
happening.
And the more kids with OCD do these rituals, the more they feel
like they have to do them. Kids with OCD can end up spending so
much time on rituals that they have little time left for the things
they really do want to do.
Here are some OCD compulsions:
- lots of hand washing or showering (doing this way more than
usual or having a hard time stopping)
- counting (like having to count 25 white cars before going
into school)
- touching (like touching every single fence post between home
and the bus stop)
- checking things over and over (such as doors, locks, or
stoves)
- doing things a certain number of times (like having to try on
five dresses before leaving your room)
- arranging things in a very particular or neat way
- asking the same question over and over
- tying and retying shoes over and over until they feel just
right
- re-reading, erasing, and re-writing
What Causes OCD?
Obsessive-compulsive disorder isn't contagious, so you
can't catch it from someone like you can a cold. Second, kids
with OCD have not done anything wrong or bad to get it. It's
not their fault that they have it.
Nobody knows exactly how and why some people get OCD, though
scientists are beginning to learn about it. Experts know that:
- OCD runs in families. Many kids with OCD have another person
in their family who has OCD or another type of anxiety. Exactly
how OCD is passed on in a family is not yet known, but scientists
are trying to learn about
genes
that may get passed on that make people more sensitive to worry
problems like OCD.
- OCD comes from a problem with the way the mind handles
messages about fear and doubt. This problem probably has to do
with the chemicals that carry messages to nerve cells in the
brain. If the flow of these chemicals gets "blocked,"
or if there is not enough of them, messages about doubts and
worry seem to get "stuck." This leaves a person with a
feeling that something's not right and creates lots of worry
thoughts.
- Some experts are studying the connection between OCD and the
body's immune system response to a
strep infection
. In some cases, it seems that OCD and strep infections may be
related. When OCD starts after a strep infection, the symptoms
appear suddenly and very intensely. Most people who get strep
infections, though,
don't
get OCD.
Who Gets OCD?
Kids with OCD are not alone. In the United States, about 1
million children and teens, both boys and girls, have OCD.
That's about 1 in every 200 children and teens. In some studies
including adults, OCD was reported as commonly as 1 in 50 people.
You might know someone who has OCD and not even realize it.
What's Life Like for Someone With OCD?
Living with OCD can be very hard. Compulsions often take up lots
of time and energy, making it hard to finish homework, do chores,
or have any fun. Some kids even find it difficult to go to school
or make friends. Sometimes kids feel ashamed. They know the
behaviors seem silly to other people, so they often keep it to
themselves. It can be really difficult to talk about OCD! But
dealing with something all alone can make it even harder.
Sometimes, even parents and friends who know about a
person's OCD have a hard time understanding that OCD is not
just a bad habit. They might act impatient or make it seem like a
person could just stop if he or she tried hard enough. But with
OCD, the need to do rituals can feel too strong to ignore. Some
kids say that OCD is like hearing a constant, nagging voice that
tells them bad things could happen if they don't do certain
things. Some kids say it seems like OCD takes over everything.
Treatment for OCD
Treatment can really help kids with OCD get better. OCD can be
treated in two ways: with
medicine
and behavior therapy. Medicines that help brain chemicals work
properly can help kids with OCD. How? These medicines can make the
obsessions and compulsions feel less intense, and they also help
tone down the worry and fear. By itself, medicine doesn't
completely fix OCD, and many kids with OCD don't need medicine
to get better. But for some kids, medicine sure does help.
With or without medicine, a special type of "talk
therapy" is the most important part of treatment for kids with
OCD. This type of therapy is called cognitive behavior therapy
(also called cognitive-behavioral therapy). For most kids with OCD,
cognitive behavior therapy helps them learn to deal with anxiety,
to face fears, to resist compulsions, and to slowly but surely
conquer OCD.
What's Behavior Therapy for OCD Like?
Lots of mental health specialists, psychiatrists, psychologists,
and counselors (also called
therapists
) are trained to do the cognitive behavior therapy that works for
OCD. The therapist might start by just getting to know the child
and parents. The therapist might ask about favorite activities or
TV shows, pets or hobbies, or particular sports.
The therapist will also ask some questions about problems with
worry and rituals that the child has been having. Then the
therapist will explain about OCD and how the cognitive behavior
therapy works to help it get better. The therapist will help
parents understand the child's OCD and what they can do at home
to help it get better, too.
In cognitive behavior therapy for OCD, kids learn different ways
to deal with their worries
without
doing a ritual. At first, it may seem hard to stop doing rituals,
but the therapist can teach kids how to feel safe enough to try.
It's definitely tough at first, but if they stick with it, kids
begin to feel stronger and braver against OCD.
After learning about ways to get their worries under control,
kids start to practice them. As with anything new (such as playing
the piano or kicking a soccer goal), the more someone practices,
the better he or she can do it. When kids practice what they learn
in behavior therapy, they find out it actually works!
Kids with OCD usually go to therapy about once a week (or
sometimes more often) for a while, then less often as they begin to
get better. Getting better can take anywhere from a few months to a
few years.
It's important to remember that with some help, kids with
OCD can get better. Kids usually are really relieved when the
symptoms of OCD get weaker and they begin to feel stronger. It
feels good to be free of OCD!
Reviewed by:
Elana Pearl Ben-Joseph, MD
Date reviewed: November 2008
Originally reviewed by:
David V. Sheslow, PhD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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