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Obsessive-Compulsive Disorder in Children and Adolescents

Obsessive Compulsion Disorder also is known as OCD is a mental and psychological disorder wherein the individual experiences repetitive and unwanted thoughts or feelings (obsession) and actions (compulsions).

Obsession behaviour deals with the inability to stop thinking about a particular idea or topic. The individual generally feels such thoughts to be unpleasant, shameful repetitive, distressing and intrusive. Every person has some worries and when a person is preoccupied these are not able to control, they try to get rid of them as these thoughts might become obsessions. They mostly don’t make any sense and hence are unreasonable. It opposes one’s own personality. They lead to depression and are usually in anxiety form. People having these obsessive thoughts will try dealing this by acting out certain behaviours which are known as rituals or compulsions. It is considered that our brain has difficulty shutting down or avoiding impulses from a circuit which leads to repetitive thoughts.

Symptoms of Obsession

Symptoms of Obsession are fear of infection from germs, dirt, poisons, or other physical and environmental substance, disturbing feelings and imaginings about sex, violence, accidents and other problems, need of knowing and remembering things, extreme worry with regularity, accuracy, organization and order.

Compulsion behaviour is where the individual carries out particular behaviour over and over again. The common compulsion signs are excessive washing hands, showering and tooth brushing repeatedly in an excessive manner, repeating number and words many times, making rules and patterns in arranging furniture, objects, books, moving in a particular direction or tapping continuously. Usually, compulsion is identified as senseless by the people having OCD. However, the person becomes helpless to stop his action and need to repeat the compulsion again and again.

It has been found that Anxiety being the most common symptom can lead to the individual believing that something might happen if the specific task not completed. For instance: washing hands repeatedly, excessive double-checking of things like locks and switches, counting multiple times, a religion that includes praying for an hour every day concerning with god doesn’t get offended. Such beliefs result in more anxiety and tension in people suffering from OCD. People with OCD try hard to hide their symptoms as they feel embarrassed by their actions. OCD is known as excessive or unreasonable when at least one obsession or compulsion is repetitive and unpleasant. This symptom lasts for 50- 60 minutes a day and interfering with normal functioning.

The exact causes of Obsessive behaviour therapy aren’t completely known by the researchers. Although it has been observed that Biological factors ie. Genetics, Psychological factors, Societal factors are the main root cause of OCD.

Biological Factors: OCD is also known as a familial disorder as genetics plays a key role in its development. It is believed that Higher risk of OCD is in the people whose paternities or relatives have OCD.

Psychological Factors: The individual becomes habitual and repetitive about the actions, specific thoughts also behaviour patterns develop based on the Learning Process. The thoughts and actions are got conditioned in childhood and affect are seen later in individuals when they grew up.

Societal Factors: Parenting style or other family problems are not just the cause OCD but how the family reacts to kid with kid can also affect the disorder. It is alleged that the behavior of the child either rise or decrease the anxiety because of the parent’s reaction.

Environmental Factors: OCD is also caused by stress and parenting styles although no evidence is there as such high stresses or traumatic life events might swift the arrival of OCD. Though OCD is not caused due to these thoughts but relatively activate it in someone already predisposed to the disorder. The person would feel bad symptoms of OCD such as anxiety and stress in day to day life if left untreated. Difficulty in schools, exam pressure and everyday issues that relationship can bring is all the factors increasing the level of severity of a person’s OCD

The most effective and powerful way to overcome OCD includes psychological therapies such as CBT. CBT stands for Cognitive Behavior Therapy which also identified as conversation therapy that can help you achieve your problems by changing the way you think and behave. Researchers have found out that CBT can also be delivered online, added to the face to face therapy sessions. This therapy can be used for people of all the ages which includes children, adolescents and adults. This theory is beneficial for various conditions like Obsessive Compulsive Disorder, eating disorder, anxiety disorder, major depressive disorder, post-traumatic stress disorder and others. Medications also play a major role in the treatment of OCD if behavioural therapy is problematic. SSRI doses are higher than those recommended for depression. Medications take time to improve symptoms of OCD. It takes two to six weeks to respond to an SSRI to the patients with major depression and 10 to 12 weeks to the people having OCD to respond. There are several side effects of SSRI medications such as distress, restlessness, insomnia and sexual dysfunction as well.

REVIEW OF LITERATURE

John Piacentini, R. Lindsey Bergman, James and McCracken conducted a study on Obsessive Compulsive Disorder with adolescents. The sample of the research were 151 youngsters and a caretaker maintain a list planned to evaluate the effect of OCD on school, social, and family functioning. The 2 mutual problems identified related to OCD were focused on a school assignment and doing the home assignment. However, 90% of youngsters testified at least one significant OCD sign, and the rest of them testified vital OCD-related problems at school, home, and socially. Parents are more often to account important losses in home and school working than children. Impairment rankings were expressively associated with clinician-generated dealings of OCD severity. These conclusions deliver the accurate description thus far of the negative effect of OCD on child psychosocial functioning

A M Ruscio, D.J Stein, W.T Chiu and R.C Kessler (2010) investigated the study on the epidemiology of OCD in the National Comorbidity Survey Replication. The study focused more on health significance, proper analytic type, and clinical heterogeneity. The results found that more than one-quarter of respondents testified facing obsessions or compulsions at some point in their lives. Although the qualified chance of OCD was powerfully related to the sum of obsessions and compulsions stated, whereas only a few people matched with full DSM-IV criteria for the period. Therefore, this conclusion shows that OCD is attached through high comorbidity, not one with anxiety and temper problems however additionally with impulse-manipulate and substance use issues.

Mark A.Riddle M.D, Robert King M.D and James F. Leckman M.D assessed the study on 21 kids and teen-agers with OCD on the basis of Phenomenology and family history. Every child and family joined in a standard clinical psychiatric test. The most common symptoms reported were repeating actions, washing, organization and placing, checking, and infection concerns. The results showed that controlling behaviours linking other family members were seen in 57% of the patients. Psychopathology was observed common: 38% diagnosed with an anxiety disorder whereas 29% diagnosed with a mood disorder; tics were detected in 24%. Fifteen of the kids had a parent with either OCD or its symptoms.

Lewis R. Baxter, Jefferey.M. Schevartz, Bergman (2009), conducted a study on “Glucose Metabolic Rate Changes with Both Drug and Behavioral Therapy for OCD”. The statistical tools used in this study were Position Emission Tomography and Behavioral Therapy. The result showed that after treatment LCMR GI was decreased compared to pretreatment due to both drugs and behavioural therapy.

Rasmussen, Steven A., Tsuang.Ming T. (2011), conducted a study on “Clinical Characteristics and Family History in DSM-III OCD”. The statistical tool used in this study was DSM-III. The sample for the research was a total of 16 males and 28 females aged 25- 30. The result showed that the findings are consistent. OCD or obsessive traits were shown in a number of 1st-degree relatives.

S.Saxena, A.L.Brody, J.M.Schwartz, L.R.Baxter (2018), conducted a study on “Neuroimaging and Frontal-Subcortical Circuitry in OCD”. The statistical tool used in this study was a literature search. The result showed that a small group of OCD- patients might be having abnormal basal ganglia development. Neuroimaging studies that symptoms of OCD are related to increased activity in the thalamus and caudate nucleus.

Martine F., Agenes Whitaker, Judith L. (2013), conducted a study on “OCD in Adolescence- An Epidemiological Study”. The sample for research was a total of 356 students. The results showed that Characteristics of OCD cases were similar to clinical cases, except for non-predominance of males. OCD is underdiagnosed and undertreated and that it is very common during adolescence.

Jeffery M.Schwartz, Paula W. Stoessel, Lewis R. Baxter (2009), conducted a study on “Systematic Changes in Cerebral Glucose Metabolic Rate After Successful Behavior Modification Treatment of OCD”. The sample for the research was a total of 9 people with OCD”. The results showed that there was a significant decline in caudate glucose metabolic rates of responders having Behavioral Therapy than those seen in poor responders to the treatment.

Hans C.Breiter, Scott Rauch, K.Kwong (2016), conducted a study on “Functional Magnetic Resonance Imaging of Symptom Provocation in OCD”. The sample for the research were 10 patients with OCD and 5 normal subjects. the results showed that more than 70% of patients having OCD in lateral frontal, anterior temporal, anterior cingulate and insular cortex showed activation. Normal subjects did not show activation in any part of the brain.

Martijn Figee, Matthijs Vink and Herman Westenberg (2006) evaluated the first functional imaging study to investigate explicitly reward circuitry in OCD. Brain activity throughout reward anticipation and receipt become as compared between 18 OCD sufferers and 19 healthy control subjects, using a monetary incentive delay task and functional magnetic resonance imaging as a technique. Reward processing became as compared among OCD patients with contamination fear and patients with the largely high-risk assessment. The results presented that OCD patients showed reduced reward. Reduced activity of the nucleus accumbens was more obvious in OCD patients with contamination fear than in patients with the high-risk assessment. This concludes that OCD clients may be less able to make beneficial picks due to different nucleus accumbens stimulation when anticipating rewards.

Susan Swedo, Mark Schapiro, Cheryl Grady (1989), conducted a study on “Cerebral Glucose Metabolism in Childhood-Onset OCD”. The sample for the research was a total of 18 adults. The statistical tool used in this study was Position Emission Tomography and Fludeoxyglucose E18. The results showed that people with OCD showed an increased glucose metabolism in left orbital frontal and right sensorimotor.

Abdel Hamid, Nasreldin M., Gohar SM (2019), conducted a study on “Sexual and Religious Obsessions in Relation to Suicidal Ideation in Bipolar Disorder”. The sample for the research was a total of 90 patients having bipolar I disorder. The statistical tool used was Dimensional Yale-Brown Obsessive-Compulsive Scale (DY- BOCS). The results displayed that patients having bipolar disorder and sexual/ religious obsessions showed more number of suicidal attempts and severe depression compared to those without sexual/ religious obsessions.

Zamanian- Azadi, Rezoel- m, Mahboubi M., Hanidpoubi M. (2018), conducted a study on “Serum Proteomic Study of Women with OCD, Washing Subtype”. The statistical tool used was Two- Dimensional Electrophoresis and Mass Spectrometry. The results showed that 240 protein spots were detected. The enrichment analysis showed that inflammation is one of the dominant processes in OCD.

Ganos C., Cerdan M., Erro R. (2015), conducted a study on “Revisiting the Syndrome of Obsessional Slowness”. The sample for the research was a total of 3 patients diagnosed with obsessional slowness. The results showed that the 3 cases had poor speech production, bizarre postures, mannerisms and echo phenomena. In 2 cases dopaminergic imaging was normal and 1 case had autistic features.

Bunmi O. Olatunji, Michelle L. Davis and Mark B. Powers (2013) conducted a study to observe the value of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) and treatment that may link up with the result. The sample size was 16 random control trials and total size was of 756 Participants. Results showed that CBT outperformed succeed situations on number one outcome measures at put up-remedy and at observe-up. Neither higher pre-remedy OCD or depression symptom severity turned into much related with a decrease in CBT impact size.

Tord Ivarsson and Karin Melin (2009) conducted a study on autistic traits in kids and adolescents with OCD. The psychiatric interview and the Children’s Yale-Brown obsessive scale were the two-method cast-off to assess the OCD and autism in the subjects. The results showed that AST was common among all the patients but Symptoms of other disorder such as OCD also scored higher. This concludes that AST traits are predominant in OCD and seem to be complicatedly linked with the co-morbidities and OCD syndrome itself.

Cynthia G. Last and Cyd C. Strauss (2011) conducted a study on OCD in Children. 20 youngsters who met DSM-III-R standards for OCD (OCD) were diagnosed between 190 consecutive referrals to an anxiety clinic for kids and adolescent. The method used for evaluating was psychopathology with structured interviews and sociodemographic data was gathered from children and their families The results revealed that Clinically referred childhood OCD is greater common among boys.

Michelle Rozenman and R. Lindsey Bergman investigated a study on the assessment of children with Obsessive Compulsive Disorder to understand the youth’s symptoms and to look out the appropriate psychological treatment goals. The questionnaire was the method of assessing the symptoms of OCD. The findings revealed that Tasks in the assessment are discussed and approvals provided for the active clinician.

Prof. Dr. med, Dr Dipl.-Psych, and Andreas Warnke (2011) conducted an investigation on “OCD in Kids and Youngsters. The method used to evaluate was the related literature and the German-language ideas for the analysis and treatment of mental illnesses in kids and adolescents. The results stated that Obsessive-compulsive are of many kinds and cause serious impairment. Comorbid mental disorders are present in 70% of patients. The disorder becomes chronic in 40% of the patients. Cognitive behaviour therapy and SSRI is preferred for treating the sufferers of OCD. This concludes that OCD activates in kids or adolescence. They basically based on neurobiological and cognitive-behavioural models of its pathophysiology. Behavioural therapy and medications are highly recommended for dealings, but the disorder, however, takes a long-lasting path in lots of patients.

Chris Weaver and Joseph M.Rey (2016) conducted research on describing the features of Kids and young people with obsessive-compulsive disorder (OCD) and assess the result of treatment. The method they adopted was a different kind of symptoms, intensity before and after medical care and factors linked with result were examined in a large group of following OCD cases stated for treatment. The results declared that 90 % of the kids had both obsessions and compulsion. This concludes that Young OCD can be treated efficiently in a normal clinical setting. Treatment plans of the sort described are every day via younger people. It is believed that in this age group a united treatment intrudes better outcomes than medication or cognitive-behaviour therapy.

Simon Baron (2015) studied out autism children reporting Obsession and Compulsion. The result showed that it’s because autistic kids are unable to view or express their own mental states and because of this inadequate evidence, it is advocated that the terms obsession and compulsion must be used with a good-sized warning to describe autistic behaviours.

Eli R Lebowitz, Michael H Bloch and Jessica Su (2014) investigated a study on family accommodation in OCD. Family accommodation stands for taking part in the act of rituals, escaping of anxiety-provoking situations or change of daily routines to support a relative with obsessive-compulsive disorder (OCD). The result showed that Family accommodation is linked with improved parental OCD and anxiety signs. Levels of accommodation are related to treatment results for both behavioural and pharmacological treatment also improvement of OCD symptoms with treatment is allied with drops in family accommodation.

Jennifer B. Freeman, Molly L. Choate-Summers and Abbe M. Garcia (2011) studied out CBT for Young kids with OCD. The study contains a quantifiable analysis of a child CBT studies to assess sign for the value of CBT for OCD. The result identifies breaks in the works that, though talked, would improve the kind of the behavior in pediatric OCD.

Susan E. Swedo and Judith L. Rapoport (2009) investigated a study on children onset Obsessive Compulsive Disorder where clinical presentation allied diagnoses, family psychopathology, treatment, and the long-term result of OCD in kids and youngsters was reviewed. The data was collected from 70 Patients. The findings of a youngster epidemiologic study was obtained and compared with the mentioned pattern, and resemblances and changes among the person and childhood-onset OCD were revealed.

Christine Lochner and Sian M.J. Hemmings (2010) conducted a study on Gender in OCD regarding clinical and genetics. The sample size was of 220 patients with OCD. Clinical and genetic data were statistically examined across gender. The outcomes were compared between women and men which displayed different patterns of OCD. The study concludes that the study supports the theory that gender encourages to the clinical and biological variety of OCD.

DISCUSSION

Obsessive Compulsion disorder is a mental and psychological disorder wherein the individual experiences repetitive and unwanted thoughts or feelings (obsession) and actions (compulsions). Genetics play a major role in manifesting the disorder in certain environments. Family transmission due to genetic factors. Obsessions and compulsions are repeated and continuous views, instincts, or images that are experienced as distressing and source of anxiety or distress.

If thoughts, impulses, or images try to go outside the normal range of worries can lead to direct problems such as severe anxiety. A person may try to avoid or suppress such obsessions, or to neutralize them by thinking about some other thought or action.

The best way to overcome Obsessive Compulsive Disorder is to teach the individual to become your own therapist. Cognitive Behavioral Therapy is one of the most reliable therapy to manage the symptoms properly. OCD is a tough behaviour to live with. It disturbs almost every single part of a person’s life whether it is family interaction or friends or simple normal tasks that we all take for granted. Guilt and Doubt are the two main features of OCD. It is believed that OCD can make subject doubt even the most basic things about themselves, others, or the world they live in. Doubt is one of the more frustrating assets of OCD where the subject starts feeling whether they are actually alive or not.

KEY LEARNING

OCD is an anxiety disorder experienced by 2.5 % of the population.
Prevalence is the same for men and women
Obsessions are unwanted thoughts or impulses that cause stress and anxiety in the individual
Obsessions are behaviour that is carried out to reduce anxiety.
Cognitive Behavior Therapy (CBT) is the most effective and safe for treating patients of OCD.