Obsessive Compulsive Disorder, The Treatment

He had a routine for everything. Joseph has Obsessive-Compulsive Disorder.

While standing over his bureau, Joseph says, “I’d have to touch all these corners until it felt right on my hands and sometimes that could be two hours or three hours on just one corner. And I could never end it on the left side because the left side was always bad.”

Drugs didn’t help. So Joseph turned to a behavioral therapist. Psychologist Dr. Elana Zimand, Director of Clinical Services for Virtually Better, says, “Most people when I start doing this with them, don’t really want to come back and see me anymore, because it’s very hard work. But it’s so effective.”

She forces her patients to break their routines. For example, if the obsession is germs, and the compulsion is endless hand washing, Dr. Zimand says, “I might have people touch a toilet seat like this, and then rub their hands together. Sometimes I’ll even have them touch their face.”

Patients learn, in time, their anxiety will diminish. Dr. Zimand says, “Their need to wash immediately will actually go down over time, and it will show them that they can start breaking up that pattern of getting germs and washing immediately. They can tolerate the anxiety of that obsession.”

His therapist taught him to stop touching and counting and repeating. Now, if Joseph doesn’t act on his compulsions, he says, “It bothers me, but I made it into a game…I let it bother me. I’ll be saying it can bother me, it’s not a big deal.”

He worked every day for six months. Today his compulsions are under control. He says, “I don’t do compulsions like count anything. I mean I get the need to but I don’t do it, because I don’t want to do it. I don’t want to waste my time you know.”

Research is beginning to indicate that Obsessive-Compulsive Disorder (OCD) is a function of abnormal brain activity, not a result of a bad home life or learned childhood attitudes or behaviors. It has also shown that for every 100 people, two or three suffer from this disorder. Consider the following statistics developed by experts at the Child Development Institute:

• About 2.3 percent of the U.S. population ages 18 to 54 – approximately 3.3 million Americans – have OCD in a given year.
• OCD affects men and women equally.
• OCD typically begins during adolescence or early childhood; at least one-third of the cases of adult OCD began in childhood.
• OCD costs the U.S. $8.4 billion in 1990 in social and economic losses, nearly 6 percent of the total mental health bill of $148 billion.

OCD can be a big enough struggle by itself for parents and children, but there are a number of additional psychiatric conditions that may accompany the disorder, thus adding to the burden. Experts at the Obsessive-Compulsive Foundation encourage parents to be aware of the possibility of the following conditions that may affect children suffering from OCD:

• Additional anxiety disorders (such as panic disorder or social phobia)
• Depression or dysthymia
• Disruptive behavior disorders (such as oppositional defiant disorder or attention-deficit hyperactivity disorder)
• Learning disorders
• Tic disorders or Tourette’s syndrome
• Trichotillomania (hair pulling)
• Body dysmorphic disorder (imagined ugliness) Sometimes comorbid disorders can be treated with the same medication prescribed to treat the OCD. Depression, additional anxiety disorders, and trichotillomania may improve when a child takes anti-OCD medication.

It is important to be aware of the symptoms of OCD, and if they are present in your child, to provide him/her with an atmosphere of support and comfort. Dr. John M. Grohol, of Psych Central, has developed the following list of OCD warning signs:

Obsessions: 

• Contamination – excessive concern over germs, disease, illness, contagion, etc.
• Harm to self or others – irrational fears such as causing a car crash, stabbing himself or herself or another person with a knife or other sharp object, etc.
• Symmetry – need to have possessions/surroundings arranged symmetrically and/or to move in symmetrical ways.
• Doubting – becoming convinced that he or she hasn’t done something he or she is supposed to do.
• Numbers – fixation on a particular number or series of numbers; performing tasks a certain number of times regardless of sense or convenience.
• Religiosity – preoccupation with religious concerns such as the afterlife, death or morality.
• Hoarding – stockpiling of useless or meaningless objects such as old newspapers or food.
• Sexual themes – obsessive thinking about sex; disturbing writing or doodling of a sexual nature.

Compulsions:

• Washing and cleaning – washing hands until they are red and chapped; brushing teeth until gums bleed.
• Checking – returning to check that the door is locked more than once.
• Symmetry – need to have socks at same height on each leg; cuffs of exactly equal width.
• Counting – counting of steps while walking; insistence on performing a task a specific number of times.
• Repeating/redoing – performing a mindless task repeatedly until it “feels right;” redoing a task that has already been acceptably completed, such as erasing letters on a page until the paper wears through.
• Hoarding – hiding food under the bed; refusing to throw away soda cans or gum wrappers, for instance.
• Praying – excessive, time-consuming repetition of protective prayers or chants.

If you believe your child is suffering from OCD, remember to avoid making him/her feel as if he/she is to blame. OCD is nobody’s fault. A medical specialist will be able to evaluate your child to determine if he/she has OCD and to decide what treatments are needed. OCD treatments generally include medications and/or behavioral therapy.

Child Development Institute
Obsessive-Compulsive Foundation
Psych Central
OCD Online