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NASP Communiqué, Vol. 36, #2
October 2007
Obsessive-Compulsive Disorder:
Information for Parents and Educators
By Leslie Z. Paige, EdS, NCSP
Fort Hays State University
Obsessive-compulsive disorder (OCD) is a type of anxiety disorder that causes unwanted, obsessive
thoughts and compulsive, repeated behaviors. The ritualistic behaviors associated with OCD are
an attempt to cope with the intrusive obsessive thoughts. For example, a child with obsessive
thoughts regarding disease or contamination might frequently wash his or her hands. OCD symptoms
range from mild to severe, and can interfere with school or social functioning.
Background
Approximately 2–3 % of adults and children have OCD. Rates of OCD in children are approximately
1.9%. Because people with OCD may try to hide the symptoms, this number may be an underestimate.
Symptoms in females usually begin in young adulthood, and symptoms in males usually
begin between the ages of 6 and 15. OCD occurs equally in both genders and is present in all
ethnic groups. The earlier OCD is diagnosed and treated, the better the outcome. The cause of
OCD is unknown, but research suggests it may be due to a problem with the way information is
processed in the brain. OCD appears to result from a biochemical imbalance that causes the brain
to send false messages of danger and prevents screening. There is also research suggesting that
OCD may be a learned response to reduce anxiety through compulsive behaviors, sometimes triggered
by a stressful event. Diagnosis of OCD is usually made by a mental health provider or physician
and is based upon the symptoms.
Characteristics of OCD
Individuals with OCD exhibit obsessive thinking and compulsive behaviors. They typically report
that they feel unable to control their thoughts and feel compelled to perform the behaviors.
Symptoms may worsen when stressed, ill, or sleep deprived.
Symptoms and Patterns of OCD
Obsessions. These are involuntary, recurring, unwanted thoughts that cause feelings of anxiety or
dread. Obsessions are irrational and interfere with normal thinking. Common obsessions include
fears of contamination, disease, or causing harm; sexual images; doubting (checking locks);
thinking something must be done a certain number of times or keeping items in certain positions
to avoid harm; hoarding; and fears associated with religion.
Compulsions. These are behaviors that are repeated to try to control the obsessions. These behaviors
reduce anxiety temporarily, but the urge to perform the compulsive behavior becomes stronger
over time. Other compulsive behaviors may be added when the original compulsive behaviors
become less effective in reducing anxiety. The vicious cycle of OCD is that more elaborate rituals are
needed to provide relief from the unwanted thoughts. Sometimes it is possible to see the connection
between the obsession and the compulsion, such as fear of contamination and washing hands.
However, sometimes there is no logical link, such as needing to wear certain clothes to prevent a burglary.
Some children can delay performing the compulsive behavior, but this is very difficult and they
will nearly always engage in the compulsive behavior later.
Common compulsions include:
- Excessive washing and cleaning
- Counting
- Checking (checking and rechecking locks, appliances)
- Hoarding (cannot throw things away)
- Praying (continuous and excessive)
- Redoing (opening and closing, erasing and rewriting)
- Symmetry (movements need to match, things have to look the same)
Some compulsions cannot be observed (such as counting rituals), but others can be easily seen
(such as hand washing).
Impact of OCD Symptons
Key questions to ask when diagnosing OCD include: How time consuming are the behaviors?
What is the degree of distress? How much do the obsessions or compulsions interfere with daily
functioning? Although many people may feel anxious and check to see if they left the iron on, once
they determine that it is off they can go about their daily lives. Individuals with OCD need to check,
recheck, and check again, and this can involve an hour or more. Cleaning household items with
disinfectant as part of housekeeping or during flu season is a good habit, but cleaning schoolbooks
dailywith disinfectant and washing hands until they bleed may indicate a problem. As a result of
the compulsions and obsessions, OCD can be very disruptive. Depression, agitation, difficulty paying
attention, feelings of shame, stress, and slow performance (owing to time-consuming rituals)
and other problems may be associated with poor academic performance and difficulties with family
and social relationships.
Treatinig OCD
Early diagnosis is important. There is no cure, but a combination of medication and cognitive behavior
therapy is considered to be the most effective treatment.
Medication. There are medications that are effective for treating OCD. Medication helps to
decrease the feelings of anxiety and the intensity of the symptoms, and allows the child to ignore
or turn down the volume of the obsessive thoughts.
Cognitive-behavior therapy. Children with OCD benefit from learning to cope with the obsessive
thoughts and reduce the compulsive behaviors. Many individuals with OCD believe that they are
going crazy and knowing what the disorder is and the brain’s role in tricking individuals into thinking
that there is danger or a threat can help to alleviate this fear. Therapy helps to decrease the
symptoms, provides explanations for the behaviors, and teaches children strategies to deal with
OCD. Treatment strategies vary, depending upon the age of the children and the severity of the
symptoms. Sometimes the behavior is limited by setting a time limit. For example children are
allowed to pray for 10 minutes instead of 2 hours. Sometimes children will be asked to perform rituals
in reverse order, or to engage in a different activity. The mental health practitioner can help children
find ways to keep OCD from controlling their lives.
Support From Families
Living with a child with OCD can be very challenging. OCD can disrupt families. Simply telling the
child to stop the behavior will be ineffective. Some families may accidentally encourage the rituals;
for example, by helping the child turn lights on and off in a set pattern. These reactions do not
reduce the child’s feeling of anxiety or danger. Many parents report feeling fear, frustration, or
anger when their child engages in these disruptive rituals. It is important for parents to participate
in therapy sessions to learn about OCD and how to help their child. Parents can help by learning
how to help their child follow the treatment plan and to take the medication. Support groups
may also be beneficial for parents.
Support From School Personnel
Identifying OCD. Children with OCD typically try hard to hide their disorder, which makes diagnosis
difficult. Teachers can help by becoming educated about OCD. If they notice that there is a
child who seems to engage in time-consuming strange behaviors that are repetitive, and interfere
with social or academic functioning, they should consult with their school psychologist or school
counselor. Some children with OCD exhibit behaviors commonly associated with Attention Deficit
Hyperactivity Disorder. For example, a child with OCD may appear inattentive because he or she
is focused on obsessive thoughts. A lesson in math or spelling is less compelling than the fear that
the house may burn down or the belief that he or she is contaminated with cancer or AIDS. The
child may become agitated because he or she wants to engage in a ritualistic behavior but wants
to comply with classroom rules to stay seated.
Interventions. Good communication between home and school is very important. Teachers can help
work with the child and the family to help alleviate symptoms by following through on treatment plans
that involve the school day. Plans for dealing with certain behaviors that work at home may be helpful
at school. Information from the outside mental health provider and/or school psychologist will be
helpful in understanding and helping the child in managing the OCD. The school nurse may need to
administer medication during the school day. The school psychologist will be able to assist with educational
and behavioral strategies to decrease anxiety, reassure the child, and reinforce coping skills.
A well-structured classroom with clear expectations, smooth transitions, and a calm climate is
helpful for most students, but particularly for the child with OCD. Be aware of any teasing or problems
with social relationships. Punishing or embarrassing the child are ineffective and should be
avoided because they may make the behaviors worse. The symptoms will tend to worsen if the child
is feeling stressed. Teachers may need to know how the obsessive thoughts or compulsive behaviors
are interfering with academic or social behaviors. For example, some children may need extra
time to take a test because they need to check and recheck their answers. Children with contamination
fears may be unable to tolerate being touched. Some children with OCD may qualify for special
education services if the disorder interferes with learning or behavior to a significant degree.
Summary
The symptoms of obsessive-compulsive disorder can be extremely disruptive and distressing.
Children with OCD can be helped with a combination of medication and cognitive-behavior therapy
designed to reduce the intensity of the obsessions and decrease the compulsive behaviors.
It is important that caregivers and educators learn about OCD and how to work together with the
child to manage the behaviors and implement the treatment plans.
Resources
Chansky, T. E. (2000). Freeing your child from obsessive compulsive
disorder. New York: Three Rivers Press. ISBN:
0812931173.
Websites
National Institute of Mental Health:
www.nimh.nih.gov/publicat/ocd.cfm#ocd2
OCD Foundation: www.ocfoundation.org/ocf1010a.htm
Web MD: www.webmd.com