Obsessive-Compulsive Disorder Obsessive-Compulsive and Related Disorders Chapter 11

OCD Presence of obsessions, compulsions, or both Obsessions Recurrent, intrusive, & persistent thoughts, urges, or images (e.g., a fear of developing a serious disease) Obsessions cause anxiety and distress children attempt to ignore or suppress obsessions w/ compulsions Compulsions Repetitive behaviors (e.g., hand washing) or mental acts (e.g., praying) that are performed in response to an obsession Aimed at preventing or reducing distress or preventing dreaded event/situation Obsessions and/or compulsions = time consuming (> 1 hr/day) or cause significant distress or impairment

Most Common Childhood Obsessions Concern with dirt, germs, or environmental toxins Concern that something terrible will happen such as fire, death, or illness Symmetry, order, or exactness Scrupulosity (religious obsessions) Lucky/unlucky numbers Concern or disgust with bodily wastes or secretions

Most Common Childhood Compulsions Excessive or ritualized hand washing, showering, bathing, tooth brushing, or grooming Repeating by going in and out of door or up and down from chair Checking doors, locks, stove, homework Rituals to remove contact with contaminants Ritual touching or a pattern of tapping

Obsessive Compulsive Disorder Prevalence = 1-2.5% 2x as common in boys as girls Mean age of onset = 9-12 yrs Predictions of poorer outcome: younger age at onset of OCD poor initial response to treatment hoarding symptoms in childhood lifetime history of tic disorder parental psychopathology

CBT for Childhood OCD Identify child’s “worries” (i.e., obsessions) Gently challenge worries Replace obsessions with more adaptive thoughts “Coping statements” Exposure and response prevention Expose child to obsessions Prevent child from engaging in compulsions

A plague of tics – Sedaris What types of symptoms does Sedaris show? We’ve talked about how distress sometimes manifests differently in children compared with adults. What insight does Sedaris give us into his distress? Does he demonstrate dysfunction? Does he demonstrate danger? Does he demonstrate deviance?