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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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?