Obsessive-Compulsive Disorder (OCD

Up until about 20 years ago, OCD was thought to be a very, very, rare disorder.  I only saw two cases in my training in the mid 1980's, and neither were children.  It wasn't important to find OCD anyway - little was known about it and there were no effective treatments.  Over the last decade, everything has changed.  We now know that OCD is one of the most common neuropsychiatric disorders.  It is also one of the most treatable ones.  In pediatric psychiatry I am always on the lookout for OCD because it is common and often very treatable.

To be diagnosed with OCD, a person must have obsessions or compulsions or both.  Besides this, the obsessions and/or compulsions must be disabling.

These are thoughts which are invisible to anyone else.  The thoughts bring some distress to the person.  The person wishes they did not have these thoughts.  They are not based on what is realistically worrisome in that person's life.  These thoughts occur over and over, usually hundreds of times a day.  A person spends so much time thinking about these things they have a hard time doing their work, taking care of themselves, or relating to others in a normal way.

The most common ones in children are fears of bad things happening to family members, exactness and symmetry, bodily functions, lucky numbers, and less likely, sexual and aggressive thoughts.  Religious obsessions are less common.  Here is the official definition.

1. Recurrent and persistent ideas, thoughts, impulses, or images that are experienced at some time during the disturbance as intrusive and inappropriate and cause marked anxiety or distress.

2. The thoughts, impulses, or images are not simply excessive worries about real-life problems.

3. The person attempts to ignore or suppress such thoughts, impulses, or images to neutralize them with some other thought or action.

4. The person recognizes that the obsessional thoughts are the product of his or her own mind (they are not hallucinations.  They are not felt to be inserted into your mind by someone or something else)

Obsessions are usually in some way extremely private, embarrassing, or disgusting.  Rarely will an adult or child with OCD tell me all of their obsessions.  Rarely are obsessions present alone.  Usually there are also related compulsions.