Obsessive-Compulsive Disorder (OCD)
part 4

While many neuropsychiatric disorders of children are partly private, a lot of the signs and symptoms are quite obvious to parents, teachers, friends, and family.  If you spend a fair amount of time with a child with a mood disorder, tics, ADHD, learning disorders, ODD or conduct disorder, you will get to see plenty of signs of the disorder.

Why is this?  All of us have little habits that we are far less likely to engage in out of our homes.  Things like picking sores, scratching your groin, and farting are common examples.  Although we might have the urge to do these in public, we can usually control it, at least until we get home.  The same applies to OCD.  A child who is really bugged by things being out of order at school may be able to control it at school.

Another reason is that things that family members do or do not do always bug us more than what total strangers do.  Likewise a mess in my neighbors house is far less bothersome than one in my own home.  So with OCD, the biggest problem is when a person is with those she loves and in her own home.

Hannah is 11.  Ever since any one can remember she was very particular about how she was dressed and how things were put away at home.  Now that she is in sixth grade and starting to go through puberty, this is getting ridiculous.  She is spending about 1.5 hours each morning getting dressed.  When she comes home she used to scream at her mom about the way the laundry was done.  So her mom showed her how to do it.  Hannah has almost worn out her clothes she got for school a month ago with all the washing.  Can a person be sure that all the soap is really out?  And is the perspiration smell really completely gone?  So there are multiple washes and rinses and Hannah spends hours cleaning, drying, and inspecting her clothes.  Since she can never be sure things are just right, she is angry and bad tempered.  But once she finally leaves the home, she is a delight.  Her friend's parents always remark on how charming and polite Hannah is.  The teacher loves her and she gets wonderful grades.  She is the top dancer in her dance class.  Her grandmother thinks Hannah's mother is being to hard on her.  Hannah's father thought the same thing until he was home for a week with a back injury.  So when Hannah had to go see a psychiatrist, everyone thought the mother was crazy, not the child.

Jared has been a lucky guy.  He is bright, handsome, and his family is pretty nice and quite well off.  He is pretty good at sports and most people really like him.  Now he is 15.  One day they were doing some science report on how the lungs work and you had to count your breathing in a minute.  He didn't think anything of it, but late that night he found himself trying to make sure that the amount of time he was breathing in was exactly the amount of time he was breathing out.  This got worse.  In school he found himself doing the same thing.  After a few weeks of this little torture it spread.  Now he feels he must sit down on a chair exactly straight.  If he moves something on the right side of his body, he feels like he has to move the same part on his left side.  No one sees any of this.  He still does fine in all his activities.  He is not really that irritable.  He told some friends that, "he knew a kid with this weird problem...."  One of them said it sounded like a show he saw on OCD.  Jared looked up some stuff on OCD and sure enough, that was what he had.  So he told his mom that he needed to go see their family doctor so that he could get referred to a psychiatrist to see if he had OCD.  His mother couldn't see that there was anything wrong and told him he shouldn't read so much.  It was just a phase.  He waited until a day when there was an inservice and went to his family doctor.  She heard the whole story and saw the anguish.  He went to a psychiatrist and the mom and dad never did think that he should have.

Julie is 14.  She has had OCD since she was a child.  She has been off and on medications most of her life for it, especially when it is bad. Last spring, it was bad.  She was counting, checking, washing, hoarding, and thinking that if she didn't do these things, something would happen to her mom.  Plus she got depressed.  Well it took a lot of work with to get her mostly well again.  The medication she is taking makes her a little tired at school and also makes her a little dizzy when she stands up.  As a result, she is unable to do some things in gym class and looks tired in school.  Since almost none of the symptoms of OCD were seen in school, the teacher's have been telling Julie that maybe she should see her doctor about cutting down the medication.  The teachers have called her mom with the same concern.  Julie's aunt and uncle have also told Julie's mom that Julie is on "way too much medication" and they should get a second opinion.  Even when Julie's mom explains that they did get a second opinion, the advice does not stop.  When Julie and her mom talk with the doctor, they decide that these side effects are certainly worth it given how sick she was a few months ago.  "Mom", Julie says, "don't make me stop the pills". Given the Hell they went through this summer, she can easily reassure Julie that she will stay on the medications.  Her doctor agrees and says it would be absolutely crazy to stop her medications now.  But the advice continues.  Julie and her mom are doing better ignoring it.

1. OCD is a very private type of suffering.  Most compulsions and obsessions are not noticed by anyone other than the person who has the disorder.  What I, as the physician, see and hear about is usually just the tip of the iceberg.  Often parents and teachers notice almost nothing at all.

. It is usually depression or a crisis that brings pediatric OCD "out of the closet"

3. OCD is probably the most embarrassing neuropsychiatric disorder.  The thoughts which go through the person's mind are often very embarrassing, and so are the compulsions.