OCD can make daily life very difficult and stressful for children. OCD symptoms often take up a great deal of a child's time and energy, making it difficult to timely complete tasks such as homework or household chores. Children may worry that they are "crazy" because they are aware their thinking is different than that of their friends and family. A child's self-esteem can be negatively affected because the OCD has led to embarrassment time and time again, or has made the child feel "bizarre" or "out of control."
In the morning, they often feel they must do their rituals exactly right, or the rest of the day will not go well. Meanwhile, they are feeling rushed to be on time for school. This combination leads to feeling pressured, stressed, and irritable. In the evenings, they may feel compelled to finish all of their compulsive rituals before they can go to bed. At the same time, they know they must get their homework done and take care of any household chores and responsibilities. Some children stay up late into the night because of their OCD, and are then exhausted the following day.
Children with OCD frequently don't feel well physically. This may be due to the general stress of having the disorder, or it may be related to poor nutrition or the loss of sleep. In addition, obsessions and compulsions related to food are common, and these can lead to irregular or "quirky" eating habits. Because of these and other factors, many children with OCD are prone to stress-related ailments such as headache, or an upset stomach.
Children with OCD sometimes have episodes in which they are extremely angry with their parents. This is usually because the parents have become unwilling (or are unable!) to comply with the child's OCD-related demands. For example, children with obsessions about germs may insist that they be allowed to shower for hours, or demand that their clothes be washed numerous times or a particular way. Even when parents set reasonable limits, children with OCD can become excessively anxious and angry. However, this anger does not justify physical or verbal abuse between parent and child. If violence or abuse is occurring within the home, it should not be tolerated, and seeking professional help may be necessary.
Friendships and peer relationships are often stressful for those with OCD because they typically try very hard to conceal their rituals from peers.
When the disorder is severe, this becomes impossible, and the child may get teased or ridiculed. Even when the OCD is not severe, it can affect friendships because of the amount of time spent preoccupied with obsessions and compulsions, or because friends react negatively to unusual OCD-related behaviors.
OCD and Other Psychiatric Disorders Children with OCD appear more likely to have additional psychiatric problems than those who do not have the disorder. Having two (or more) separate psychiatric diagnoses at the same time is called comorbidity. Below is a list of psychiatric conditions that frequently occur along with OCD:
Additional anxiety disorders (such as panic disorder or social phobia)
Depression/dysthymia
Disruptive behavior disorders (such as oppositional defiant disorder, or attention-deficit hyperactivity disorder)
Learning disorders
Tic disorders/Tourette's syndrome
Trichotillomania (hair pulling)
Body dysmorphic disorder (imagined ugliness) Sometimes comorbid disorders can be treated with the same medication prescribed to treat the OCD. Depression, additional anxiety disorders, and trichotillomania may improve when a child takes anti-OCD medication.
On the other hand, ADHD, tic disorders, and disruptive behavior disorders usually require additional treatments, including medications that are not specific to OCD. A booklet of this size cannot fully address all the possible comorbid conditions a child with OCD could have, nor all the possible medication approaches used for these comorbid disorders.
However, in general, using the smallest amount of medication effective in controlling symptoms, and starting low and going slow in regard to drug dosing are common sense approaches. In unusually complicated situations, or in situations where the OCD appears resistant to drug treatment, a consultation with an expert in the area of childhood OCD is warranted.
There is little doubt that OCD often runs in families. However, it appears that genes are only partially responsible for causing the disorder. If the development of OCD were completely determined by genetics, pairs of identical twins would always both have the disorder, or both not have it.
For example, eye color is entirely determined by genes and identical twins always have the same color eyes. However, in the case of OCD, if one identical twin has the disorder, there is a 13 percent chance that the other twin will not be affected. This supports the idea that genes are only part of the cause of OCD, and that some other factor is also important. At this point, no one really knows what that other factor might be, although some have suggested that it may be a viral infection that occurs at a critical point in a child's development, or perhaps an exposure to an environmental toxin.
Some experts have speculated that there may be different types of OCD, and that some types are inherited while other types are not. Although the findings are preliminary, there is evidence that OCD which begins in childhood may be different than OCD that begins in adulthood. Individuals with childhood-onset OCD appear much more likely to have blood relatives that are affected with the disorder than are those whose OCD first appears when they are adults.
If a parent is affected with OCD we can roughly estimate how likely it will be that their child will also have the disorder. If one parent has OCD, the likelihood the child will be affected is about 2 to 8 percent. It is important to remember that this statistic is an approximation, and several other factors should be considered when attempting to estimate the risk of a child developing OCD. One factor is whether or not the parents themselves have a family history of OCD. For example, if a parent who has OCD also has blood relatives with the disorder, the risk for the child increases somewhat. Conversely, if a parent has OCD but none of his or her blood relatives are affected, then the risk decreases. Another factor is whether the parent has OCD that began when they were an adult or began when they were a child. If the parent's OCD did not start until adulthood, there is probably a decreased likelihood that his or her offspring will be affected. Conversely, if the parent's OCD is the "variety" that starts in childhood, the chances of passing the disorder on are increased.
Another factor to consider is the family history of tic disorders (such as Tourette's syndrome) or other anxiety disorders. If a child has parents or other blood relatives with tic disorders or anxiety disorders, then the child is probably at some increased risk for OCD. Conversely, having blood relatives with OCD means that not only does the child have increased risk for OCD, but may also have an increased risk for developing a different anxiety disorder or a tic disorder. In summary, having blood relatives with OCD, anxiety disorders, and tic disorders all increase a child's risk of developing any of these same disorders.
As the above information indicates, it is difficult to precisely estimate the chances that a parent will pass OCD on genetically to his or her child. This is an area of active research, and new developments appear frequently.
Because of this, prospective parents may wish to consult with a genetics counselor prior to attempting to conceive a child. This can help assure that they have the most up-to-date information available.
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