MENTAL HEALTH
W
hen my nine-year-old son Andrew suddenly started repeatedly touching walls for hours, I was perplexed. I became frightened when he rubbed his head against bushes and poles. And when he got down on the filthy subway floor and started to gnaw it, I became numb. What was happening?
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Counting to a “safe” number for hours
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Constant reassurance-seeking
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Continually praying or asking for forgiveness
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Repeatedly touching or tapping objects
He told me his brain was “forcing” him to engage in these rituals to stop terrifying thoughts in his head that my husband and I would die, or his sister would be kidnapped. He knew these thoughts and rituals made no sense, but he was helpless in stopping the cycle.
The IOCDF estimates that 1 in 100 adults and 1 in 200 kids and teens have OCD. Over 90% of people with OCD also have a co-occurring disorder. It can occur at any age, although it tends to be identified between the ages of 8 and 12 or in late adolescence/early adulthood.
This is the face of obsessive-compulsive disorder (OCD).
The exact cause of OCD isn’t known, although both genes and environmental factors like stress and trauma play roles.
What is OCD? The International OCD Foundation (IOCDF) defines OCD as a serious mental health disorder that occurs when an individual “gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease distress. “In order for a diagnosis of OCD to be made, this cycle of obsessions and compulsions must be so extreme that:
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It consumes a lot of time (more than an hour every day)
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Causes intense distress, or
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Gets in the way of important activities that the person values.”
Obsessions can cause great anxiety, disgust, guilt, anger, anguish, and shame. The person knows they are illogical but cannot stop them. Common obsessions involve a fear of:
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Germs
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Becoming sick or dying
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Hurting someone
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Making mistakes and not being “perfect”
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Offending God
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Romantic and platonic relationships
Some of the most common compulsions include:
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Repeatedly washing your hands until they are raw and bleeding
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Checking over and over that you didn’t hurt your loved one
Unfortunately, a lack of awareness and education about OCD can lead to fear, stigma, and misunderstandings. The myth that “everyone has a little OCD” or “I’m so OCD” trivializes this disorder and the disruption and pain it causes in people’s lives. Just because you like to keep your home clean, and your desk orderly does not mean you have OCD!
How is OCD treated? Medical, lab, or blood tests do not identify OCD; instead, psychiatrists ask about symptoms, thoughts, feelings, images, urges, and history. The IOCDF notes that “some estimates indicate that it can take up to 14–17 years from the onset of symptoms for a person to get an appropriate diagnosis and effective treatment.” This should not be acceptable to any of us! The good news is that evidence-based therapy and/or medications are often effective. First-line medications include anti-depressant SSRIs, selective serotonin reuptake inhibitors, which increase serotonin levels (a chemical that carries messages between nerve cells) in the brain to ease symptoms. Exposure and Response Prevention (ERP) is the gold standard in therapeutic treatment. ERP is a type of cognitive behavior therapy in which a therapist helps the individual learn to confront their distressing thoughts (exposure) and teaches their brain not to respond to these thoughts through rituals (response prevention). Picture a child terrified of germs slowly learning to tolerate getting their hands dirty for longer periods and not reacting by engaging in rituals. The child learns to face their fears, irrational and powerful as they may be, and sit with the discomfort. Andrew learned that while he couldn’t control those thoughts plaguing his mind, he could let them wash over him and not respond through rituals. His therapist also Exceptional Needs Today | Issue 19 | 67