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OCD symptoms in children exhaust parents, family At first, it seemed easier to give in, easier to wash Rachel’s* jeans an extra time a day, than to deal with her meltdown if her jeans were “contaminated.” Then, two times a day became three times a day or more, until Rachel’s parents spent all of their free time doing laundry. Like many parents who have children with obsessive-compulsive disorder (OCD), Rachel’s parents never intended for the situation to get so out of control. But the time and energy spent accommodating a child’s OCD behavior quickly becomes exhausting and affects the whole family. “Often parents don’t know what OCD is and they don’t know how to effectively manage it,” said Thröstur Björgvinsson, PhD, director of the Obsessive Compulsive Disorders Treatment Programs at Menninger. “Accommodating their children’s behavior is their way of coping with the situation, but unfortunately, the symptoms of OCD will continue to get worse without treatment.” Children with OCD have intrusive, obsessive thoughts or impulses such as fear of dirt or contamination, a concern with order or fear of harming a family member. To relieve that fear, they compulsively perform rituals such as excessive hand washing, counting to the same number repeatedly or praying constantly. OCD often starts in childhood, typically between ages 9 and 13. Dr. Björgvinsson stated that nearly 90 percent of families, according to one study, accommodate their child’s OCD. They may find themselves going to extremes to help their child with OCD--like going on a fast food run at 3 a.m. to buy their child an “uncontaminated” meal. In severe cases, parents may quit their careers to stay home and take care of their child, because accommodating OCD rituals becomes a full-time job. “Parents get drawn into the rituals whether they like it or not,” Dr. Björgvinsson said. “By the time they seek professional help for their child, their lives are on hold.” The Menninger Clinic’s OCD Treatment Program uses intensive cognitive-behavioral therapy to help patients with OCD face their fears. Accommodation of rituals and avoidance behaviors cannot be stopped all at once. Gradually, patients are exposed to the source of their fear, for example contamination from germs. With the support of program staff and family, they learn how to resist performing the ritual that relieves their fear, such as washing their hands. “The first week or the first few days in treatment, we meet the patients at the point where they are with their OCD struggles,” Dr. Björgvinsson said. “We may allow patients to wash their hands and use rubber gloves, in extreme cases, all with the intention of removing those accommodations and systematically increasing their exposures.” Patients who fear contamination from doorknobs practice touching doorknobs at different levels of perceived contamination. They may practice touching a doorknob in a doctor’s office, then a doorknob in a train station and finally a doorknob in a public restroom. By repeatedly not washing their hands afterwards, they get used to the anxiety. Research shows that an estimated 60 to 70 percent of patients with OCD improve with cognitive-behavioral therapy, Dr. Björgvinsson said, adding that the families of children with OCD play an important role in the therapy’s success. Parents of patients in Menninger’s adolescent OCD Treatment Program meet frequently with program staff to learn more about their child’s progress, and how to help their child, while not accommodating their OCD behavior. Therapists help patients and families create behavior contracts that target areas of family life affected by OCD, helping parents coach their child and disentangle themselves from OCD symptoms. Staff also encourages parents to take care of themselves, take trips they postponed and seek therapy for themselves to deal with the overwhelming stress of caring for a child with OCD. For more information on treatment programs and support groups for obsessive-compulsive disorder, visit Menninger’s Web site at http://www.MenningerClinic.com/ or the OC Foundation at http://www.ocfoundation.org/. * Composite patient case used for illustrative purposes only
The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in
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