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Obsessive Compulsive Disorder

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Obsessive Compulsive Disorder





Joseph has a compulsive fear of dirt and germs. Because of his compulsive fear, he only leaves his home when it is absolutely necessary. He continues to go to school but, in order to avoid bringing germs into the house he changes his clothes at the front door whenever he leaves the house, as well as each time he returns home. “He explains that should this not happen, he would feel completely out of control and that there would be ‘germs everywhere’, which he would not be able to fight”. Each morning and evening he showers for at least half an hour in order to leave his home to go to school and go to bed at night. If for some reason he is interrupted in his shower ritual, he would not permit himself to sleep in his own bed, but would sleep in a sleeping-bag on the floor in the hall. This ensures that germs are not transmitted to the rest of the house.


As much as Joseph is aware that his compulsive behaviour is affecting his daily life he can’t seem to stop his actions. The reason Joseph can’t control his actions is because he has Obsessive Compulsive Disorder (OCD).


What is OCD?


OCD is obsessive thoughts or actions that constantly enter your mind. The thoughts and actions are often embarrassing and may cause excessive worry about things that you cannot control. For example, you may worry excessively about your parents getting sick or hurt because of the germs and dirt in the house or you may feel that you have to follow a ritual over and over again to keep bad things from happening. OCD are involuntary thoughts that you may not agree with but feel compelled to follow due to the stress and anxiety they cause (Kingsley, 1998).


Compulsive actions (part of OCD) can also appear to be completely bizarre, where for example, you wash your hands every ten minutes, or a particular number of times each day (up to 100 times or more). You may also have an irresistible need to wash your hands after touching other people, or after particular situations. Other children and adolescents cannot resist the urge to take frequent and long showers, for example for half an hour every morning and evening, in order to leave the house, and in order to go to bed. If they are unable to carry out these actions, they may feel that the bacteria and germs are with them, wherever they stand, or walk. (Kingsley, 1998).

It is important to note that OCD is not a Psychotic condition. A Psychotic condition is when someone perceives that the thoughts and feelings they are experiencing are real (Insel and Akiskal, 1986). OCD sufferers are able to acknowledge that the thoughts and feelings that they are experiencing are irrational and illogical (Insel and Akiskal, 1986).


The Most Common Compulsive Symptoms


Joseph is not the only one who has a compulsive fear towards dirt and germs. The most common symptoms seen in approximately 40 per cent of all cases are compulsive thoughts in connection with fear of dirt and infection (Kingsley, 1998). Many other symptoms are also found amongst the majority of OCD children and adolescents. Below I have highlighted some of these symptoms:

Common OCD symptoms in Children




Dirt and Contamination


That something terrible will happen










Fear of harming oneself or others




Washing Rituals




Repeating Rituals


Ordering and Arranging




Source: Kingsley, J. (1998). From Thoughts to Obsessions: Obsessive Compulsive Disorder in Children and Adolescents. Jessica Kingsley: London. Page 16.


What Causes OCD Behaviour?


OCD is considered a neurotic illness caused by a traumatic development during certain periods of personality development. It is not an illness that you can simply pick up from hanging around a friend. It is also not an illness caused by doing something wrong or being a bad person.

There are some theories that researchers are now beginning to learn about OCD which have been highlighted below:

Biological Causes

In recent years, there has been much interest in the possibility of discovering biological causes for OCD. Some theorists believe that OCD is caused because of a lack of serotonin in the brain. Serotonin is responsible for managing the transmission of nerve impulses (Kingsley, 1998). This theory has been strengthened by the fact that drugs which increase the volume of serotonin in the nerve pathways have helped many children with OCD.

Family Structures

There has been some research conducted that shows that OCD may be hereditary. In all of these studies, it was established that a number of parents had, or had previously experienced the same problems. For example, a study by Riddle et al. (1990), on parents of 21 children and adolescents with OCD found that 36 per cent of the parents had either OCD or sub-clinical OCD.

 Are OCD Children overly Anxious when they are small?

A number of studies have been conducted to determine whether anxiety at a young age causes OCD behaviour. From these studies they have concluded that there is no link between anxiety levels at a young age and developing OCD later in life (Kingsley, 1998).

Treatment Options for OCD

It is important to note that treatment options for OCD is complex, due to the fact that the exact cause of the illness is still unknown. However the most usual course of treatment involves medication in conjunction with therapy.


There are two different types of therapy options available for children: They are Behavioural and Cognitive therapy. Behavioural Therapy involves direct exposure to OCD whereas Cognitive Therapy works with the child’s internal thoughts and feelings to reshape negative thoughts and provide strategies to deal with OCD in a more positive and effective way.

Using our example above, and applying a behavioural management strategy, Joseph would be deliberately exposed to the situations that causes him fear. For example Joseph would be asked to touch a door handle a specific number of times. Joseph may experience a strong, irresistible need to wash his hands immediately after doing this, and under normal circumstances he would have rushed to the wash-basin. But as part of the behavioural therapy strategy, he is stopped from rushing to the wash-basin and, therefore, hindered in washing his hands. Initially, he is made to wait just a few minutes after being confronted with the compulsion-inducing situation (touching the door handle), but this is followed with a gradual increase in the length of time he has to wait before being permitted to wash his hands. Despite the violent fear and discomfort that Joseph may experience, he would soon realized that nothing has actually happened that the compulsive thought had told him would happen as a result of not washing his hands (i.e. sickness, death or even an accident) (Kinglsey, 1998).

Both therapy types are done by a mental health professional, often a psychologist, who has been specially trained. Both forms of therapy include stress management strategies, relaxation training as well as practical coping strategies. A child with OCD usually attends therapy about once a week (or sometimes more often) for a while, then less often as they begin to get better. Getting better can take anywhere from a few months to a few years (Riddle et al. 1990).

Home Assignments

Kingsley (1998) notes that OCD requires discipline, training and constant repetition, until the behaviour is mastered, which is no different to playing a sport or video game. The real challenge with home assignments is that the child must fight against the compulsive symptoms each day. “The home assignments must be time-limited and specific and must be under the child’s control” (Kingsley, 1998, p83). The idea behind home assignments is that, within the home, the child exposes himself to compulsion inducing circumstances and subsequently attempts to resist the urge to carry out the resulting compulsive action. The child must only undertake these assignments to such a degree that he feels able to control them, as it is better for him to experience a minor success than a major disaster (Kingsley, 1998).


Anti -depressant medication may be prescribed by your doctor to assist with OCD. Numerous studies have been conducted and have shown some positive results. It should be noted that these studies are not conclusive and further research is still required.

OCD is an illness that you can overcome. With perseverance and the right treatment techniques, you can reduce the strong hold OCD has on your thoughts and feelings. The more persistence and disciplined you are; the stronger you will become and the weaker OCD will be.








Insel, T.R. and Akiskal, H.S. (1986) ‘Obsessive-compulsive disorder with psychotic features: A phenomenological analysis.’ American Journal of Psychiatry 143, 1527–1533.

Kingsley, J. (1998). From Thoughts to Obsessions: Obsessive Compulsive Disorder in Children and Adolescents. Jessica Kingsley: London.


Riddle, M.A., Scahill, L., King, R., Hardin, M.T., Towbin, K.E., Ort, S.I., Leckman, J.F. and Cohen, D.J. (1990) ‘Obsessive compulsive disorder in children and adolescents: Phenomenology and family history.’ Journal of the American Academy of Child Adolescent Psychiatry 5, 766–772.

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