Obsessive compulsive disorder, OCD, is an anxiety disorder that is often disabling and may become a chronic disorder. According to Drs. Ciechanowski and Katon, writing in the medical database Up To Date, the average age of diagnosis during childhood is about 10-years-old. As is the case with other mental disorders, there appears to be a genetic component, but the exact cause is not yet known. In order to fulfill official criteria for a diagnosis, a child must have obsessions or compulsions and be affected by them in a significant way.
Obsessions
Obsessions are impulses, thoughts, images that persist and recur on a regular basis. In order to fulfill the official criteria for an obsession, these thoughts, impulses or images must cause the child who is experiencing them to feel very anxious or distressed. There also must be some recognition of the fact that these impulses, thoughts or images are both inappropriate and intrude upon the person's ability to live a normal life. It is important to note that for an obession to meet part of the criteria for obsessive compulsive disorder, these thoughts are not simply being overly worried about a real life problem. For example, being intensely focused on the topic of mortgage payment just after losing a job is a real life worry, not an obsessive thought. Additional aspects of the obsessions component of an OCD diagnosis include the realization that these thoughts, impulses or images are due to the child's own mind--not imposed upon him by an outside force; also, the person suffering from these disturbances must make attempts to neutralize the thoughts with other thoughts or with certain actions. If all these statements are true about a person's thoughts, images or impulses, official criteria for obsessions have been met.
Compulsions
Compulsions may be thought of as the frequent partner of obsessions: they are repetitive behaviors--such as hand-washing--or mental acts--such as counting--that a child feels obligated to do, either in order to deal with an obsession, or in order to correctly follow a rigid set of self-imposed rules. The point of these acts or behaviors is to prevent a situation that will result if the behavior or mental act does not occur. This is not a potential consequence that is taken lightly--a child with compulsions feels distress, stress, and dread at the perceived consequences of not following the rituals or behaviors. It is important to note that whatever the behaviors are, they are not connected in any real, logical way to the event or situation that they are meant to prevent. Alternatively, the ritual is excessive; for instance, washing one's hands a thousand times in order to prevent contamination with germs--hand-washing is a logical way to prevent the spread of germs, but doing so a thousand times is generally considered to be excessive.
Significant Degree of Impairment
A child may have either obsessions or compulsions to be diagnosed with OCD; he may also have both obsessions and compulsions. However, the presence of either of these is not enough. According to the DSM-IV, which is the standard textbook of psychiatric diagnosis, "significant impairment" must be part of the situation. Specifically, the child's obsessions and/or compulsions must either cause great distress in the child's life or take up over one hour each day.
References
- "CURRENT Diagnosis & Treatment: Psychiatry;" Michael H. Ebert et. al.; 2008
- "Up To Date;" Denise Basow; 2010
