Obsessive-compulsive disorder (OCD) is one of the rambunctious siblings in the anxiety-disorder family, and contrary to popular belief, it has nothing to do with how you're raising your child. "OCD is not the result of an unresolved issue from childhood, despite what society may falsely believe. It's neurobiological," says Jerome Bubrick, Ph.D., a cognitive and behavioral psychologist specializing in the treatment of OCD and director of the Intensive Pediatric Obsessive-Compulsive Spectrum Disorders Program at the Child Mind Institute in New York City.
The obsessive thoughts that lead to compulsive behavior are most likely the result of faulty brain circuitry and its transmission. Part of the cause is an imbalance of brain chemicals known as neurotransmitters that can cause symptoms of anxiety. Serotonin is one such neurotransmitter; glutamate and dopamine are others. A lack of serotonin will usually result in sadness, irritability, and anxiety; abnormal levels of glutamate over stimulate excitatory neurons and can cause symptoms of anxiety and OCD behavior. But it's different for each child, says Moira Rynn, M.D., child and adolescent psychiatrist and director of the Division of Child and Adolescent Psychiatry at Columbia University Medical Center and New York State Psychiatric Institute.
Children with OCD are more likely to have a first-degree relative with similar symptoms, but there's considerable debate and ongoing research to determine which specific genes may play a role. "Parents should be aware of their own behavior," Dr. Rynn says. "If [they] remember having similar symptoms to the ones they are witnessing in the child, addressing the problematic anxiety behaviors early in a child's life can help significantly in preventing later problems in social and intellectual development."
Through cognitive behavioral therapy (CBT), a therapist works to rewire the brain in this way to form new ways of responding to anxiety-provoking situations that may spiral into obsessions. Kids can be helped to stop repetitive habits that negatively affect them, and they can develop strategies to decrease and tolerate their anxiety.
Medications such as selective serotonin reuptake inhibitors (SSRIs) and the antidepressant clomipramine provide the necessary neutrotransmitter balance to ease anxiety during the time therapy is starting to take effect. Current research is looking at glutamate modulators. But symptoms of OCD vary widely, and some kids respond to certain medications more than others, Dr. Rynn says. So a child who feels the need to wash his hands 10 times in an hour may respond to one medication, while a child who has obsessive religious or catastrophic thoughts will respond to a different one.
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