Obsessive-compulsive disorder is becoming one of the most common mental disorders in children and adolescents. I remember when I began my career in 1981, OCD was a rare form of mental illness, and “cleanliness”, for example, with compulsive washing as the main compulsive behavior, was far less common than it is today. What is the reason for the rapid increase in the prevalence of OCD in children and adolescents today in the past 30 years? I think that genetics plays a role, but the main responsibility lies with the adults who are the parents of these children, who are raising them to be OCD sufferers. Prior to 1984, the lifetime prevalence of OCD in authoritative textbooks in Western countries was reported to be 0.5.
Prior to 1984, authoritative textbooks in Western countries reported a life-time prevalence (LTP) of 0.01-0.23%, while the LTP in the United States in 2005 was 2.3% in a large sample survey, and the authoritative LTP in China in 1982 was 0.023%, and in recent years the LTP has been reported to be around 0.3%. Moreover, the high prevalence of OCD is mainly in childhood, adolescence and early adolescence. Children and adolescents with OCD are often detached from close contact with their peers due to the severity of the disease, which affects their ability to adapt to school and life, and further impairs their ability to adapt to society, making them one of the main groups of people with mental disabilities. Because of these serious consequences, OCD is becoming a problem that deserves the attention of parents, educational institutions and society as a whole. Although civilization, social progress and economic development and the improvement of people’s living standards, which are social changes that are environmental factors, have played a considerable role in this, “not having the conditions to ‘settle’ and having the conditions to ‘preach’ “, so that the prevalence of OCD tends to increase rapidly. However, the misconceptions of contemporary adults play a more important role. Let’s take the example of OCD, a compulsive symptom dominated by cleanliness, and see how our society and adults are raising their offspring to become obsessive-compulsive. Let’s start with the role of civilization. Civilization is one of the most important signs that humans are mavericks in the animal kingdom. Since it is a maverick, it means that humans have a tendency to part ways and drift apart from other animals in the animal kingdom, and even have a tendency to be ashamed to admit that they are part of the animal kingdom. In order to prove their civilization, the behavior of human beings in cleaning their bodies is very different from that of their close relatives, the monkeys, who are also primates: in the so-called “civilized society”, the bathing of human members has become a habitual behavior or even a “ritualized behavior” with only symbolic meaning. In so-called “civilized societies”, bathing by human members has become a habitual or even symbolic “ritualistic behavior”, while bathing by monkeys on their own may be an occasional cooling or playful act on hot days. Not to mention that in civilized societies, members of the human race have generally accepted the rule of washing their hands before and after meals, and no longer even look into its meaning or necessity. Of course, civilization has brought more than cleanliness to humans, and sometimes the meaning of these behaviors may only be to prove that they are not monkeys or “inferior”. For example, on a crowded public transport, if a migrant worker in less-than-clean-looking work clothes gets off, even if the seat he vacates is no different from any other seat, someone will choose either not to sit down, or to wipe it with a paper towel or put a newspaper on the original seat before sitting down. This kind of discriminatory behavior for the workers at the bottom of the society is the unique behavior change brought by the civilization of human beings or even just the “civilization” process of ideas. Then look at the changes brought about by social progress and economic development. An important sign of social progress is the protection of privacy, accompanied by an increase in the privacy of the living environment and respect for the independent behavior of others. In a more fully civilized social environment, each individual human being enjoys an agreed-upon right to privacy, the specific content of which includes non-discrimination and non-interference in the personal life and behavior of others. Therefore, people with OCD, which is mainly characterized by “cleanliness”, are not restricted or prevented from doing so as long as their compulsive behavior of excessive washing does not cause problems to others. Economic development has brought about the convenience of water and cleaning activities. For example, in rural and even urban areas in the north, public toilets used to be “dry toilets” with no flushing and no hand-washing conditions, and people had neither the conditions nor the habit of flushing and washing their hands after using the toilet. Now, the public toilets in the city have generally had the facilities and conditions for flushing and hand washing, so as a natural result of civilization, people are used to the clean behavior of flushing and hand washing after defecating. As a result, people with OCD, which is mainly characterized by “cleanliness”, are in a position to carry out their excessive washing behavior anytime and anywhere, without being blamed or stopped as long as they do not interfere with others. As a result, the compulsive behavior of the patient is inevitably exacerbated as a matter of course. Many contemporary adult misconceptions contribute directly to the occurrence of OCD in children and adolescents, which is characterized by “cleanliness”. First, adults implement misconceptions about the training of children and adolescents regarding hygienic eating habits. For example, when parents train their young children to eat, they are bound to spill bits of food on the table or on their lapels, and the children may pick up the food and put it in their mouths. If the parent immediately stops the behavior and repeats the correction, the toddler will accept it, even though he may not understand the reason for the parent’s stopping the behavior. As he grows older, he will eventually accept his parents’ philosophy based on the bonding factor and unconditional trust in them, and will consciously implement it in his behavior. If his parents overemphasize and mechanically enforce hand washing before and after meals, or even reinforce such behaviors with rewards or punishments, the child will form habits and implement them consciously. As the child grows, if he is still influenced by his parents’ perceptions of dietary hygiene or behavioral constraints, his desire for cleanliness may be even stronger and his standards for cleanliness may be even higher. Once he comes in contact with what he considers “unclean” and believes he has been “contaminated”, he will react with anxiety and nervousness, and in order to eliminate this concern and anxiety, he will adopt “super standard” washing. In order to eliminate this concern and anxiety, they will adopt “super standard” washing, i.e., compulsive washing, which will eventually evolve into OCD that meets the diagnostic criteria. Especially if they grow up without establishing other healthy pleasures that are sufficient to counteract the pleasure of the “treats” they receive in their pursuit of cleanliness (including psychological treats like self-affirmation), such as a rich school life and peer friendships that have a mutually attractive effect, they are highly vulnerable to becoming trapped in compulsive symptoms. The same misconceptions that adults carry with them in the development of children’s and adolescents’ personal hygiene habits can also contribute to the development of OCD in children and adolescents, which is characterized by “cleanliness”. For example, parents’ overly strict fingernail trimming and regular and rigid bathing and shampooing requirements and standards for their children from an early age can cause young children to develop an almost reflexive habit of trimming their fingernails and bathing and shampooing, and once they fail to follow the appropriate standards, they will have an unbearable sense of impurity or incompleteness. Such habits and feelings may stay with them for the rest of their lives, and may even appear to worsen and deteriorate with age. Among them, some people will use bathing as a watershed between dirty and clean: the body before bathing and the corresponding inner and outer clothing are unclean, and they must not touch the objects or body parts that they can only touch after bathing, or even touch or break into what they consider “clean space” such as beds and bedrooms. What is more, children and adolescents who grow up in this way begin to resent their parents, who are the initiators of their personal hygiene habits, and not only do they conform to their own standards of cleanliness excessively, but they also do not allow their parents, who have not bathed and shampooed, to sit in their beds or even allow their parents or relatives to step into their bedrooms. Of course, other misconceptions of hygiene espoused by adults can also influence children and adolescents to develop “cleanliness”-like compulsions. For example, adults believe that dust in the environment is a dirty substance, so some children or adolescents are overly concerned about the hazards of dust in the air and believe that the dust they breathe into their nostrils can cause disease, and often clean their nostrils in some way; some children or adolescents believe that the dust that enters their mouths can cause disease, and often “spit” in a way that is not appropriate for the occasion. Some children or adolescents believe that dust entering their mouths can cause disease, and often “spit” to clean their mouths regardless of the occasion. In fact, many of the ideas adults have about hygiene may not always be scientifically sound and may mislead their offspring. For example, many adults are overly concerned about the shelf life of food, believing that the fresher the food, the better, and that food is spoiled once the shelf life has passed, so that food in supermarkets is rejected a day or two after the production date, and must be destroyed a day or two after the shelf life, without regard to storage conditions and the nature of the food, which are very important factors. For example, some people regard melamine in milk as a toxic substance, and milk containing melamine as toxic milk. It is not known that even milk with excessive melamine is safe, especially for adults, if it is not given to infants and children who use it as a staple food. In short, such irrational and unscientific notions of adults can easily lead young children to believe in their rationality, and if they are overly concerned based on their beliefs, they may develop into some kind of obsessive-compulsive symptoms or even develop into obsessive-compulsive disorder that meets the diagnostic criteria.