Obsessive-compulsive disorder in children and adolescents

  Case: 12-year-old boy who repeatedly checked, washed his hands, and bought things for more than two years. Two years ago, the child was criticized by the teacher for not listening to the teacher’s request, and then gradually, he called the teacher after school to ask questions about it, sometimes even after 10:00 p.m., affecting the teacher’s rest. Once the workbook fell on the floor and got dirty, after being criticized by the teacher, he repeatedly checked whether the workbook was broken or dirty, and even had to rewrite the work once it was wrong, and developed to copy the old work into a new book. When I came home, I had to check repeatedly whether my body was clean and whether I had brought anything with me, which often took more than 40 minutes. I checked my homework and school bag repeatedly, often until 1-2 a.m. The homework books and school bags had to be replaced with new ones as soon as they were wrinkled, and it often took two or three days to buy a new school bag. Sometimes, she forced her mother to wash her hands repeatedly until she thought they were clean. It often takes 40 minutes to go to the toilet and 2-3 hours to take a bath and scrub repeatedly.  This is a child with obsessive-compulsive disorder. Obsessive-compulsive disorder is a real, chronic illness that plagues me and my family. It often affects the child’s school and life.  Children and adolescents in the process of psychological development, may appear similar to compulsive symptoms or ritual-like actions, such as walking to count the grid, repeatedly folding handkerchiefs, etc. Such actions with certain rules or given special meaning by the child, often in stages, last for a period of time will naturally subside, will not bring a strong emotional reaction to the child, will not affect the child’s life. OCD is a chronic disease with a complex etiology and various manifestations, with recurrent obsessive-compulsive ideas and compulsive actions as the main symptoms, accompanied by anxiety and difficulties in adapting to various things.  Obsessive-compulsive actions are often manifested as: compulsive questioning, compulsive washing, compulsive checking, compulsive counting, compulsive ritual actions, etc.; compulsive ideas are often manifested as: repeated fear of germs, fear that one will steal, fear that one will hurt others; compulsive doubts, doubts about what has just been said or done, school-age children doubt whether they have finished their homework, whether they have done it wrong, whether they have brought all their books to class, and in general Compulsive doubts and compulsive actions occur together; compulsive memories; compulsive exhaustive thinking; compulsive oppositional ideas, etc. The child often tries to counteract the compulsive ideas with other thoughts and actions.  The clinical manifestations of OCD in children and adolescents are different from those in adults. Some children have prominent but atypical obsessive-compulsive symptoms without obvious antiobsessive-compulsive tendencies and corresponding anxiety; some children are dominated by complicated ritual actions; some children not only compel themselves but also manipulate their parents to participate, and if their wishes are not met, they become irritable and even impulsive and hurtful to force their parents to comply with their obsessive-compulsive actions.  In terms of age of onset, early onset has been reported in children as young as 2, 6, and 8 years old, but more often OCD starts in adolescence. The age of onset is often in preadolescence in males and in adolescence in females. Approximately 50% of adults with OCD have an onset in adolescence. If left untreated, adolescent OCD can have lifelong consequences and can increase the risk of developing anxiety, depression, and avoidant personality disorders. Etiologically, OCD is a disorder that results from abnormalities in the metabolism of substances and the functioning of certain areas of the brain. In some children, it is associated with immunity following Streptococcus haemolyticus A infection.  Successful treatment consists of both pharmacological and psychological treatment. SSRIs are the optimal choice, followed by the option of chlorpromazine. Among psychotherapy, cognitive behavioral therapy is the only psychotherapy that has been studied and proven effective. Biofeedback therapy, psychoanalytic therapy or inner-directed psychotherapy have been shown to be ineffective for OCD (Rapoport, 2007). As for Morita therapy, a 1994 study by Zhang Xiangyang in China found that Morita therapy had good efficacy in treating OCD, but some scholarly studies have reported that a large number of hallucinations occurred and had to be terminated during the absolute bed rest period in Morita therapy.  If a child has obsessive-compulsive behavior that worries parents, it is important to seek professional help. The incidence of OCD in children and adolescents is not low, but the treatment rate is very low. 70% of children who receive effective treatment will continue to benefit.