OCD/OCPD

General Information

 Obsessive–compulsive disorder (OCD) is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry; by repetitive behaviors aimed at reducing the associated anxiety; or by a combination of such obsessions and compulsions.  The acts of those who have OCD may appear paranoid and potentially psychotic. However, OCD sufferers generally recognize their obsessions and compulsions as irrational, and may become further distressed by this realization.
Obsessive–compulsive disorder affects children and adolescents as well as adults. Roughly one third to one half of adults with OCD report a childhood onset of the disorder^.

The phrase obsessive–compulsive is often used in an informal or caricatured manner to describe someone who is excessively meticulous, perfectionistic, absorbed, or otherwise fixated.^[2] Although these signs are present in OCD, a person who exhibits them does not necessarily have OCD, but may instead have obsessive–compulsive personality disorder (OCPD), an autism spectrum disorder.

Despite the irrational behaviour, OCD is sometimes associated with above-average intelligence. Its sufferers commonly share personality traits such as high attention to detail, avoidance of risk, careful planning, exaggerated sense of responsibility and a tendency to take time in making decisions.

From http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder 

Obsessive–compulsive personality disorder (OCPD) is a personality disorder characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control at the expense of flexibility, openness, and efficiency. In contrast to people with obsessive-compulsive disorder (OCD), behaviors are rational and desirable to people with OCPD.

OCPD is a chronic non-adaptive pattern of extreme perfectionism, preoccupation with neatness and detail, and a need for control or power over one's environment that causes major suffering and stress, especially in areas of personal relationships. Persons with OCPD are usually inflexible and controlling. They may find it hard to relax, and must plan out their activities down to the minute

From http://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_personality_disorder

 

Warning signs that your child may have OCD/OCPD

Symptoms of OCD are variable and may include excessive washing or cleaning; repeated checking; extreme hoarding; preoccupation with sexual, violent or religious thoughts; relationship-related obsessions; aversion to particular numbers; and nervous rituals, such as opening and closing a door a certain number of times before entering or leaving a room. These symptoms can be alienating and time-consuming, and often cause severe emotional and financial distress. The following is a sampling of possible signs and symptoms of OCD.

Obsessions are thoughts that recur and persist despite efforts to ignore or confront them. People with OCD frequently perform tasks, or compulsions, to seek relief from obsession-related anxiety. Within and among individuals, the initial obsessions, or intrusive thoughts, vary in their clarity and vividness. A relatively vague obsession could involve a general sense of disarray or tension accompanied by a belief that life cannot proceed as normal while the imbalance remains. A more intense obsession could be a preoccupation with the thought or image of someone close to them dying or intrusions related to relationship "rightness". Other obsessions concern the possibility that someone or something other than oneself—such as God, the Devil, or disease—will harm either the person with OCD or the people or things that the person cares about. Other individuals with OCD may experience the sensation of invisible protrusions emanating from their bodies, or have the feeling that inanimate objects are ensouled.


Some people with OCD experience sexual obsessions that may involve intrusive thoughts or images of "kissing, touching, fondling, oral sex, anal sex, intercourse, incest and rape" with "strangers, acquaintances, parents, children, family members, friends, coworkers, animals and religious figures", and can include "heterosexual or homosexual content" with persons of any age. As with other intrusive, unpleasant thoughts or images, most "normal" people have some disquieting sexual thoughts at times, but people with OCD may attach extraordinary significance to the thoughts. For example, obsessive fears about sexual orientation can appear to the person with OCD, and even to those around them, as a crisis of sexual identity. Furthermore, the doubt that accompanies OCD leads to uncertainty regarding whether one might act on the troubling thoughts, resulting in self-criticism or self-loathing.

People with OCD understand that their notions do not correspond with reality; however, they feel that they must act as though their notions are correct. For example, an individual who engages in compulsive hoarding might be inclined to treat inorganic matter as if it had the sentience or rights of living organisms, while accepting that such behavior is irrational on a more intellectual level. In severe OCD, obsessions can shift into delusions when resistance to the obsession is abandoned and insight into its senselessness is lost.

OCD sometimes manifests without overt compulsions. Rather than engaging in observable compulsions, the person with this subtype might perform more covert, mental rituals, or might feel driven to avoid the situations in which particular thoughts seem likely to intrude. As a result of this avoidance, people can struggle to fulfill both public and private roles, even if they place great value on these roles and even if they had fulfilled the roles successfully in the past. The covert mental rituals can take up a great deal of a person's time during the day.

Some people with OCD perform compulsive rituals because they inexplicably feel they have to, others act compulsively so as to mitigate the anxiety that stems from particular obsessive thoughts. The person might feel that these actions somehow either will prevent a dreaded event from occurring, or will push the event from their thoughts. In any case, the individual's reasoning is so idiosyncratic or distorted that it results in significant distress for the individual with OCD or for those around them. Excessive skin picking (i.e., dermatillomania) or hair plucking (i.e., trichotillomania) and nail biting (i.e., onychophagia) are all on the Obsessive-Compulsive Spectrum. Individuals with OCD are aware that their thoughts and behavior are not rational, but they feel bound to comply with them to fend off feelings of panic or dread.

Some common compulsions include counting specific things (such as footsteps) or in specific ways (for instance, by intervals of two), and doing other repetitive actions, often with atypical sensitivity to numbers or patterns. People might repeatedly wash their hands or clear their throats, make sure certain items are in a straight line, repeatedly check that their parked cars have been locked before leaving them, constantly organize in a certain way, turn lights on and off, keep doors closed at all times, touch objects a certain number of times before exiting a room, walk in a certain routine way like only stepping on a certain color of tile, or have a routine for using stairs, such as always finishing a flight on the same foot.

Whether or not behaviors are compulsions or mere habit depends on the context in which the behaviors are performed. For example, arranging and ordering DVDs for eight hours a day would be expected of one who works in a video store, but would seem abnormal in other situations. In other words, habits tend to bring efficiency to one's life, while compulsions tend to disrupt it.

In addition to the anxiety and fear that typically accompanies OCD, sufferers may spend hours performing such compulsions every day. In such situations, it can be hard for the person to fulfill their work, family, or social roles. In some cases, these behaviors can also cause adverse physical symptoms. For example, people who obsessively wash their hands with antibacterial soap and hot water can make their skin red and raw with dermatitis.

People with OCD can use rationalizations to explain their behavior; however, these rationalizations do not apply to the overall behavior but to each instance individually. For example, a person compulsively checking the front door may argue that the time taken and stress caused by one more check of the front door is much less than the time and stress associated with being robbed, and thus checking is the better option. In practice, after that check, the person is still not sure and deems it is still better to perform one more check, and this reasoning can continue as long as necessary.

It has been proposed that sufferers are generally of above-average intelligence, as the nature of the disorder necessitates complicated thinking patterns. OCD is associated with higher IQ scores.

From Wikipedia pages on OCD and OCPD

How can OCD/OCPD Affect a Child?

With obsessions, pre-adolescent children tend to focus on some feared catastrophic family event such as the death of a parent. They may have feelings of contamination (not necessarily feeling dirty as such), fears about their bodies, sexual fears and worries about doing the right thing. It seems, from some research that the younger the child the more unusual or bizarre the symptoms are likely to be. Compulsions are most commonly: washing, repeating activities, checking things and putting things in order. Putting things in order could mean putting them precise distances away from each other, facing the same way or making a precise geometric shape. This should not, of course, be confused with the tendency many very young children have of ordering toys or placing them in sometimes quite complicated patterns.

These symptoms tend to wax and wane with childhood OCD and change within a spectrum of four or five different focuses as mentioned above, so it is not always easy to say, precisely, what the child is obsessing, or performing compulsive rituals, about. Young children also very often describe their obsessions as worries or fears and it can be difficult to assess whether these are in fact worries normal to the child's stage of development or obsessions.

Not unexpectedly, young children tend to involve their parents in their obsessions and compulsions a good deal. This can be just one parent. It has also been known for the other parent to be excluded almost totally, or even to be viewed, by the child, as responsible for some of the ritual. This naturally leads to family problems and can cause great unhappiness among siblings and other family members.

Any parent conscripted into supporting a young child in his or her OCD has to be very aware of the fact that there may be no end to the help demanded unless boundaries are set. OCD often takes up as much space in life as the sufferer allows it, pressing on the child's abilities to function, always ready to make more and more things difficult or impossible on particularly bad days. In the throes of this disability, the child is even more likely that an adult sufferer to see being thwarted in a need to obsess or ritualise as outrageous; and a child is usually adept at knowing how to get his or her own way with the chosen parent and to have little inhibition about doing this.

Taken and adapted from http://www.anxietycare.org.uk/docs/ocdchild.asp 

Options for Children with OCD/OCPD

People with OCD are usually offered some form of 'talking treatment' and/or medication. The talking treatments are behavioural therapy which tries to change behaviour by gradual exposure to the feared situation; or cognitive-behavioural therapy which tried to help sufferers to understand their thinking patterns, and the errors they make when processing incoming data, so that they can react differently to situations that make them obsess or ritualise. With very young children and others who have little insight into the irrationality of their thinking, this can obviously prove difficult.

Medication is usually some form of serotonin reuptake inhibitor (SSRI); or the tricyclic clomipramine. Both are anti-depressants that have been found to have a good affect on OCD. There are quite a large number of SSRI's. All are from the same 'family' but are different enough from each other for another to be tried if one doesn't work or has unacceptable side effects. Sometimes one or other of the benzodiazepines (tranquillizers) are used to supplement the anti-depressant. With all medication, the side effects occur before the benefits, so if a person has waited to take medication until he or she couldn't stand feeling this bad any longer, the side effects might make him or her feel worse for a while, which might present as intolerable and result in essential medication being given up.

Some people may be so overwhelmed by their disorder, spending all their time defending themselves from it and terrified of it, that they do not believe that they can do anything to counter its effects. In reality, this person is living permanently at crisis level. With the mind set in this way, a response to a talking treatment alone, that required the sufferer to confront the obsessions, would probably be very poor. When medication is added, this can reduce the crisis level so that the sufferer can actually accept that the disorder is not all-powerful. The anti-depressant medication will also lift mood and offer a more positive outlook when depression is a contributing factor to the OCD.

However, many sufferers are very unwilling to take medication and many parents are unhappy with urging this form of support on their children. It is obviously a personal choice, which should include the child's choice too, but this alone should not dictate withholding medication. Talking help is essential, medication alone won't change patterns of behaviour and when the medication is stopped, if no talking help has been available, the odds are the disorder will return. Sometimes a person is so ill with OCD that they simply don't hear what is said to them in a talking therapy, or can't see that they can do anything personally to counter the disorder. No talking therapist can do the work for the sufferer; he or she has to do the practical activities at some point. There is also no drug or talking treatment out there that will magically take the pain away. That perennial hope that 'finding out what caused it' will cure everything simply doesn't happen. People have grown old looking for the reason (usually who made me like this); and those who have established probable social causes through long (and often expensive) psychotherapy have not immediately recovered. At best it has started a long recovery process that still needs much support; or pointed out to them ways in which they could think or act differently in the future. No miracles at all.


Taken and adapted from http://www.anxietycare.org.uk/docs/ocdchild.asp 

OCD/OCPD in the Classroom

In any classroom, the teacher is the central figure who leads the class in learning, enlightens with insight, maintains order, promotes good behavior and rewards good work.  The teacher also sets the mood of the classroom.

When a teacher has a positive attitude, the students are also likely to be positive.  Conversely, a teacher's negative attitude can have an adverse impact on the class.  A teacher's approach is all the more important for students with OCD.  When a teacher supports and encourages these students, and tolerates no ridicule or discrimination from other students, it can make a huge difference in terms of how the student with OCD progresses.

One of the most important things teachers must remember when faced with the challenge of managing OCD in the classroom is that children and adolescents are very impressionable.  Peer pressure to fit in and to be part of a group of friends can be extremely hard for the student who has OCD.

There are a number of ways teachers can provide support.  With some basic planning, a teacher can make accommodations that help the student academically, socially, behaviorally and emotionally.  The following sections, beginning with Healthful Support Strategies, will provide ideas and strategies for teachers and other school personnel to work more successfully with and improve the school functioning of the student who has what may be a very distressing disorder.

From http://www.ocdeducationstation.org/role-of-school-personnel/managing-ocd-in-the-classroom/

 

OCD/OCPD Resources

OCD Education Station
http://www.ocdeducationstation.org/role-of-school-personnel/managing-ocd-in-the-classroom/

Anixety Care UK 
http://www.anxietycare.org.uk/docs/home.asp 

OCD Resource Centre of Florida
http://www.ocdhope.com/index.php