What is OCD?
According to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-V), Obsessive Compulsive Disorder (OCD) is characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
Many researchers have argued that early-onset or childhood OCD may be a distinct type of OCD. Between 1/5 and 1/2 of adults with OCD, developed the disorder in childhood. Childhood-onset OCD has been associated with greater severity and higher rates of compulsions without obsessions. When OCD begins in childhood, other disorders such as tic disorders, (ADHD) attention-deficit hyperactivity disorder, and anxiety disorders are more likely to be present. Also, genetic factors appear to play a larger role in the causes of OCD that onsets in youth.
For the most updated information on PANS/PANDAS, visit www.pandasnetwork.org.
Pediatric Autoimmune Neuropsychiatric Disorders (PANDAS) was defined in 1998 by Dr. Sue Swedo. Abrupt, dramatic onset of OCD is the first diagnostic criterion for PANS. For those familiar with the CYBOCS (Childhood Yale Brown Obsessive Compulsive Scale) scores, some clinicians look for an increase in total score of more than 16 in the course of a few days. Children may have mild “quirks” or even some signs of OCD prior to this abrupt dramatic onset.
In retrospect some clinicians suggest that mild micro-episodes may even have occurred in the past. However, in the space of a few days, they “fall off a cliff,” dramatically causing a significant decrease in the child’s ability to function. Impairment is significant. Parents can usually name the day that the crisis occurred and have vivid memories of the first obsessions or compulsions because of their extreme nature. As an example, a normally joyful, balanced emotionally, independent, social child may turn into a child that has extreme temper tantrums that are out of character, and can no longer leave a parent’s side without accommodation. Panic attacks and unusual anxieties are not uncommon.
In addition to the typical obsessional fears and compulsive behaviors, this criterion also may be satisfied by the sudden severe onset of food avoidance, anorexia and eating restrictions. Clinically, these occur as solitary symptoms among PANS patients, as well as from complications resulting from obsessional fears of choking, vomiting or of contaminated foods.
Although there appears to be uniformity in the acuity and severity of onset of the co-occurring symptoms, there is great variability in the nature of the symptoms accompanying the OCD. As a result, the second major criterion for PANS is the concurrent acute onset of additional symptoms from at least two of the following seven categories:
anxiety (particularly acute separation anxiety and irrational fears)
emotional liability and/or depression
irritability, aggression and/or oppositional behaviors
behavioral (developmental) regression
sudden deterioration in school performance
sensory or motor abnormalities (particularly dysgraphia/ trouble with handwriting)
somatic/physical signs and symptoms
As in most of psychiatry, PANS is a clinical diagnosis, meaning that there are currently no laboratory or genetic tests that can confirm the diagnosis. As such, a second opinion to find consensus on the diagnosis of PANS between two experienced physicians may be useful.
Treatment for OCD
The average person takes 14-17 years from the onset of OCD to get the right treatment.
What are the Obstacles to Treatment?
Hiding OCD Symptoms. Often because of fear of embarrassment or stigma, people choose to hide their symptoms. Sometimes people with OCD don’t seek the help of a mental health professional until years after the onset of symptoms.
Lack of Public Awareness of OCD. Many people did not know there was even a name for their illness until recently. Without a name, they assumed there was no treatment.
Lack of Proper Training of Health Professionals. Often, people with OCD get the wrong diagnosis and need to see several doctors, over several years, getting incorrect treatment, before getting the right diagnosis.
Trouble Finding Local Therapists Who Can Treat OCD Effectively.
Lack of Affordability for proper treatment.
Best treatment for most people with OCD
The Best Treatment Should Include One or More of These:
A therapist who is properly trained
Cognitive Behavior Therapy (also called CBT), specifically Exposure Response Prevention (ERP)
Finding a Therapist
It is important to interview your therapist to find out if they are trained to do Exposure and Response Prevention (ERP) therapy. Some therapists are better at treating OCD than others.
Their responses to your questions will be a good guide for you.
You can start by asking about what techniques they use to treat OCD.
If the therapist doesn’t mention Cognitive Behavior Therapy (CBT) or Exposure and Response Prevention (ERP), or if they are vague, use caution.
When you ask about Exposure and Response Prevention to treat OCD, Beware of therapists who say that they use CBT but who won’t be specific.
Ask about their training and background in treating OCD.
If they went to a CBT psychology graduate program or if they did a post-doctoral fellowship in CBT, that is good. Another positive would be membership of the International OCD Foundation (IOCDF) or a member of the Association of Behavioral and Cognitive Therapists (ABCT). Look for therapists who have attended specialized workshops or training offered by the IOCDF. An example would be Behavior Therapy Training Institute (BTTI) or the Annual Conference.
Here is an example of Exposure and Response Prevention (ERP)
Using a CBT strategy called exposure and response prevention (ERP), people can learn to do the something other than what their OCD is telling them to do. They learn to do this by facing their fears gradually (exposure), without giving in to their OCD rituals (response prevention). This helps them to realize their fears don’t come true and that they can get used to the feeling, just like they might get used to cold water by gradually entering a swimming pool.
Here is an example:
Imagine a person who repeatedly touches things in their room to prevent bad luck from happening. Using ERP, this person would learn to leave their room without touching anything. This feels very scary at first, but after a while, the anxiety goes away as they get used to it. They also find out that nothing bad happens.