Obsessive–Compulsive Disorder

Obsessive–compulsive disorder (OCD) is a debilitating disorder characterized by recurrent obsessions and/or compulsions that cause significant impairment in an individual's daily functioning (American Psychiatric Association [APA], 2000). Adults diagnosed with OCD often realize that their obsessions or compulsions are excessive or unreasonable; however, children with OCD may not be able make this determination. The individual's obsessions and/or compulsions cause significant distress and can significantly interfere with social, school, and occupational activities, and relationships. Given the intrusive nature of OCD's symptomatology and the distress that the disorder causes, it is imperative that school psychologists are aware of the nature of the disorder and how to accurately diagnose and treat children with OCD.

OCD can occur in children as young as 4 years old (Chansky, 2000), with a mean age of onset occurring between 6 and 11 years of age and bimodal peaks in early childhood and early adolescence (Piacentini & Bergman, 2000). More than a million children in the United States suffer from OCD (Chansky, 2000), and OCD has a lifelong prevalence estimated at 1% (Flament & colleagues, 1988). Pauls & colleagues (1995) found that 80% of adults with OCD identify the onset of symptoms before the age of 18 years. Rates of OCD in individuals vary from study to study; however, it is generally accepted in the literature (Snider & Swedo, 2000) that OCD affects 2% to 3% of the total population. It is estimated that 1 in 200 youngsters experience diagnosable OCD (March & colleagues, 1995). However, many researchers conclude that OCD is underreported in children and youth because of an inability to properly recognize and diagnose the disorder. OCD is more common in boys than girls; however, by adulthood, OCD occurs equally across the sexes. Developmentally, most children experience minor obsessive–compulsive symptoms as part of the normal process of achieving mastery and control over their environment. However, the difference between normative obsessions or compulsions and pathological symptoms is that OCD symptoms produce “dysfunction rather than mastery” (March, 1995).

OCD is best conceptualized as a neurobehavioral disorder (March & Mulle, 1998). The etiology of OCD is complex, with evidence supporting a genetic component (Pauls & colleagues, 1995), faulty circuitry between the basal ganglia to the cortex (Rauch & colleagues, 1994), and neurotransmitter and neuroendocrine abnormalities (Swedo & Rapoport, 1990). Additionally, in a subgroup of children with OCD, symptoms may develop or be exacerbated by the presence of group A β-hemolytic streptococcus (GABHS) infection. This onset is known as “pediatric autoimmune neuropsychiatric disorder associated with streptococcus” (PANDAS) (March & Mulle, 1998). Research supports both biological and neurobehavioral conceptualizations of the disorder.

Children suffering from OCD often experience difficulties in familial, social, academic, and normal-life functioning. Students may exhibit academic difficulties resulting from perfectionism and slowness in completing scholastic assignments, or tests (March & Mulle, 1998). Children may also find it difficult to function effectively in socially complex environments where they might be ridiculed for being seen performing embarrassing compulsions. Youths with OCD often feel that they need to hide their compulsions, creating both physical and emotional isolation from their peers and family.

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