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The Informed Parent

Obsessive-compulsive Behavior

by Peter W. Welty, M.D., F.A.A.P.
Published on Nov. 20, 2000
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We all know teen-agers have their moods, sometimes coupled with odd behavior. Last week a 17-year-old girl, accompanied by her mother, came in for a routine physical. Mom was perplexed at the young girl’s recent display of changed personality. Until now she had always been a great student, and a real perfectionist. Her room was always clean, and she often offered to help around the house.

Lately, she has begun washing her hands all day long and taking 10-to-12 showers each day. She says there are a lot of germs that need to be washed away, and can even name them. Whenever we leave the house to run an errand she needs to check all the locks, appliances and windows. This routine alone can last incessantly. Now her grades are suffering, and her friends no longer come around.

Armed with this information we concluded that there are a few issues here. It appears that this young lady has developed the anxiety disorder called obsessive-compulsive disorder. This is a psychiatric irregularity that has been extensively researched, and is now known to be the result of a very specific chemical imbalance in the brain.

The symptoms are expressed by obsessions, which are repetitive thoughts occurring so often that they interfere with the person’s life and ability to carry on with normal routine. Typical obsessions might include religious thoughts, the idea of being dirty or germ-filled, wanting things just "so", the fear of danger, fire or impending catastrophe, and anxiety over harm befalling loved ones.

Compulsive symptoms are expressed by acts designed to neutralize the repetitive thoughts. These might include washing, checking, counting, doing things over to get them right, etc.

It is important to remember that everyone, at one time or another, has repetitive thoughts about making things just right, or wanting to check and count things a few times. We all know of students who will check their homework several times, or those who examine the door lock more than once before retiring. This is generally not a picture of a typical obsessive-compulsive person.

The obsessive-compulsive person has so many thoughts and behaviors throughout their day that it interferes with their normal routine. Their behavior can occupy literally hours at a time. The person generally realizes that the thoughts or behaviors are irrational or silly, but he or she feels compelled to perform them anyway. Usually they are very depressed over their symptoms realizing how this has affected their friendships and schoolwork as well as their social life.

It is important to note that physicians have recently recognized a new type of obsessive-compulsive disorder that begins very rapidly and generally follows a strep throat infection.

There is, of course, another possibility to consider with this young lady. Perhaps she has been exposed to some trauma, such as a sexual experience. It is common for one to feel compelled to wash and shower themselves in an effort to "clean" away any such trauma.

Open communication is imperative. She will need to be referred to a therapist to help her develop ways to address her obsessions and compulsions. These would include relaxation techniques, thought-stopping behavioral modification measures, etc. A child psychiatrist is also highly recommended who can prescribe a course of medicine to help decrease these symptoms. The newer seratonin antidepressants have been thoroughly researched and are found to have a clear benefit in child and adult patients with this disorder.




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