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Obsessive Compulsive Disorder | Dr. William Winter is a child and adolescent psychiatrist.
Will Winter, MD, FAAP
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This disorder is characterized by 2 things:

  1. Obsessive thoughts that cause mental discomfort
  2. Compulsions- a need to act. The actions are time consuming but do not accomplish anything useful.


Vignette 1
You are 18 and away at college for the first time.  When you go to the washroom on the hall, you notice a student who lives on the floor.  He is always there, lathering up and washing his hands and face.  When you walk by him, you can't help but look at him.  He looks back at you with a mean look.  Once you are almost past, he resumes his ritual.  The other guys on the floor also have had this awkward experience with the fellow who washes his hands and face.  They laugh it off and, as no one knows his name, they refer to him as "Bubbles".

Vignette 2
A 25 year old woman presents to the psychiatrist to talk.  She is successful professionally.  She is bright, pleasant and her appearance is fine.  While the psychiatrist is obtaining information he notices that she seems distraught.  He asks her about it and she says that she notices that one of his diploma frames is slightly askew.  She is allowed to straighten it, after which she returns to her seat appearing much more relaxed, relieved and sociable.

After a number of visits, she brings up the fact that she does certain things that she knows are silly but that she can't help.  She wakes up early- 2 .5 hours early- to start with her 'morning rituals' which include specific activities for specific lengths of time around self-care and cleaning her apartment.  In the evening, she also must do about 2 hours of rituals.  Most recently the problem is that she is working later hours and it is interfering with her evening ritual time.  This causes her to have fewer hours to sleep.  Her lack of sleep is causing her to be more sensitive to stress and her ritualistic behaviors are worsening. She is embarrassed of these and knows it is 'weird'.  When she is happier/ less stressed, i.e. when she has a boyfriend, the rituals decrease.

She says that even as a young child, her room always had to be immaculate and properly arranged. Her mother also remembers this well.

Discussion

These stories illustrate compulsive behavior. Compulsive behaviors are unpleasant for those who perform them because they know that it is nonsensical. Regardless, they feel compelled to do them. Other examples of compulsive behaviors can include touching things, i.e. wall touching, tapping something, and checking even when it was just checked. It can include hand washing. It can include doing things in a certain order that cannot be comfortably changed.

Treatment
Like with the other anxiety disorders, talk therapy and relaxation exercises or hypnosis can be helpful.  If clinically warranted, medication may also be helpful.

Final Vingette
-  When this person walks down the street he makes great efforts to avoid the cracks on the side walk. 
-  He is very interested in collecting things. 
-  He seems quite rigid and is obsessed with what is 'fair'.

This sounds like OCD right?  Well, it might be if we were talking about an adult.  But, as it so happens, we are talking about a 7 year-old boy- a normal 7 year-old.

These findings- avoiding the cracks or lines on the pavement, collecting things (like stickers, baseball or Pokemon cards, etc,) are typical in a child this age.  As children mature in age and development, what may appear like OCD symptoms will disappear in almost all cases.