There are many factors to consider in the evaluation and treatment of Obsessive-compulsive disorder (OCD). This paper will discuss the strategies that have proven most effective in treating the disorder, including: drug therapy, cognitive therapy, and family-based therapy. It will focus on the benefits of flexibility, emphasizing combination therapy, especially with cognitive-behavioral therapy (CBT).
Obsessive-compulsive disorder (OCD) has become an increasingly familiar disorder within the world of health and medicine. The recurring obsessions and compulsions associated with the disorder seem quite easy to identify, yet the acknowledgement of OCD in children had been overlooked for quite some time. Many people believe “that children have no reason to develop depression or anxiety disorder such as OCD” (Wiznitzer, 2003). Diagnoses and treatment of OCD patients has only recently shifted from adults to children. Some of the most important questions facing psychologists studying OCD today are how to determine which children suffer from OCD and what treatments most effectively reduce or eliminate their symptoms. Researchers have offered that by applying some of the information learned from treating adults, our understanding of the disorder in children may improve immensely.
With the majority of psychologists agreeing with this proposal, OCD has gained a large amount of attention in the last couple of decades. Recent studies have estimated that “the condition is 2 to 20 times more common than previously thought and has been the catalyst for research activity in the area” (Waters, 2000). Though this heightened attention is good news for suffering children, it has not been as helpful as originally expected. A number of unnecessary drug-based therapies have been implemented in an attempt to meet the increasing demand of OCD treatment. Many of these drugs have proved successful in treating anxiety disorders; however, many OCD cases require more complex treatments. Many could benefit from several alternative forms of OCD treatment, such as family oriented treatments and cognitive-behavioral therapy. Unfortunately, the advantages of combining these methods with drug therapy have nearly been overlooked in the scramble for easy answers.
“Cognitive-behavioral therapy (CBT) has emerged as a safe, viable, and efficient treatment for OCD among children and adolescents” (Wagner, 2000). One specific form of CBT that has proven to be quite successful is exposure plus response prevention (ERP). In this method, patients are guided into conscious confrontation with the objects and situations that serve as the triggers of their obsessive fears. Following exposure, patients are taught how to abstain from the obsessive habits that they have constructed to relieve their anxieties. This treatment is quite similar to conditioning in that the response prevention immediately follows the exposure, maximizing the reinforcement effectiveness of the therapy. The idea behind this treatment is that repeated exposure to the anxiety-producing stimulus leads to the patient’s habituation and progression in overcoming the disorder. “Additionally, the realization that obsessive fears do not materialize during ERP appears to reduce the potency of the obsessions” (Wagner, 2000).
The second form of CBT that has proven to be successful is the RIDE theory. In this theory, encounters and enactments of OCD symptoms are broken down into four different stages: R, I, D, and E. In the R stage, individuals are taught to recognize OCD thoughts as impractical to the child’s normal being. By doing this they could realize their urges and take the necessary steps in dismissing them from their consciousness. Once they have done this they are taught the I stage. In this stage they must insist that they are in fact in control of their behavior. This assertion puts them in the driver’s seat where they determine what actions will be taken next. The third stage is the D stage. This is the stage where the actual change of behavior takes place. Children learn to defy OCD, resisting their urges by doing the exact opposite of what they feel. The fourth and final stage of the RIDE theory is the E stage. When the child has learned to successfully complete the first three stages, they are taught to enjoy and celebrate their success. By recognizing, insisting, and defying their unusual urges, children have learned to overcome OCD and should be able to appreciate their hard-deserved success.
Though both the ERP and RIDE methods have proven successful, their effectiveness is both limited and varying. The unfortunate truth is that many children do not benefit from these strategies and many others diagnosed with OCD do not receive CBT at all. A variety of reasons have been offered in explanation to this, the most common being simply that there are not a sufficient amount of clinicians who are trained in managing the challenges expected in this type of treatment. The second is that the disorder itself can be difficult to detect and diagnose in the first place. Many children reason that they either have to or are uncertain why they perform some of their actions, which has lead others to believe that the obsessive behavior is willful. Although this does pull treatment potential back, it is important to take full advantage of the resources available right now.
Among these available resources is the role of the family in childhood obsessive-compulsive disorder. A large percent (67%) of adults suffering from OCD have reported signs of symptoms extending well into childhood memories. One groups of researchers state that “OCD is a common childhood onset psychiatric condition” (Steinberger, 2002). This information hints that the family may play a critical role in the development and treatment of OCD, both genetically and cognitively. Research on the subject has yielded inconsistent results, but on average, 20% of parents of children with OCD are also diagnosed with the disorder. Cognitively, psychosocial factors have also been acknowledged as important. Although the exact factors are still being investigated, many have already been found. These factors range widely in their influence including high expressed emotion, overprotection, lack of warmth, avoidance, caution, and fearfulness.
Each factor is relative self explanatory, though the direct correlation of each with the disorder differs slightly. While in some instances the cause for each factor can be negative, most cases are related in an indirect from. The most common are a result from a feeling of helplessness, generally resulting from a failure to successfully support the family member with OCD in previous situations, or some sort of confusion in actions that were originally made with good intention. For example, a common misconception of people is to accommodate the OCD behavior when in fact, “it is widely recognized that accommodation of the OCD behavior through assistance with rituals, giving reassurance, and facilitating avoidance of feared stimuli serves to reinforce and maintain the symptoms” (Waters, 2000).
There are many different strategies to consider when treating OCD. It is important to realize that OCD varies in type and severity, so treatment will vary in their effectiveness. “Whatever is tried, it is important to urge flexibility, as a combination of drug and behavioral treatment may be needed” (Rapoport, 2000). Recent studies such as the ERP and RIDE approve and recommend CBT in treating OCD. They also emphasize the importance of flexibility in successfully treating the disorder. Many cases may benefit best from a combination of drug and behavioral treatment.
Rapoport, J., ; Inoff-Germain, G. (2000). Treatment of obsessive-compulsive disorder in children and adolescents. Journal of Child Psychology ; Psychiatry, 41(4), 419-431.
Steinberger, K. (2002). Classification of OCD in children and adolescence. Acta Psychiatrica Scandinavic, 106(2), 97-102.
Wagner, A. (2003). CBT for Children and adolescents with OCD. Brief Treatment and Crisis Intervention. 3(3). 291-306.
Waters, T., ; Barret, P. (2000). The role of the family in childhood obsessive-compulsive disorder. Clinical Child ; Family Psychology Review, 3(3), 173-184.
Wiznitzer, M. (2003). Why do psychiatric drug research in children? Lancet, 361(9364). 1147-1148.