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Not Again
Page uploaded 21 August 2009
The Weekend Australian - November 20-21, 2004 by Kylie Carberry
Re-printed with permission
Repeatedly washing one's hands or checking if the door is locked can be telltale signs of obsessive compulsive disorder, affecting 500,000 Australians. It is known to destroy lives, reports Kylie Carberry
There was a time when it was thought that people who suffered from obsessive compulsive disorder were possessed by the devil.
Exorcism was considered the most effective treatment to rid the sufferer of their compulsive, often strange symptoms. Fortunately, obsessive compulsive disorder, OCD, is now recognised as an anxiety disorder tormenting and disrupting the lives of about 500,000 Australians.
OCD is characterised by the presence of recurrent, unwanted, intrusive ideas or impulses that seem silly or horrible, known as obsessions, and a compulsion to do something that will relieve the discomfort they cause.
Common obsessions include concerns about contaminations, doubt, loss and aggressiveness. Rituals include constant hand washing, repeated checking to make sure a door is locked, or mental rituals including repetitive counting.
In recent films such as As Good as It Gets , in which Jack Nicholson plays an obsessive compulsive author, and the television-detective series Monk have lifted the profile of the disorder.
However, many people don't realise the disorder affects children as commonly as adults. A research paper published in the Journal of American Academy of Child and Adolescent Psychiatry reveals almost 4 per cent of children studied had OCD.
While it can strike some as young as three, according to the manual Obsessive-Compulsive Disorder Theory, Research and Treatment , published in 2003, the average age for childhood OCD ranges from 7.5 to 12.5 years.
Melbourne speech pathologist Lisa Byrne, 26 says that she recalls symptoms from when she was eight. However, there is evidence she was one of the disorder's younger casualties.
Her mother kept a diary of notable quotes from when Byrne was a child, and one entry reads:
5 February, 1983 . Age: 4 years 9 months.
Lisa (frustrated): Mum, when I was born I didn't think about anything did I?
Anne (mother): No, I don't suppose you did.
Lisa: Well, now I keep thinking about things, thinking about things, and I get rid of one and get that out of my head and another one comes.
The thoughts Byrne referred to increasingly filled her mind with a fear that tragedy loomed, and the ill-fated event would result in her lack of scrutiny.
This fear led to her need to repetitively wash to make sure she did not contaminate anyone, and to check over and over that everything was locked, and electrical appliances were switched off.
The anxiety would subside for a short time but soon return and the rituals begin again. By age 11, OCD consumed Byrne's every waking moment.
Byrne, who has had skin problems on her hands from constant washing, knew her behaviour was not rational. She noticed nobody else seemed to feel that they had the potential to contaminate others, or cause a tragedy.
A visit to the GP proved futile. He claimed that her symptoms were "just a phase". Byrne says "he lent over and told me not to worry so much."
The turning point for Byrne came when, aged 14, her father read a magazine article about OCD. In the story a boy discussed his battles with OCD, and his symptoms duplicated hers.
Her family referred Byrne to the clinic mentioned in the story. Initially, therapy was fruitless, possibly because Byrne was also suffering clinical depression - a condition that often co-exists with OCD. Finally, at 18 she was diagnosed with depression. Once diagnosed and given the appropriate medication, her depression eased and she began to work on some strategies using cognitive behavioural therapy (CBT).
Byrne, although fully recovered, laments about the carefree childhood she was denied. She is not alone in enduring undiagnosed OCD - at least two-thirds of adults with OCD endured symptoms as a child.
To help juvenile OCD sufferers regain control of their lives, the National Health and Medical Research Council (NHMRC), in 1999, funded at Queensland 's Griffith University a pioneering clinical trial of cognitive behavioural therapy in children and adolescents.
The four-year trial was conducted by the university's associate professor of psychology Dr Paula Barrett, clinical psychologist and research fellow Dr Laura Farrell and Professor John March from Duke University in the US . About 67 of 77 participants were successfully treated with therapy.
From the research came the inception of the program, Freedom from Obsessions and Compulsions Using Cognitive-Behavioural Strategies (FOCUS), which Barrett and Farrell now facilitate at Pathways Health and Research Centre in Brisbane , where they are co-directors.
Farrell says OCD in children is one of the most severe and disruptive of anxiety disorders, affecting the child's peer relationships, academic performance, and family functioning. She says the success of FOCUS, which has been developed into user-friendly manuals and globally disseminated to other clinical practitioners, is due to its family-based therapy.
It involves parents and siblings working with their child to overcome OCD symptoms.
By the time Julie* discovered Pathways, her daughter Paige*, 11, was incapacitated with OCD. She was taking medication that alleviated the anxiety, but Julie wanted to find a treatment that also focused on behavioural strategies.
The involvement of all family members in FOCUS provided Julie with a feeling she had found optimal care.
She says considering Paige's OCD symptoms had encroached on herself, her husband and Paige's sister it seemed their inclusion in treatment was appropriate and logical.
Julie recalls how upsetting it had been for everyone to watch a carefree child become devoured by anxiety.
To ease Paige's fear-filled obsessions, doors needed to be positioned in a certain way, every item in her room needed to be in place and she needed continual reassurance that everything would be fine.
Ultimately, the family fed Paige's OCD by appeasing her fears. This is common, says Farrell, as family members don't have any other technique to ease the stress. "They have to be accommodating to the OCD - they have to help the child wash, they have to help the child check, or they have to make sure they wear gloves so they don't contaminate the child's food, if that's the child's fear."
The manifestation of OCD symptoms such as those in Byrne and Paige are the most common in children and adolescence.
Farrell says it is important to clarify the distinction between the actions of a fussy child and one who has OCD.
"All young children go through a developmentally appropriate ritualistic phase where they are quite superstitious. They have habits and rituals that kind of keep their routine and keep them feeling comfortable."
However, for children with OCD the nature of the rituals is beyond the norm. "There's an extreme amount of distress if they are interrupted from performing their ritual. Also, it's driven by fear, so they appear terribly frightened."
Experts suggest an early diagnosis of OCD is often remiss in the young as they feel ashamed of their symptoms. "Because kids find it quite bizarre that the OCD causes them to count or wash their hands continuously, they try to keep it secretive because they don't want to look strange to other kids - and then it's not picked up by other people," says Dr Jennifer Hudson, clinical psychologist and research fellow at Macquarie University's Anxiety and Research Unit (MUARU) in Sydney.
If the disorder is recognised, some assume children will just grow out of it. This, says Hudson , has been a common fallacy that has led to children not receiving needed assistance.
Further impeding a diagnosis is the fact that OCD in children often co-exists with another mental health problem. Farrell says this was evident in almost 80 percent of the children in the Griffith University trial. Mostly OCD is accompanied by general anxiety, separation anxiety and depression.
Hudson says studies have found connections between OCD and other behavioural disorders.
It was once thought that OCD was the result of a mother's inordinate emphasis on cleanliness, or her belief that certain thoughts are dangerous or unacceptable.
The cause of OCD is no longer attributed to such parental attitudes. Experts now focus on the interaction of neurobiological factors and environmental influences.
Farrell says it's early days, but several biological theories have emerged. OCD tends to run in families, so many researchers believe there is a genetic link - especially when young children are affected. Others believe it is caused by a chemical imbalance in the brain. A third theory, which Farrell argues is the strongest, is that certain regions of the brain in an OCD sufferer may be more active and messages may get "stuck".
Investigators have used positron emission scanners (PET) to study this activity with results suggesting there are abnormal patterns in those with OCD.
Environmental stressors may sometimes act as a trigger if a child has the biological predisposition to OCD. Stressors include serious illness, death of an extended family member, disruption of family functioning or school related stress.
In a study by Farrell and Barrett, conducted at the same time as their Griffith University trial, over 70 percent of children, adolescents and adults studied reported a precipitating traumatic event prior to the onset of OCD symptoms.
The outlook is promising, though, as there has been neurological research conducted that shows abnormal brain activity in people with OCD does not go back to functioning in a normal way following CBT, Farrell says.
International guidelines recommend that children and adolescents with mild to moderate OCD should first be treated with CBT. If no improvements are seen within six to eight weeks medication may be incorporated.
A few sessions at Pathways and Paige was showing signs of recovery.
For her family, gaining knowledge of OCD was step one. They were incorporated further by undergoing separate counselling sessions with Paige.
"The psychologist could speak and explain to each of us what the next process was and also just check on our feelings," says Julie.
Group therapy can also be helpful, particularly for some children because they are relieved to find they have peers in the same situation. Julie says one of Paige's first hurdles was to conquer the anxiety aroused from doors not being in the right position. Julie says FOCUS program armed her to help Paige's terrifying thoughts to flow and disappear - a process described as changing red thoughts to green.
Next, Julie would take Paige through a relaxation process.
"The thought would come back but we'd go through it all again," Julie explains. "It was a tough road but well worth it."
These days Paige is a typical 13-year-old girl.
"I tell them that they have cured her too well - her room is always a mess now," Julie quips.
*Not their real names.
DO YOU HAVE OCD?
* Do you feel you have to complete rituals to avoid something bad from happening?
* Do you clean constantly, either repeatedly washing your hands, showering, constantly cleaning the house?
* Do you check several or even hundreds of times to make sure that stoves are turned off and doors locked?
* Do you repeat a name, phrase or action over and over?
* Do you take an excessively slow and methodical approach to daily activities, spending hours organising and arranging objects?
* Are you unable to throw away useless items, such as old newspapers, junk mail, even broken appliances?
* Are you afraid you will act or speak aggressively when you really don't want to?
* Do you avoid situations or people you worry about hurting by aggressive words or deeds?
* Do you check things over and over again or repeat them many times just to make sure they are done properly?
If you feel any of these things are occurring, you may want to speak to your doctor or a clinical psychologist.
There are a number of different approaches to treating OCD, most being quite effective. If you feel you are suffering.
WHAT YOU CAN DO
There are a number of different approaches to treating OCD, most being quite effective. It you feel you are suffering from OCD, you may want to speak with your local doctor. Your local doctor may then refer you to a psychiatrist or a clinical psychologist, who will help you manage your OCD.
In some cases, medication may also be helpful.
However, this is something your psychiatrist or psychologist can discuss with you.
There are also many support groups available for people with OCD. People with OCD and their families may benefit from discussing their experiences with others who have had similar ones. You can ask your local doctor, psychologist or psychiatrist if they know of any support groups, or you can check out some of these links.
WHERE TO GET HELP
The Anxiety Disorders Unit, St Vincent 's Hospital, Sydney
Ph: (02) 9332-1188
Anxiety Disorders Clinic Westmead Hospital , Sydney
Ph: (02) 9845-6686
Obsessive Compulsive & Anxiety Disorders Foundation, Victoria
Ph: (03) 9886-9377
Links:
Pathways Health and Research Centre: (07) 3846-4443
www.pathwayshrc.com.au/
Macquarie University Anxiety and Research Unit (MUARU): (02) 9850-8711
www.psy.mq.edu.au/MUARU/
Anxiety Recovery Centre Helpline: (03) 0886-9377
Kids Help Line: 1800 55 1800
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