Table of Content
Obsessive-compulsive symptoms dimension
Evidence-based diagnosis of OCD
Obsessive Compulsive Disorder (OCD) is a neuropsychiatric disorder often characterized by the manifestation of obsessive and compulsive actions that are time consuming and interfere with the client’s life. OCD is characterized by recurrent obsessive thoughts or mental images that are disturbing, unwanted and cause distress. The obsessions are distasteful, senseless, and to some people, repugnant. The compulsions are the thoughts that an individual suffering from OCD performs in the attempt to suppress or overcome their obsessions. The compulsive behavior typically involve repetition of some behavior such as washing, avoiding, or checking, or some mental acts that the individual feels compelled to do so as to avoid a dreaded outcome or reduce the distress. These activities are of bizarre quality because they do not relate to what they are supposed to neutralize or in some instances, prevent. The aim of this paper is to integrate clinical diagnosis with Evidence Based interventions in the management of obsessive and compulsive disorder among children and adolescents.
Many young children undergo a period where they insist on some elaborate rituals at meal-times, bed-time or bath-time, as part of the process of learning and mastering their daily routine. These behaviors cannot be described as OCD since they form part of the normal development and normally subside as the child grows (Freeman et al., 2008). However, for children with OCD, The obsessive thoughts and the consequent compulsive behavior continue past the age the child would be expected to have stopped such behavior. The obsessions and compulsions would also start to interfere with the child’s daily functioning and impacts negatively on the child’s ability interact with other children, attend school, or pursue hobbies (Mataix-Cols et al., 2005). The disorder could also affect the functioning of the family forcing the parents to change the organization of their life to accommodate the child’s demands and rituals.
The lifetime prevalence of obsessive compulsive disorder is three percent which makes it one of the most common neuropsychiatric conditions. Often, OCD symptoms appear before puberty in about one-third of the sufferers. In some study comprising about three hundred and thirty adult sufferers forty-nine percent were found to have shown their first symptoms before the age of eleven and twenty-three percent before eighteen years (de Mathis et al., 2009). However, before 1988, OCD was viewed as rare until a study was published which give an estimation of a one year prevalence of about 0.7 percent I the United states of America (Freeman et al., 2008). A recent British study estimated point prevalence among the five to fifteen years old of point two five percent, and surprisingly, most of the cases had not sought treatment. The data was similar to the adult epidemiological studies. The studies also found that the incidences of OCD had two peaks with different gender distribution (Mataix-Cols et al., 2005). The first peak appears among children aged between seven and twelve years old with a male preponderance. The second peak has a female preponderance starting at a mean age of twenty-one.
Obsessive compulsive disorder is characterized by the exhibition of obsessions or compulsions that consume time, cause distress in the patient’s life. Obsessions are intrusive, images, fears, unwanted ideas or thoughts that the patients find uncomfortable, distressing, and unpleasant or anxiety provoking (Freeman et al., 2008). The compulsions behaviors are the repetitive acts performed in order to ignore, eliminate, or reduce the anxiety caused by the obsessive thoughts. The compulsive actions are undertaken according to the rules the patient feels driven to observe or follow. The symptoms differ from a patient to the other but also from time to time in the same patient. Children and adolescent present a higher probability of exhibiting compulsions without obsessions. Children are also unlikely recognize the symptoms as ego dystonic, thus, making them unwilling to resist the urge to perform the compulsive behavior. Consequently, DSM-IV does not demand that the children should have insight in order to qualify for the diagnoses. It is possible that the children may present some tic-like behavior which is most likely confused with complex tic, especially if the compulsions are simple acts of touching (Micali et al., 2010). It is possible that the compulsion is accompanied by an obsession as well as various types of sensory phenomena.
Obsessive-compulsive symptoms dimension
Although subdividing the clients into age groups of onset has been useful in identifying the homogenous sub-groups, the dimensional approach has been found to have greater value. Consequently, factor-analytic research has reduced OCD symptom to few consistent and clinically valuable dimensions such as contamination and cleaning, symmetry and ordering and hoarding, as well as obsession and checking. The symptoms dimensions are similar in all age groups, and, therefore, can be understood as overlapping clinical features that occur alongside the normal worries that are first evident in childhood, and correlate with several genetic and neural imaging treatment variables (Martais-Cols et al., 2005). Some studies have indicated that in the early on-set of OCD, most patients display higher severity in such symptoms dimensions as aggressive obsessions and the related compulsive behavior, sexual and related compulsions, as well as ordering and obsessions and their related compulsive behaviors (Rosario et al., 2008).