Regarding the causes of OCD, according to Nestadt et al. (2009; as cited in Gelleret al., 2012), the early onset of OCD (childhood), has a 12% risk factor of being heritable from first degree relatives. It was also suggested that said disorder has non-genetic biological factors such as a dysregulation in the cortical-striatal-thalamic circuits, which are responsible for cognitive control and motivation (Boileau, 2011). This fact could explain the motivation of a person with OCD to perform a certain ritual, as well as the decreased cognitive control accompanied with the process. And finally there are also psychological factors like parental control, where overly protective parenting styles are associated with OCD, in case of the presence of a familial history of mental disorders (Boileau, 2011). Moreover, cognitive biases like dichotomous thinking and catastrophizing events cause greater psychological distress in people suffering from said disorder (Herschitt et al., 2017).
Leaving OCD untreated for a long amount of time, can decrease insight, and even increase the severity of the disorder (Pinto et al., 2006; Aspvalla et al., 2020). Among treatments, the most widely used drugs are SSRIs; however, more recently deep brain stimulation and neuroleptics are gaining more acceptance for treating OCD that is unresponsive to medication (Herschitt et al., 2017). However, for minors, medications are not usually considered as a primary intervention, but more so as a last resort; and are always coupled with CBT. So, cognitive-behavioral therapy, or CBT is the most popular and effective treatment for OCD, and it consists of several aspects.
According to Geller et al. (2012), the first component is information gathering. This method consists of collecting information regarding the family’s psychosocial history (since OCD has a genetic component), the child’s symptoms, and the course of development of the disorder (allowing the therapist to understand the obsessions and rituals and propose a prognosis). The first step can also involve aiding the child or adolescent to understand the disorder more. Which brings us to the next step, the EX/PR. It involves developing a hierarchy of fears, and gradually exposing the person to those fears while controlling the response initiated by the obsession. Later on, generalization must take place from this one tree to all trees, and several techniques are taught in order to prevent relapse (like continuing to face challenging stimuli on a regular basis). Furthermore, an online based intervention (tCBT), was found to be effective for clients who are of a low socioeconomic status. Additionally, videogames have been developed to control and prevent relapse such as “Ricky and the spider” (Miranda et al., 2019; Aspvalla et al, 2020), however, both types of interventions are complementary to CBT, and are not very adaptable to our country according to Dr.Haj.
Finally, in an interview with Dr. Elham Haj Hassan, she stressed the importance of understanding the context of the behavior before diagnosing OCD. For instance, one of her clients was an 8 year old girl, who had to shower every 1 hour. The first step for her was to make sure that this girl had not been subject to any form of physical, and specifically sexual abuse that could lead her to do this behavior as a way to cope with the traumatic experience. These types of compulsion, meaning the one related to cleanliness are the most common in Lebanon (specifically in females) from her experience, which is in line with the presented literature. She also suggested that cultural or religious related household cleaning traditions, might play a role in the obsessions, like taking off and then putting on shoes repetitively before walking into the house. This form of the behavior is usually common in Lebanese and Arabic households. And finally, Dr. Haj remarked that parents must be vigilant specifically during this time, they shouldn’t provoke too much anxiety regarding cleanliness in their children, to avoid triggering OCD for individuals who already have a predisposition, or increasing the distress for people suffering from it.
To conclude, OCD is a fairly prevalent, but very much stereotyped disorder. It is characterized by obsessions that are universal, although some could be specific to certain cultures. OCD is treatable through CBT and medication which increase the patient’s insight and enhance their quality of life. So, with enough social, parental, and therapeutic support, the child or adolescent could deal with this extremely challenging disorder, and adapt to its presence in their everyday lives.
Aspvall, K., Lenhard, F., Melin, K., Krebs, G., Norlin, L., Näsström, K., ... & Mataix-Cols, D. (2020). Implementation of internet-delivered cognitive behaviour therapy for pediatric obsessive-compulsive disorder: lessons from clinics in Sweden, United Kingdom and Australia. Internet interventions, 20, 100308.
Boileau, B. (2011). A review of obsessive-compulsive disorder in children and adolescents. Dialogues in clinical neuroscience, 13(4), 401.
Geller, D. A., Biederman, J., Faraone, S., Agranat, A., Cradock, K., Hagermoser, L., ... & Coffey, B. J. (2001). Developmental aspects of obsessive compulsive disorder: findings in children, adolescents, and adults. The Journal of nervous and mental disease, 189(7), 471-477.
Geller, D. A., & March, J. (2012). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 98-113.
Hirschtritt, M. E., Bloch, M. H., & Mathews, C. A. (2017). Obsessive-compulsive disorder: advances in diagnosis and treatment. Jama, 317(13), 1358-1367.
Miranda, J., Teofilo, V., Lins, A., Oliveira, B. S., Campos, F., & Nesteriuk, S. (2019, July). Literature Review: The use of games as a treatment for obsessive compulsive disorder. In International Conference on Human-Computer Interaction (pp. 512-531). Springer, Cham.