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Article Excerpt
Obsessive compulsive disorder I(OCD) is a debilitating disorder with two distinct features: a) obsessions that are intrusive, disturbing, and recurrent, and (b) compulsions or repetitive behaviors that are performed to reduce the acute discomfort caused by the obsessions (Bartz & Hollander, 2006; Carter & Pollock, 2000; Storch et al., 2005). Children often describe their obsessions as worries that will not go away. Examples include, but are not limited to, worry about having a serious illness, germs, or intruders in their home, and harm to family or friends. These worries become pervasive, interfere with the child's normal activities, and often require ritualistic behavior to reduce the discomfort (Carter & Pollock, 2000; Ivarsson & Valderhaug, 2006). Ritualistic, repetitive behaviors (compulsions) are often carried out to prevent perceived harm to self or others and to relieve subjective feelings of distress (Storch et al., 2005). Examples of compulsions vary and can include checking or washing rituals, mental rituals in which thoughts are intended to neutralize fears, or touching rituals devoid of cognitive content (Ivarsson & Valderhaug, 2006).
A variety of theoretical perspectives offer insight regarding OCD and children, providing different principles for addressing treatment of OCD in the pediatric population. Because the presentation of OCD symptoms in children can change over time (Rettew, Swedo, Leonard, Lenane, & Rapoport, 1992) and because cognition and emotional regulation differ greatly in children compared to adults (Barrett & Healy, 2003), exploring factors associated with the onset of pediatric OCD symptoms may provide greater understanding of this disorder, its etiology, and its treatment. An overview of the predominant theories in the biomedical, behavioral, and psychosocial models are presented in this article, supporting an interdisciplinary approach to the treatment of OCD in children (see Figure 1).
Theories from a Biomedical Model
Genetic theory. Results from family and twin studies suggest that genetic factors are implicated in the transmission and expression of some forms of OCD (do Rosario-Campos et al., 2005). Familial aggregation of OCD is concentrated primarily in families with early onset OCD probands (Nestadt et al., 2000). Obsessive compulsive behaviors expressed most prominently in multiple family members include obsessions about contamination, aggression, and religion, and compulsions involving washing, checking, ordering, and arranging (Hanna, Fischer, Chadha, Himle, & Van Etten, 2005). Another significant finding by do Rosario-Campos and colleagues (2005) is that there is a familial relationship between childhood onset OCD and tic disorders. The diagnosis of tics was concentrated in 57% of families. Whether there are clinical, neurobiological, and treatment response differences between the varying presentations of OCD in families requires further study.
Immunology theory. The onset of OCD and tics is supported...
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