Areas of Specialization - Children and Adolescents
Exposure and Response Prevention for Obsessive Compulsive Disorder
Case example
| Jake is 11 years old and
constantly worries about germs.
He is terrified when he touches
or comes close to certain
things that he is "dirty"
and the germs will cause him
to become sick and die. He
also fears that if he touches
anyone without cleaning himself
he will cause him or her to
become sick and die. He worries
that chemicals from cleaning
products his mother uses in
their home are toxic and will
cause cancer. As a result,
Jake refuses to allow anyone
into his room to clean. He
spends hours in his room arranging
his toys and books repeatedly
and becomes extremely distressed
if his younger sister moves
anything without his permission.
Despite his concern that nothing
be altered, his room is exceptionally
messy and disorganized. Jake
washes his hands throughout
the day for up to 10 minutes.
His mother reports that she
has spent more money on soap
and paper towel for Jake in
the previous month than for
the rest of the family this
past year. He has recently
begun to refuse using public
restrooms out of fear he will
become contaminated. School
has become increasingly difficult
as he refuses to relieve himself
during the day and comes home
directly from school to use
the bathroom. Thus, Jake insists
that the can no longer stay
after school to play soccer
or go over to his best friend's
home for a playdate. Jake
has suddenly become avoidant
of things that previously
caused him no difficulty.
For example, the family's
dog vomited last week in the
kitchen and he now refuses
to pet the dog and will not
eat any food that is prepared
at home. Last week at school
on of his classmates came
down with the flu and vomited
in class. Jake came home from
school and ran into the shower
for over an hour. Jake currently
has only one pair of pants
that he will wear and he insists
that all his shirts are blue. |
The symptoms of Obsessive Compulsive
Disorder in children and adolescents
are consistent with those found
in adults, with the exception
of children having to understand
the unreasonable nature of their
thoughts and behavior. Children
and adolescents may experience
obsessions (intrusive and distressing
thoughts, images or impulses that
reoccur) or compulsions (repetitive
behaviors, such as washing and
checking, or thoughts, such as
counting or repeating phrases).
In children and adolescents, characteristic
themes of obsessions include contamination,
morality and religiosity, aggressive
actions toward oneself or others,
orderliness and neatness, and
repeated doubts. The compulsions
most frequently found in children
involve washing, checking, and
ordering and are often performed
in a superstitious or ritualistic
manner. Children are most likely
to perform their rituals at home
as a means of neutralizing their
anxiety or preventing some feared
consequence. However, decreases
in concentration due to the disorder
frequently affect grades, academic
performance, and peer relationships.
Obsessive compulsive symptoms
are frequently time consuming
and result in marked distress
and restrictions within the family.
Describe
treatment>>
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