Obsessions and Compulsions in Children, from the Harvard Mental Health Letter

BOSTON— It is normal for many children, at various stages of development, to be concerned about sameness and symmetry and having things perfect, to insist on certain bedtime routines, or to develop superstitions and rituals like avoiding cracks in the sidewalk. But when such beliefs or behaviors become all-consuming and start interfering with school, home life, or recreational activities, the problem may be obsessive-compulsive disorder (OCD). “Symptoms may appear as early as age three,” notes Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter. “Over the past decade, several randomized controlled trials and literature reviews have concluded that both cognitive behavioral therapy and medication can help youths better manage OCD—but that the combination of both is best. The ideal approach is to try this psychotherapy before turning to medication.”

A version of cognitive behavioral therapy known as exposure and response prevention is typically used in treating OCD in patients of any age. During therapy, a clinician gradually exposes patients—either physically or mentally (through the imagination)—to the things, places, and circumstances that provoke obsessions. Eventually, if all goes well, the patient learns to tolerate the anxiety through habituation. In a sense, this detoxifies the stimuli and makes the compulsive behaviors unnecessary.

Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) are the drugs most often used and studied in youths with OCD. SSRIs require two months or more to have an effect on OCD symptoms—a longer time than they usually take to relieve depression. Young people may need to keep taking an SSRI for at least a year and sometimes indefinitely. When the drug is the only treatment, youths usually relapse in a few months if they stop taking it. Read the full-length article: “Obsessions and compulsions in youths”

Also in this issue:

- Schizophrenia and epilepsy

- Recognizing and managing delirium

- Taming the frenzy in your brain

- Updated guidelines for treating ADHD

- Mindfulness training helps people quit smoking

- Interpersonal therapy

The Harvard Mental Health Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $59 per year. Subscribe at www.health.harvard.edu/mental or by calling 877-649-9457 (toll-free).