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100 Questions & Answers About Your Child's 100 Questions & Answers About Your Child’s OCD Josiane Cobert, MD Child and Adolescent Psychiatrist Hospital-Based Practice Elizabeth, NJ World Headquarters Jones and Bartlett Publishers Jones and Bartlett Publishers Jones and Bartlett Publishers 40 Tall Pine Drive Canada International Sudbury, MA 01776 6339 Ormindale Way Barb House, Barb Mews 978-443-5000 Mississauga, Ontario L5V 1J2 London W6 7PA [email protected] Canada United Kingdom www.jbpub.com Jones and Bartlett’s books and products are available through most bookstores and online booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jbpub.com. Substantial discounts on bulk quantities of Jones and Bartlett’s publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones and Bartlett via the above contact information or send an email to [email protected]. Copyright © 2010 by Jones and Bartlett Publishers, LLC All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the healthcare provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. Production Credits Executive Publisher: Christopher Davis VP, Manufacturing and Inventory Control: Senior Acquisitions Editor: Alison Hankey Therese Connell Production Editor: Rachel Rossi Composition: Appingo Publishing Services Senior Editorial Assistant: Jessica Acox Printing and Binding: Malloy, Inc. Marketing Manager: Ilana Goddess Cover Printing: Malloy, Inc. Cover Credits Cover Design: Carolyn Downer Cover Images: Smiling sisters, © Yuri Arcurs/ShutterStock, Inc.; Family portrait, © Dmitriy Shironosov/Dreamstime.com; Smiling toddler, © Shupian/Dreamstime.com Library of Congress Cataloging-in-Publication Data Cobert, Josiane. 100 questions and answers about your child’s obsessive compulsive disorder / Josiane Cobert and Barton Cobert. p. cm. ISBN-13: 978-0-7637-7154-6 (alk. paper) ISBN-10: 0-7637-7154-6 (alk. paper) 1. Obsessive-compulsive disorder in children—Popular works. I. Cobert, Barton L. II. Title. III. Title: One hundred questions and answers about your child’s obsessive compulsive disorder. RJ506.O25C65 2010 618.92’85227--dc22 2009001084 6048 Printed in the United States of America 13 12 11 10 09 10 9 8 7 6 5 4 3 2 1 DeDication To my children: Emilie and Julien CONTENTS Introduction vii Part 1: The Basics of OCD 1 Questions 1–8 define and explain obsessive-compulsive disorder in children: • What is obsessive-compulsive disorder? • Are OCD symptoms always the same in an individual patient, or do they change over time? • What is the cause of OCD? Part 2: The Diagnosis 17 Questions 9–33 review the diagnosis process and types of OCD common in children: • What are the symptoms of OCD that I may see in my child? • Should I be concerned about my child’s superstitions? • As a parent, what should I look for in our child? I don’t want to miss seeing or doing something that will help our child. Part 3: TheTreatment—General Concepts 49 Questions 34–45 describe general treatment options available to families and patients with OCD: • What kinds of treatment choices do we have for our daughter’s OCD? • Is there anything I can do to help in the treatment of my son’s OCD? • How often should my son see the doctor? Part 4: TheTreatment—Non-Drug Therapy: CBT 63 Questions 46–56 discuss cognitive-behavioral therapy (CBT): • My son’s doctor has proposed a non-drug therapy called cognitive- behavioral therapy (CBT). What is this? If OCD is a biological disorder, shouldn’t it be treated with drugs? • How long does CBT take to work? • I’ve heard there are group treatments. I’ve also heard there are support groups. Are they useful, and do they work? 100 Q&A ABOUT YOUR CHILD’S OCD Part 5: TheTreatment—Medications 75 Questions 57–84 explain the different drug treatment options available for children suffering from OCD: • What are the drugs used to treat OCD? • How quickly will the SSRI work in my son? How long should treatment be given? • How will the doctor choose which medication to give my child? • My child has not responded well to any of the medications that usually work in OCD. Are there any other medications that can be tried? Part 6: The amily,F School, and Siblings 111 Questions 85–100 offer advice on how to maintain a balanced home and school life for a child with OCD in addition to providing the best care: • Should I try to get the rest of the family to help in the treatment of my child? What should I tell them? • Should I tell my daughter’s school that she has OCD? Whom do I tell, and how do I do this? • Help! My health insurance carrier has very limited reimbursement for OCD treatment and support functions. What can I do? Appendix 127 Glossary 135 Index 145 vi intr oDuction Since you are reading this book you are well aware that OCD can be a devastating problem not just for your child but for you and the rest of your family as well as friends, associates, schoolmates and even your employer if caring for your child interferes with work. You also are likely to have a fairly good understanding of OCD and the issues and treatments associated with it, afterall this is something you live with on a 24/7 basis. The aim of this little book is to fill in some of the gaps in your knowledge of the disease using a user-friendly format: namely a question and answer session between you and your child’s doctor, counselor, health care provider and others involved in his or her care. This is not a textbook but rather a summary of what is known about diagnosis, causes (briefly), treatment, prognosis, and ongoing experimental work. It is purposely kept simple, straightforward and non-technical. If you want further, more detailed in- formation the literary and online references offered in the appendix will be useful. OCD can cover a broad spectrum ranging from mild to severe, isolated or accompanying other psychiatric diseases in a child. There are no hard-and- fast rules, and predictions are sometimes hard to make about the course of the disease. Nonetheless, over the last 20 years, the understanding of OCD (and of psychiatric diseases in general) has advanced. New treatments (in- volving both medications and behavioral therapy) have evolved and become available. There is more understanding (and hopefully tolerance) in the community and in the schools for children with OCD. The picture then is guardedly optimistic. The child with OCD can be helped and can live a successful and happy life (as can the family!). I hope this book will be a small piece of the evolution in the successful treatment of your child with OCD. Par t ONE The Basics of OCD What is obsessive-compulsive disorder? Are OCD symptoms always the same in an individual patient, or do they change over time? What is the cause of OCD? More . 100 Q&A ABOUT YOUR CHILD’S OCD Obsessions Recurrent and 1. What is obsessive-compulsive disorder? persistent thoughts, There is strong evidence that obsessive-compulsive disorder impulses, or images (OCD) is an illness with a large biological component. OCD that are experienced as intrusive and is partly due to medical issues (i.e., biological or genetic) and is inappropriate and not just a “mental problem.” It is a chronic illness with waxing that cause marked and waning symptoms. anxiety or distress. Compulsions OCD is a type of anxiety disorder characterized by recurrent Repetitive behaviors obsessions, recurrent compulsions, or both. Compulsions are or mental acts that a also called rituals (but not in the religious sense of the word). person feels driven to perform in response Of course, all children have occasional worries and doubts. to an obsession, or according to internal But when they cannot stop thinking about these concerns, rules that must be and when these issues start affecting their daily functioning applied rigidly. and interfering with others in the family, then this becomes a problem that needs to be addressed. The children The children (depending on their age and degree of under- may be aware standing) may be aware that what they are doing does not that what they make sense, but, nonetheless, they feel very distressed if they are doing does do not carry out the compulsions.
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