The Need for Early Intervention in Treating OCD
I am sure at some point you have heard or even said “I’m so OCD” in response to a behavior that typically has to do with being organized or clean. While organization and cleanliness can present as symptoms of obsessive-compulsive disorder (OCD), it does not mean you have it. Thus, I find that it is important to make a clear distinction between OCD and normal quirks or habits. This article will detail the importance of early intervention for treating OCD and the best methods for treating it.
What is OCD?
First, what exactly is OCD? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), Obsessive-Compulsive Disorder is characterized by obsessions, compulsions, or both, that are time consuming and cause significant distress.
Obsessions can be seen as repetitive and persistent thoughts, images, and urges. which are disturbing and unwanted in nature. An example of this can be something as mundane as thinking your hands are dirty to having thoughts of hurting your child. The important factor here is not the content of the obsession, but rather that these thoughts are persistent and causing the individual significant distress. We will go further into this later.
In turn, compulsions are typically performed in response to the obsession. Also known as rituals, compulsions are repetitive behavior or mental acts (such as counting) that one feels driven to perform. The purpose of the compulsion is to diminish the distress one is feeling due to the obsession, or to prevent the feared event.
It is important to note that there is a large genetic component, meaning you are typically “wired” for OCD or you are not. If an individual does have a genetic disposition for OCD, it is more likely that life stressors will exacerbate and trigger the “wiring”.
The unfortunate truth about OCD is that it is chronic and typically have an early age of onset – with the average age of onset 19.5 years old. Roughly 25% of cases of OCD, if left untreated, run a lifelong course of illness and are associated with reduced quality of life. Further, with early onset there is greater chance for the development of comorbidities and the likely chance of impairment of social and occupational functioning.
The good news is that studies show that early intervention can be extremely beneficial. While early intervention in any illness is necessary and best practice, it is particularly important for diagnosing OCD in children and adolescents for a variety of factors:
Early Onset OCD is More Prevalent
Studies are now showing that onset of OCD is different and earlier than formerly expected. Previously, it was thought that the onset of OCD occurred between the ages of 20 to 30 years old. However, a research study shows that there are two peaks of onset, one in pre-adolescence (average age 11 years old) and another in early adulthood with an average of 23 years old. Further, this study showed around two thirds of OCD cases present by the age of 22, with no new cases after the age of 37.
With the awareness that the age of onset is earlier than previously known, the need for intervention during these vulnerable developmental ages is necessary. As I will explain later, earlier onset leads to a variety of potential comorbidities, quality of life struggles, and societal impairment.
Disruptions in Developmental Milestones
OCD can have a direct impact on developmental milestones for children and adolescents. Due to the crippling nature of OCD, children and adolescents’ development can be disrupted and have long-lasting, cascading effects. OCD is seen to cause significant social and occupational impairments, further harming the necessary secure attachment relationships needed for healthy psychological development.
Normalize the Experience to Reduce Shame
Children and adolescent are less likely to communicate their distressing obsessions or compulsions due to a variety of reasons. The most common reason is they feel shame around the intrusive thoughts, as if these thoughts make them who they are. In turn, the most common response is to suppress the thoughts which creates a variety of problems on its own. The first risk of thought suppression is that it causes the thought to more likely appear. For example, what if I tell you to not think of a pink elephant? Most likely, a pink elephant just popped in your mind. Thus, suppression does not actually work. Another outcome of thought suppression is that it also increases the fear of the obsession. The more one avoids something, the more the fear of that thing is increased. Humans fear the unknown, and the less familiar we are with something we already fear, the more we come to fear it.
Reduce Chances of “Full-Blown OCD” and Potential Comorbidities
In taking the approach to intervene early on symptoms that present as “OCD-like”, the hope is to start to tackle some of these behaviors, thoughts, and patterns prior to the symptoms becoming more severe. OCD is much like a snowball. If we allow the obsessions and compulsions to take over and we give in, the more grip they will take and the larger the snowball will become. Thus, once an individual is suffering from “full blown OCD” it is much harder to break these patterns as well as uncover all the existing rituals and obsessions that have built up over time.
Symptoms of OCD wax and wane, however it is overall persistent and will gather strength if left untreated. According to the DSM, research shows that children and adolescents who receive early treatment are twice as likely to have remission in OCD than those who waited until adulthood to receive treatment.
In addition, those with an onset in childhood or adolescence have a higher chance of gaining comorbid mental illness. This can be seen in direct accordance with troubles in meeting developmental milestones. If a child or teen is unable to function in a healthy manner, they are often going to pick up maladaptive “coping skills” (in addition to their obsessions and compulsions). These maladaptive coping skills could even further the impact of the obsessions or compulsions the individual is experiencing. Regardless, behaviors and patterns are formed in reaction to living with OCD, which in turn can cause further mental illness to develop (for example, depression, anxiety, etc.).
An easy example of this is the development of an anxiety disorder in conjunction to OCD. Think about it – as an adolescent or child, intrusive and disturbing thoughts, images, and urges are guaranteed to raise levels of anxiety. Especially if you are not communicating these thoughts with anyone, it becomes lonely, isolating, and scary. Without the proper treatment, it is no surprise that often anxiety disorders develop over the lifespan in response to these consistent levels of raised distress.
Through psychotherapy, children and adolescent learn that these thoughts do not mean they are broken, bad, or any other story they tell themselves. Simply by being able to speak these obsessions aloud and see no judgement is a fundamental shift in beginning the treatment process. From there, a variety of evidence-based practices can be implemented. However, it is the relationship that begins the process of halting OCD in its tracks.
Early Intervention Increases Positive Outcomes and Quality of Life
The good news is that various research shows that early intervention and treatment with children and adolescent not only improves quality of life. In particular, early intervention with long-term cognitive behavioral therapy (CBT) has been seen to lead to “about two thirds of children [having] good outcomes with response and remission”.
Do you or someone you know suffer from obsessive-compulsive disorder or identify with some of these struggles?
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