Abstract: Obsessive-compulsive disorders are most often seen during adolescence and increase the risk of depression, anxiety, mood disorders, and phobias in adulthood.
Conventional treatments can only bring about marginal change. However, early treatment can reduce subsequent morbidity. A case study of a child with full blown traits of OCD is presented.
Keywords: OCD in children, domination, strict parenting, obsessive thoughts, anxiety, perfection, sympathetic, hand washing, pityriasis alba, Carcinosin.
Obsessive compulsive disorder is a chronic mental disorder (the term is used more casually these days) with a prevalence rate of around 1-2 % in the general population. Someone suffering from this disorder has overpowering obsessive thoughts or a compulsive need to do certain acts.
It could be checking locks, gas burner knobs or the mail box repeatedly or ritualistically following certain activities with a sense of urgency not to miss a single component of the action. These thoughts are linked with fears of contamination, disease or disaster.
The patient finds it very difficult to change, without going through anxious thoughts and feelings. Body dysmorphic disorder, trichotillomania and some skin picking disorders also fall in the spectrum of OCD.
Aetiology of this disorder is not very clear; research suggests that people with OCD don’t have enough serotonin in their brains. According to some studies, there is a strong family history of OCD. Parents can sometimes pass their obsessions onto their children.
It can affect the day to day routine, and studies, career and relationships. It is known to aggravate or coexist with other psychiatric conditions like neurological tics, depression and suicidal thoughts.
It usually starts around 20 years of age, however it can occur as early as 2 years. So often, we come across children clinging to their favourite toy or wanting to eat or bath only with specific routines.
The obsessive disorder can involve rituals around playtime and hobbies. Hoarding or collecting items or obsession with religion or technology can also be an expression of OCD. Each case can have some combination of following symptoms:
- An extreme obsession with dirt or germs and repeated handwashing (often 100 or more times a day). In one case a child was anxious about playing with a dark-skinned child, fearing getting dirty if touched.
- Hoarding objects, counting and recounting a lot, or grouping objects or putting things in a certain order.
- Repeating words spoken by oneself or others or asking the same questions again and again.
- Long periods of time spent touching things, counting, and thinking about numbers and sequences.
- Troubled by thoughts that are against personal religious beliefs, having a lot of curiosity about God.
- A great need to know or remember things that may be very minor or too much attention to detail or too much worrying about something bad occurring. Giving justifications about ones acts over and over again.
- Aggressive thoughts, urges, or thoughts about doing offensive sexual acts or forbidden, taboo behaviours
In most cases, the activities of OCD such as hand washing or checking the locks on doors use up many hours each day. They also cause mental health distress and affect how the child thinks. Often, children can’t see that their behaviour is irrational and abnormal.
Treatment for OCD often includes a combination of the following:
- Therapy with cognitive and behavioural methods –Cognitive methods help a child identify and understand his or her fears. They also teach a child how to better resolve or reduce those fears.
Behavioural methods help the child and their family make pacts or rules to limit or change behaviours. One example is setting a maximum number of times a compulsive hand washer may wash his or her hands.
- Family therapy –Parents play a vital role in any treatment process. Unconditional support is expected from family and friends. A child’s school may also be included in care.
Master VS, aged 7 years was brought on 9/7/2014 with complaint of discomfort/strain while passing urine and some pain for 3 months. He also had hypo-pigmented patches on his face and legs, for the last year. His associated complaint was his preoccupation with cleanliness.
Personal history with physical generals: Appetite: good, He likes chocolates+++, curd+, fruits esp. citrus fruits. Dislikes: eggs, Thirst: 4-5 glasses, prefers cold water. Perspiration: profuse on face. Sleep: He takes long time to fall asleep and talks during sleep. Thermal state: Hot patient. Milestones: normal. P/H- prolonged, cough 2 years back.
Life situation and mental characteristics:
He comes from a rigid south Indian Brahmin family. His father is a top executive in a multinational company and has high expectations for him. His mother is very religious and spends a lot of time performing rituals at home and at temples.
He has two older siblings who are of different temperaments and trouble their mother a lot. This often vexes the mother who vents her anger and frustration on the patient.
The body closer to his father, though he harbors no ill feelings towards any family members. He is sociable, mixes well. He is extremely scared of darkness and being alone. He switches off the TV if some ‘horrible scene’ is on (eg. some wild animal eating a small creature.) He recovers quickly after any conflict.
He finds his mother quite strict and dreads disobeying her. He is quite particular about switching off the fan, light etc. If someone forgets he asks: “Why haven’t you done that?”.
He wants his plates to be cleaned well. He will clean his hands thoroughly before meals. If soap happens to fall, he asks for another one and also cleans the fallen soap. He washes his slippers on alternate days.
His personal habits seem to be over and above anyone at his age. He also has some strange notions and habits. He avoids walking on the cement joints of tiles. If he hears any bad news, he needs to spit out immediately fearing that the news will enter his body.
He is quite particular about his bed sheets, belongings, toys etc. He keeps all his books and toys in order and cannot sleep unless things are in place. He prefers to clean up himself, even after his mother has tidied things. This often gives him little time for indulging in activities appropriate for his age, like playing with his friends.
He dislikes eating street food as he believes that the food is badly contaminated. He falls sick every time he visits his native place as he can’t stand the dirt in the long-distance trains.
He does not like to stay at anybody’s house and would prefer be back home by night. He will not use others’ toilet. He mixes well with strangers, guests. He is quite helpful to others.
He has a sharp memory and has “excellent grasping power”. He gives his best shot in whatever he undertakes. He does not get discouraged by failures, rather says that he will try it again with better preparation. But of late, all his hobbies and interests have been shelved due to ever growing obsessions and compulsions for trivialities.
Diagnosis: OCD with Pityriasis Alba
Fear of dark
Fear of contagious disease
Sleeplessness in children
Desire – fruits
Skin – white spots.
Remedies that fit the above totality are Arsenic, Phosphorus and Carcinosin. Arsenic is fastidious, concerned with cleanliness and has fear of contracting diseases. Phosphorus is sympathetic, fun loving and craves chocolates and fruits.
But the remedy which is closest to the totality is Carcinosin. Carcinosin is so often indicated for children with history of excessive parenting control and pressure. It’s not unusual to find a typical Carcinosin misdirecting his energies and carrying things too far, pushing too hard, expending undue time or effort on a job, hobby or favourite sport, as seen in this case, in his obsession with cleanliness.
Fastidiousness to the point of obsession, is a feature of Arsenic and Nux Vomica as well as Carcinosin. They dread making a mistake and avoid all situations which may call for correction or reprimand. Craving for chocolates, fruits and difficulties in falling asleep point to Carcinosin.
Remedy given: Carcinosin 1M 3 Doses. Follow up on 30-7-2014: his discomfort while passing urine was less and the white patches were better. Obsession for cleanliness persists but he is not so rigid. He now goes to friends’ houses to play. He was prescribed Sac Lac.
On 14/8/2014, the white patches cleared completely. Slight coryza in the last 2 days. A/f: having cold drinks with watery discharge. OCD >> He was kept on SL. He continued to progress.
Follow up: Carcinosin was repeated a couple of times in the next six months following which the patient was put on Report SOS. His mother continues to visit for her psoriasis and gives updates on the patient who is now a confident teenager. He is pursuing badminton seriously and excelling in his studies also.
Discussion: In cases of children with OCD it is also very important for the parents to be understanding of the child’s condition. In these formative years if a child is made to feel that there is something wrong in his behavior then it can permanently scar him and affect his emotional and psychological well-being.
Carcinosin was given based on the totality and the case being syco-syphilitic. Besides the prescription of Carcinosin, the child was also counseled for his obsession by channeling his energy in the right direction.