Disorders That May Co-exist with OCD

Most children or adolescents who have OCD also have other mental health disorders.  If another condition exists concurrently with OCD, it can be confusing to try to pinpoint just what conditions the student may have. A mental health professional can help identify related disorders and also determine how to treat the individual so that not only OCD but any related disorder is also treated.

Disorders That Commonly Co-exist with OCD

A number of different mental health disorders may occur with OCD. Following is a discussion of several of the more common.

DEPRESSION.  Children or teens who are depressed typically are persistently sad and feel empty or hopeless.  There can be loss of interest in usually pleasurable activities (such as sports, hobbies, or friendships), decreased energy, difficulty concentrating, insomnia or oversleeping, irritability, weight gain or loss, and thoughts of death or suicide. For many young people, depression is secondary to OCD and goes away when OCD is treated successfully.  In some cases, OCD is misdiagnosed as depression. (Resource: National Institute of Mental Health ).

ANXIETY DISORDERS.  Children and adolescents with OCD frequently have another anxiety disorder in addition to OCD.  These anxiety disorders include separation anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, panic disorder (panic attacks), social anxiety disorder (social phobia) and specific phobias such as fear of snakes or heights. All of these disorders include symptoms such as excessive worrying and fear but, because each disorder is different, symptoms can be quite varied.
(Resource: Anxiety Disorders Association of America ).

EATING DISORDERS.  Eating disorders involve serious disturbances in eating behaviors.  Eating disorders include anorexia nervosa (self-starvation and excessive weight loss), bulimia (binge eating with compensatory behavior such as self-induced vomiting), and binge eating (recurrent overeating without compensatory behavior). Approximately 40% of people with anorexia also have OCD.

Because there can be intense peer pressure among children and teenagers, especially where appearance is involved, it’s normal for children and adolescents to be concerned about their weight.  But if school personnel suspect that one of the actual eating disorders may be occurring, parents should be notified.
(Resource:  National Eating Disorders Association) .

ATTENTION DEFICIT/HYPERACTIVITY DISORDERS (AD/HD).  Symptoms of AD/HD include inattentiveness, physical restlessness or hyperactivity and impulsivity.  Children or teens with AD/HD exhibit symptoms such as poor listening skills, making careless mistakes in schoolwork, difficulty performing homework tasks, fidgeting and not remaining seated in class, experiencing feelings of restlessness, excessive talking or interrupting teachers or peers.  A therapeutic assessment can determine whether a child has AD/HD.
(Resource: Children and Adults with Attention Deficit/Hyperactivity Disorder ).

In some cases, OCD is misdiagnosed as AD/HD. The attention of individuals with OCD may be consumed by obsessions and/or mental rituals (e.g., mental praying, trying to think of something neutral to "undo" an obsession). As a result, little, if any, attention is available for the task at hand. What appears to be inattentiveness, then, may lead to a diagnosis of AD/HD. A mental health clinician will be able to distinguish between the two disorders.

It is also important to note that a considerable number of children and adolescents with OCD have AD/HD. The coexistence of OCD and AD/HD in children has been documented in many research studies and young people with both disorders frequently experience more impairment (such as problems in school and social functioning or depression) than children and adolescents with OCD alone.

TOURETTE SYNDROME OR TIC DISORDERS.  Motor and vocal “tics” are involuntary movements, facial expressions and vocalizations that include shrugging, rapid blinking, sudden head movements, sniffing, clearing the throat, humming, making other sounds, blurting out repetitive words or phrases or uttering exclamations or obscenities.  Tourette Syndrome and tic disorders are among the most commonly cited coexisting disorders in children.
(Resource:  Tourette Syndrome Association of America ).

AUTISM SPECTRUM DISORDERS.  Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders, involve deficits in social interaction and verbal/nonverbal communication, as well as repetitive behaviors or interests. ASD comprise a range of disorders, including autistic disorder at the more severe end, to Asperger Syndrome, a much milder form of ASD. Individuals with Asperger Syndrome have autism-like problems in areas of social interaction and communication, but have normal intelligence and verbal skills. A distinctive characteristic of Asperger Syndrome is having an obsessive interest in a single object or topic to the extent that the individual ignores other objects, topics, or thoughts. It is important to note that focusing on these interests brings individuals with Asperger Syndrome pleasure -- unlike the symptoms of OCD, which produce anxiety or discomfort.
(Resource: National Institute of Child Health & Human Development ).

OTHER DISORDERS.  Learning disabilities occur in children with OCD at a higher rate than the population at large.  One type of learning disability that youth with OCD may exhibit is a nonverbal learning disability (NVLD).  With an NVLD, verbal skills such as language, reading and spelling are intact, but the child experiences difficulties in nonverbal areas that tap visual-spatial abilities.  On IQ tests, these students’ performance IQs are significantly lower than verbal IQs.  Dyscalculia (math disability) and dysgraphia (handwriting disability) may be evident.  Children with NVLDs have difficulty processing social-emotional information, resulting in deficits in social judgment and social interaction.

Disruptive behavior disorders, such as oppositional defiant disorder and conduct disorder, also occur in children with OCD at rates higher than control groups.  The behavior of children and adolescents with both OCD and disruptive behavior disorders may be particularly challenging.

Other Disorders That May Co-exist with OCD: OC Spectrum Disorders

Other mental health disorders that may occur simultaneously with OCD are Obsessive Compulsive Spectrum Disorders (OSCD). They are referred to as Obsessive Compulsive Spectrum Disorders because they share many similarities with OCD, including repetitive thoughts and behavior, similar brain activity, and similar responses to certain treatments. Sources differ as to the exact disorders included in the OC spectrum. For example, some sources include Tourette Syndrome as an OC spectrum disorder. However, Body Dysmorphic Disorder, Trichotillomania and compulsive skin-picking and nail biting are commonly included in the OC spectrum.

BODY DYSMORPHIC DISORDER.  Children and teens with Body Dysmorphic Disorder (BDD) have an intense preoccupation with their appearance -- specifically an imagined or exaggerated defect in their appearance.  They may think of themselves as ugly, and are often obsessed with a perceived flaw -- for example, a facial feature such as the nose.  They also frequently engage in repetitive behaviors in response to these concerns, such as constantly checking mirrors and even seeking plastic surgery to correct the perceived imperfection. In addition, individuals with BDD have difficulty controlling negative thoughts about how they believe they look, even when others believe they look just fine.

While all developing young people have some concerns about their appearance (or how others perceive them) children and teens with body dysmorphic disorder may be truly miserable and cannot be consoled or reasoned with about their appearance.  When the concern causes overwhelming distress for the child or teen, and the preoccupation interferes with normal activities, it requires treatment.   (Resource: Mayo Clinic Tools for Healthier Lives ).

TRICHOTILLOMANIA, SKIN-PICKING and NAIL BITING.  Compulsive hair-pulling (Trichotillomania or “Trich”), and two different but related conditions -- skin-picking and nail biting -- are body-focused repetitive behaviors.  Some signs of these conditions include:

• Trichotillomania -- pulling hair out by the roots, including on the scalp, eyelashes, eyebrows, or any other part of the body, resulting in noticeable hair loss.
• Skin-picking -- picking at the skin (face and body) to the point that sores or scabs develop; continued picking may cause bleeding.
• Nail biting -- biting nails past the nail bed until they bleed; nails are uneven and no nail extension is present.
  (Resource: Trichotillomania Learning Center ).

If you are a classroom teacher and observe a student who exhibits any of the symptoms discussed above, the child’s parents should be notified.  It will be helpful to provide the parents with specifics or details about the behavior to explain what you’ve observed.  It may be helpful to consult with your school psychologist, social worker, counselor, or school nurse about your observations and also to involve that person in the parental discussion.

 

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