Disorders That May Co-exist with OCD

Most children or adolescents who have OCD also have other mental health disorders, which can complicate diagnosis and treatment.  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 disorders are treated as well.

Disorders That Commonly Co-exist with OCD

Some of the most common coexisting disorders in children and  adolescents are anxiety disorders (e.g., separation anxiety disorder, social phobia); mood disorders (e.g., major depressive disorder [depression], bipolar disorder); attention-deficit/hyperactivity disorder; disruptive behavior disorders (e.g., oppositional defiant disorder, conduct disorder); and tic disorders, including Tourette Syndrome.  The following section contains a description of these and many other disorders that may occur with OCD.

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 ).

MOOD DISORDERS

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 ).

Bipolar Disorder.  Bipolar disorder, previously known as manic depression, is characterized by severe changes in a person's mood, energy level, behavior, and thinking.  It is called bipolar disorder because the mood of the individual can vary, or swing, between two poles: depression (sad, hopeless, depressed mood) and mania (an elevated or irritable mood).  These changes in mood occur in cycles and are referred to as "episodes."  Individuals may experience mixed episodes, in which features of both mania and depression are present at the same time.  Mood changes can last for hours, days, weeks, and even months.  A number of different categories of mood disorders fall under the umbrella of bipolar disorder (e.g., a category for individuals who are experiencing a first episode of mania, another for those who have recurrent mood episodes).  (Resource: National Institute of Mental Health)

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 these eating disorders may actually be occurring, parents should be notified.  (Resource:  National Eating Disorders Association) .

AUTISM SPECTRUM DISORDERS.  Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders, involve difficulties with social interaction and verbal/nonverbal communication, as well as repetitive behaviors or interests.  ASDs include a wide range of disorders, including autistic disorder at the more severe end, to Asperger syndrome, a much milder form of ASDs.  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 a focused 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 ).

ATTENTION-DEFICIT/HYPERACTIVITY DISORDERS (AD/HD).  Attention-deficit/hyperactivity disorder, or AD/HD, is well-known among education professionals.  There are three different types of AD/HD: (1) AD/HD, predominantly inattentive type; (2) AD/HD, predominantly hyperactive-impulsive type; and (3) AD/HD, combined type.  The inattentive type of AD/HD is characterized by behaviors such failing to attend to details, making careless mistakes, having difficulty with organization, losing items necessary for the given task, not listening when spoken to, not following through on instructions, and being forgetful and distracted.  Children with the hyperactive-impulsive type of AD/HD may show signs of hyperactivity such as fidgeting, running around  or climbing in settings in which it is inappropriate to do so, having difficulty playing or participating in free-time activities quietly, getting out of their seats when they are supposed to remain seated, talking excessively, or always moving.  Impulsivity may be seen in difficulty waiting for turns, interrupting others, and blurting out answers instead of waiting for the right time to speak.  Children with the combined type of AD/HD exhibit a combination of both inattentive and hyperactive-impulsive symptoms.  (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 also 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.

DISRUPTIVE BEHAVIOR DISORDERS (DBDs).  Disruptive behavior disorders such as oppositional defiant disorder (ODD) and conduct disorder (CD) may co-exist with OCD.  In some cases, the symptoms of disruptive behavior disorders may be more problematic than the OCD symptoms themselves.  Some experts even recommend treating the symptoms of a disruptive behavior disorder prior to implementing treatment for the OCD (for example, parent management training).  Following are descriptions of oppositional defiant disorder and conduct disorder.  Please note that some sources include AD/HD as a DBD, while others do not.  For the purposes of this discussion, AD/HD is treated separately -- see above.

Oppositional Defiant Disorder.  ODD is a disorder that usually arises during childhood or adolescence. Youth with ODD exhibit, as the name implies, oppositional, defiant, and negative behavior.  They frequently lose their tempers, argue with adults, refuse to comply with adults' requests, purposely irritate others (and are easily irritated by others), blame others for their misbehavior or mistakes, are angry and resentful, or spiteful or vindictive.  These behaviors occur more frequently in individuals with ODD than in others of similar age and developmental levels.

Conduct Disorder.  Although CD, like ODD, typically emerges during childhood or adolescence, it has been known to occur in preschool-aged children.  Individuals with conduct disorder violate the basic rights of others or important rules established by society.  Behaviors associated with CD include destroying others' property, setting fires, stealing, lying, demonstrating aggression or cruelty toward people (e.g., bullying, robbery, mugging, forced sexual activity) and animals, and committing major rule violations (e.g., running away from home, being truant from school).

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

Another group of mental health disorders that may occur simultaneously with OCD are Obsessive Compulsive Spectrum Disorders (OCSDs).  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.  Experts are not in complete agreement with regard to which disorders are included in the OC spectrum.  For the purposes of this discussion, Tic Disorders/Tourette Syndrome, Body Dysmorphic Disorder, Trichotillomania and compulsive skin-picking and nail biting are included in the OC spectrum.

TIC DISORDERS/TOURETTE SYNDROME.  Tic disorders and Tourette Syndrome occur quite frequently in children and adolescents with OCD.  Tics are sudden, rapid, recurring motor movements (motor tics) or vocalizations (vocal tics).  Motor tics range from simple movements such as eye blinking, head jerking, and wrinkling of the nose to more complex and longer-lasting motor movements, e.g., jumping, touching, and twirling while walking.  Similarly, vocal tics range from simple vocalizations such as sniffing and throat clearing to complex vocalizations, e.g., spontaneously expressing a phrase or repeating one's own words. An individual has a Chronic Motor Tic Disorder when he or she experiences motor tics but not vocal tics for a period of more than a year; a Chronic Vocal tic Disorder is characterized by the presence of vocal tics only for over a year.  Tourette Syndrome involves both motor and vocal tics for more than a year.  These disorders are neurobiological in nature and begin before 18 years of age.  (Resource:  Tourette Syndrome Association of America ).

BODY DYSMORPHIC DISORDER.  Children and teens with Body Dysmorphic Disorder (BDD) are extremely preoccupied 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 repeat behaviors frequently 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 also be helpful to consult with your school psychologist, social worker, counselor, or school nurse about your observations and also to involve that person in discussions with parents.

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.

 

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