What is an obsession? (obsessions-obsessions)
They are repetitive thoughts that come to mind beyond their own control, make the person uneasy, cause distress and stress, cannot be removed with willpower and consciousness, and cannot be dismissed.
What is compulsion? (compulsions)
Unwanted repetitive movements that are mostly done to banish obsessive thoughts or reduce the distress caused by these thoughts. Compulsions have no logical connection to their intended purpose, they are exaggerated.
I touched a place, is it contagious? Could I have left the stove with the door open? Slippers, will my business go bad if my things are not symmetrical? If I don’t do this move 3 times, will things go wrong? What if something happens to my loved ones? These and similar thoughts;
If it comes to your mind unintentionally,
If it causes a certain distress in your life,
If you can’t get it out of your head even though you think they are ridiculous
To suppress or neutralize these thoughts;
If you have repetitive behaviors that must be strictly followed
that you can’t stop doing, And
Because of these thoughts or behaviors, our lives are turned upside down and become unbearable. For example, if a person thinks that his hands are dirty despite knowing that they are clean, it is an ‘obsession’, and washing his hands unnecessarily in order to get rid of this thought is ‘compulsion’.
Obsessions, which are tricks our mind plays on us, begin to affect our entire lives over time. This turns our lives upside down, as well as those around us. Obsessions with children, that is, obsessive compulsive disorder (OCD), with its scientific name, can often be overlooked. Families who think that their children will not suffer from such discomfort describe obsessions as ‘attachments’ of children. However, OCD is an important problem that needs to be treated. The fact that it usually has an insidious onset in childhood, children cannot define the event very well, and the symptoms can be confused with childhood characteristics make the diagnosis difficult. Although the onset is insidious and long-lasting, it can sometimes be perceived as if it started suddenly, as an important event triggers it. If there is no treatment, its symptoms increase in adulthood, and it can turn into a disease that affects the whole of life.
The most common obsessions in children
Pollution, the thought of being infected, the thought that something bad will happen, the fear that someone will die or get sick, symmetry, sexual thoughts, forbidden or violent thoughts, telling asking confirmation appears to be needed.
Common compulsions are; Washing, checking, arranging, sorting, counting, touching, repeating, accumulating, thinking over and over.
Obsession with Cleanliness: the most common obsession with contamination from germs and filth. The person with this type of obsession avoids touching anything. Making sure it’s clean is the most important thing to him. It is one of the most common types of obsessions and is also known as the ‘Cleaning Sickness’. For this reason, they have to constantly wash their hands, bathe, change clothes or do cleaning. It can stay for hours with the thought that it has not been cleaned in the toilet or bathroom.
Counting Obsession: If he does not do or count certain things, he thinks that something bad will happen to him or his family, that things will go wrong, and he experiences distress. In this type of obsession, the person tries to count everything he sees or thinks in order to relieve his distress. Vehicle plates, building numbers, parquets, people, etc. During this process, it gets tired seriously. Some numbers are auspicious while others are unlucky. While trying to get the unlucky numbers out of his mind, he tries to think of the auspicious numbers or to repeat his movements in this number. For example, if the lucky number is 2, he touches the door twice and does many movements twice.
Obsession with controlling, doubt: In this type of obsession, the person cannot be sure of what they are doing and they need to check repeatedly whether they have done it or not. He has to check again and again even though he has turned off the light, he checks again and again despite closing the door.
Symmetry Obsession with Order: Has the obsession that events or objects must be in perfect or precise symmetry, in the exact order they want. Their over-attention with details causes obsessive slowness and taking too long to finish their work. The person organizes everything very carefully and makes an incredible effort to keep the order established. He may react violently to the mixing or even touching of his belongings. They have trouble finishing their work and may often be late because of their obsession with symmetry or being “just right”. It may take hours for these patients to eat a meal and get ready before going to school. eg. It may take a lot of effort to keep the slippers, the top of the table, the things in the house symmetrical, but it can also be very messy and untidy in other things.
Obsession with harm or aggression: It is the thought of harming one’s own child, friend, mother or relatives. Although they know that they will not harm anyone else, they cannot overcome their thoughts and fears of harming their children or loved ones. They don’t really want to do what they’re worried about, they’re uncomfortable with the thought that they might want it. They develop other attachments to combat this fear; they need to tell or ask to get reassurance that they won’t actually do what they’re worried about. like doing anything a certain number of times. For example, opening the window three times, closing the door twice.
Religious Obsessions: Thoughts of cursing or insulting Allah or religious values, even though they never wanted to. The person trying to get rid of this emotional state has to repeat the prayer he recited many times. Especially in adolescence, he feels guilty and sinful with these thoughts, he thinks that he is a bad boy, that bad things will happen to him because he thinks about such things. He tries to count numbers forwards or backwards in a certain order in order to relieve his boredom and distract his attention. To one of the family members, usually to the mother, ‘I thought that, wouldn’t it be okay?’ he feels the need to ask and confirm. He can’t be comfortable without getting confirmation that nothing will happen.
Sexual obsessions: Repetitive sexual images or feelings bother the person. They fear that they will engage in sexual and aggressive acts that are contrary to them. It is especially common in adolescents. He feels guilty for thinking these things and creates intense distress. Doing certain movements to relieve the feeling of boredom, ‘I thought about it, wouldn’t it? ‘ they feel the need to ask to confirm.
When Does It Start?
Although the frequency of Obsessive-Compulsive Disorder (OCD) is reported to be 0.3-0.9% in children and adolescents, it is thought to be more common. The most common age of onset is 7 years, the average age of onset is 10 years. However, in clinical practice, cases starting at a much younger age (up to 2 years of age) are encountered. It is accepted that OCD is a neuropsychiatric disease with biological basis. A similar disease can be found in 35% of the patients’ first-degree relatives. If it is not treated, it does not turn into another disease, but it affects the whole life of the person; the person’s friends, work, family relationships are damaged.
Why and how do obsessions arise?
It is assumed that the causes of obsessions are biological, psychological, environmental factors, obsessions in close family members and predisposed personality traits, but the exact cause has not been determined yet.
The main cause of obsessions is hereditary factors. The co-occurrence of obsessive disorder in identical twins is 85%. Having an obsessive disorder in the family increases the risk 5-10 times compared to the normal population.
Psychological; school failure, exam anxiety, problems in friendships, problems with acceptance of sexual identity, problems in adolescence, divorce, life events
Environmental factors; Having obsessions in the family is both a biological and an environmental factor in terms of being a model. Children may also learn symptoms by imitating their parents. However, the symptoms of patients are often different from those of other members of the family. For example, the child of a mother who has an obsession with controlling may develop an obsession with hand washing.
Who is it more common in?
“People who have a high sense of responsibility, are generally successful, ambitious, worry easily, nervous, anxious, perfectionist, and detail-oriented are more prone to the disease. Obsession is common in families who criticize their children too often, blame them, ask them to be perfect, or instill concepts such as shame and sin in an exaggerated manner.
Research shows that the disease begins suddenly. In 50-70% of the patients, the complaints begin after stressful events such as pregnancy, changing house, sexual problems, loss of a close relative. It also shows fluctuations in the form of increasing and decreasing from time to time. Stress also has an effect on exacerbations. Obsessions and compulsions can be seen in everyone to a small extent, but if they impair the quality of life and functionality of the person and cause serious loss of time, it is considered a disease and needs treatment. In order for obsessions to be classified as a disease, at least 1 hour a day must be allocated to obsessions.
It is known that OCD is much more common in children than is thought, but children tend to hide their distress due to thoughts that they will often be blamed and misunderstood. If parents or teachers can be reassuring in their approach to children and can make children be comfortable and open with them, children will also be comfortable in expressing their problems.
How do children express their obsessions? They often seem troubled when talking about the subject. They say that an inner voice (sometimes they say it is their own opinion, some may describe it as someone else’s voice) causes certain behaviors and thoughts, even though they do not want to think or act in this way. For example: cursing something, seeing disturbing sexual images, thinking that something bad will happen if he doesn’t do something twice, or thinking that even though he has locked the door, he has to check it over and over again, his hands are dirty, he will get infected. like thinking and washing his hands all the time. Sometimes, only repetitive behaviors (compulsions) may occur without accompanying thoughts and these can be easily observed from the outside.
What are ritualistic behaviors in childhood?
Some features in childhood show similarities with symptoms of illness. Some things are ritualistic, especially during the development of young children. For example, some behaviors before going to bed are normal at a young age, but may turn into obsessions and compulsions in later ages. Young children follow some rules that follow a certain order before they go to bed. Like dressing, telling a story, sleeping in a certain place. Without these, they can become irritable. But after the age of eight or nine, this order changes. However, this situation continues when there is a symptom of the disease, and when there is no one, symptoms such as excessive anxiety and making the event over occur. Similarly, walking without stepping on the lines for young children is a game. In adulthood, this can be a compulsion. The biggest feature that distinguishes these childhood rituals from compulsions is that while rituals play a role in increasing socialization and reducing anxiety, compulsions are restrictive and distressing. If rituals have become boring, worrisome, and life-affirming, it has reached the level of sickness. One of the things to consider when making a diagnosis is the history and descriptions given by the family. Families often describe compulsions as ‘tices’. This expression is observed especially when touching a place or repeating a certain movement. However, a tic is an involuntary contraction of the muscles and they are different diseases from each other. Due to the difficulties in transferring certain things in children, other diseases should be evaluated for diagnosis.
Treatment: The most successful treatment in OCD is medication + behavioral cognitive therapy. It is a disease that usually responds well to treatment. Depression can often be added to the picture in untreated cases. It increasingly impairs the child’s functionality and can make school and home life unbearable. It begins to create serious difficulties for its environment. Sometimes childhood psychoses may begin as OCD. Therefore, it is very important that the child is treated by a physician.
Dr Deniz Tirit Karaca
Child and Adolescent Psychiatry
