Obsessive Compulsive Disorder
What is Obsessive Compulsive Disorder?
Obsessive-compulsive disorder (OCD) is a disorder in which people have recurrent, persistent, thoughts, ideas, sensations, or images (obsessions) that make them feel driven to carry out repetitive actions or behaviors (compulsions). [1]
Since the thoughts or obsessions are persistent, they often cause significant anxiety and distress for the individual.
Most people with OCD, are aware their obsessions are not realistic, however, they have a hard time disengaging from the obsessions or performing the compulsions. [1]
OCD often begins in childhood, adolescence, or early adulthood; the average age symptoms appear is 19 years old. [1]
OCD impacts 2-3% of the US population, with more adult women being impacted than men. [1]
Once considered to be rare in youth, epidemiological studies have found an estimated prevalence of 0.25%–4% among children and adolescents. [2]
Diagnosis of OCD and other anxiety disorders affect up to 37% of children and adolescents with autism. Due to a significant overlap of symptoms of autism and OCD, differentiating the diagnosis of these disorders is difficult. [4]
A diagnosis of OCD requires the following criteria:
Presence of obsessions and/or compulsions
Obsessions and/or compulsions must be time-consuming
>1 hour/day spent experiencing obsessions or performing compulsions
Significant distress and impaired work and social functioning
Signs & Symptoms
Symptoms of OCD may come and go, worsen, or ease over time. Many children do not realize that their behaviors are abnormal. However, due to the anxiety obsessions may give them, they may avoid situations that trigger them. [6]
Obsessions are recurrent, persistent, thoughts, ideas, sensations, or images that can cause anxious feelings or distress. Examples of common obsessions [1]:
Fear of being contaminated by germs from people or environments
Fear of shouting inappropriate obscenities or insults
Extreme concern with ensuring order, symmetry, or precision
Recurrent intrusive thoughts of sounds, images, words, or numbers
Fear of misplacing something important
Fear of sickness or illness
Compulsions, also known as rituals, are the repetitive actions or behaviors that an individual is drawn to do in response to an obsession. These compulsions typically help to reduce or prevent the anxious feelings or distress an obsession may cause. Examples of common compulsions include [1]:
Repeatedly cleaning or sanitizing objects
Lining things up, order, or arranging items in a specific way
Repeatedly checking that doors are locked, appliances or switches are turned off
Constantly seeking approval, reassurance, or validation
Excessive or ritualized hand washing, showering, brushing teeth, or toileting
Repeated counting to a certain number
Contributing Factors
Neurotransmitter Dysfunction
Serotonin
Inflammation/overactive immune response
Gut bacteria imbalance (see: Dysbiosis)
May be related to antibiotic use
Streptococcal Infection (PANDAS/PANS)
PANDAS/PANS from the streptococcal infection will cause SUDDEN and drastic OCD symptoms, it will not be a gradual progression.
Structural or functional brain abnormalities
A common cause for sudden and drastic onset of OCD symptoms are two auto-immune conditions called PANS & PANDAS. Read more here.
Diagnosis + Treatment
A variety of screening tools are used to identify OCD in pediatric populations. Some examples include:
Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS)
Screen for Child Anxiety-Related Emotional Disorders
Child Behavior Checklist-Obsessive-Compulsive Subscale (CBCL-OCS)
Child Obsessive-Compulsive Externalizing/Internalizing Scale (COCEIS)
There are multiple treatments for OCD, however, the two most common that have established evidence for pediatric OCD include:
Cognitive Behavioral Therapy (CBT) incorporated with Exposure with Response Prevention (ERP) [3]
The main strategy for ERP involves gradually assisting the child in confronting their feared situations (such as touching dirty door handles, etc). [2]
After confronting the obsession, they are encouraged to avoid performing a compulsion and wait until their anxiety of fear calms naturally. [2]
This process is guided in a gradual manner by a licensed professional
Selective Serotonin reuptake inhibitors (SSRI’s)
Medication is only prescribed under the supervision of a licensed professional.
Next Steps
Diet
Boost serotonin naturally [5]
Serotonin is a neurotransmitter that has been shown to be imbalanced in individuals with OCD.
The amino acid tryptophan can be obtained from food and supplements and has been linked to the regulation and production of serotonin levels in the brain. [5]
Boost serotonin naturally by emphasizing tryptophan-rich foods such as:
Increase Omega-3 Fatty Acids
Trial avoiding Glutamate
Supplements
NAC [2,3]
Glycine
Myoinositol
Although previous studies showed that the above herbal and nutritional supplements might be beneficial in OCD treatment, further studies with larger samples sizes are needed.
Treatment with S. boulardii successfully reduced obsessive-compulsive disorder (OCD) and self-injurious behavior (SIB) symptoms in a child with Autism Spectrum Disorder. [11]
Lifestyle
Cognitive Behavioral Therapy (CBT)
Exercise
Deep meditation techniques such as mindfulness meditation, yoga, pilates.
Support Healthy Sleep Habits
Social support
Visit the International OCD Foundation website for social resources such as The Peace of Mind Virtual OCD Community.
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
OCD & Autism in the Research
PANS/PANDAS & OCD
Emerging evidence over the past 10-15 years has identified a subgroup of children who experience sudden onset of OCD and/or tics after streptococcal infection. [2]
This subgroup is now identified as PANDAS/PANS.
Children in this subgroup tend to have greater neuropsychiatric difficulties as compared to other children with OCD, including enuresis, impulsivity, and motor deterioration. [2]
Visit the PANDAS/PANS note to learn more!
Gluten-Free Diet and OCD
A study was conducted on 29 individuals (23 children and 6 adults) with Gilles de la Tourette syndrome (GTS). 69% of children and 100% of adults with GTS also had associated OCD. Participants were instructed to follow a strict gluten-free diet for 1 year. [7]
The study found that following a gluten-free diet was useful for reducing the frequency and intensity of OCD symptoms. The diet also showed improvement in quality of life and reduction of NSAID drugs in children. [7]
Gastrointestinal Health and OCD
High stress levels and antibiotic use have been proposed mechanisms that lead to changes in healthy gut bacteria that could lead to the onset of OCD symptoms.
Suggesting that the symptoms presented in PANDAS/PANS are due to antibiotic treatment used against streptococcal infections and not the infection itself.
With the above in mind, proposed future treatments should include the reintroduction of beneficial bacteria and healthy stress management. [8]
One study compared individuals with OCD and non-OCD controls and found that both gastrointestinal symptom severity and prevalence of irritable bowel syndrome were significantly higher in the OCD population as compared to non-OCD controls. [9]
Insulin Resistance and OCD
This animal study aimed to identify if there was a relationship between dysfunctional insulin levels and OCD. [10]
The study found that mice with Type 1 and 2 diabetes were more likely to display anxiety and OCD symptoms. [10]
Both blood glucose and blood glucose levels in the right dorsomedial striatum region of the brain were both negatively related to spontaneous behaviors. [10]
Results suggest there is a relationship between insulin-related pathways and insulin levels in the central nervous system. [10]
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[1] What is obsessive-compulsive disorder? https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder. Accessed August 10, 2021.
[2] Krebs G, Heyman I. Obsessive-compulsive disorder in children and adolescents. Arch Dis Child. 2015;100(5):495-499. doi:10.1136/archdischild-2014-306934
[3] Kuygun Karcı C, Gül Celik G. Nutritional and herbal supplements in the treatment of obsessive-compulsive disorder. Gen Psychiatr. 2020;33(2):e100159. Published 2020 Mar 11. doi:10.1136/gpsych-2019-100159
[4] van Steensel FJ, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302–17.
[5] Jenkins TA, Nguyen JC, Polglaze KE, Bertrand PP. Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients. 2016;8(1):56. Published 2016 Jan 20. doi:10.3390/nu8010056
[6] NIMH Obsessive-Compulsive Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd#part_2228. Accessed August 10, 2021.
[7] Rodrigo L, Álvarez N, Fernández-Bustillo E, Salas-Puig J, Huerta M, Hernández-Lahoz C. Efficacy of a Gluten-Free Diet in the Gilles de la Tourette Syndrome: A Pilot Study. Nutrients. 2018; 10(5):573. https://doi.org/10.3390/nu10050573
[8] Rees JC. Obsessive-compulsive disorder and gut microbiota dysregulation. Med Hypotheses. 2014;82(2):163-166. doi:10.1016/j.mehy.2013.11.026
[9] Turna J, Grosman Kaplan K, Patterson B, et al. Higher prevalence of irritable bowel syndrome and greater gastrointestinal symptoms in obsessive-compulsive disorder. J Psychiatr Res. 2019;118:1-6. doi:10.1016/j.jpsychires.2019.08.004
[10] van de Vondervoort IIGM, Amiri H, Bruchhage MMK, et al. Converging evidence points towards a role of insulin signaling in regulating compulsive behavior. Transl Psychiatry. 2019;9(1):225. Published 2019 Sep 12. doi:10.1038/s41398-019-0559-6
[11] Kobliner V, Mumper E, Baker SM. Reduction in Obsessive-Compulsive Disorder and Self-Injurious Behavior With Saccharomyces boulardii in a Child with Autism: A Case Report. Integr Med (Encinitas). 2018;17(6):38-41.
Authors
Sinead Adedipe, MS, RDN
Edited & Reviewed by: Brittyn Coleman, MS, RDN/LD, CLT
