The Interplay of Risk and Resilience Factors in Childhood Obsessive Compulsive Disorder
The emotional disorders are termed the ‘internalising disorders’ and comprise depression and the anxiety disorders. Although the emotional disorders of childhood are discussed as separate entities, in reality it is not that easy to separate them because there is a lot of common ground. The reason they are seen as separate entities is due to the clinical approach of DSM IV. Often, in any given case, depression and anxiety are both present to some degree and there is also often overlap with the conduct disorders. Obsessive Compulsive Disorder (OCD) is categorised as one of the ...view middle of the document...
With compulsions, the acts must be an unrealistic attempt to prevent or reduce distress or a dreaded situation and the person must feel driven to perform them.
In children, the most common obsessions involve concerns with dirt or germs; a terrible event happening to the self or a loved one and neatness, orderliness and symmetry. Compulsions most commonly involve excessive hand-washing or other grooming rituals; repeating rituals (for example performing an action a certain way and a certain number of times); and checking behaviours (Swedo, Rapoport et al., 1989).
With adults there is the requirement that the person realises the thoughts and behaviours are unreasonable. This is not required in children although with older children and adolescents it may well be part of the picture. In fact, even in younger children, the child may view the repetitive actions as strange and may certainly be aware that other people find it odd. Like Julie in the case study (see Appendix), children may worry that they are "crazy" because they are aware their thinking is different to that of their friends and family. A child's self-esteem can be negatively affected because the OCD has led to embarrassment and shame.
Another diagnostic element is that the thoughts and behaviours must take up a disproportionate amount of the child’s time, interfering with normal functioning. OCD can make daily life very difficult and stressful for children and their parents. OCD symptoms often take up a great deal of a child's time and energy, making it difficult to complete tasks such as homework or household activities.
In the morning, children often feel they must do their rituals exactly right, or the rest of the day will not go well. Meanwhile, they feel rushed to be on time for school. This combination leads to feeling pressured, stressed, and irritable. In the evenings, they may feel compelled to finish all of their compulsive rituals before they can go to bed. At the same time, they know they must get their homework done and take care of any household chores and responsibilities. Some children stay up late into the night because of their OCD, and are then exhausted the following day.
The concept of risk and resilience
The issue of risk and resilience centres on the question of what makes one child develop a disorder whilst another does not. Risk factors are variables that increase the likelihood of behavioural impairments or problems. However, in the presence of similar risks it is well known that some individuals develop problems, in other words they are vulnerable, whilst others do not because they are resilient. Resilience implies protection from risk and is the ability to ‘bounce back’ from life’s adversities. (Wicks-Nelson & Israel, 2000).
When speaking of risk and resilience, there are two key concepts namely:-
❑ Multifinality – which means having similar beginnings (for example low socio economic status) but very different possible...