OBSESSIVE-COMPULSIVE DISORDER KNOWS NO AGE LIMITS
At what age does obsessive-compulsive disorder typically become noticeable in children? My 7-year-old recently has become very focused on having things straight and checking to make sure his stuffed animals are lined up before he goes to sleep. He even gets up to check them multiple times. Is this typical of a kid his age, or should I have him evaluated?
The behaviors you're seeing in your son could be appropriate forms of play for a child his age. It's possible, however, that they might point to obsessive-compulsive disorder, or OCD, if he feels driven to do them, or if doing these routines interferes with his daily activities or causes significant distress. If that's the case, an evaluation may be in order.
OCD is characterized by a pattern of unreasonable thoughts and fears (obsessions) that lead people to do repetitive behaviors (compulsions). People with OCD may try to ignore or stop the obsessions, but that only increases their distress and anxiety. They then feel driven to perform compulsive acts to try to ease the stress. Despite efforts to ignore or get rid of the bothersome thoughts or urges, they keep coming back. This leads to more ritualistic behavior, and the cycle of OCD continues.
OCD can start at any age and has been known to affect very young children, even those under 5. Most often, though, OCD in children begins around 10, usually a little earlier for boys and a little later for girls.
The behaviors you mention are not, in themselves, problematic. In the same way, following a certain routine around bedtime is good for children and can help them feel secure. So the fact that your son is engaging in these activities isn't out of the ordinary.
These activities could be signs of an underlying problem, such as OCD, if your son doesn't enjoy doing them, but believes he won't feel good unless he does, or if he gets very upset if he cannot do them. In addition, if your son feels compelled to do these activities to the point that they get in the way of other activities or routines, that may signal a problem too.
For example, if he has difficulty leaving for school in the morning if he hasn't first straightened his blankets and papers just so, then it may be time for an evaluation with his primary health care provider or a mental health professional.
If your son is diagnosed with OCD, the first treatment should be a type of psychotherapy called exposure and response prevention. It involves gradual exposure to a fear and learning to cope with the anxiety that fear triggers. For a child with OCD, that means breaking the rules the child has set, such as straightening, rearranging and double-checking, and learning that those routines aren't needed in order to feel okay.
Keep in mind as you consider whether or not to have your son evaluated for OCD that it is the feelings his behaviors produce in addition to the behaviors themselves that must be examined. If he simply likes lining up his stuffed animals and straightening his things, and that doesn't cause disruption or undue stress in your household, you can feel confident just letting him continue to enjoy these activities.
Stephen Whiteside, Ph.D., L.P., Psychiatry and Psychology, Mayo Clinic, Rochester, Minn.
A LINK BETWEEN SUICIDE, GENETICS?
Why does it seem that suicide tends to run in families? Does it have anything to do with genetics?
The association between genetics and suicide is complicated. Research has shown that there is a genetic component to suicide. But it is only one of many factors that may raise an individual's risk. And even if someone is at high risk for suicide, that doesn't predict whether or not an individual will actually act on suicidal thoughts.
Genetic research, including studies involving twins, has revealed that many psychiatric conditions, including having suicidal tendencies, are influenced by genetics. While studies demonstrate that specific genes, such as one called the BDNF Met allele, can increase risk for suicide, it's more likely that a range of genes affect connections and pathways within the brain, and impact suicide risk.
Complicating matters further, a process called epigenetics also comes into play when considering the effect of genes on suicide. This process controls when certain genes are turned on or off as a person grows and develops, and it can be influenced by what happens in a person's environment.
For example, if someone goes through a difficult event as a child, that experience could have an impact on how or when a gene is activated within that person's brain. Researchers speculate that negative experiences influencing epigenetics in a person who has a family history of suicide could further compound that person's suicide risk.
In addition, it is known that 90 percent of people who die by suicide have a psychiatric illness at the time of death. Mood disorders, psychotic disorders, certain personality disorders and substance use disorders can increase suicide risk substantially. Each of those disorders has a genetic component, too.
It's important to understand, however, that an increased risk of suicide does not predict who will commit suicide. For some people, even those whose genetics may seem to predispose them to a higher suicide risk, the thought of suicide doesn't enter their minds. For others, suicide may become a focus of their thoughts.
For those whose thoughts do turn to suicide, the way they arrive at suicidal thoughts may be a well-imprinted and familiar pathway. Psychotherapeutic treatment can help examine the process they go through to get to that point and find ways to interrupt the process.
Genetics, family history and environment all matter when it comes to the risk of suicide. But knowing risk factors is not a substitute for a tho-rough assessment of an individual's situation and the process he or she takes to arrive at suicidal thoughts.
If you or a loved one is concerned about your risk for suicide, or if you've had suicidal thoughts, talk to a mental health professional. He or she can work with you to treat any psychiatric illness that may be present and help you understand the process you're going through when you turn to the possibility of suicide.
If you are in a suicide crisis or emotional distress, the National Suicide Prevention Lifeline provides free, confidential emotional support 24/7 at toll-free 1-800-273-8255.
Brian Palmer, M.D., Psychiatry and Psychology, Mayo Clinic, Rochester, Minn.
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