RESOURCES FOR FAMILIES AND TEACHERS

WEBQUEST: Obsessive Compulsive Disorder (OCD)

WEBSITES TO VISIT:

http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder

http://www.ocfoundation.org/

http://www.nlm.nih.gov/medlineplus/obsessivecompulsivedisorder.html

http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

QUESTIONS TO ANSWER:
1. Do you think you have obsessive compulsive disorder? Why? Take a self-test at http://psychcentral.com/ocdquiz.htm. What were your results? 2. What is OCD? 3. What are the symptoms? a. What kinds of things do people with OCD obsess about? b. What kinds of compulsions do people exhibit to deal with those obsessions? 4. What causes OCD? 5. Is OCD a result of nature or nurture? What does the recent research say? 6. What is it like to live with OCD? Find one persons story and summarize a day in their life through a journal entry or blog. 7. How is OCD treated? Describe the treatment methods in detail. How effective are those methods? 8. Do people who are cured of OCD through treatment often have relapses? Why or why not? Explain. 9. Who are some famous people with OCD? Describe the experiences of at least 5 celebrities living with OCD. 10. How does OCD affect young people specifically? Describe.

OCD PowerPoint

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Website: Mental Health America Obsessive-compulsive Disorder (OCD)

People with obsessive-compulsive disorder (OCD) suffer intensely from recurrent unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals, such as hand washing, counting, checking or cleaning, are often performed in hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing those increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person's life. OCD is often a chronic, relapsing illness.

Characteristics
Obsessions are thoughts, images or impulses that occur repeatedly. The person does not want to have these ideas, finds them disturbing and intrusive and, usually, recognizes that they really don't make sense. Obsessions are accompanied by uncomfortable feelings, such as fear, disgust or doubt. Common obsessions include contamination fears, imagining having harmed self or others, imagining losing control of aggressive urges, intrusive sexual thoughts or urges, excessive religious or moral doubt, or a need to tell, ask or confess. People with OCD typically try to make their obsessions go away by performing compulsions. Compulsions are acts the person repeatedly performs, often according to certain rules. These rituals are performed to obtain relief from the discomfort caused by the obsessions. Examples of compulsions are washing, repeating, checking, touching, counting, ordering/arranging, hoarding or saving, and praying. In some instances, a person may suffer from only obsessions or only compulsions. OCD symptoms cause distress, take up a lot of time (more than an hour a day), or significantly interfere with the person's work, social life or relationships. Most individuals with OCD recognize that their obsessions are not just excessive worries about real problems and that the compulsions they perform are excessive or unreasonable. The extent to which a person with OCD realizes that his or her beliefs and actions are unreasonable is called his or her insight.

Causes
There is growing evidence that OCD has a biological basis. OCD is no longer attributed to family problems or to attitudes learned in childhood. Instead, the search for causes now focuses on the interaction between biological factors and environmental influences. Research suggests that OCD involves problems in communication between parts of the brain. These problems may be caused by insufficient levels of certain brain chemicals, called

neurotransmitters. Drugs that increase the brain concentration of these chemicals often help improve OCD symptoms.

Treatments
The most common treatment for OCD is a combination of cognitive-behavioral psychotherapy (CBT) and medication. A type of behavioral therapy known as exposure and response prevention (E/RP) is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts (exposure) and is then taught techniques to avoid performing the compulsive rituals (response prevention). The cognitive portion of CBT is often added to E/RP to help challenge the irrational beliefs associated with OCD.

Co-occurring Illnesses
OCD is sometimes accompanied by depression, eating disorders, substance abuse, attention deficit/hyperactivity disorder or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.1 On average, people with OCD see three to four doctors and spend over nine years seeking treatment before they receive a correct diagnosis. Studies have also found that it takes an average of 17 years from the time OCD begins for people to obtain appropriate treatment

Obsessive Compulsive Disorder (OCD)

By Saint Louis Behavioral Medicine Institute Obsessive Compulsive Disorder (OCD):

Persistent, recurring intrusive thoughts (obsessions) Typical obsessions include worry about contamination, fears of behaving improperly, acting violently, or religious misconduct. Performing a ritual or routine (compulsions) to relieve the anxiety caused by the obsession becomes an interference with daily life.

Some people try to cope with severe anxiety by repeatedly doing something that may calm their fears. Individuals obsessively worried about contamination, for example, may wash their hands repeatedly. People who fear causing harm may check something such as whether the gas is turned off, over and over. I know it sounds silly, but I feel like something terrible is going to happen if I dont wash my hands. Other signs of obsessive-compulsive disorder include excessive collecting or hoarding, compulsive counting, doing things in an unnaturally slow or ritualistic manner, replacing bad thoughts with good ones, and scrupulosity (religious obsessions and excessive concern about sin or being morally wrong. People who behave in these ways are usually aware their behavior is unnecessary or extreme, but they feel unable to stop. The above quote expresses the kind of dilemma faced by many individuals with obsessive compulsive disorder (OCD). Most people have obsessed about one thing or another or have engaged in some kind of compulsive behavior. For those with OCD, however, the obsessions are overwhelming and the compulsions can interfere even with the most basic tasks of daily living. Vivian was a 29-year-old housewife who had just given birth to her first child. She was looking forward to being a mother, but one week after the baby was born, Vivian started worrying that she might contaminate her child with germs. She was terrified even by the thought of being responsible for the death of her child. As a result, Vivian washed her hands hundreds of times a day and wouldnt take the baby out of the house for any reason. In addition, she spent hours talking about her fears and her behavior, seeking reassurance that she had not contaminated her child.

What is Obsessive Compulsive Disorder?

OCD is a potentially disabling condition in which an individual experiences unwanted and disturbing thoughts, impulses, or images (obsessions) and/or engages in repetitive mental or behavioral acts (compulsions). Because people with this condition typically experience severe anxiety, OCD is considered an anxiety disorder. In order to understand OCD it is first necessary to know something about the nature of obsessions and compulsions.

What are Obsessions?

Obsessions can be any unpleasant thought, scary image, unacceptable impulse, or object that creates fear or distress. In all cases, obsessions are involuntary and resisted by the person with OCD. Most people with this disorder understand their obsessions are unrealistic or excessive but feel unable to control them. Here are some common obsessions: o Dirt, germs, contamination o Doing something that might cause harm to others o Making a mistake o Thoughts perceived as evil or sinful o Hostile or violent thoughts o Sexual thoughts or impulses o Thoughts about unacceptable behavior o Disease or illness o Things that are asymmetrical or imperfect

What are Compulsions?

Because the anxiety and other feelings triggered by obsessions can be so distressing, people with OCD develop strategies to try to feel better. These strategies called compulsions or rituals are attempts to relieve the distress caused by obsessions. For example, people afraid of dirt may wash their hands over and over again. An individual afraid of causing harm to other people may spend hours rechecking the stove to see if it is still turned off. Usually, compulsions are performed in a stereotyped, repetitive fashion. Most with OCD realize their compulsions are unnecessary or in some way counterproductive but feel unable to resist them. Because they are influenced by emotions, more than logic, compulsions can be thought of as superstitious behavior. Here are a few of the more common compulsions: o Washing (e.g., hands, personal objects, house) o Checking (e.g., locks, pilot lights, electrical outlets) o Collecting or hoarding items (i.e., cant throw things away) o Repeating certain movements over and over again o Seeking reassurance o Straightening or lining things up

o Placing items in a certain order or pattern o Thinking about special numbers, images, thoughts, or designs in ones mind

Is Obsessive Compulsive Disorder (OCD) Common?

For many years, mental health professionals believed that OCD was extremely rare. However, recent studies of the general population have revealed that OCD affects about 2% of the adult population. Less is known about the prevalence of childhood OCD, but it is likely that the disorder is also more common among children than was once thought. Among the different types of OCD, washing and checking, compulsions occur most frequently.

What Causes Obsessive Compulsive Disorder (OCD)?

Although there are many ideas about what causes OCD, no single theory has been universally accepted. Most experts agree that a combination of factors, both biological and psychological, contribute to the development of OCD. Therefore, the cause of this disorder can best be understood using a contributing factors model. This simply means that a number of factors might potentially contribute to the onset of OCD. Some of the factors that have been proposed include: * Genetic predisposition * Biochemical irregularities * Stressful or traumatic life events * History of childhood anxiety * Faulty beliefs and unrealistic expectations * Certain skill deficits * Family problems

Can Obsessive Compulsive Disorder (OCD) be Treated?

Yes. Most individuals with OCD improve with appropriate treatment. Many exciting advances have been made in recent years. Treatment should begin with a comprehensive evaluation. It is important to take a close look at anything that could be contributing to the problem, be it physical or psychological. Then, a treatment plan should be tailored to the particular needs of the individual. This plan often includes a well-balanced combination of several approaches.

Cognitive Behavior Therapy

The goal of cognitive behavior therapy (CBT) is to help people learn to think, feel, and behave in ways that will reduce the symptoms of OCD. Patients are educated about the nature of obsessions and compulsions and are assisted in identifying, challenging, and modifying their inaccurate beliefs. They are also taught techniques to manage the physical and mental symptoms of anxiety caused by obsessions. Finally, through a series of exercises called exposure and

response prevention, CBT helps people gradually face and become more comfortable with the things that used to make them fearful.

Medication for OCD

A class of drugs called serotonin reuptake inhibitors (SRIs) has been helpful in reducing OCD symptoms. Changes in serotonin are believed to be associated with OCD. Five SRI medications approved by the FDA for the treatment of OCD in the United States are Anafranil (clomipramine), Luvox (fluvoxamine), Prozac (fluoxetine), Paxil (paroxetine) and Zoloft (sertraline). Other related medications, such as Celexa (citalopram), may also be effective. SRI medications may be used alone or in combination with other drugs, depending on the individual case. For a few individuals, being on medication for a period of time is all that is necessary. For the majority, however, medication may need to be combined with cognitive behavior therapy.

Other Treatments for OCD

Forms of psychotherapy other than CBT can sometimes be helpful adjunctive treatments for OCD. Support groups meetings with others who have the same problem can also be useful. Family involvement in the treatment process is often valuable, and sometimes essential.

Where Can I Find Help?

While it would be reassuring to say that the average psychologist, psychiatrist, therapist, social worker, or counselor is skilled in the type of treatment approaches described, this is not the case. There may be only a handful of professionals in your area skilled in cognitive behavioral treatments for OCD. Similarly, although most physicians have prescribed medication for anxiety, fewer will have extensive experience specifically with OCD. Be a good consumer. Contact resources in your community such as a university medical center or an anxiety disorders treatment program and ask about the resources available. If you live in a community in which this type of facility is not available, contact the Obsessive Compulsive Foundation (203) 8785669, or your local chapter of the Mental Health Association. They may be able to provide you with information as well as the names of practitioners in your area. Finally, do not hesitate to ask questions of the professionals you contact. They should be able to answer your questions and not be offended if you inquire about their credentials and experience.

What If someone I know has Obsessive Compulsive Disorder (OCD)?

People with anxiety disorders frequently feel isolated and alone. This is particularly true for individuals with OCD. They are often ashamed of or confused by the unusual nature of their symptoms and are understandable hesitant to discuss their problem with others. OCD sufferers sometimes actively hide their symptoms from family members. It is difficult for others to understand the overwhelming terror that people with OCD experience on a daily basis. Not surprisingly, individuals who have been able to tell friends, family members, or even healthcare professionals about their problem may have been met with disbelief or unintentional insult.

If you suspect that someone you care about OCD, please try to be understanding. Encourage him or her to be evaluated by a professional. Reassure the person that OCD is a common condition that affects all kinds of people that it is not a sign of weakness, and most importantly, that it is treatable. If the OCD sufferers problem is interfering with your life and the person is not willing to seek help, you can contact a professional yourself to learn how best to deal with the situation.

Saint Louis Behavioral Medicine Institute, Universal Health Services an academic affiliate of Saint Louis University Health Sciences Center is an established mental health care resource for St. Louis, MO. Visit their website at www.slbmi.com

FAQ About OCD

Most Frequently Questions About OCD

1. What is OCD?

OCD stands for Obsessive Compulsive Disorder. It is a disorder which causes an individual to have intrusive thoughts of a frightening or disturbing nature, which in turn may cause the person to do things repeatedly. They might perform certain rituals to guard against danger, or clean one's self or personal areas of home or work again and again. Fact sheet about OCD.

2. What are some of the symptoms of OCD?

Symptoms and behaviors associated with OCD are wide and varied. The primary thing they have in common is they are generally unwanted behaviors and/or thoughts that occur very frequently -- ie, several times a day. Symptoms, if untreated, may progress to the point of taking up all of a sufferer's waking hours.

Some of symptoms and behaviors may include, but are not limited to:

Checking things repeatedly, such as doors, locks, stoves, etc. Constant counting, "in one's head" or outwardly, while performing routine tasks. "Having" to do things a certain number of times. An example of this would be: when taking a shower, "having" to wash the left foot three times. Obsessively arranging things in an extremely orderly fashion -- which often makes no sense to anyone save the OCD sufferer. Pictures, words or images that "pop" into head and won't go away -- usually of a disturbing nature. Nonsensical words or phrases repeating themselves in the person's mind. The "what if's".....

Hoarding of objects with usually no apparent value -- as in one man collected small pieces of lint from the dryer. The person usually saves such objects under the rationalization of "what if I need it/them someday?" or is just unable to decide what to discard. Excessive fear of contamination -- as in fears to touch normal everyday things because they might have germs.

A more comprehensive check-list of possible symptoms.

3. Are all people with OCD 'washers' or 'checkers'?

No. OCD manifests itself in a large variety of ways, and individuals usually suffer from a combination of symptoms. Most people with OCD also share common difficulty with daily activities, such as tardiness, perfectionism, procrastination, indecision, discouragement and family difficulties.

4. If I have any of these symptoms or behaviors, does it mean that I have OCD?

That depends much upon the degree in which the symptoms or behaviors interfere with your thinking, reasoning, and/or life functioning. If you feel you have any of these symptoms or symptoms of a similar nature, see a competent psychiatrist experienced with OCD and discuss your symptoms.

5. Is OCD considered to be an anxiety disorder?

Yes. The obsessions cause anxiety, which results in a need to perform compulsions which provides temporary relief. See the OCD cycle.

6. How common is OCD?

Although once thought to be rare, OCD afflicts as many as five million Americans, or one in fifty. The disorder is found uniformly among men, women, children, and people of all races and socio-economic backgrounds.

7. Is OCD just a fad?

No. Throughout history, new disorders have been discovered, and more information has been gathered about those illnesses. Cases of OCD have been documented throughout the centuries. The secretive nature of OCD kept many away from doctors and other health care workers. After effective treatments were developed, more people stepped forward with their symptoms or were diagnosed by clinicians who now knew to look for the disease. Unfortunately, mental illness still carries a stigma. With time, experts and patients alike hope this will change.

8. Why doesn't an individual with OCD "just stop" their behavior?

Most truly wish they could. Probably the biggest reason why they do not "just stop" is anxiety. The person with OCD suffers intense anxiety over whatever their symptoms focus upon. They want to "make sure" that whatever they are focusing upon is taken care of. OCD is a disease of doubt; therefore the person with OCD feels they can never be sure that whatever it is really taken care of. Often this will show in the form of a compulsion such as hand washing. The person cannot, no matter how hard they try, feel that their hands are really clean. There is always a "what if" such as "what if I missed a teeny tiny little spot?" and so they continue to wash -- just in case. With a

compulsion, the anxiety rises to unbearable and terrifying levels if the compulsion is not allowed to take place.

9. Is a person with OCD crazy?

No. A person who does not recognize that their behaviors and thoughts are abnormal is "psychotic." Most people with OCD are aware that their behavior does not make sense. People with OCD are not crazy.

10. Is OCD psychological, biological or both?

OCD is usually considered to have both psychological and biological components. OCD-like behavior has been observed in animals, including dogs, horses, and birds. Specific brain abnormalities have been identified that mediate the expression of OCD symptoms. These brain abnormalities improve with successful treatment by either medication or behavioral therapy.

11. Is OCD acquired or are people born with it?

Persons are generally considered to have been born with a predisposition for OCD. This predisposition however does not always manifest itself. Sometimes the OCD is triggered by a traumatic or stressful event, even an illness (strep throat), but one must first have the predisposition toward OCD to develop the disorder.

12. Are there any other disorders related to OCD?

Tourette's syndrome is strongly related to OCD, and many people have both. Several other disorders appear similar to OCD, including Body Dysmorphic Disorder (BDD), Trichotillomania (hair pulling), and impulse control disorders, but it is not clear whether or not these disorders are truly related to OCD. Other disorders, such as major depression, social phobia, and panic disorder are more common in people with OCD.

13. Are OCD and depression related?

Approximately 60-90% of OCD sufferers have also suffered at least one major episode of depression at some point in their life. Some schools of thought feel the OCD causes the depression while others believe the OCD and depression simply tend to co-exist.

14. What are some signs of depression?

Loss of appetite Weight loss Early morning awakenings Lack of energy Too much sleeping Sadness Crying, especially without knowing why Suicidal thoughts Feelings of hopelessness Feelings of helplessness Lack of interest in most activities Lack of enjoyment in life

The presence of one or more of these symptoms does not necessarily indicate the presence of depression, however if severe or interfering with your life, treatment should be explored.

15. What are the chemical causes of OCD?

At the present time there is no definitive agreement among members of the medical community. OCD appears to be mediated by increased activity in the orbital frontal cortex and caudate nucleus of the brain. The orbital frontal cortex, located behind the eyebrows, is involved in the perception of fear and danger. The caudate nucleus is involved in one's ability to start and stop different thoughts and activities. OCD may also involve abnormal functioning of the neurotransmitter serotonin in the brain.

16. Is OCD curable?

No, but it is usually controllable.

17. What are some of the biggest problems in treating OCD?

The generally secretive nature of the disease, lack of knowledge about OCD, fear of medication, and the fear of facing one's fears in behavioral therapy.

18. Why do so many people with OCD hide their symptoms?

Usually because of feeling shame for doing/thinking such bizarre things, coupled with a fear of being considered "weird", "strange" or crazy.

19. What is the prognosis for OCD without treatment?

The disorder waxes and wanes, but left untreated the OCD will continue indefinitely. Without treatment, generally only about 10-20% of OCD sufferers have a spontaneous remission of symptoms.

20. What is the prognosis for OCD with treatment?

Very good, especially if the patient is determined to work hard. Up to 80% of OCD sufferers improve significantly with proper treatment of behavioral therapy and medication. Slips and relapses of thinking or behavior may occur but if the person is determined, these slips can usually be caught and treated before blossoming into a full blown OCD episode.

21. What are some of the treatment methods for OCD?

The two most effective treatments for OCD are drug therapy and behavior therapy. It is generally most effective if the two can be used together.

22. What medications are used for drug therapy?

The most effective medications for OCD are the SSRI's (selective serotonin reuptake inhibitors) Prozac, Paxil, Luvox, and Zoloft as well as the tricyclic Anafranil. These are the only medications proven effective for OCD thus far. Other medications are frequently added to improve the effect.

23. How much can medications help OCD?

This varies by individual but generally a 40-95% decrease in symptoms can be expected. The medications may take from six to twelve weeks to start showing an effect. The initial mechanism of these medications is to increase the availability of the neurotransmitter serotonin at the synapses (connections between brain cells) in the brain. This leads to other brain changes over several weeks which may be more related

to improvement in OCD symptoms. Please see Drug Treatment of OCD in Adults by Michael A. Jenike, M.D. or Healthy Guide for more information about these type of medications.

24. What are the primary types of behavior therapy used for OCD treatment?

Exposure and response prevention is the most effective type of behavior therapy for OCD. More about behavioral therapy.

25. Is behavioral therapy treatment easy?

No, but it is the best method of permanently reducing obsessions and compulsions.

26. Is marijuana a good treatment for OCD?

Although marijuana is now legal in California for medicinal purposes, it is not a good treatment for OCD. It may provide some short term relief, but it causes symptoms to later worsen. Marijuana can also interfere with OCD medications and make depression more severe.

27. Can stress affect OCD?

Yes. It is typical to notice a worsening of OCD symptoms during stressful periods. Stress does not cause OCD, but a stressful event (like the death of a loved one, birth of a child, or divorce) can actually trigger the onset of the disorder or exacerbate it.

28. Do people with OCD need to be hospitalized?

The vast majority of people with OCD can be treated without ever having to be admitted to a hospital. Medication and behavioral therapy allow most people to improve while being treated as outpatients. Hospitalization, however, is an important and valuable option for people with severe OCD who are unable to function as outpatients.

29. Do obsessions ever change over time?

Obsessions may change themes over time. Sometimes a person simply adds new ones to old ones and sometimes the old ones are completely replaced by newer ones.

30. Is OCD contagious?

No, it is not.

31. If a parent has OCD, what are the chances that the children will have it too?

In general, about 10% of relatives of people with OCD have the disorder, and another 510% has mild "subclinical" OCD symptoms. But the risk of having a child with OCD varies, depending on whether someone has childhood- vs. adult-onset OCD (higher risk of genetic transmission with childhood-onset OCD), and on whether someone also has Tourette syndrome or tic-related OCD (conveying a higher risk of familial transmission). If both parents have OCD, the risk is doubled, around 20% on average.

32. Does everyone with OCD have obsessions and compulsions?

Approximately 80 percent of people with OCD have both identifiable obsessions and compulsions; about 20 percent have only obsessions or compulsions.

33. Can trying to reason out an obsession help?

Usually not. Trying to reason out or make sense from an obsessive thought usually only strengthens the thought.

34. Are there any techniques to help stop an obsession before it strengthens?

Yes there are, but they are usually not considered very helpful. The most effective way to stop obsessions is to actually stop the compulsions. When one stops the compulsions, the obsessions will initially get stronger, but over time they will decrease and become less anxiety-provoking.

35. What is scrupulosity as it relates to OCD?

Some people with OCD worry excessively that they may have done or said something blasphemous. Fears and worries may vary according to the person's religion. For example, an Orthodox Jewish person may worry incessantly that he did not perform a religious ritual correctly; while one who was raised Catholic may worry and fear that they did not say enough rosaries or confess enough sins. They may fear they have a hidden sin they have not repented, so they keep examining all their daily thoughts and actions in an attempt to make sure they didn't miss any sins. Others may simply fear

doing anything because they fear whatever they do might be wrong, upsetting the God or gods they believe in.

36. What is a YBOCS?

The YBOCS, or Yale-Brown Obsessive Compulsive Scale, is a scale clinicians use to grade the severity of OCD in a patient. It is based on the amount of interference, distress, and control the person has related to their OC behaviors.

37. How do I find treatment?

Contact your local OC Foundation, the National OC Foundation in Connecticut, the Association of Advancement of Behavior Therapy, the American Psychiatric Association, or the American Psychological Association with offices throughout the United States and Canada. If you live in California, please see our list of professionals who treat OCD. If you have a doctor you see, ask for a referral to a psychiatrist or psychologist who is experienced in treating OCD.

38. How can I reach the OC Foundation?

Contact information for the OC Foundation and local affiliates can be found on this web site. If you join, the OC Foundation will send you a packet of information and a bimonthly newsletter for the membership fee of $35.00.

39. What are some titles of books about OCD?

Below are most of the books available from the OC Foundation's Publication List. You can order many of these directly from the book store at this website. Go to Book Store now.

Getting Control: Overcoming Your Obsessions and Compulsions by Lee Baer, PhD. Stop Obsessing!: How to Overcome Your Obsessions and Compulsions by Edna Foa, PhD and Reid Wilson, PhD. Over and Over Again: Understanding Obsessive Compulsive Disorder by Fugen Neziroglu, PhD and Jose A. Yayura-Tobias, MD. When Once Is Not Enough: Help for Obsessive Compulsives by Gail Steketee, PhD and Kerrin White, MD. The Boy Who Couldn't Stop Washing, by Judith Rapaport, MD. Funny You Don't Look Crazy: Life With Obsessive Compulsive Disorder by Connie Foster. The Doubting Disease: Help for Scrupulosity and Religious Compulsions by Joseph W. Ciarrocchi. How I Ran OCD Off My Land by John March, MD is a cognitive behavioral protocol for children and adolescents. It also contains tips for parenting. Dr. March is associated with Duke University Medical Center. Brain Lock by Jeffery Schwartz, MD. Regan Books, 1996.

Other books: Steven Levenkron, 1991, Obsessive-Compulsive Disorders: Treating and Understanding Crippling Habits: Warner Books ISBN: 0-445-39348-7 John H. Greist (Dean Foundation), 1992, Obsessive Compulsive Disorder: A Guide: Dean Foundation, Madison, WI (Comment: This booklet is available through the OC Foundation.) Polly's Magic Games: A Child's View of Obsessive Compulsive Disorder by Constance H Foster. Dilligaf Pub, 1994. Alone in the Crowd: One Man's Struggle With Obsessive Compulsive Disorder by Joe Vaughan. Joe Vaughan Assoc. Pub., 1993. OCD Anonymous - Obsessive Compulsive Disorder: A Survival Guide for Family and Friends. OCD Anonymous, Inc., 1993. There is also a fiction novel dealing with OCD in a character. The book's name is "Xenocide" by Orson Scott Card. Obsessive Compulsive Disorder by Frederick Toates, D. Phil., D.Sc., 1992. Published by Thorsons (An Imprint of Harper Collins Pub). Section on famous people who have OCD. New Developments in the Biology of Mental Disorders (The authoritative guide). Research and Education Assoc. 1995. Section on government funding/research. Living with Prozac and other selective serotonin reuptake Inhibitors by Debra Elfenbein. Harper Pub. San Franciso 1995. 303 pages $9. Personal accounts of life on anti- depressants. The Sky is Falling: Understanding and Coping with Phobias, Panic, and Obsessive-Compulsive Disorders by Raeann Dumont. W.W. Norton and Co., 1996. Feeling Good by David Burns, MD. Ten Days to Self-Esteem by David Burns, MD. Mind over Mood by Greenberger and Padesky.

It's Nobody's Fault - New Hope and Help for Difficult Children and Their Parents by Harold S. Koplewicz. Published by Times Books. Features the latest treatments including medication for ADHD, anxiety, school phobia, eating disorders, OCD and depression.

40. Are there other resources for OCD that I can contact?

Yes! See our listing of OCD Related Organizations.

41. What Internet resources are available for OCD?

Please see OCSDA's Listing of Useful Links.

42. What can family and friends do to help?

Education about OCD is important for the family. Families can learn specific ways to encourage the person with OCD by supporting the medication regime and the behavior therapy. Self-help books, such as those listed above, are often a good source of information. Some families seek the help of a family therapist who is trained in the field. Also, in the past few years, many families have joined one of the educational support groups that have been organized throughout the country. A booklet called "Living with OCD" is available through the OC Foundation.

Early Intervention For OCD

Early intervention helps

By Anita Manning, USA TODAY

At the age of 8, Elyse Monti of East Greenwich, R.I., was staying up half the night to do homework.

It's not that her teachers were piling it on. It's that in Elyse's mind, it had to be perfect. "All my obsessions were on school," she says. "Am I doing this right? I'd spend hours on homework. If I couldn't get a math problem, I'd start crying." Elyse has obsessive-compulsive disorder, OCD, an anxiety disorder that affects about 1% of children and about 2.3% of adults. OCD causes intrusive, repetitive, often fearful thoughts, such as an excessive dread of germs. These fears result in compulsive behaviors, such as the need to constantly wash hands or the inability to eat in restaurants. About a third of adults with the disorder say their symptoms began in childhood, but effective treatments for children are not widely known, and therapists familiar with OCD in children are rare. (Related quiz: Does your child have OCD?) In Elyse's case, her father was alert to the symptoms because he has OCD himself. Her parents took her to a doctor for evaluation, and she began weekly therapy. Her symptoms abated but recur with major life changes. Upon entering high school, "I felt I had so much work to do, I didn't take time to eat. I was out of control," says Elyse, 17. "I couldn't do my homework, I was obsessing, it just keeps going round and round in circles. I just felt this unbelievable high level of anxiety." Her worried parents sought help, and Elyse was hospitalized in the adolescent unit at Bradley Hospital, East Providence, for three weeks. To explain her absence from school, she told her friends she had mononucleosis. "You get really good at hiding it," she says. "People with OCD don't want to show it."

Bradley is one of a handful of hospitals at the forefront of researching OCD in children. Child psychiatrist Henrietta Leonard and psychologist Jennifer Freeman, co-directors of the Pediatric Anxiety Research Clinic at Bradley/Hasbro Research Center, Providence, are leading studies on how to treat OCD in young children. "Children aren't just little adults, and kids with OCD aren't just treated with adult protocols," Leonard says. "You can't just substitute words and think the treatment is going to work." The researchers have developed a form of cognitive behavioral therapy, CBT, that is being used successfully to help children as young as 5. The family is "the critical component of the treatment," Leonard says, so "essentially we teach the family to deliver the CBT treatment." Young patients are encouraged, gently and over time, to confront whatever it is that they fear. A child may have washed her hands 30 times in a day but be terrified of leaving the house without washing them once more. In that case, a parent might remind the child of another time when she didn't wash her hands and nothing bad happened, and suggest waiting a few minutes for the fear to pass away. Often, medications can help. A recent study by researchers at Duke University found that a combination of behavioral therapy and anxietyreducing drugs is more effective than either approach on its own, says pediatrician Susan Swedo of the National Institute of Mental Health. The medications "allow the child to do internal behavioral therapy and provide stress relief." But treatment can't begin unless there is a diagnosis. About 15% of children with OCD have a relative who also has it, but "most of it comes out of the blue," Swedo says, and parents may not recognize it. Early diagnosis is important because therapy is more effective before rituals and obsessions become entrenched, and "there's also a demoralization that comes with having symptoms for a long time." People with OCD know "what they're experiencing doesn't make any sense," she says. "They are frightened and try to hide it as long as possible. People may spend six or seven hours a day on their rituals, and nobody knows."

her sophomore year of high school, when she was assigned to write a personal essay and read it aloud in English class. The responses from friends "were all so positive. People said: 'If there's anything I can do,' or 'You were strong to come out about it.' " Buoyed by that support, Elyse has become an advocate for awareness of OCD in teens and children and is active in the Obsessive-Compulsive Foundation, a national research and support group. Meanwhile, she's busy at school, where she's an A-student, vice president of the student council and secretary of the student government. She also plays field hockey and runs track. She's looking forward to college next fall. Her OCD is "not completely gone. It's never gone," she says. "It's cyclical. There's always an event that triggers it. Last year, it was the SATs. That was like the only thing I could think about." Her medication was adjusted for a week, "then the SATs were over, and I was fine. But I know there are still bumps in the road."

IEP Process

Archived Information

A Guide to the Individualized Education Program

Office of Special Education and Rehabilitative Services U.S. Department of Education July 2000

Parent and Teacher Partnership

Questionnaire for Parents:

1. What are your childs strengths? 2. What do you think are your childs weaknesses? 3. What are your childs best abilities? 4. What abilities does your child struggle with? 5. What things would you like to see your child improve on? 6. What are your childs hobbies? 7. What does your child like to do for fun? 8. How does your child react when he/she does not get their way? 9. What are some things that make your child smile? 10. Is your child an only child? 11. If your child has siblings how does he/she react to them? 12. What are the things you would like to see from your childs teacher? 13. Is there anything in your childs home life that I should know about that would be beneficial to the child? Divorce? Poverty? Etc? 14. Is there any additional information you want to me know about your child?

Questionnaire for the Student

1. What do you like the most about school? 2. What do you dislike about school? 3. What do you think your strengths are? 4. What do you think your weaknesses are? 5. What are your hobbies? 6. What things do the teacher do that make you feel great in school? 7. What things do you think help you in class (example sitting closer to the teacher, not sitting near a window, or anything like that)? 8. How do other students treat you? 9. How do you treat other students? 10.What kind of projects do you like doing the most? 11. What things would you like to see the teacher do to help you in school? 12. Is there anything else you want the teacher to know about you?

Adaptations for a LRE (Least Restrictive Environment)

Problems at School: OCD can affect homework, attention in class, and school attendance. Check in on arrival to see if the child can succeed in certain classes that day Allow more time to complete certain types of assignments Accommodate late arrival due to symptoms at home Identify ways for teachers to assist the child in breaking out of an obsession or compulsion Offer strategies for the child to resist uncomfortable thoughts Allow the child to tape record homework if the child cannot touch writing materials Give the child a choice of projects if the child has difficulty beginning a task Suggest that the child change the sequence of homework problems or projects ( for example, if the child has fears related to odd-numbers, start with even-numbered problems ) Adjust the homework load to prevent the child from becoming overwhelmed. Academic stressors, along with other stresses, aggravate symptoms. Anticipate issues such as school avoidance if there are unresolved social and/or academic problems If the child insists on certain OCD rituals at school, work with the child to identify less intrusive rituals (such as tapping one desk rather than tapping every desk) Assist with peer interactions in order to alleviate concerns for both the child and peers

Helpful Contact Resources

Academy of Cognitive Therapy Phone: (267) 350-7683 Email: info@academyofct.org Website: http://www.academyofct.org

American Academy of Child and Adolescent Psychiatry Phone: (202) 966-7300 Website: http://www.aacap.org

American Foundation for Suicide Prevention Phone: (888) 333-2377 Email: inquiry@afsp.org Website: http://www.afsp.org

American Psychological Association Phone: (800) 374-2721 Website: http://www.apa.org

Anxiety Disorders Association of America Phone: (240) 485-1001 Email: information@adaa.org Website: http://www.adaa.org

Association for Behavioral and Cognitive Therapies Phone: (212) 647-1890 Website: http://www.abct.org

Clutterers Anonymous Phone: (310) 281-6064 Website: http://www.clutterersanonymous.net

Freedom From Fear Phone: (718) 351-1717 Email: help@freedomfromfear.org Website: http://www.freedomfromfear.org

Mental Health America Phone: (800) 969-6642 Website: http://www.nmha.org

National Alliance on Mental Illness Phone: (800) 950-6264 Website: http://www.nami.org

National Disability Rights Network Phone: (202) 408-9514 Email: info@ndrn.org Website: https://www.ndrn.org

National Institute of Mental Health Phone: (866) 615-6464 Email: nimhinfo@nih.gov Website: http://www.nimh.nih.gov

National Mental Health Information Center Phone: (800) 789-2647 Website: http://mentalhealth.samhsa.gov

National Suicide Prevention Lifeline Phone: (800) 273-8255 Website: http://www.suicidepreventionlifeline.org

Obsessive Compulsive Anonymous (OCA) Phone: (516) 739-0662 Email: west24th@aol.com Website: http://obsessivecompulsiveanonymous.org

The Other OCD: "Purely-Obsessional" OCD Email: info@academyofct.org Website: www.theotherocd.com

Tourette Syndrome Association, Inc. Phone: (718) 224-2999 Website: http://www.tsa-usa.org

Trichotillomania Learning Center (TLC) Phone: (831) 457-1004 Email: info@trich.org Website: http://www.trich.org

Legal Resources

Legal and Employment Resources

Americans with Disabilities Act U.S. Department of Justice Phone: (800) 514-0301 Website: http://www.ada.gov

Bazelon Center for Mental Health Law Phone: (202) 467-5730 Website: http://www.bazelon.org

Individuals with Disabilities Act (IDEA) Phone: (202) 884-8215 Website: http://idea.ed.gov

Office of Disability Employment Policy U.S. Department of Labor Phone: (866) 487-2365 Website: http://www.dol.gov/odep

Insurance Help

Cover the Uninsured Phone: (877) 655-2889 Email: info@covertheuninsured.org Website: http://covertheuninsured.org

Medicare Rights Center Phone: (800) 333-4114 Website: http://www.medicarerights.org

Professional Associations
Academy of Cognitive Therapy Phone: (267) 350-7683 Email: info@academyofct.org Website: http://www.academyofct.org American Academy of Child and Adolescent Psychiatry Phone: (202) 966-7300 Website: http://www.aacap.org American Psychiatric Association Phone: (888) 357-7924 Email: apa@psych.org Website: http://www.psych.org American Psychological Association Phone: (800) 374-2721 Website: http://www.apa.org Anxiety Disorders Association of America Phone: (240) 485-1001 Email: information@adaa.org Website: http://www.adaa.org

Benefits of Inclusion

Benefits of Inclusion for Exceptional Learners 1. Friendships 2. Increased social initiations, relationships and networks 3. Peer role models for academic, social and behavior skills 4. Increased achievement of IEP goals 5. Greater access to general curriculum 6. Enhanced skill acquisition and generalization 7. Increased inclusion in future environments 8. Greater opportunities for interactions 9. Higher expectations 10. Increased school staff collaboration 11. Increased parent participation 12. Families are more integrated into community

Benefits of Inclusion for Typical Learners 1. 2. 3. 4. 5. 6. 7. 8. Meaningful friendships Increased appreciation and acceptance of individual differences Increased understanding and acceptance of diversity Respect for all people Prepares all students for adult life in an inclusive society Opportunities to master activities by practicing and teaching others Greater academic outcomes All students needs are better met, greater resources for everyone

Benefits of Inclusion for Society 1. Children learn compassion and kindness which is a lesson they will take into adulthood. 2. Society learns more about a person who has a disability 3. This helps children with disabilities grow up with confidence in an accepting society.

Books on Inclusion Best Behavior : Building Positive Behavior Support in School by Jeffery Sprague 241 pages published by Sopris West. 2004 10 digit ISBN 1593180713 -13 digit ISBN 9781593180713 COACH 2 by Michael Giangreco, Deanna J. Sands (Editor) published by Paul H Brookes Pub Co. 1998 10 digit ISBN 1557663297 -13 digit ISBN 9781557663290. Creating an Inclusive School by Richard A. Villa & Jacqueline S. Thousand (Editor) Paperback - Feb 2005 - 2nd edition 219 pages published by Assn for Supervision & Curriculum. 10 digit ISBN 1416600493 - 13 digit ISBN 9781416600497. Don't Laugh at Me by Steve Seskin, Allen Shamblin, Glin Dibley 32 pages published by November 2002 by Tricycle Pr. 10 digit ISBN 1582460582 - 13 digit ISBN 9781582460581. From Disability to Possibility: The Power of Inclusive Classrooms by Patrick Schwarz 90 pages published 2006 by Heinemann 10 digit ISBN 0325009937- 13 digit ISBN 9780325009933. Including Students with Severe and Multiple Diabilities in Typical Classrooms : Practical Strategies for Teachers by by June Downing, Martha E. Snell (Foreword By). 3rd edition published April 2008 by Paul H Brookes Pub Co. 334 pages 10 digit ISBN 1557669082 - 13 digit ISBN 9781557669087. Inclusive Teaching: Creating Effective Schools For All Learners by J. Michael Peterson, Mishael Marie Hittie. Published December 2004 by Allyn & Bacon 533 pages 10 digit ISBN 0205464793 - 13 digit ISBN - 9780205464791. Inclusive Schooling Practices : Pedagogical and Research Foundations A Synthesis of the Literature That Informs Best Practice About Inclusive Schooling by Gail McGregor, R. Timm Vogelsberg. Published June 1999 by Paul H Brookes Pub Co 10 digit ISBN 1557663955 -13 digit ISBN 9781557663955. It's So Much Work to Be Your Friend : Helping the Child With Learning Disabilities Find Social Success by Richard Lavoie published Oct 2006 by Touchstone Books 10 digit ISBN 0743254651 -13 digit ISBN 9780743254656.

Just Give Him The Whale! : 20 Ways to Use Fascinations, Areas of Expertise, and Strengths to Support Students with Autism and it was written by Paula Kluth, Patrick Schwarz. Published February 2008 by Paul H Brookes Pub Co 143 pages i 10 digit ISBN 1557669600 - 13 digit ISBN is 9781557669605 Modifying Schoolwork aby Rachel Janney, Martha E. Snell. 2nd edition. Published August 2004 by Paul H Brookes Pub Co.150 pages 10 digit ISBN 1557667063 -13 digit ISBN - 9781557667069. The Inclusion Facilitator's Guide by Cheryl M. Jorgensen, Jan A. Nisbet Ph.D., Mary C. Schuh. Published November 2005 by Paul H Brookes Pub Co.250 pages 10 digit ISBN 1557667071 - 13 digit ISBN 9781557667076. The Teacher's Guide to Intervention and Inclusive Education : 1000+ Strategies to Help ALL Students Succeed! by Glynis Hannell. 251 page Published January 2007 by Corwin Pr. 10 digit ISBN 1890455075 -13 digit ISBN is 9781890455071. Widening the Circle : The Power of Inclusive Classrooms by Mara Sapon-Shevin. Published March 2007 by Houghton Mifflin.250 pages 10 digit ISBN is 0807032808 -13 digit ISBN 9780807032800 Wrightslaw From Emotions to Advocacy : the Special Education Survival Guide by Pamela Darr Wright. 2nd edition. Published January 2006 by Harbor House Law Pr. 311 pages10 digit ISBN 1892320096 - 13 digit ISBN is 9781892320094. You Can't Say You Can't Play by Vivian Gussin Published September 1993 by Harvard Univ Pr. 10 digit ISBN 0674965906 -13 digit ISBN 9780674965904. A 5 Is Against the Law! Social Boundaries : Straight Up! an Honest Guide for Teens and Young Adults by Kari Dunn Buron. published January 2007 by Autism Asperger Pub Co. 10 digit ISBN 1931282358 - 13 digit ISBN is 9781931282352.

References

"About Obsessive Compulsive Disorder (OCD) Anxiety Disorders Program." Semel Institute for Neuroscience and Human Behavior at UCLA. Web. 21 July 2011. <http://www.semel.ucla.edu/adc/about/ocd>. "Famous People with Obsessive Compulsive Disorder. Disability News, Information and

Resources - Disabled World. Web. 21 July 2011. <http://www.disabledworld.com/artman/publish/famous-ocd.shtml>. "Inclusion Resources." Kids Together Inc. (TM) Disability, Inclusion, Rights, Information & Resources. Web. 29 July 2011. <http://www.kidstogether.org/inclusion/inclusionresources.htm>. International OCD Foundation (IOCDF). Web. 21 July 2011. <http://www.ocfoundation.org/whatisocd.aspx#Definition>. "Mental Health America: Obsessive-compulsive Disorder (OCD)." Mental Health America: Welcome. Web. 28 July 2011. <http://www.nmha.org/go/ocd>. "Obsessive Compulsive Disorder (OCD)." Children's Disability Information. Web. 28 July 2011. <http://www.childrensdisabilities.info/OCD/obsessive-compulsive-disorder.html>. "Obsessive-Compulsive Disorder." KidsHealth - the Web's Most Visited Site about Children's Health. Web. 21 July 2011. <http://kidshealth.org/parent/emotions/behavior/OCD.html>. "Obsessive-Compulsive Disorder (OCD): Symptoms, Behavior, and Treatment." Helpguide.org: Expert, Ad-free Articles Help Empower You with Knowledge, Support & Hope. Web. 21 July 2011. <http://helpguide.org/mental/obsessive_compulsive_disorder_ocd.htm