It is not uncommon for children with OCD to struggle with more than one disorder. Depression, eating disorders and panic disorder can frequently occur alongside OCD. If your child is diagnosed with multiple mental health disorders, it is important for him to receive specialized treatment for each disorder. Cognitive behavioral therapy for OCD, for example, will help a child with his OCD but will not help with his depression.
Care should be taken during diagnosis to determine if a child only has obsessive-compulsive disorder, or if the child has OCD and another disorder, or perhaps a disorder that is similar to OCD but is actually a separate disorder such as acute-onset OCD or a disorder on the “obsessive-compulsive spectrum.”
The obsessive-compulsive spectrum
There is a spectrum of disorders that share some characteristics with OCD and are treated in similar ways. These include:
- Tourette’s syndrome
- Illness anxiety disorder (or somatic symptom disorder)
- Body dysmorphic disorder
- Skin picking (or excoriation disorder)
- Chronic tic disorders
While these disorders have similar clinical characteristics — and some experts believe that they may have the same underlying neurobiological causes as OCD — they differ from OCD in certain ways and therefore require a specialized treatment.
One distinction worth making is between OCD and two other disorders that involve obsessive thoughts: illness anxiety disorder (a child is obsessed with the idea that she has a serious illness despite not having symptoms) and body dysmorphic disorder (a child obsesses on a minor or imagined flaw in her appearance). The difference is the extent to which a child believes her thoughts. For example, a child with OCD may know her obsessions are irrational and yet have so much anxiety that she feels the need to perform compulsions to reduce the anxiety anyway. A child with illness anxiety disorder or body dysmorphic disorder, however, may believe her thoughts are based in reality. Children with these disorders usually need cognitive therapy and strategies to gain insight into the irrationality of their obsessions before they can begin exposure and response prevention therapy. If they receive ERP before they are cognitively prepared for it, then their anxiety may actually worsen over time.
Hoarding, skin picking, trichotillomania and tic disorders including Tourette’s can be treated by exposure and response prevention and other behavioral strategies.