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Thirteen-year-old Roy was brought to the Child Psychopharmacology Clinic because he was staying up until 3 or 4 o'clock in the morning compulsively checking the door and window locks of his house. "I've been doing this dumb thing since I was 9 years old," he told the clinic staff. "After I lie down in bed, I begin to wonder if the doors are locked. I always check them before I go to bed, but then I'm not sure. I lie there in bed telling myself to forget it, the doors are locked, but I just can't let it go. So finally I get up and tiptoe downstairs to check the front and back doors. Usually I check them each three times, just to be absolutely sure. Then I go back to bed. Soon I'm wondering if I might have jiggled the lock loose while I was checking ...Then I start thinking about all the robbers and murderers I have ever heard about. Finally, I'm so disgusted I get up and check them all again. Lately, I've started checking the windows too. I just can't stand it. In the morning I'm so tired I can hardly get to school and I'm falling asleep in classes."
Roy was diagnosed with obsessive compulsive disorder (OCD), a brain disorder characterized by special kinds of thoughts (obsessions) and actions (compulsions). In children with OCD, these are of such persistence and/or severity that they cause distress or interfere with everyday life. It has been estimated that perhaps as many as 200,000 children in the United States have this disorder. Usually, patients have both obsessions and compulsions. Sometimes, however, only one or the other is present.
Most children describe their obsessions as being very much like fears or worries. Some common obsessions of children with OCD are fears of intruders, fears of contamination with germs or a toxic substance, or worries that they might have a serious illness. Obsessions are involuntary: These thoughts come into the child's mind despite the child trying to think of something else. In fact, most children try to resist obsessions.
Children with OCD usually have several obsessions. Some may be specific, such as a fear of catching …