Doctors and psychotherapists are now learning there are two kinds of Obsessive Compulsive Disorder.The regular OCD – which is a neurobiological condition which is characterized by obsessive behaviors -- involves repetitive unwanted thoughts, ideas or images typically about harm that intrude in the mind and won't let up and compulsions-repetitive behaviors (washing hands, counting, tapping, checking) in an attempt to ward off perceived risk and harm. Unlike everyday worries, obsessions are experienced as disturbing, bizarre, senseless and counter to the child's sense of self.
Now there is also PANDAS – known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep – which is a subtype of OCD. For approximately 25 percent of children who have Obsessive Compulsive Disorder, the sudden onset of the OCD is exacerbated or triggered by strep throat, in which the body's own immune cells attack a part of the brain, the basal ganglia, rather than the strep. This disorder does not occur in all children, but only those who have a genetic predisposition to OCD or tics. The difficulty in diagnosing may occur because the OCD can develop shortly after the strep infection but many times months after, and the strep infection could have been so minor that it was not treated. It is most common in children who have not yet reached puberty, though it is not limited to this age group.
The biggest difference between regular OCD and PANDAS-OCD is the sudden onset. OCD usually develops slowly over weeks, months or even years; however, PANDAS OCD seems to come out of the blue with parents saying one day their child woke up a different kid. There are also other symptoms that help differentiate the 2 types of OCD. PANDAS OCD is also characterized by:
- Choreiform movements: involuntary or irregular writhing movements of the legs, arm or face
- Presence of tics and/or hyperactivity
- Irritability, temper tantrums, or mood lability
- Nighttime difficulties
- Severe nightmares and new bedtime rituals or fears
- Separation anxiety
- Age regression: going back to younger developmental stage
- New handwriting problems, loss of math skills, sensory sensitivities
One of the most thorough books on OCD for parents is Freeing Your Child from Obsessive-Compulsive Disorder by Tamar Chansky. If a parent is looking for a book to read to the child, try Mr. Worry: A Story About OCD by Holly Niner. For more, see Worry Wise Kids or this special link on PANDAS.
