Harrington building

SYMPTOMS

Anxiety affects the way the individual feels, thinks and behaves. These three components are characterized by

Physical symptoms (feels) - palpitations, nausea, weak limbs, stomach churning, shakiness, shortness of breath, dry mouth, sweating, feeling flushed and/ or tingling sensations.
Psychological symptoms (thinks) - feeling frightened/ worried, feeling tense/ irritable, feeling a loss of control or of wanting to escape, that you are losing your mind or that something terrible is going to happen, thinking that people are staring at you/ commenting about you, thinking that you are going to have a heart attack or have a brain tumour, that you will faint if you do such a thing.
Behavioural symptoms (behaves) avoiding situations/places/people or objects, going somewhere when it is quiet, making excuses, rushing away from situations, using props before or when out, avoiding being alone or going out alone.
An individual experiences several components of anxiety which reinforce each other and result in the individual avoiding situations which makes the situation harder to cope with in the long term and so the opportunity for overcoming anxiety is taken away.
TREATMENT

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  Education about the components of anxiety and behaviours that can help to address them
  
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  Monitor the anxiety in different situations, identify antecedents and consequences
  
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  Exposure to the object or situation
  
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  Relaxation techniques
  
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  Cognitive restructuring such as positive self-talk/ Cognitive Behaviour Therapy
  
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  Reward systems
  

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  Modelling, involving the family which is crucial in helping the child to learn positive and effective methods of coping with anxiety
  

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  Medication
  

SUGGESTED READING

Barker, P. (2004) 'Basic Child Psychiatry' (7th Edition), Blackwell: Oxford.
Puri, B. K., Laking, P J, Treasaden, I H. (1996) 'Textbook of Psychiatry' Churchill Livingstone: London.

OBSESSIVE-COMPULSIVE DISORDER

OCD is an anxiety disorder. Other types of anxiety disorders include: separation anxiety, phobias, generalized anxiety disorder, panic disorder, and post traumatic stress disorder.
OCD is characterized by recurrent and persistent obsessions and/or compulsions that cause distress, or interfere with a child's everyday life. It is usual for a child suffering with OCD to experience high levels of anxiety throughout their daily life; this may result in the child repeating actions or thoughts in order to try and gain some control over their feelings. Children with OCD can exhibit bizarre behaviour that is distressing both for the individual and their family. OCD is exhausting and causes much mental anguish for its sufferers. This can be further exacerbated in children who fear they are 'going crazy' and develop elaborate ways to hide the disorder from parents, teachers and friends. This is why it may be beneficial for a child with OCD to attend Galaxy House as a seven-day in-patient for a thorough assessment into the extent of their disorder and the impact it has on their daily life.

DEFINITION

Obsessions are involuntary thoughts and feelings that arise repeatedly in a child's mind these may be unpleasant for the child, or they may become frightened or disgusted. The child will not want to have the obsessive thoughts, may find them intrusive and create a feeling of being out of control. The child may recognize that their obsessions don't make rational sense, during individual sessions with their key nurse at Galaxy House or, when talking to parents. Examples of obsessions include feelings that something bad will happen to a loved one and fears of contamination or getting sick.
Compulsions are repeated behaviours or rituals that are done rigidly and in response to an obsession. Children with OCD try to remove their obsessions by performing compulsions. For example a child with an obsession about contamination may wash constantly to the point where their hands are raw.
"Unlike compulsive drinking or gambling, OCD compulsions are not pleasurable.

Rather, the rituals are performed to obtain relief from the discomfort caused by the obsessions" (O-C foundation, 1998).

CLINICAL FEATURES

These can be described under six headings

Perceptions

Specific situations, for example, those involving the child getting dirty, may be perceived as scary.

Cognition

Obsessional thoughts, images or impulses that may intrude into consciousness and may involve themes of contamination, sex, or aggression. The child tries to exclude these thoughts from consciousness.

Affect

The obsessions cause anxiety.

Arousal

Ongoing moderate hyper arousal occurs. Hyper arousal occurs when the child resists the compulsions.

Behaviour

Motivated by their obsessional beliefs, children engage in compulsive rituals which they believe will prevent a catastrophe from occurring or undo some potentially threatening event which has occurred. These rituals are usually unrealistic.

Interpersonal Adjustment

Members of the child's family or social network may become involved in helping the child perform compulsive rituals and inadvertently reinforce them.

CAUSES

The exact causes of OCD are unknown; however, it will probably be due to a combination of factors. According to learning theory, OCD is a result of the individual 'learning' negative thoughts towards normal situations as a result of life experiences, e.g. a child may develop a ritualistic system of food preparation and cleanliness as a response to having bad food poisoning. Performing ritual acts will ease the anxiety provoking thoughts about it happening again.
Another theory, supported by recent research into the positive effects of tricyclic antidepressants, practically selective serotonin reuptake inhibits (SSRI's), suggests OCD is caused by an imbalance of the brain chemical and neurotransmitter called serotonin.