Does My Child Have Obsessive-Compulsive Disorder or Bipolar Disorder?

A child with Obsessive-Compulsive Disorder (OCD) may struggle with obsessions, compulsions, or both. According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders), obsessions are "persistent thoughts, ideas, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress to the individual." Examples of obsessions include fear of germs, fear of harming a family member (even though this is not what a child wants to do or will do, he is tortured by the repetitive thought), and repetitive self-doubts (such as "Did I save the file on my computer?").

Compulsions are repetitive acts of seemingly nonpurposeful behavior. Examples include the need to put things in order, repetitive hand washing, and repetitive checking (such as checking again and again to see if the homework is in the book bag).

Though a child may not be consciously aware of it, the goal of these obsessions and compulsions, as outlined in the DSM-IV-TR, is to prevent or reduce anxiety or distress, not to provide pleasure or gratification. Youngsters with OCD also often have other disorders, including Major Depressive Disorder and other anxiety disorders such as specific phobias, social phobias, panic disorders, eating disorders, and Tourette's Disorder. Children with Bipolar Disorder and those with OCD can have symptoms that look somewhat similar. Both Bipolar Disorder and OCD children can be very rigid and may insist on doing things in a certain way. Many bipolar youngsters show their rigidity by demanding the same foods every day. Eight-year-old Angie, for instance, likes to eat ham and cheese sandwiches for lunch—but only if the cheese is shredded cheddar. If not, a major tantrum will ensue.

As for getting to school, bipolar kids with OCD traits are often late because (in addition to all the other reasons) they need to have their socks and shoes feeling "just right"—equal in height and/or with the shoelaces tied with precise and consistent tension. If they can't adhere to their personal anxiety-driven dress code, they will cry, throw a tantrum, and refuse to keep their shoes or socks on until everything feels right. Of course, routine is comforting for most children. But for bipolar kids with OCD traits, as well as for kids with OCD alone, these repetitive thoughts and behaviors are not comforting; they are all-consuming.

For the bipolar child, these rituals and routines are often somewhat mood related. When depressed, bipolar kids often become more rigid and more resistant to change. They may need to go over their bedtime ritual of having their stuffed animals arranged in a certain way or of having mom say goodnight in a particular manner: "Good-night, Jamie. Sleep well. Have good dreams." The child can get very upset if mom mixes up the word order, and the bipolar child may insist that her mother repeat the words precisely in order before she can fall asleep.

When the bipolar child is depressed, nothing is right and everything grows more difficult. This is part of the reason why a depressed bipolar kid with OCD traits may have an extra hard time seeing that his socks really are even and are therefore OK. Or why he may complain to his mom that she put his school snack in the wrong-sized bag, even though it's the same size bag she has used for weeks. Instead of the normal whining, however, the bipolar child will become overwhelmed and collapse into tears. If parents give in to the child's requests (and I'm not saying that they should or shouldn't), that likely won't be the end of it. Within a short while, odds are that the child will find something else that is wrong.

It's natural to get annoyed and frustrated when your child has a meltdown over what seems like nothing—invariably at a time when it's incredibly inconvenient. A parent's first instinct is to reason with the child. But at these times, you might have more success reasoning with the family dog. Instead, it may be better to look at your child, take a deep breath, and imagine that he's having a brain seizure. Then think about how much good it would do if you got frustrated with him and told him, "Stop having that seizure!" Sounds absurd, right?

Though it is easier said than done, it's worth trying to regroup and give yourself time to respond with your new perspective. There are no pat answers for these situations, but many of the parents I see have very good instincts. Just remember: If you act frustrated and overwhelmed, you're mirroring what your child is experiencing, except he's experiencing it with even more intensity. You may want to give your child a break and try to discuss the issue with him later. No matter how you choose to handle the situation, the primary concern must always be the safety of you and your child.

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