Children with obsessive-compulsive disorder are three times more likely to be bullied than other children, and the name-slinging could cause symptoms of OCD to worsen, University of Florida researchers have found.
"One of the things we have noticed working with many kids with OCD is that peer relations are extremely impaired," said Eric Storch, Ph.D, a UF assistant professor of psychiatry and pediatrics and lead author of the study. "Kids target kids who are different. Kids with OCD sometimes exhibit behaviors that peers simply don't understand."
More than one-quarter of the children with OCD who researchers studied reported chronic bullying as a problem, according to findings described in the September issue of the Journal of Clinical Child and Adolescent Psychology.
By comparison, only 9 percent of kids in the two other groups researchers studied - healthy kids without medical or mental conditions and children with type 1 diabetes - reported serious problems with bullies.
Nearly all children are bullied at least once in their lives. But chronic bullying equates to about one taunt per day, ranging from kicking or hitting to name-calling or excluding children from activities in school.
"The kids with OCD are really experiencing higher rates of peer problems than other kids," Storch said. "We're not saying one causes the other, but there is a positive relationship between (OCD and bullying)."
About one in 100 children struggle with OCD, an anxiety disorder that leads people to engage in rituals such as hand washing to drive away obsessive thoughts about germs or other worries. Rituals often become so involved that they interfere with a person's ability to function, according to the National Institute of Mental Health.
"Their day becomes filled with repeating behaviors," Storch said. "For a lot of kids, peers don't understand what is going on. They are isolated. They are ostracized because it doesn't make sense why they are washing their hands. Why they keep repeating questions."
The researchers also found links between bullying and other problems, namely loneliness and depression, in children with OCD, Storch said. Kids were also apt to internalize bullies' negative comments, telling themselves, "No one will ever love me," or "Maybe I am a loser," Storch said.
Having OCD and conditions such as depression is linked to worsening obsessive-compulsive symptoms, potentially explaining why researchers also found a link between bullying and more serious symptoms.
"It could be that the peers are attacking because they are doing things that are so different," he said. "Or it might be that bullying is in some way contributing to OCD."
Compulsive behaviors such as repeating questions, recounting and rechecking information can draw attention to kids with OCD in school, as can vocal or physical tics, common among children with OCD, said Phoebe Moore, Ph.D., an assistant clinical professor of child psychiatry at Duke University.
"That kind of behavior can draw fire," Moore said. "I definitely see that clinically."
Treating OCD either with approved drugs or behavior modification techniques will help patients control their obsessions and compulsions, Storch said. But he emphasizes that doctors need to examine the whole child and not just treat OCD symptoms.
"When one focuses solely on the obsessions and compulsions you experience a resolution of those problems, but problems like depression or anxiety and loneliness may still exist," he said. "If you address the OCD without addressing the peer problems, that depression and loneliness may not go away."
Storch suggests parents help children learn how to handle aggressive peers, either at home or by finding a counselor who can help them develop social skills. Parents should also take their concerns to their child's school if teachers or administrators are not stopping the bullying before it becomes a problem.
"Bullying is one of the largest challenges kids, with OCD and in general, have to face," he said. "One of the main clinical implications is considering the child as an entire person, one who has OCD but who also has other impairments."
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