Back to our regularly scheduled worrying

Or, as we note in trends around here, OCD.

I have to look for psychiatrists for Dubya. His doctor told us to check out which ones our insurance covers, then give her the list. She'll select one who does more than act as a highly degreed drug dealer for children, i.e., one who spends time on behavioral therapies without (or with, as necessary) pharmaceutical intervention. He's a tricky case because his tics preclude many pharmaceuticals for ADHD, and the OCD just complicates things even more.

And apparently, we're not a moment too soon. The OCD behaviors have jacked up big time around here lately. Luckily, he came by it honestly--through his mother, i.e., Me. As an experienced obsessive myself (compulsions? only really really healthy ones these days), I can at least help him out with managing the intrusive thoughts that he's complaining about, having developed some good management techniques over the years. My obsessiveness doesn't interfere with my life; it just makes me a pretty good editor.

Intrusive thoughts like what, you may ask? Well, let me tell ya. Before I got into writing this post, I googled "pediatric OCD" and came up with a list of standard behavioral features. In fact, these are so prevalent among this population that if the behaviors differ from this list, it's likely something else, not OCD.

Common obsessions and compulsions in the pediatric population include

• --Things having to be arranged in a certain way
• --Contamination-related behaviors, like handwashing
• --What they call "aggressive obsessions," which can include intrusive thoughts related to violence or catastrophic events
• --Obsessions about harm to oneself or others
• --Need to confess

There are a few others, but the ones I listed above are Dubya's set. He exhibited the handwashing behaviors starting a couple of years ago. He's so obsessed with it that if he touches his nose, he thinks he has to wash his hands. He's requested that we put the hand soap he likes in the upstairs bathroom, too, so he can wash when he's up there, as well. In other words, he's seven, and he's got a soap preference. We've informed his teacher and asked her to limit the number of times he can go handwash. With the limitations we set on it, he's not gotten to the scab stage again, although he did when he was about five. He's very concerned about contamination, and it's not helping much right now that everyone's talking talking talking about handwashing because of the flu. Nevermind the fact that it probably transmits most often by air.

He's notorious for his arrangements of things and for flying off the handle when they get disarranged. But it's the "aggressive obsessions" that are most prominent. These come through by way of his confessional impulse, so several times a day, he will "confess" something. Usually, it's related to some accident he was involved in as the causative agent, sometimes years earlier. He'll worry that rather than its having been an accident, he did it on purpose, which is classic OCD. He'll "confess" to replaying terrifying scenes in his head from movies that he hasn't even seen--he's just heard about it from friends. His complaint is that he just can't stop playing it over and over, freaking himself out. If he gets a consequence for the most minor infraction, he'll worry it for days, saying many days or even weeks later, "I'm still worried that I did that." And then, there's the typical family SIFO catastrophic thinking that abounds.

I'd say he probably spends most of his waking hours replaying these things in his head and worrying about them. And lately, in the last few weeks, he "confesses" several times a day. Sometimes, it's intended as a real confession, some very minor transgression of a year or two vintage that he's got to get off his chest. Repeatedly. Other times, it's a "confession" of the replaying videos of violence or aggression in his head. Never, I add, any violent behavior on his part. And then, other times it's some accidental harm he's caused a friend or family member that's eating away at him, even if it happened literally years ago.

I have watched that child from infancy develop into this anxious and obsessive little person. As an obsessive person myself, I've recognized some of the clear signs along the way and have done my own version of cognitive behavioral therapy to show him that his compulsions aren't required for life to go on. But given his youth--only just turned seven--and these escalating manifestations, those signs have become flashing alarms. Must. Head. Off. OCD.

Starting with this list of psychiatrists. Not my favorite MD population, so I confess that it likely will become just another thing that I obsess about.