Obsessive Compulsive Disorder in Adolescents

Obsessive compulsive disorder or OCD starts from adolescence onwards. OCD is feeling of strong obsessions and compulsions which result in intense discomfort and affects daily functioning. Obsessions are thoughts which are persistent and recurrent. They even include unwanted images and impulses which lead to distress and anxiety. These feelings and thoughts are usually irrational or unrealistic. Compulsions are repetitive rituals or behavior such as checking something again & again, or mental acts such as counting. These obsessions & compulsions cause intense distress and anxiety and can interfere with the daily activities, relationships, social activities and academic functioning. The person with OCD thinks that he has no control over his actions. OCDs are relapsing and chronic illness. 

The thoughts change as the adolescent grows. Younger children suffering from OCD often have thoughts of harm befalling on them and their family such as thief getting into the house through an unlocked door.  This will make the children to recheck the door and windows again and again fearing that they might have left the door unlocked accidentally. Teenagers suffering from OCD fear that they might get fall sick due to germs, contaminated food and AIDS. The adolescent develops certain rituals, such as washing hands innumerable times, in order to get over the fear. These rituals help them to think that they have overcome the problem for the time being and give them temporary relief. If they do not perform these rituals, they become more and more anxious. 

OCD is a sign of brain circuitry’s unusual functioning and it involves the striatum part of the brain. The brain activity patterns of such people differ from normal people and people with other mental disorders. Researchers have concluded that OCD is usually a family problem and is a disorder of the brain. Streptococcal bacterial infection can create or worsen the condition of OCD. Adolescents with no family history of OCD can also develop it. Most of the adolescents feel embarrassed to talk about their OCDs. They think that people will label them as crazy and this will make them feel ashamed. This will make it difficult for the parents to talk to their children about their OCD, in order to solve them. Parents need to develop good communication skills for this purpose. Parent’s support is also very important to the adolescent. Cooperation is extremely important along with treatment, because if the problem is not treated the adolescent will grow into a disturbed adult.     

Most of the adolescents with OCD can receive effective treatment. The treatment can include psychotherapy and intake of medications such as fluoxetine, clomipramine, fluvoxamine, paroxetine, sertraline and other serotonin reuptake inhibitors. When OCD is caused due to streptococcal infection, the adolescent can be administered with antibiotics to kill the bacterium which is causing it. Exposure and response prevention behavioral therapy is very useful in solving OCD. In this therapy, the adolescent is wontedly exposed to his/her fears which give him/her obsessive thought. After that he/she is trained to avoid these thoughts and the rituals which he/she carries out to tackle the anxiety.

An adolescent having OCD can also have depression, substance abuse, attention deficit hyperactivity disorder, eating disorders, and other types of anxiety disorders. When a person with OCD and other mental illness, is treated, OCD becomes more difficult to treat and even diagnose.

Read More

Menstrual Disorders in Adolescent Girls

Adolescence is the time when there is sudden transformation in the body and many questions arises in the minds of the adolescents. Firstly they are not able to cope with the changes and secondly the changes bring along problems with them. The most challenging problems are related to menses, in girls. Menstrual conditions are many that may require physician’s attention or any other healthcare professional’s attention. The most common of the menstrual disorders are premenstrual syndrome, dysmenorrheal and amenorrhea.

Before the onset of the menses, females face many uncomfortable symptoms which last for a short period, stretching from few hours to few days. But some of them can be very intense and can disturb the normal functioning of the person. These symptoms are grouped as premenstrual syndrome. In usual cases, the symptoms come to a halt when the menses begin, but for some they may last even after the menstrual periods are over. Eighty five percent of the females experience some of the symptoms of premenstrual syndrome at one time or the other. Nearly forty percent experience the symptoms so intensely that their daily chores are affected by it and ten percent are disabled by it.

There are many premenstrual syndrome symptoms which can be broadly classified as neurologic & vascular symptoms, psychological symptoms, gastrointestinal symptoms, fluid retention, eye problems and respiratory problems. The cause of premenstrual syndrome are fluctuations in the levels of progesterone & estrogen, hypoglycemia, hyperprolactinemia, psychogenic factors, changes in carbohydrate metabolism, excessive aldosterone, progesterone allergy and water retention by kidneys. The good thing is that premenstrual syndrome can be prevented by exercising regularly, eating balanced diet and sleeping adequately.

Dysmenorrhea is feeling intense menstrual pain and cramps. Depending on the severity, dysmenorrhea is stated as primary dysmenorrhea or secondary dysmenorrhea. Primary dysmenorrhea symptoms are felt from the onset of the menstrual periods and are felt life-long. Because of abnormal uterine contractions due to chemical imbalance, severe menstrual cramping is experienced. Secondary dysmenorrhea starts in the later stages. The causes are different for primary and secondary dysmenorrhea. Secondary dysmenorrhea can be blamed on medical conditions such as endometriosis, uterine fibroids, pelvic inflammatory disease, tumors, infections, and abnormal pregnancy.        

Dysmenorrhea symptoms are lower abdomen cramping & pain, lower back pain, nausea, diarrhea, vomiting, fatigue, fainting, weakness and headaches. Females who are overweight, smoke, and have started to menstruate before turning eleven are at a higher risk of developing dysmenorrheal. Females who drink alcohol during menstrual period experience prolonged pain. After studying the health conditions, age, cause of dysmenorrhea, and extent of condition of the individual, corresponding treatment will be recommended. Regular exercise, abdominal massage, hot bath, vitamin supplements, and dietary modifications can help overcome dysmenorrhea.

Amenorrhea is the condition in which the female skips her menses for more than three consecutive menstrual cycles. Amenorrhea is also classified as primary amenorrhea and secondary amenorrhea. Primary amenorrhea develops from the onset of menstrual periods. In this condition, the adolescent might not get periods when she enters puberty. Secondary amenorrhea is a condition where periods become irregular after a period of time and not from the start.

There are many causes of amenorrhea such as ovulation abnormality, eating disorders, birth defects, anatomical abnormalities, malnourishment, anorexia, bulimia, pregnancy, over exercising, thyroid disorder, obesity and other medical conditions. Out of these ovulation abnormalities are a common cause for absent or irregular periods. It is a must that an adolescent start getting menses at least by the age of sixteen. If not, anatomical abnormality, birth defect and other medical conditions are the cause. Adolescents who participate in sports actively and are athletic have a lower body fat content because of which they have absent menses. Even because of malnourishment, the body is incapable of sustaining pregnancy. So in turn the body itself shuts down the reproductive system and menses. Extra fat cells in the body interfere with ovulation and that is the reason why obese female have irregular menses. Amenorrhea is treated by dietary modifications, ovulation inhibitors and hormone treatment.

Read More

Eating Disorders in Adolescents

Since the adolescence is the age where bones are sprout and grow rapidly, well nourished food must be given to the adolescent to facilitate normal growth & development. The nutritional intake must be monitored regularly and modified depending upon the growing needs. Teenagers tend to develop eating disorders which affect their nutritional health. The eating behavior must be corrected as early as possible as it can lead to the development of complex illnesses. Eating disorder is the third common chronic illness, especially in adolescent females and the number has been increasing rapidly from the past thirty years.

There are two subcategories of eating disorders, anorexia nervosa and bulimia nervosa. Anorexia nervosa is the restrictive form, where the intake of food is limited severely. In bulimia nervosa is the eating disorder where the adolescent binges on food and then tries to minimize the effects by forcibly vomiting, fasting, and catharsis or over exercising. When handling adolescence eating disorders, they must be handled differently from adult eating disorders. Adolescents face problems such as growth retardation, suppressed height, abnormal weight, pubertal delay, menstrual periods absence, and menses unpredictability. When the adolescent is growing there will be critical tissue components loss like loss of body fat, muscle mass and bone mineral. 

Nutritional imbalance is also caused which reflect abnormalities in the levels of vitamins, mineral and other trace elements. The problem is that these abnormalities cannot be recognized clinically. But since protein and calories are essential to the growth of the adolescent, it is important to trace their abnormalities. Because of the problems, healthy adulthood is not a possible thing. Because of all these reasons, it is important to diagnose adolescence eating disorders as early as possible. Eating disorders give rise to peak bone mass impaired acquisition in case of adolescents. When they turn into adults, this problem aggravates to osteoporosis. Even internal organs get affected due to eating disorders.  All this can be prevented by early intervention so as to limit, prevent and ameliorate medical complications, which can turn become life threatening.

Adolescents who practice unhealthy weight control practices and are obsessive about figure, weight, food or exercise should be treated clinically. Not only should the symptoms be checked, but their duration, intensity and frequency should also be checked. Although most of the physical complications caused due to eating disorders get solved with the help of nutritional rehabilitation some of the conditions become irreversible and the long term consequences of this are very dangerous.  It is best if the eating disorders are recognized in the early stages as it won’t result in irreparable damage. The medical monitoring should be pursued till the adolescent returns back to appropriate psychological and medical health. 

Eating disorders not only result in physical abnormalities, but also psychological abnormalities. Adolescents with eating disorders take onto social isolation, low self esteem, affective disorders, low self concept, substance abuse, anxiety, and depression. Usually adolescents switch to unhealthy eating habits because of depression and lack of knowledge about affective techniques to lose weight. So the patients who are being treated for eating disorders must also be treated for psychiatric illness, if they have any. Even if the habits doesn’t fit the strict criteria, adolescents who limit food intake, binge, vomit or purge accompanied with or without harsh weight loss, should be monitored because of the involvement of risk of even death. Early treatment will have an improved outcome. But the level of intervention in adolescents should be less when compared to adults.

Read More