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OCD and Anxiety Differences

ANXIETY IN BRIGHT CHILDREN

Bright children and anxiety tend to go hand in hand.  Bright children worry about many things, from personal interactions with others to global issues.  In the same way that they think about thinking, they may also have anxiety about having anxiety.  Some anxiety is positive as it serves as a motivator.  Problems arise when it becomes paralyzing.

Common Signs of Anxiety

Excessive or unrealistic worry Avoidance of new or uncertain tasks Somatic complaints related to a dreaded situatiion
Nail biting Dreading school  Expressions of low self-concept
Making comments about stress and worry Excessive need for reassurance  Deep concern with feeling powerless
 Clinging behaviors  Lack of appetite or not eating  Self-imposed social isolation
 Excessive concern about competence  Extremes of activity or inactivity  Repeated signs of distress such as frequent crying and temper tantrums

TYPES OF ANXIETY IN CHILDREN

There are several types of childhood anxiety identified in the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). 

Agoraphobia:  Avoidance of social situations which may prompt a panic attack.

Eating Disorders:  An obsessive need to have one's body appear perfect.

Generalized Anxiety:  Ongoing worry about a variety of situations.

Obsessive-Compulsive Disorder:  Characterized by an intrusive obsession that drives a compulsive behavior. (This is discussed in more detail below).

Panic Attacks:  Intense physiological sensations characterized by a rapid heart beat and difficulty breathing.

Post-Traumatic Stress Disorder (PTSD):  Anxiety stemming from a traumatic experience from which the child cannot seem to recover.

Separation Anxiety: Fear of leaving a parent due to a belief that something bad will happen to the child or parent while they are apart.

Social Phobia:  A persistent fear of social or performance situations in which a child is exposed to scrutiny or unfamiliar people.

Specific Phobias:  A pervasive fear that is triggered by the presence or anticipation of a specific situation or thing.

Perfectionism is an additional type of anxiety which is not identified in the DMS-5.  Perfectionism is  comprised of thoughts and behavior which are driven by a fear of failure.  

MISDIAGNOSIS OF OCD (OBSESSIVE-COMPULSIVE DISORDER IN BRIGHT CHILDREN)

Many bright children have some characteristics of OCD, warranting a dedicated section to this particular anxiety difference.   Bright children often enjoy organizing people and things into some type of systematized order. They may construct complicated rules or systems that are not always appreciated by their peers. They can be seen as bossy, rude or domineering. These children seek to learn and follow the rules of life and are most comfortable with consistency. These character traits have led Obsessive-Compulsive Disorder (OCD) to be one of the most commonly misdiagnosed conditions in gifted children. 

Auditory-sequential Learners

Bright children who are auditory-sequential learners may take things very seriously and can be very intense. Their seriousness can cause them to appear rigid, worried or depressed when they may not be experiencing these feelings at all. Some of these characteristics can lead to a misdiagnosis of OCD.

OCD (OBSESSIVE-COMPULSIVE DISORDER)

According to the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), OCD is characterized by the presence of obsessions, compulsions or a combination of the two.

Obsessions are defined by (1) and (2):

1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.

2.The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.

2.The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.

Note: Young children may not be able to articulate the aims of these behaviors or mental acts.

Common Obsessive/Compulsive Themes:

  • Contamination: Fearful of germs with compulsions to wash.

  • Safety: Fearful of harm or danger with compulsions to repeatedly check things such as the oven and doors.

  • Need to do the Right Thing:  Fearful that something bad will happen if they do something wrong with compulsions to do everything right.
  • Need for Order/Symmetry: Fearful of certain numbers, colors or arrangements due to superstitious beliefs. Have compulsions to organize things.

 

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