obsessions vs. compulsions

January 4, 2007

My 14 y.o. son has diagnosed OCD as well as TS and ADHD. For years, we have

been watching our 11 y.o. son like hawks, analyzing every possible hint of a

symptom. Until recently, we have not noticed any TS or OCD, although he was

diagnosed with ADHD in kindergarten.

However, during the past year, he's been telling us of compulsions to spin

around while walking and touch objects a certain number of times. We've also

noticed that he taps his foot or skips a step while walking, climbing stairs, or

even running. We have an appointment with our pediatrician this evening to

discuss this.

But here is my main question, one that's been nagging at me since we started

down this road with our older son. As far as we can tell, neither of our boys

have obsessions, only compulsions. The closest my 14 y.o. comes to obsessive

thought is his hyperfocusing (to the point of really struggling to put it away)

on fantasy role-playing games (D & D primarily but others as well). I think he

also has some minor phobias that keep him from participating in some adventurous

activities, but this doesn't seem to be debilitating.

I have been reading and surfing the internet and cannot find information about

dealing with compulsive behavior only. I also have compulsions, primarily

counting, so clearly this is genetic. As far as obsessions go, mine would be

similar to my son's, where I have trouble shifting gears or setting aside a

preoccupation (such as deciding I want to go back to school and researching

obsessively about programs and schools etc.). But to my knowledge, none of it

is fear-based.

It seems to me that the treatment strategies, such as ERP, are designed to

specifically address fear and anxiety in order to reduce both obsessions and

compulsions. But how does that work when the overwhelming majority of symptoms

are compulsions?

We are working with a psychiatrist on medication management and CBT for my

older son. I am pleased with the med management but not with the CBT. I don't

think it's having any impact at all; in fact, my son is so annoyed about having

to go that I think it could be counter-productive. But before I make a change,

I want to understand what I'm looking for.

I live outside Washington, D.C. and would be willing to drive even to a

neighboring state to have my kids evaluated properly, if anyone has suggestions

for specific therapists.

Thanks,

Stefanie

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