My 13-year-old nephew washes his hands compulsively. How can I help him?

By Patrick J. McGrath, OC, PhD, FRSC

Dr. Pat

Question:

My 13-year-old nephew is always washing his hands. I mean it makes sense to wash your hands several times a day. He washes his hands for hours a day. He tries to hide it but his hands are raw. He also uses a disinfectant spray to clean most things before he will touch them. He doesn't do much outside of school because of this germ thing. What can I do to help him?

Dr. Pat responds:

Washing hands after using the toilet, before meals, and maybe a few times a day other than that, is healthy. Washing hands for hours each day is a big problem.

Your nephew may have obsessive-compulsive disorder (OCD). People with OCD have repeated thoughts known as obsessions and/or repetitive behaviours known as compulsions. The thoughts and behaviours take control of the person's life.

People with OCD are often secretive about their symptoms and hide them.

Thoughts of being dirty, harming others or oneself, or the need to have everything in order are common obsessions. Washing, checking, counting, and ordering things are common compulsions.

A very unusual form of OCD in children occurs after strep infection. It comes on very suddenly and is treated with prompt use of antibiotics.

The cause of OCD is unknown. Some OCD is inherited and some occurs after a trauma. Most just happens.

Children most often develop OCD between about eight and 14 years of age. Sometimes OCD comes on in the 20s or 30s. In childhood, boys are more likely to have OCD.

Most of us have some obsessions or compulsions. Having a ritual at bedtime is pretty common. Some of us greet our spouses or our children in very specific way every time. Many people have recurring thoughts. That old rhyme, "Step on a crack and break your mother's back," describes a compulsion. All of those advertisements about germs in the kitchen and bathroom encourage obsessive cleaning. OCD is different because it seriously interferes with life.

Some obsessive and compulsive behaviour can be associated with other problems such as autism, attention deficit, phobias, or anorexia nervosa. But there are lots of other symptoms of these problems as well.

There are two types of treatment for OCD. These are cognitive behaviour therapy and the selective serotonin reuptake inhibitors (SSRIs). A recent study showed that cognitive behaviour therapy and drugs were both effective, with cognitive behaviour therapy being more effective. Combining the two was even better.

Cognitive behavioural therapy for OCD includes:

• education about OCD
• changing thinking about the particular obsessions
• keeping track of the symptoms
• exposure to what is triggering obsessions or compulsions
• prevention of the compulsive behaviour

Chat with your nephew and his parents about your concerns. Understand how difficult it is for your nephew. Let him know that he is not crazy or weird. His brain has just become stuck on particular thoughts and behaviours.

Let them know that effective treatments are available. Treating OCD in childhood is more effective than waiting until adulthood for treatment. Encourage them to talk with their family doctor or contact their mental health centre.

Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. Read more "Ask Dr. Pat" columns Ask Dr. Pat a question