Other obsessive-compulsive conditions
Autoimmune variant of OCD
A small group of children end up with a very acute obsessive-compulsive syndrome, coupled with severe anxiety, separation anxiety, incontinence, sleeping problems and oppositional-defiant behaviour. They have a hard time finishing schoolwork, can no longer write normally, may revert in their overall development and can change their personality to the point that they may come off as completely different people. This condition is referred to as Pans or Pandas and is presumed to be immunologically caused. It requires fast examination and treatment.
Body dysmorphic disorder (BDD)
Some children obsessively perceive themselves as ugly, even though they look perfectly normal. These perceptions often involve something being wrong with one’s nose, hair or skin. Acne can make the problem worse. The person may spend hours trying to cover up areas they are ashamed of, by putting on more clothes or make-up, or even refuse to go to school at all. They may become deeply depressed and will often try to get reassurance that they do not look so bad after all. They ask friends and family about their appearance and compare themselves to others. The treatment consists of CBT and/or treatment with medication, but one should avoid engaging in discussions with them about their looks, and the solution is most definitely not plastic surgery.
Excoriation disorder and Trichotillomania
Excoriation disorder refers to when the person scratches and claws at themselves, usually their own face, but sometimes also their body. Girls may use make-up to cover up reddened areas and cuts. These cuts are sometimes very serious; some of the worst cases even require bandaging and end up causing ugly scars. Excoriation disorder means that one simply cannot resist clawing at scabs or uneven parts of the skin. It can be similar to BDD in that every little blackhead is subjected to intense squeezing, which in itself leads to the formation of scabs.
Trichotillomania is similarly an inability to resist pulling out eyebrows or eyelashes or hairs from one’s head. Pulling out the hair gives the child a sense of relief, but they end up devastated once they start seeing bald spots on their head or thinned out eyelashes. Boys can solve some problems by shaving their hair, while girls try to cover up bald spots using scarves or specific hairstyles. CBT is the treatment that should primarily be implemented, but there is unfortunately a high risk of relapse.