It's Nobody's Fault (18 page)

To all outward appearances Lonnie was a difficult, oppositional, spoiled brat. It was only when he made some very unusual demands on me—the strangest was asking me to curse at him loudly from across the room—and explained that he wanted me to do it to keep something bad
from happening that I looked past the bad behavior and detected the symptoms of OCD.

Once in a while a parent faced with a child’s OCD just snaps. One distraught father, his eyes filled with tears, told me about the night he lost his temper with his 11-year-old daughter, Renée. Night after night Renée would bang on her parents’ bedroom door, screaming, “Do you love me? Am I attractive?” “Yes, you’re very attractive. Go back to bed,” Mom and Dad would tell her. “Do you mean attractive or do you mean pretty?” she’d ask. “Do you mean pretty or do you mean beautiful?” was next. They kept responding and kept telling her to go to sleep, but it was never enough. The banging and crying went on for hours. Completely frustrated, the father finally dragged Renée back to her room and locked her in. When he described wedging a chair against his daughter’s door, he broke down.

As amazing as it may seem, some parents are unaware of OCD in their children. Even parents who realize that their kids have some pretty strange habits are very often stunned to find out just how bad the situation is. A 16-year-old girl with crippling fears about germs and dirt came to see me. She washes her hands dozens of times a day. She’s disgusted by and scared of bodily functions; she’s never had sexual intercourse but is terrified of getting pregnant. Her mother does the laundry for the family, but the girl says her clothes are never clean enough to suit her. For a year now, without her mother’s knowledge, she has been washing her own clothes, sometimes as often as five times a day. The week before she came to see me she finally let down her guard and told her parents.

According to the mother of 12-year-old Howard, he’s always been “fussy about his clothes.” His undershirts have to be skintight, and he’ll wear only one brand and color of pants. He has five pairs of identical pants and wears a pair every day to school. No one in the family thought too much about Howard’s strange notions about wardrobe. After all, everything else about him was normal, or so his family assumed. One day Howard was typing out a report for school. Somewhere in the middle of the paper he realized that every time he typed the letter
s
, he felt compelled to hit the space bar. Soon he couldn’t stop doing it, and he got scared. Fortunately he confided his fears to his mother and father, and soon thereafter he was in my office. It turns out that Howard had a host of other painful habits that he had never told anybody about.

There is some debate among professionals about whether or not to involve teachers and other school officials in the treatment of OCD. As a general rule I’m in favor of full disclosure, of letting the school know about a diagnosis of OCD and working out a strategy for managing the problem, but only if the symptoms are affecting a child’s performance or behavior while he’s in school. There’s no question that OCD can manifest itself in behavioral problems—for instance, a child who keeps jumping up out of his seat and running to the bathroom to wash his hands is more than a little disruptive to the rest of the class—and a teacher is entitled to know why the kid is doing it. Once the lines of communication with the school are open, decisions can be made about how a teacher will respond. On the one hand, a child should not be punished for behavior over which he has no control. On the other hand, teachers must maintain order in the classroom, and there’s no way they can do that without holding children responsible for their actions. OCD or no OCD, actions must have consequences. With the help of a professional, parent and teacher should be able to work out some realistic guidelines.

I always suggest that teachers choose their battles carefully when confronted with a child who has OCD. Some children will write only with a pen, drink from only one special water fountain, or use only one bathroom. Those behaviors, while certainly not ideal, do not significantly disrupt the classroom, nor do they interfere with the child’s learning, and I recommend that a teacher ignore them if possible. However, the more disruptive behaviors—talking out of turn, making broad gestures, and especially leaving the classroom—must be dealt with more directly.

T
he first time I saw Jenny, age seven, it was a late Thursday afternoon at her school in a suburb of Boston. She was sitting on her teacher’s lap, crying. When I asked her what was wrong, Jenny said she had a stomachache. I volunteered to help her, but she told me not to bother. “This is my Monday through Friday stomachache,” she told me. “Today is Thursday, so I just have one more day to feel bad.” I asked if there was anything that would make the pain go away, and she answered immediately: “Bring my mother here.” A few weeks later Jenny’s parents told me more about their daughter—how she’d sneak into their room at night and sleep on the floor, how she had to be forced onto the school bus every morning, how she would often ask them when they’re going to die. When Jenny’s goldfish died, she mourned for weeks.

Nine-year-old Ernie came to see me after he’d missed four months of school. He had had trouble with school ever since kindergarten, but by the fourth grade he was in terrible distress. When his parents tried to get Ernie to go to school, he complained of headaches, stomachaches, and fatigue. In the previous four months he had been in and out of the hospital with various infections. Ernie was inordinately anxious, especially about leaving his parents. He had trouble sleeping in his own bed and crept into his parents’ room nearly every night. He didn’t want to be with his friends after school because he worried about what would happen to Mom and Dad; even when he was away from home for a short time, he’d become homesick. Recently he wasn’t sleeping even on weekends, and his appetite had decreased dramatically.

Nearly everyone knows what separation anxiety feels like. Changing jobs, taking a vacation, even spending the night away from home can cause discomfort. When I was a kid, I used to get a lump in my throat every time I heard the theme song from
Bonanza
, not because I was moved by the adventures of the Cartwrights but because that music, coming as it did on Sunday night, meant that it was almost Monday morning. My weekend was nearly over, and I wasn’t prepared for school. I didn’t know then that I was suffering from the “Sunday Night Blues,” a common response.

The anxiety that Jenny and Ernie feel is, of course, more serious than my Sunday Night Blues. On Sunday nights Jenny is anxious not because she hasn’t done her homework for the next day but because she knows she is about to lose access to her mother. Ernie is not fretting over a forthcoming spelling test. He’s worried that something terrible is going to happen to his parents. My diagnosis was the same for both kids: separation anxiety disorder, or SAD.

There is an important difference between separation anxiety and separation anxiety disorder. Children between seven months and 11 months experience
stranger anxiety:
when they see somebody unfamiliar—not Mom, Dad, a relative, or a regular caregiver—they become alarmed. Most children have
separation anxiety
between 18 months and three years. For instance, a normal two-year-old whose father goes outside for a few minutes, leaving the child with a family friend, will probably have some separation anxiety. As he leaves, the father might say, “I’ll be right back, Sam. I’m going to the car to get something. Talk to Carol.” Almost immediately, Sam will start to get anxious, thinking, “Wait. I don’t know this person. Where’s my father?” That reaction is normal, provided that Carol is able to console or distract Sam so that the anxiety doesn’t last more than a few minutes. Another two-year-old playing comfortably outside might well take a break, touch base with Mom, and then resume
playing after a few minutes. That’s normal too. So is some weepiness in the early days of nursery school.

However, by the age of four, a child should be able to leave his parents or his home without distress or anxiety, and about 96 percent of all children can do so without a problem. (The fact that many children start nursery school at age four is no accident.) It is estimated that 4 percent of all children have SAD.

Every once in a while SAD makes its first appearance not in the early days of nursery school or in first or second grade but later, during adolescence. The disorder seems almost to “spring up,” with no earlier evidence that there was a problem. Often what brings on the symptoms of SAD is a change or a loss. That was the case with two young people I treated for late-onset SAD. Amelia, 15 years old, showed the first signs of SAD when she and her family moved to a new state in the middle of her sophomore year of high school. Amelia had always loved school, but she just couldn’t adjust to the new setting. Every day there were tearful phone calls home, in which Amelia would beg her mother to come and get her. By the time I met Amelia, she had stopped going to school. In fact, she was refusing to leave her front yard. Her parents were completely baffled by the change in their daughter.

Another “late bloomer” with SAD was 13-year-old Rafael, whose SAD came on after he missed a few weeks of school because of a case of mononucleosis. When he was finally well enough to go back to class, Rafael didn’t feel comfortable being there any more. He told his parents he was tired and light-headed, and he insisted on staying home, where he would spend the day watching TV and sleeping. When I saw Rafael for the first time, it had been nine weeks since he’d been to school and almost that long since he’d left the house. Before the mono he had seemed perfectly normal, with no symptoms of SAD.

Children suffering from SAD are preoccupied with thoughts that harm is going to come to them or their parents. They feel distress when they have to leave their parents, to go to bed at night or to school in the morning. At school during the day or if they have to go away overnight, they’re terribly homesick. Sometimes they experience physical symptoms. Younger children often get stomachaches and diarrhea; older kids may experience dizziness and rapid heartbeat. Their nightmares have a recurring theme: something bad is happening to their family. The house burns down; Mom gets sick and has to go to the hospital; someone evil is
chasing the child. Children with SAD don’t like to be alone in the house and may shadow their parents, following them from attic to basement. One mother I spoke to said she literally could not go anywhere in the house without having her six-year-old daughter tag along. Children with SAD can have worries that aren’t obviously associated with the disorder; an eight-year-old boy named Eddie told me he was worried that someone was going to break into his apartment and steal the silver. Why the silver? The family always used the good silver for their special Sunday night suppers.

Kids with SAD can have extremely high IQs. John was one of the smartest children I’ve ever met. At the age of 10 he had verbal skills way above the norm. He was also one of the best-natured, sweetest kids I have come across. Dressed in his school uniform with his blond Dutch boy haircut, he looked like a youngster right out of a Norman Rockwell illustration. A few minutes into our meeting it became obvious that something wasn’t quite right. Increasingly fidgety, John kept looking toward the door, behind which his mother was waiting. Suddenly he ran to the door and opened it to make sure Mom was still there, an act he repeated many times during the visit. I soon learned that John was preoccupied with the thought that his mom and dad were going to die. When he was in school, the idea sometimes upset him so much that he would get down on his knees and pray that nothing bad would happen to his parents.

The morning nine-year-old Elizabeth stepped into my office, the first thing I noticed were large patches missing from her curly red hair. My first thought was that she was being treated for cancer. I soon learned that her hair loss had nothing to do with chemotherapy. Every night, after she went to bed and was left alone in her room, she would pull out clumps of her own hair. There was nothing compulsive or ritualistic about the hair-pulling; she didn’t pull three strands on one side and then three on the other, for instance. She pulled her hair out because she was worried. Elizabeth was convinced that as she slept, someone was going to break into her apartment and do something terrible to her mother and father. Lately her fears had been getting worse, and she’d been
refusing to go to school. She was afraid of what would happen if she left her parents at home alone.