Perfectionism in young children indicates OCD risk

Children who tend to be perfectionists and show excessive self-control from a young age are two times more likely than their peers to develop obsessive-compulsive disorder (OCD) by the time they reach their teens, a study has found.

MRI scans taken as part of the research, published in the journal JAMA Psychiatry, showed that the perfectionists often had smaller volumes of a brain structure previously linked to OCD.

"Having a lot of self-control and striving for perfection often are considered by parents and society as good because they can eliminate mistakes, but excessive self-control and perfectionism raise a red flag," said Kirsten E Gilbert, from the Washington University in the US.

"In adolescents and adults, these characteristics are associated with OCD and other disorders, such as anorexia and social anxiety. We've now been able to link this to OCD risk in children," said Gilbert.

OCD is a chronic mental health disorder that often involves uncontrollable, recurring thoughts, or obsessions - such as a fear of germs or a need to have things in perfect order - and behaviours that a person feels the urge to repeat over and over - such as hand-washing, compulsive counting or repeatedly checking on whether doors are locked.

It is important to identify the disorder as early as possible because the condition often is chronic and recurs throughout life.

If very young children at risk can be identified, it may be possible to intervene earlier to prevent or at least lessen the intensity of obsessions and compulsions linked to OCD.

The researchers enrolled 292 children ages 4 and 5. Over the next 12 years, 35 kids went on to develop OCD.

Among children the researchers determined were exercising excessive self-control and perfectionism, an OCD diagnosis was twice as likely as among those who did not care as much about performing a task absolutely correctly.

"The experimenter would hand the child a blank sheet of paper and a green marker and simply say, 'I need you to draw me a perfect, green circle," Gilbert explained.

After a child would complete the drawing and show the circle to the researcher, the latter would provide negative feedback, calling the circle "too small" or "too flat" and then would tell the child to try again.

After 3 and half minutes of negative feedback, the experimenter would admit to being too harsh, would praise the child and would tell him or her that everything was fine.

Researchers evaluated the children's behaviour in videos of the attempts to draw perfect circles. They rated the intensity of a child's own performance monitoring as the youngster attempted to do a better job.

"Some kids were very self-critical. The researcher would point out flaws, but the child was critical of the effort, too. That excessive perfectionism was the strongest predictor of OCD later on," Gilbert said.

"In its most severe forms, OCD is a highly disabling and intractable disorder. Therefore, this first identification of tangible risk behaviours in early childhood opens exciting new opportunities for the design of preventive interventions," said Joan L Luby, a professor at Washington University.