Dr. Angela Hanford
The terms “obsessive,” “compulsive,” or “OCD” are frequently thrown around, especially when it comes to someone being overly clean or displaying rigid behaviors. However, true Obsessive Compulsive Disorder (OCD) is far more impactful than is apparent in these examples, often becoming extremely distressing and causing significant impairment.It has been estimated that in a single year approximately 1.2% of people in the United States struggle with OCD (American Psychiatric Association, 2013). Furthermore, OCD is not only diagnosed in adults but also occurs in children and teenagers. In fact, it has been estimated that more than one million children in the United States struggle with symptoms of OCD (OCFMC, 2006).
Another source estimated that one child or teenager in every 200 will develop OCD (AACAP, 2013). Furthermore, the mean age at which OCD begins is 19.5 years old, with 25% of people diagnosed with OCD demonstrating significant symptoms by age 14 (American Psychiatric Association, 2013).
As a parent, it can be very overwhelming and confusing to see your child becoming more and more fearful or developing rigid behaviors that, when interfered with, result in emotional meltdowns or battles. Thankfully, there is an effective treatment available. The first step is to arm yourself with knowledge so that you can understand what your child is experiencing and how to seek the appropriate help.
What is Obsessive Compulsive Disorder?
As the Name implies, OCD is a condition that is characterized by the presence of obsessions and/or compulsions.
- Obsession: Obsessions are thoughts, images, or urges that become intrusive and difficult to ignore (American Psychiatric Association, 2013). Obsessions could include such things as fear of germs/contamination, the need for perfection, or the fear of harming oneself or others.
- Compulsion: A compulsion is a behavior or mental act that must be done repetitively, often in response to an obsession (American Psychiatric Association, 2013). Common compulsions include washing hands, performing rituals, engaging in checking behaviors, counting, and even praying compulsively.
When someone has OCD, he or she performs certain acts (i.e., compulsions) that are aimed at reducing tension or anxiety (American Psychiatric Association, 2013). These compulsive behaviors are often performed in order to reduce the anxiety that results from an obsession. The individual experiences relief after performing the behavior. However, the tension reduction is only temporary. In fact, a cycle develops as the relief then reinforces the need to perform the compulsive behavior.
In terms of the content of OCD symptoms, sometimes the obsessions and compulsions appear directly related to each other, such as the fear of germs and hand washing. Similarly, a child who fears failing may compulsively check over answers on a test, resulting in using recess and lunch times to finish the test.
Other times, the obsessions and compulsions do not seem directly connected. For example, someone may count a certain number of times in order to avoid a loved one becoming hurt. The bottom line is that it does not matter if the obsessions and compulsions appear related in order to be classified as OCD. In addition, an individual may have obsessions and no compulsions or vice versa.
The course of OCD varies and the content of obsessions and compulsions can change over time. For example, it is not uncommon that during times of stress obsessions and compulsions may become more pronounced (American Psychiatric Association, 2013).
In contrast, during times of low stress, such as summer vacation, symptoms may lessen. Furthermore, once one obsession or compulsion is eliminated (e.g., hand washing), the obsessions and compulsions may change content.
Finally, it needs to be highlighted that these obsessions and compulsions or not simply mild annoyances, but take up a great deal of time for the child and/or cause significant distress. For example, a child who has obsessions about germs may wash his or her hands so frequently that they become dry, cracked, and even bleed.
This same child may be terrified of touching something who has been in the presence of someone who is sick, thus causing disruptions in relationships or result in teasing by peers. A sibling may end up feeling rejected because the child struggles with intense fears of sickness and may avoid hugs due to the terror associated with germs.
As you can see, OCD affects not only the individual struggling with the obsessions and compulsions but the entire family and social circle. Furthermore, someone with OCD often feels shame for his or her reactions and the need to engage in these distressing cognitive and behavioral acts. In fact, the emotional distress that accompanies OCD can be so significant that depression can also develop. Again, there is hope because treatment is available! Hold onto this hope as you learn more about OCD.
Signs of OCD
It can, at least initially, be difficult to notice signs of OCD, as children may hide behaviors due to shame and embarrassment. However, there are signs to watch for that could suggest the presence of OCD (OCFMC, 2006; AACAP, 2013), such as:
1. Repetitive behaviors (e.g., hand washing, touching objects in a certain order, frantically checking and rechecking school work or doors, etc.).
2. Fears that become habitual and extreme (e.g., contamination or that harm will come to a loved one).
3. Repetitive comments that may signify superstitious/magical thinking, such as, “If I don’t touch the light seven times then my friend will hate me” or “If I don’t pray _____, I will fail the test”.
4. Habits that begin to interfere with daily life or relationships.
5. Needing frequent reassurance (e.g., “will it be ok if…?”; “will I be ok…?”).
6. The constant need to do a behavior until it feels “right”.
7. Continually confessing thoughts that are “bad”, such as sexual images or “mean thoughts” about others.
8. Increased avoidance of activities
9. Frequently being late or slow (due to the obsessions and/or compulsions).
10. An increase in physical symptoms associated with anxiety, such as stomach aches and headaches.
What Causes of Obsessive Compulsive Disorder?
As with many types of mental illness, the specific causes of OCD are not completely known. In fact, it is likely a combination of factors, such as biological and environmental, that produce the symptoms of OCD. According to the authors of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), those with a first-degree relative who has OCD are two times more likely to develop OCD than those who do not have a first degree relative with OCD (American Psychiatric Association, 2013).
However, the authors also reported that when the first-degree relative has a case of childhood-onset OCD, that the risk of developing OCD goes up 10 times. Other factors that have been linked to OCD include abuse, loss, and significant life transitions (e.g., divorce, school change) (AACAP, 2013; American Psychiatric Association, 2013).
Regardless of the specific cause, we do know that OCD affects the brain. Specifically, brain scans have demonstrated differences in brain activity between people with a diagnosis of OCD and those without a diagnosis of OCD (Scharwtz, 2016).
Furthermore, there may also be physical causes for OCD. Therefore, a medical evaluation is always warranted. For example, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal (PANDAS) can result in a severe and a sudden onset of OCD or tic disorder symptoms (National Institute of Mental Health, 2016). Therefore, medical treatment would be needed in order to treat the streptococcal infection.
How to Help Someone With Obsessive Compulsive Disorder
If you know a child who is showing symptoms of OCD, there are ways to provide support.
- Seek professional help and guidance if you believe that you or a loved one is struggling with OCD. You do not have to do this alone!
- Do not constantly reassure, as this does not effectively stop the symptoms or allow your child to learn to combat the OCD symptoms.
- Do not avoid everything, as avoidance reinforces symptoms.
- Help your child to learn healthy coping skills, such as relaxation exercises, memorizing helpful Bible verses, engaging in soothing activities, checking the rationality of thoughts, and mindfulness. Since stress tends to exacerbate symptoms, it is important to have effective tools to manage stress.
- Teach and model for children how to set healthy boundaries. As with coping skills, healthy boundaries can help a child manage stressful situations.
- Healthy self-care, such as nutrition and sleep.
- Help your child learn to identify obsessions and compulsions. Knowledge is important!
- Do not shame! Even though OCD symptoms are not based on logical thinking, they are very real. Also, it is not your child’s fault.
- Allow space for your child to express and process feelings that may accompany OCD symptoms, such as shame and embarrassment.
- Find support and space so that you can process your own emotions regarding your child’s OCD symptoms. There are going to be times of frustration, fear, and a host of other very normal emotional reactions. You need to take care of yourself so that you can be available to help your child.
Treatment for OCD
If you or someone you know struggles with signs of OCD, it is important to obtain an evaluation from an experienced mental health professional. According to the authors of the DSM-5, untreated OCD is typically chronic, with symptoms fluctuating over time (American Psychiatric Association, 2013).
For the treatment of OCD, there are different types of therapies that your counselor may recommend. Cognitive behavioral therapy (CBT) is typically the treatment recommended for OCD. Exposure and response prevention (ERP) is a type of CBT that is often used to treat OCD symptoms. As the name implies, ERP is a type of exposure therapy where the client is instructed not to perform any compulsive acts to ease anxiety.
Your counselor will also teach tools to cope with difficult emotions since ERP does include exposure to the anxiety-provoking stimulus. Although this method of therapy may sound scary, your therapist will work with you at a pace that is manageable. Other methods of CBT may be utilized, such as imagined exposure and learning to combat negative and illogical thinking patterns. Depending on the child’s age and needs, play therapy may also be incorporated into treatment.
Along with psychological interventions, your counselor will likely recommend a medical evaluation, which may include an evaluation to determine if medication would be helpful. Furthermore, it may be necessary to involve the school in order for your child to obtain appropriate accommodations. Involving the school is something that you can discuss with your counselor.
Remember, you are not alone! If you have any questions or would like to explore treatment, reach out to a counselor today to discuss the many options available. Remember, there is hope and healing!!
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National Institute of Mental Health (2016). PANDAS- Questions and Answers. https://www.nimh.nih.gov/health/publications/pandas/index.shtml. Retrieved on 7/24/18.
Obsessive Compulsive Foundation of Metropolitan Chicago (OCFMC) (2006). How to help your child: A parent’s guide to OCD. https://adaa.org/sites/default/files/How-to-Help-Your-Child-A-Parents-Guide-to-OCD.pdf. Retrieved on 7/24/18.
Schwartz, J.M. (2016). Brain lock: Free yourself from obsessive-compulsive behavior. New York, NY: Harper Perennial.
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