What is OCD?
Obsessive Compulsive Disorder (OCD) is an anxiety related condition that causes kids to have unwanted thoughts that cause fear (obsessions) and causes compulsive behaviors or rituals that are aimed at reducing the anxiety.
Kids feel out of control over the unwanted thoughts and the rituals are the way they try to take back control. The rituals are an attempt to stop “Bad things” from happening or to “Feel right.”
Children are often embarrassed about their obsessive thoughts and worry about being teased. As a result, many kids will feel uncomfortable talking about their fears and unwanted obsessions.
Kids may also refuse to talk about their obsessive thoughts because talking about them might make the fear come true.
What Are Obsessions?
Obsessions are unwanted intrusive thoughts, images, or impulses/urges that cause intense feelings of shame, guilt, and doubt.
This can trigger uncomfortable levels of anxiety, including panic attacks (aka anxiety attacks).
Kids may know that their obsessive thoughts may not be real or make any sense but they feel very anxious because they can’t stop thinking about them.
Kids might have repetitive thoughts that focus on getting it “right” or thoughts that involve the fear of something that has not happened yet, such as “What if I did something wrong that caused someone to get hurt.” Or more disturbing, “What if I can’t control myself while using a knife and I stab everyone in the room.”
These are not fantasies or actual urges. These are unwanted fearful thoughts that can cause feelings of shame and self-doubt.
Types of Obsessions
Fear of Germs
Fear of Chemicals
Fear of Bodily Fluids (urine, saliva, and blood)
Fear of losing control
Fear of acting on impulse and saying inappropriate things
Fear of acting on an impulse to harm oneself
Fear of acting on an impulse to harm others
Fear of violent thoughts and images
Fear of inadvertently causing another person’s harm (by thinking it or not being careful enough)
Unwanted Sexually Explicit or Perverse Thoughts and/or Images
Over-concern with right and wrong judgement
Over-concern with sin or angering God
Fear of losing or forgetting important information when throwing something out
Fear of making mistakes or doing something wrong
Over-concern about things being exact and precise
Over-concern with a need to know something or to remember something
What Are Compulsions?
Compulsions are behaviors or rituals that are used to decrease the intensity of the obsessions and anxiety.
Compulsive behaviors neutralize the feeling of anxiety caused by the obsessive thoughts and beliefs. But the compulsive behavior only provides short-term relief from anxiety.
When the compulsive behavior reduces a person’s anxiety, it also confirms that the obsessive thoughts are dangerous or somehow true.
Because anxiety is reduced, the compulsive behavior or ritual is reinforced and is more likely to be repeated again in the future. This becomes a vicious cycle.
Kids do these rituals in an attempt to get things rights, remove doubt, and to avoid some future fear.
Compulsions are time consuming and often interfere with important obligations such as getting to school.
Compulsive behaviors only temporarily reduce obsessive thoughts and the resulting anxiety. These behaviors attempt to get things rights, remove doubt, and to avoid some future calamity.
Compulsive rituals are time consuming and often interfere with important obligations such as getting to school or work on time.
Types of Compulsions
Staying away from people, places, and things that trigger obsessive thoughts, images, and/or impulses
Checking to make certain that you did not make a mistake
Checking that you did not harm others (calling them, calling hospitals)
Checking anything to remove feelings of doubt
Asking the same question over again or repetitively seeking reassurance
Cleaning and Washing
Cleaning and then re-cleaning
Excessively washing hands
Excessively showering (too many times or too long)
Mentally counting to land on a specific number (ex. “Must be an even number”)
Praying or reciting
Repeating a task (ex. locking the door 3 times)
Repeating body movements (tapping, blinking)
Tics are sudden, uncontrolled, and repetitive movements or vocal sounds that are common with OCD, Tourette’s, and ADHD. There are 2 kinds of Tics, motor and vocal.
Motor Tics or simple motor tics include head twitching, eye blinking, nose twitching, facial grimacing, and shoulder shrugging.
More complex motor tics include skipping, jumping, kicking, and smelling hands or other objects.
Vocal Tics include throat clearing, coughing, grunting, barking, and hissing. More complex vocal tics include yelling, making animal sounds, and repeating words and/or phrases.
What are Warning Signs of OCD in Children?
Because your child might be embarrassed or afraid to talk about what is happening, the symptoms of OCD may go unnoticed.
Here are some signs parents might notice that could indicate a child has OCD:
Having more difficulty at school with focus and concentration.
Feeling more irritable or anxious.
Feeling unsure, doubting self, and difficulty making decisions more than usual.
Seeking more reassurance from parents.
Having a very inflexible routine and becoming very upset if the routine is changed.
Asking parents to do or say things in an exact way and becoming upset when things are out of place.
Taking too long to complete tasks and being late to school more often.
What Kids Are At Risk for OCD?
It is estimated that 1 out of 200 kids and teens may be diagnosed with OCD.
It can begin as early as 8 years of age and typically develops between the ages of 15 and 44. OCD is the 4th most common mental illness after phobias and depression.
Risk factors for developing OCD include a family history of OCD, trauma, and chronic stress.
What Causes OCD in Children?
To this date there is no definitive cause for OCD in kids.
Most theories suggest a possible genetic link, changes in brain chemistry and functions, and environmental factors such as infections (PANDAS).
Unhelpful reactions to intrusive thoughts or obsessions and poor coping skills can contribute to the development of OCD.
Exaggerated and catastrophic beliefs about the importance of the obsessive thoughts triggers anxiety and anxious behavior.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a type of OCD that develops in children after being exposed to infection. The body reacts to the infection, causing sudden and severe symptoms of OCD.
How is OCD Treated in Children?
If you believe your child could have Obsessive Compulsive Disorder (OCD) it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
Please consult with your child’s pediatrician or a psychiatrist regarding the use of medication.
Anti-depressant medications are also effective at reducing symptoms of anxiety on a daily basis.
Medication helps dampen the physical and emotional effects of anxiety and increases a person’s capacity to cope with stressful situations.
Commonly prescribed anti-depressants are:
Medication alone, however, is usually not enough for treating OCD. Certain medication can be more helpful when combined with psychotherapy.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving.
Your child will learn different ways of responding to the symptoms of OCD and to the feelings of anxiety.
CBT helps challenge and change unhelpful beliefs that cause anxiety by restructuring automatic thinking and changing the way you behave in response to obsessive thoughts.
Exposure and Response Prevention (ERP)
A form of Cognitive-Behavioral Therapy (CBT) known as Exposure and Response Prevention has been the most effective method for treating the symptoms of OCD.
With Exposure and Response Prevention, a mental health professional trained in CBT conducts a series of sessions to gradually expose your child to situations that trigger his or her obsessive thoughts and compulsive behaviors.
Over time, the person learns to respond differently to these triggers, leading to a decrease in the frequency of compulsions and the intensity of obsessions.
Exposure and Response Prevention is an evidence-based treatment that interrupts the link between the anxiety produced by the obsessive thought and the compulsive behavior or ritual.
With the help of a mental health professional your child is exposed to the obsession that triggers anxiety and then your child is prevented from carrying out the compulsive ritual that usually decreases the anxiety.
For example a child with an obsession about contamination, will touch something dirty. Their anxiety will increase and they will sit with the anxiety and not engage in their ritual of hand washing. The anxiety will reach a peak and then it will naturally decrease and return back to normal levels, all without engaging in the compulsive ritual.
This process will be repeated until touching the dirty object no longer produces anxiety.
The exposure is gradual at first and then the exposure becomes more prolonged overtime.
Cognitive Behavioral Therapies, such as ERP, can actually change the biochemistry in the brain that causes the symptoms of OCD.
How can parents help their child with OCD?
1. Seek the help of a mental health professional
Again, if you believe your child could have Obsessive Compulsive Disorder (OCD) it will be important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
2. Deal with your own anxiety effectively
As parents, we need to be mindful of not imposing our own anxieties and fear onto our kids by limiting their exploration and experiences, such as helping them to avoid scary situations or things that trigger the OCD.
Our kids will learn how to deal with anxiety by watching us and how we deal with our own anxiety.
3. Provide empathy
Tell your child that you know how scary things can feel. Sometimes it’s helpful to tell your child about a fear you had when you were their age and how you got over that fear.
Confidently tell your child “It’s going to be OK, you will get through this, and I am going to help you.”
4. Limit reassurance
Children with OCD often ritualistically repeat questions over and over again and seek constant reassurance from their parents to ease their self-doubt and uncertainty, “Did I get it right” or “Is this clean.”
By giving constant reassurance, you are reinforcing the anxiety and the likelihood that this ritual will continue.
So instead, give reasonable reassurance freely (“Everything will be ok”) when your child has not asked you for it.
Give reasonable reassurance the first time your child asks for it but not again.
If your child repeatedly asks for reassurance ask them, “What was my answer the first time you asked me” and “Tell me what you think” or “What would you tell your friend if they asked you that.”
The goal is to increase your child’s ability to reassure themselves and reduce self-doubt.
5. Teach your child about OCD
Let your child know that sometimes we have unwanted, sticky thoughts that can make us feel scared, worried, and unsure. Tell your child that other people feel this way too and they sometimes do rituals to make the worry go away.
6. Avoid “Avoiding” and Accommodating Fear
Kids will normally want to avoid even talking about what they fear or are embarrassed about.
Avoiding only provides temporary relief.
Avoidance falsely confirms that the danger is real and should be feared when it is not real. Avoidance ultimately maintains the anxiety.
Don’t avoid dealing with your child’s OCD by making accommodations such as not going places that may trigger the symptoms or enforcing that other family members change their behavior.
7. Label the feelings and thoughts
Asking your child to label and name their feelings will help move her/him from reacting to problem solving. This will begin to increase your child’s sense of control when feeling out of control.
Stay calm and use a soothing voice to ask what your child is feeling emotionally and physically.
Label the thoughts as unwanted sticky thoughts that cause fear.
Have your child write down the feelings and thoughts if unable to speak it.
8. Practice Exposure Skills at Home
The goal is to make this fun and rewarding for your child. Let’s use an example that deals with fear of contamination.
Model exposure: Have your child watch you (and/or other family members) sit calmly with jelly on your hands without washing it off. Reward your child for watching you.
Child exposure: After your child watches you, challenge your child to beat your time and sit with jelly on their hands longer than you for an even bigger reward.
9. Teach your child how to manage physical symptoms of anxiety
Deep Breathing Exercise
Inhale through your nose slowly by expanding from your belly first then fill your upper lungs for a count of 5
Hold your breath for a count of 2
Exhale slowly and forcefully through pursed lips for a count of 10
Repeat this 5 to 10 times or do it for at least 1 minute
Progressive Muscle Relaxation
From a seated position begin by tensing your legs and buttocks for a count of 5, then relax
Tense your abdomen for a count of 5, then relax for a count of 5
Tense your arms for a count of 5, then relax for a count of 5
Shrug your shoulders to your ears and tense for a count of 5, then relax for a count of 5
Press your tongue to the roof of your mount for a cou