OCD in Children - How Parents Can Help
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
Contamination Fears
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
Harm Obsessions
Fear of inadvertently causing another person’s harm (by thinking it or not being careful enough)
Moral Obsessions
Unwanted Sexually Explicit or Perverse Thoughts and/or Images
Over-concern with right and wrong judgement
Over-concern with sin or angering God
Self-Doubt Obsessions
Fear of losing or forgetting important information when throwing something out
Fear of making mistakes or doing something wrong
Perfectionistic Obsessions
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
Avoiding
Staying away from people, places, and things that trigger obsessive thoughts, images, and/or impulses
Checking
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)
Mental Compulsions
Mentally counting to land on a specific number (ex. “Must be an even number”)
Praying or reciting
Repeating
Repeating a task (ex. locking the door 3 times)
Repeating body movements (tapping, blinking)
Other Symptoms
Tics
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.
Medication
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:
Citalopram (Celexa)
Escitalopram (Lexapro)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Medication alone, however, is usually not enough for treating OCD. Certain medication can be more helpful when combined with psychotherapy.