Dealing with OCD in Children

The terms OCD, obsessive, and compulsive are frequently used, most often when talking about somebody who is very worried about uncleanliness or showing rigid behaviors. Obsessive-compulsive disorder, however, has a greater impact than the situations make it seem. People who have OCD can actually be really distressed and experience significant impairment.

In 2013, the American Psychiatric Association estimated that 1.2 percent of United States citizens struggle from OCD. We oftentimes imagine OCD in adults, however, children and teens also struggle with it. The estimation is that over 1 million children exhibit symptoms of OCD (OCFMC, 2013).

It has also been projected that one out of every 200 teens or children is going to develop OCD (AACAP, 2013). Also, the average age that symptoms of OCD start is about 19.5 years of age, and a quarter of all individuals with OCD begin exhibiting symptoms by the time they are 14 years old (American Psychiatric Association, 2013).

Watching a child start to show symptoms of OCD such as irrational fears or quirky behaviors can be very distressing for a parent. Fortunately, treatment is available that will control the symptoms and the emotional breakdowns or fights that come with them. The first thing parents can do is educate themselves on OCD in children so they are able to understand what their children are experiencing and ways to get beneficial assistance.

What is OCD?

Obsessive Compulsive Disorder is exactly what it sounds like. It is the presence of obsessions and/or repetitive compulsions.

Obsession: Obsessions are urges, images, or thoughts that begin to be intrusive and hard to ignore (American Psychiatric Association, 2013). Obsessions can include many things, including fears of uncleanliness, urges for perfection, or fears of hurting other people or oneself.

Compulsion: Compulsions are behaviors or mental acts that have to be repeated, which is usually a response to something that would classify as an obsession (American Psychiatric Association, 2013). Compulsions can include rituals, washing hands, checking behaviors, praying, or counting compulsively.

Children who have OCD perform certain behaviors that are an attempt to reduce tension or crippling anxiety caused by an obsession (American Psychiatric Association, 2013). He or she will experience relief after completing the behavior. Unfortunately, though, the tension is reduced only temporarily. A cycle begins because the relief reinforces the urge to complete the behavior.

Obsessions and compulsions can exhibit themselves in related ways. For example, a student might be afraid of failing an exam so he or she will miss lunch or recess to compulsively check his or her answers. Another example would be those who are afraid of germs and bacteria and therefore compulsively continue to wash their hands.

Sometimes, it is difficult to find a connection between obsessions and compulsions, such as when an individual counts to a specific number because they are afraid of someone they love being harmed if they don’t. In the end, it doesn’t matter that the obsessions don’t appear related to the compulsions — they can still lead to a diagnosis of OCD. Also, people with OCD may have compulsions without obsessions or obsessions without compulsions.

The course that OCD takes can evolve as time goes on. For example, stressful times and experiences can cause obsessions and compulsions to come more often and be more intrusive (American Psychiatric Association, 2013).

On the contrary, non-stressful times and situations such as a day off of school can lessen symptoms. Also, if a specific obsession or compulsion goes away, other obsessions or compulsions could change as well.

It is very important to note that obsessions and compulsions are much more than mild annoyances and can take a lot of time and cause noticeable distress. As an example, if children with OCD have obsessions over germs, they might wash their hands so often that they become so dry that they crack, or bleed.

These children can also be afraid of being near something or someone who has been around an ill person, which can cause social issues and detachment or lead to things like teasing at school. Family members might begin to feel rejected because the children struggle with the fear of illness so they might reject affection and hugs because they are afraid of germs.

It is clear that OCD also affects family members and friends as well as the struggling child. This is made even worse if the child is ashamed of the behaviors and the urge to engage in distressing behaviors. The symptoms can act as an emotional stressor and lead to depression. However, there are ways to treat OCD, so don’t lose hope while you are learning about it.

Signs of OCD in Children

At first, it can be hard to notice the symptoms of OCD in children. They may be embarrassed and attempt to hide them; however, some signs you can watch for include (OCFMC, 2006; AACAP, 2013):

• Engaging in repetitive behaviors like counting rituals, constantly checking doors, frequent hand washing, etc.
• Fears that begin to be habitual and severe (e.g. fear that a loved one will be harmed or illness-causing contamination)
• Repeated comments that might be a sign of superstitious thoughts (e.g. “If I forget to tap my pencil on my desk three times, I am going to fail the exam” or “If I fail to check the light eight times, my best friend will start to hate me.”)
• Habits that have started to interfere with the child’s social life.
• Asking for reassurance constantly (e.g. “Would it be alright if…?” or “Will something bad happen to me if…?”
• Doing behaviors constantly until they feel “right.”
• Frequently confessing thoughts and mental images that could be considered “bad,” including “mean” thoughts and sexual images.
• Increasingly avoiding activities.
• Frequently being slow or tardy because of the obsessions or compulsions.
• Physical symptoms such as increased anxiety, headaches, and stomach aches.

Causes of OCD

Just like many other mental illnesses, what specifically causes OCD is not known. Instead, it’s likely that it is a group of various factors combined (including both environmental and biological factors) that cause OCD symptoms.

The authors of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) report that people who have a first-degree relative with OCD are twice as likely to develop it themselves compared to individuals without an affected first-degree relative (American Psychiatric Association, 2013).

Furthermore, the authors reported that if the first-degree relative has childhood-onset OCD, the risk of getting OCD increases to ten times. Additional factors that could be involved in the development of OCD are life transitions (e.g. moving cities or schools), loss, and abuse (AACAP, 2013; American Psychiatric Association, 2013).

What we do know is that OCD has an effect on the brain. Brain scans typically demonstrate alterations in the activity of the brains from people with OCD to people without OCD (Scharwtz, 2016).

Taking this a step further, there could also be a variety of physical causes that lead to the development of OCD in children. For example, these can include Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal (PANDAS), which can lead to tic disorders or sudden-onset OCD. Therefore, it is crucial to get medically evaluated to identify if some form of medical treatment is necessary.

Helping a Child With OCD

If you are acquainted with a child who exhibits OCD symptoms, you can provide support in the following ways.

• Seek professional guidance if you think someone you love or yourself is struggling with OCD. Nobody is alone in this!
• Don’t measure constantly, because this won’t be effective in stopping symptoms or helping your child find ways to overcome the symptoms of OCD.
• Avoidance can reinforce symptoms, so don’t avoid everything.
• Teach your child healthy skills of coping, such as soothing activities, mindfulness, relaxation exercises, analyzing the logic of thoughts, and which should include Bible study. Tools that can help control stress are critical since stress can exacerbate symptoms.
• Help the child learn what healthy boundaries are. These can help in managing stressful situations.
• Teach the child self-care, which includes adequate sleep and nutrition.
• Teach the child how to identify the symptoms of OCD. Knowledge is very important.
• Don’t shame the child. The symptoms of OCD are real despite not being based on rational thinking. Also, the child is not at fault for the OCD.
• Give the child space to process feelings and express emotions that can accompany symptoms of OCD, which includes being ashamed and embarrassed.
• Seek help and space that will help you process your own emotions about the child’s OCD. There will be instances of fear, frustration, and many other natural emotional reactions. It is vital to care for yourself in order for you to be able to assist the child.

Treating OCD in Children

If you have a hunch that you or a loved one might struggle with OCD, you should get evaluated by a professional who is experienced in mental health. The DSM-5 indicates that OCD that goes untreated is usually chronic and has fluctuating symptoms over time (American Psychiatric Association, 2013).

Different kinds of therapy are available to treat OCD. The most commonly recommended is cognitive behavioral therapy (CBT), including a type of CBT called exposure and response prevention (ERP). Clients who are getting ERP therapy are instructed to refrain from performing compulsive acts that ease their anxieties.

During ERP, a counselor will teach you ways of coping with hard emotions that arise from being exposed to the stimuli that provoke anxiety. Of course, this can sound scary but the counselor will work at a manageable pace with you.

Additional CBT methods include imagined exposure as well as learning ways to overcome illogical or negative thinking patterns. Play therapy is sometimes included in treatment depending on a child’s needs and/or age.

Alongside these psychological interventions, the counselor will probably also recommend that the child gets evaluated medically, which can also include the determination of whether medication may be useful. Also, the child’s school should be notified in case the child needs special accommodations. The counselor can discuss getting the school involved.

Overall, you should remember that nobody is alone in this. If you’re looking to explore treatment options or have questions, contact a counselor. There is always healing and never-ending hope!