Obsessive Compulsive Disorder (OCD)

In children and teens, OCD may be characterized by an obsession with a fear of germs, illness, lucky and unlucky numbers or a fear of harm coming to loved ones. Children often have checking, touching, counting or washing rituals (such as the hands or shower). OCD is likely to have a drastic impact on school performance because obsessions and compulsions tend to take over. Parents may notice OCD because getting ready routines will likely be much longer and more involved. Parents may notice a higher water bill or chapped and dry skin from over-washing. Some children may ask repetitive questions related to germs or illness and may need an exact answer from a parent to move forward.

What are Obsessive Compulsive Disorder (OCD)?

Obsessive Compulsive Disorder (OCD) is characterized by intrusive thoughts and compulsive, repetitive physical or mental acts that relieve some of the anxiety surrounding the intrusive thoughts. For example, a fear of germs and contamination may be lessened when a person engages in excessive unnecessary hand washing. OCD used to be considered an anxiety disorder because it is characterized by obsessive thinking that can be conceptualized as worrying. In the current Diagnostic and Statistical Manual (DSM-5), the authors created a separate chapter for Obsessive Compulsive Disorders. However, a number of individuals with OCD may also have an anxiety disorder.

OCD is sometimes confused with Autism Spectrum Disorder (ASD) because of the rigidity and routine. The difference is the significant anxiety about the rigid routine. Children with ASD like structure and routine, but they do not engage in structure and routine to contain symptoms of anxiety. In autism, this behavior is more of a preference. Anxiety Disorders can be differentiated from OCD with a consideration of the compulsions for certain behaviors, such as washing, checking counting or touching.

What are the signs and symptoms of Obsessive Compulsive Disorder (OCD)?

OCD includes obsessions and compulsions that are time-consuming, cause distress and interfere with daily activities. If your child has to check the oven to be sure it is off each day before you leave for school, this behavior may be obsessive and compulsive, but it is likely not something that causes significant distress and is time consuming. Rather, a child who must count every step he takes from his bedroom in the morning throughout the day in order to “protect the family from harm” is obsessive compulsive in a way that probably interferes with his daily activities.

Children with OCD have worries, images, thoughts, ideas or feelings that bother them. These concerns are the obsessions. They spend a long time each day trying to ease these obsessions with mental or physical compulsions and rituals, such as checking, counting, collecting, or washing. These compulsions often have to be performed repeatedly and in a certain way to keep obsessions at bay. OCD interferes with daily functioning and causes significant distress for children, teens and their families.

How is Obsessive Compulsive Disorder (OCD) treated?

Cognitive Behavioral Therapy (CBT) with use of Exposure and Response Prevention. Cognitive Behavioral Therapy is a modality with considerable research to support its effectiveness. CBT can be paired with exposure and response prevention treatments that are slowly introduced in a gradual manner, giving anxiety time to dissipate within the situation. For example, a child with OCD may work to gradually touch something with germs and not wash their hands. The child is going to be slowly and gradually presented with the obsession but be unable to complete the compulsive ritual or thinking pattern. Then, CBT can guide children to understand their obsessions and anxiety, recognize their worry and fears, and develop healthy and appropriate coping strategies. OCD treatment is generally individual therapy, but parents or family members may be involved in some cases to work on exposure and response prevention.

Some goals of CBT include the following:

Improve Coping Skills. CBT often teaches and helps kids identify and practice coping skills, such as deep breathing, relaxation, reading, listening to music, taking a walk, jumping on the trampoline, or talking to a friend. Children learn to stop and identify feelings and use a coping skill or to try an anxiety-producing task with support. They work with a therapist to recognize the antecedents, behaviors, and consequences associated with their thoughts and feelings.

Work to improve self-confidence. CBT focuses on identifying thoughts that lead to certain behaviors and determining whether those thoughts are valid or whether they are cognitive distortions. Children learn to combat negative thoughts and to see actions and experiences not as global and uncontrollable but as singular instances and under a child’s control.

Medication. OCD is thought to be related to serotonin levels in our brain. As OCD can be such a time-consuming and life-altering disorder, it is important to consider the use of psychotropic medication prescribed by a child psychiatrist to help treat these symptoms. Medication alone is not likely to successfully solve the problem, but many children and teens make great gains when medication is combined with CBT treatment using Exposure and Response Prevention.

OCD is a very serious diagnosis, but it can be treated. Taken together, it is valuable to obtain a diagnosis and to engage in the appropriate therapies as early as is feasible. With these supports in place, it is possible to see improvement in OCD symptoms, through identifications of obsessions and compulsions, work to manage thoughts without compulsive behavior, better coping skills for anxiety, and the potential to live a happy life.

How can Clear Child Psychology help with Obsessive Compulsive Disorder (OCD)?

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, it’s time to seek professional help.

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