Obsessive Compulsive Disorder

Is your child constantly checking on you, asking repetitive questions that you’ve already answered, repeating behaviors such as closing drawers? Do you find yourself constantly wondering if it’s normal that your child has particular rituals when it comes to bedtime or eating?  As a parent, there are many things that you can look out for when considering whether or not your child has Obsessive Compulsive Disorder.

Obsessive-Compulsive Disorder (OCD) is a condition in which an individual experiences intrusive thoughts, images, or impulses which create a high degree of emotional distress. Typically, your child will feel feelings of anxiety regarding these thoughts, but guilt and shame are also closely associated with OCD thoughts.  For example, a child with OCD, may experience an obsession which involves the thought or image of killing his/her sibling by stabbing him or her. This intrusive thought causes him/her to feel anxious, disgusted with himself/ herself, as well as guilt-ridden. The difficulty children have with their intrusive thoughts are not simply because the thoughts exist but because they are thoughts that the child does not want to have. As a result of this emotional distress, the person feels a need to perform some type of ritual (either overt or covert in nature). The ritual serves two functions: (1) to reduce the intensity of the anxiety, disgust, etc. and (2) to prevent or lessen the likelihood of acting on the thought/image. This is referred to as “thought-action fusion” (TAF).

In the DSM- V, criteria for qualifying for OCD include the following:

Under the DSM-5, Obsessive-Compulsive Disorder (OCD) is characterized by obsessions and/or compulsions. Those individuals who do not report engaging in compulsions (rituals) are often referred to as “Pure O’s”, or “Pure Obsessionals”.

As was discussed earlier, a person who evidences OCD experiences obsessions and/or compulsions (rituals) which result in emotional distress. Examples of obsessions may include themes related to cleanliness, aggression, harm, symmetry, etc. Examples of compulsions include cleaning, counting or arranging.

Obsessions are defined as:

  • Recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety or distress; but are not excessive worries about real-life problems;
  • The person attempts to ignore, suppress or neutralize these thoughts, impulses, or images;
  • The person is aware that the obsessional thoughts, impulses, or images are a product of his or her own mind, as opposed to delusional in nature.

Compulsions are defined as:

  • Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession;
  • The behaviors or mental acts are directed at preventing or reducing distress or a dreaded event or situation;
  • These behaviors or mental acts may not always be associated with the content of the obsessional theme. For example, if the theme is Contamination, the ritual may involve mental rehearsal or counting;
  • The symptoms of OCD are not the result of another psychiatric disorder present or caused by a medical condition or substance abuse.

Symptoms of OCD in Children/ Adolescents:

Because children under the age of 8 do not typically have awareness of their own thoughts, it might be difficult to figure out whether or not your child’s behaviors are caused by certain obsessions. However, there are clinical ways of assessing your child for OCD thoughts.

Common obsessions in children may include:

  • Worrying about germs, getting sick, or dying.
  • Extreme fears about bad things happening or doing something wrong.
  • Feeling that things have to be “just right.”
  • Disturbing and unwanted thoughts or images about hurting others.
  • Disturbing and unwanted thoughts or images of a sexual nature.

Common compulsions in children may involve:

  • Excessive checking (re-checking that the door is locked, that the oven is off).
  • Excessive washing and/or cleaning.
  • Repeating actions until they are “just right” or starting things over again.
  • Ordering or arranging things.
  • Mental compulsions (excessive praying, mental reviewing).
  • Frequent confessing or apologizing.
  • Saying lucky words or numbers.
  • Excessive reassurance seeking (e.g., always asking, “Are you sure I’m going to be okay?”).

For more details on OCD in Children, check out Child Mind Institute’s slideshow on OCD.

What Causes OCD?

Typically, kids with more negative temperaments and behavioral inhibition are more likely to develop obsessive-compulsive disorder, as are those with first-degree relatives who have OCD. Likelihood particularly increases with relatives who had child-onset OCD. Children who have experienced abuse or other stressful or traumatic events are also more at risk.

Some children experience a sudden onset of OCD symptoms associated with various infectious agents and a post-infectious autoimmune syndrome (also known as PANDAS or PANS).

At MCFT, we will also screen your child for other OCD related disorders such as: Body Dysmorphic Disorder,Excoriation (skin picking) Disorder, Trichotillomania (hair pulling), Hoarding Disorder, Induced OCD, & PANDAS.

How Do You Treat OCD?

Various treatments have been effective in reducing the symptoms of OCD. Evidenced-based treatments such as Cognitive-Behavior Therapy (CBT) techniques are typically the first-line course of treatment, which primarily consist of Exposure and Response (Ritual) Prevention methods. Psycho education plus relaxation training (PRT) may be used to treat severe functional impairment in children. Modifying family accommodation strategies has also been used with PRT (Piacentini et al., 2011).

At MCFT, we begin by assessing your child for OCD symptoms using the Children’s Yale-Brown Obsessive Compulsive Scale.

At MCFT, if your child is 10 years old or older, we will use CBT  and ERP to treat the obsessions and compulsions. We start by identifying the underlying fears associated with the obsessions and compulsions. In treatment, we work through Dr. Edna Phoa & Dr. Reid Wilson’s 4 stages of treating the obsessive thoughts : 1.) Self motivation to deal with the issue 2.) Label obsessions as anxiety instead of trying to rationalize or correct them 3.) Replacing ritualizing with other forms of relaxation to reduce anxiety cause during obsessions 4.) Begin accepting obsessions instead of resisting them.

If your child is 10 years old or younger, we will use play therapy techniques and bibliotherapy to help your child identify the obsessions and begin fighting these thoughts in different ways through activities & relaxation techniques that are developmentally appropriate for your child. We also give parents ways to work at home with their child on identifying these obsessions.

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