"I am SO OCD"
Many of us have heard someone say they “are OCD”. We may have also told someone, “You are so OCD!” Some people do, in fact, have minor characteristics of OCD. They like things tidy, or they like to do things in a certain order and in a particular way. But clinical Obsessive Compulsive Disorder (OCD) can be a serious, even debilitating, mental illness for both adults and children. It can create significant distress, and interfere with daily functioning. People with severe symptoms of OCD may find it difficult to work, go to school, or carry out other daily activities.
Children with OCD and their families face unique challenges.
Parents and teachers may not understand why a child is acting out or not achieving up to their potential. They may see the child’s behaviors as willful or defiant when the child is actually struggling with very painful symptoms that are confusing and difficult to explain to adults. According to the International OCD Foundation (2014), at least 1 on 200 children has OCD, and getting an accurate diagnosis is essential for children and family members to get the help they need.
Obsessive Compulsive Disorder is more than the occasional worry or quirky behavior. Many of us like to stick to a routine, and we also sometimes worry or ruminate about things that are bothering us. However, these things generally do not impact our performance at work or school, or our relationships with others. OCD is different. OCD is a real, diagnosable mental illness and children and teens suffering with OCD may experience:
· Obsessions: These are unwanted, and often unpleasant, thoughts, ideas and impulses that occur over and over again. They just won’t go away, and get in the way of normal thinking. They can cause great anxiety and fear. Obsessive thought and impulses may be sexual or violent, or they may cause unrelenting worry about becoming ill or dying, or worry about a love dying or becoming sick. The obsessions may also include a powerful need to do things perfectly, or to avoid getting dirty (Obsessive Compulsive Disorder, 2014).
o Compulsions: These are behaviors the child or adolescent may repeat in order to try to control the obsessive thoughts and impulses. The behaviors can be rigid and structured, while others have very complex behaviors that may change. Some of these behaviors include:
o Counting while doing another compulsive activity like hand washing
o Washing repeatedly (self or objects)
o Repeatedly checking that something has been done
o Repeating things over and over, or constantly moving or sorting things to be in perfect order
o Constant praying, or reciting things
o Hoarding behaviors
Obsession and compulsions can take over a person’s life, and usually take up a lot of time—often more than an hour each day (Obsessive Compulsive Disorder, 2014). They can cause people to be late for school or work, and can frustrate loved ones who don’t understand the disorder. Adults are more likely than children or teens to understand that their thoughts and compulsions are not real, which makes them even that more distressing for kids.
Other Disorders that Look Like OCD
It’s important to see a professional to get an accurate diagnosis of the symptoms a child or teen is experiencing. There are a number of disorders, according to the International OCD Foundation (2014), that share symptoms in common with OCD; however, treatment for these disorders is different. Some of these disorders include:
- Obsessive Compulsive Personality Disorder (OCPD): While people with both disorders may engage in list-making, hoarding, and perfectionism, people with OCPD often do not see an issue with their behaviors, and may not have the same level of anxiety. Additionally, people with OCD may not struggle with perfectionism.
- Tic Disorders/Tourette’s Syndrome: Children or teens with these disorders do their tics because they have a sense of discomfort, while people with OCD do repetitive behaviors in response to their obsessive thoughts or impulses. People with these disorders may also respond better to therapy and medications than people with OCD.
- Trichotillomania (compulsive hair pulling): While people with OCD do compulsive behaviors to reduce / avoid anxiety, people with this disorder pull their hair out because it feels good. They may also do it to relieve stress, and again, they may respond better to medication and other treatments, as compared to those with OCD.
- Body Dysmorphic Disorder: This disorder includes obsessive thoughts and focus on parts of the body and appearance, which is uncommon for people with OCD.
- Asperger’s Disorder/Autism: Children and teens with these disorders may need to follow rigid routines, and may develop “obsessive” interest in something. They usually just focus on repeating things, and they don’t try to prevent their thoughts. They can also have mild-moderate problems with social interactions.
- Impulse Control Disorders: Young people with these disorders may have strong impulses to do certain behaviors because they create pleasant feelings (e.g. shopping, sexual activity, gambling), whereas people with OCD engage in behaviors to prevent or avoid unpleasant feelings and anxiety.
- Schizophrenia/Psychotic Disorders: People with these disorders may have bizarre thoughts that can be repetitive in nature. However, they also have delusions that are not reality-based, and may not have insight that their thoughts and beliefs are not real.
These disorders can all have symptoms that look like OCD, so getting a professional diagnosis to ensure the child or adolescent gets the right treatment. OCD is not a disorder that generally goes away on its own, and symptoms can intensify during stressful times.
Children and OCD
Children and teens may really believe their fears are real, causing them great anxiety or fear. Two young women, ages 17 and 10, describe their experiences with OCD in these ways:
“Alissa Welker (age 17) would switch the lights on, off, on, off, on, off -- however many times it took to feel "right." When she was 9, she'd spend the equivalent of an adult workday doing these kinds of rituals. She also washed her hands excessively, avoided sick people and barely ate because she feared food poisoning.
Mystery Almond (age 10) has also felt that she needed to wash her hands more than most people, to the point that her classmates picked on her. She would see words spelled out in her head -- "like reading a book" -- telling her to do things, like hitting a girl in second grade who taunted her for obsessing over hand washing” (Landau, 2011).
Kids may recognize they are “different” in some way from other children, but are not sure what the problem is, or how to cope with what they’re experiencing. Adults, teens, and children all experience some similar symptoms and difficulties in their struggles with OCD, including obsessions and compulsions. According to the Massachusetts General Hospital School Psychiatry Program (2010, there are some challenges that are unique for children and their families.
· For children, symptoms can be worse at home than at school, and family life can become very stressful. At school, children may be able to suppress their symptoms, but at home the symptoms emerge again. The child and family may feel powerless to change the child’s rigid /obsessive behaviors and thoughts.
· Children may have trouble explaining their unusual thoughts and behaviors, and may be ashamed or embarrassed about them. They may try to keep their thoughts and obsessions secret, and hide their rituals from others.
· Often, children cannot be reassured by parents and teachers (e.g. about germ contamination), and will insist on completing rituals and other compulsive behaviors.
· At school, children may have trouble concentrating because of repetitive thoughts, and that may isolate them from others.
· Children may suffer from low self-esteem and behavior problems due to misunderstandings with peers and teachers, and frustration of teachers with their behaviors. Their unusual behaviors may also distress other children, or make the child the focus of unwanted attention, or even bullying.
· Children with OCD may also struggle with side effects from medications, and should be monitored for changes in mood or behavior.
· Children may also have other mental illnesses, in addition to OCD, including ADHD, anxiety, or mood disorders.
· It’s important that children are also evaluated for learning disorders, or other cognitive problems, as OCD may not be fully to blame for behavioral or academic problems a child is having.
Help for Children with OCD
No one knows for certain the exact cause of OCD, but it’s believed that a combination of biological and environmental factors contribute to the disorder. There is some research that has shown a possible connection between strep throat infection and the development of OCD. This rare type of OCD is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, or PANDAS. With this disorder, symptoms may appear quite quickly, and can include things like obsessions, compulsions, and vocal or motor tics (Obsessive Compulsive Disorder, 2010). Although this illness is uncommon, it’s a good idea for parents to let doctors know about any illnesses their child has had.
Counseling, and other interventions, can help children and their families understand the disorder, and develop coping skills to better manage the symptoms. Medications may also be helpful in some situations. Children’s OCD symptoms may not be evident in the doctor or counselors’ office and clinicians may need to meet with the child and family a few times to get a real sense of the problem, and make an accurate diagnosis (Obsessive Compulsive Disorder, 2010). Once OCD has been diagnosed, there are a number of interventions that can help the child and family cope, and minimize the impact of the symptoms on daily functioning.
· Family Coaching/Counseling: Families need to receive information and education about OCD, so they know what to reasonably expect from their child. They can also learn about treatments and medications that may be helpful, as well as ways they can best respond to and support their child.
· Individual Counseling: Counseling can help the child or teen to cope with daily stressors that may make OCD symptoms worse. Sometimes kids feel guilty for having OCD, or think they have caused it. Counseling can help kids to increase their self-esteem, and overcome feelings of guilt, inadequacy and self-blame that having OCD can cause.
· Family Therapy: Symptoms of OCD impact the entire family and this type of counseling can help support the whole family as they support the child.
· Group Therapy: Being a part of a group can help a child feel less alone, and less “different”. They can get support from other children who know what it’s like to live with OCD.
· Cognitive Behavioral Therapy (CBT): This type of therapy can help children recognize obsessive thoughts and compulsive behaviors and begin to challenge them with different thoughts and alternative behaviors (Obsessive Compulsive Disorder, 2010). This can help kids feel empowered, instead of feeling powerless over the disorder.
· School-Based Interventions: It can be helpful for parents and counselors to meet with teachers and other school personnel to develop strategies to help the child be successful in school (e.g. planning for daily transitions, adjusting expectations until treatment has begun to work, and praising a child’s efforts).
· Medication: If counseling and other psychosocial interventions are not enough to alleviate symptoms of OCD, treatment with medication may be necessary. Some medications that have been approved by the FDA for the treatment of OCD include Anafranil, Zoloft, Luvox, and Prozac. Other medications may also be used, based on the judgment and discretion of the child’s medical provider. In most cases, medication will start to help within 2-4 weeks, and sometimes dosages must be increased to get the needed symptom relief. Medications may not completely eliminate symptoms of OCD, but can provide considerable relief (Obsessive Compulsive Disorder, 2010). It’s important to be patient, and stay in close contact with the medical provider about concerns or side effects the child experiences.
All of these interventions can help children and families understand OCD, and begin to manage the symptoms. OCD is a painful disorder that children need help to cope with. The obsessions and compulsive behaviors associated with OCD are not willful and defiant behaviors on the part of the child, but rather real symptoms of a potentially debilitating disorder. Getting the right treatment can alleviate unnecessary suffering and interference with schoolwork and relationships.
It’s essential that children and their loved ones understand the illness, and that everyone listens to the child’s feelings and concerns. As children enter treatment, it’s helpful to praise their efforts to overcome the disorder. It’s not easy to make changes. Parents and other loved ones may also need extra support (e.g. counseling or a support group) as they help the child to succeed at home, at school, and with peers. Having OCD can be scary and very isolating for a child and their family, but there is help available to reduce symptoms and provide support to move forward.
Landau, Elizabeth. "OCD in Children: 'A Darkness Has Overtaken Me'" CNN. CNN, 11 Oct. 2011. Web. 7 July 2014. <http://www.cnn.com/2011/10/11/health/ocd-kids-website/#2>.
"Obsessive-compulsive Disorder (OCD) in Children and Teens." Obsessive-compulsive Disorder (OCD) in Children and Teens. Massachusetts General Hospital, 2010. Web. 5 July 2014. <http://www2.massgeneral.org/schoolpsychiatry/info_ocd.asp#looklike>
Obsessive-compulsive disorder (OCD): Causes, symptoms, treatments, and more. (2014, January 03). Retrieved 2014, from http://www.webmd.com/anxiety-panic/tc/obsessive-compulsive-disorder-ocd-topic-overview
The "D" in OCD. (2014). Retrieved July 6, 2014, from http://www.ocfoundation.org/the_D_in_OCD/