Obsessive Compulsive Disorder
What is Obsessive Compulsive Disorder?
Obsessive Compulsive Disorder (OCD) involves unwanted and disturbing thoughts, images, or urges (obsessions) that intrude into a child/teen’s mind and cause a great deal of anxiety or discomfort, which the child/teen then tries to reduce by engaging in repetitive behaviors or mental acts (compulsions). Often, compulsions are performed in a ritualistic, or very specific way, for example, counting to six each time an article of clothing is removed. The following table lists common obsessive themes and compulsive rituals:
Contamination Fear or distress about coming into contact with dirt, germs, sticky substances, or chemicals (e.g., household cleansers), or getting sick, or getting others sick after touching "dirty" or "contaminated" items
Accidental harm to self or others Fear of harming yourself or others through carelessness. For example, "what if I didn't clean off the counter properly and there are still germs on it, and my mom gets sick because of me!"
Symmetry and exactness A need to have items ordered in a certain way (for example, according to color, size, or facing a certain direction). Children and teens with this type of obsession are either anxious because "it just doesn't feel right" or because of a superstitious belief that something bad will happen (e.g., "if my shoes are not arranged properly, my mom will die!"). Often, the content of obsessions sounds very odd or makes no sense. For example, a child with OCD might say that he or she needs to arrange all the teddy bears from smallest to biggest or else something bad will happen to mom. Most children and teens are aware that these thoughts are strange; however, do not be surprised if your child doesn't think his or her thoughts are odd. Most younger children have no idea that their obsessions sound peculiar to others.
A need for perfection Some kids and teens feel a strong need for things to be perfect or right. For example, your child might not be able to start her homework until her books are all ordered and perfectly arranged, or cannot turn in an assignment until she is certain its perfect. Other kids struggle to tolerate if something isn’t 100% right, focusing on doing the right thing all the time or thinking about every tiny mistake.
Forbidden thoughts Entering into adolescence is a time of sexual maturity and most teens think about sex and sexual identity during this time. However, for some teens they are plagued with unwanted thoughts and images about being gay when they know they are not, or thinking about engaging in sexual behavior that feels upsetting and even repulsive to them.
Washing or cleaning Washing hands excessively, sometimes until they are raw and bleeding. There are many other types of washing behaviors, including:
Checking These types of compulsions can involve checking doors, locks, or backpacks, to make sure everything is safe. Some children and teens check to make sure that everyone is okay. For example, calling family members to "check" that they are safe.
Counting, tapping, touching, or rubbing Compulsions can involve counting, touching, or tapping objects in a particular way. Some children and teens have lucky and unlucky numbers involved in their rituals (e.g., needing to touch a door four times before leaving a room).
Ordering/arranging This compulsion involves arranging items in specific ways, such as bed sheets, stuffed animals, or books in the school locker or book bag. For example, a child might need to line up all the shoes in the closet so that they all face forward, and are matched by color.
Mental rituals Not all children and teens with OCD will have compulsions that can be seen. Some perform rituals in their head, such as saying prayers or trying to replace a "bad" image or thought with a "good" image or thought. For example, a teen might have a bedtime prayer that he or she mentally repeats over and over again until it "feels right".
- OCD can begin early, starting between ages seven and 12. In fact, up to half of all adults with OCD say their symptoms started when they were children
- OCD is more common in boys than girls in childhood, but into adulthood, women are affected at a slightly higher rate than men
- OCD symptoms can change over time. For example, when OCD first appears your child might begin with excessive washing compulsions, but over time this can shift to excessive checking compulsions while compulsive washing disappears
- OCD occurs in 2-3% of children and adults during their lifetime
- Seeking reassurance from others that things will be okay or a ritual was completed “correctly” is common in children and teens with OCD. This can include asking parents and siblings to do rituals as well
Signs & Symptoms
Thoughts (Note: very young children may be unable to identify specific fear thoughts):
- I’m responsible for that accident
- What if I get sick?
- If I don’t get an A on this paper my future is ruined
- Am I attracted to that guy? Do I find him good looking? This must mean i'm gay
- What if I’m sick but I don’t know it and then I get my parents sick when I touch them?
- I can’t stand not knowing!
- Racing heart
- Shallow breathing
- Muscle tension
- Shortness of breath
- Feeling detached from one’s body (derealization)
- Asking parent to buy extra toilet paper or cleaning supplies
- Making parents wash their hands before making a meal
- Washing hands and body excessively
- Checking with parents that s/he didn’t make a mistake
- Repeating certain phrases in multiples of 2 or 4
- Doubting something has been done correctly
- Avoiding touching doorknobs, handles, etc.
Common Stuations or Affected Areas
- School or athletic performance
- Recreational attendance and participation
- Organization and focus
- Meal times
- Personal hygiene
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How OCD impacts the child at different ages:
It is common in toddlers, preschoolers, and even young children to have rituals and superstitions. For example, many children will eat their food in a certain order, believe and act in accordance with superstitions such as “step on a crack, break your mother’s back,” or have elaborate bedtime rituals. However, this does NOT mean the child has OCD; rather this is the child’s way of mastering new skills and exerting some control in their life. However, as children mature we expect to see many of these “requirements” become less necessary and often disappear altogether. However, in a minority of children we see a strengthening if these “requirements” and new areas of rigid expectations crop up. A careful assessment of your child can help determine whether OCD is at play. For those diagnosed with childhood OCD, themes of harm and contamination are the most common themes in this age group.
As children mature into adolescence the focus of OCD shifts to themes that have greater relevance to the adolescent, such as sexual and religious/moral concerns. Furthermore, because the adolescent years are typically marked by a desire to “fit in and “be normal,” those adolescents experiencing the onset of OCD may keep it a secret due to the shame and embarrassment caused by their intrusive thoughts and “strange” behaviours. Encouraging adolescents to unburden themselves by talking with an adult they trust about their OCD is a good start.
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