OCD is an anxiety disorder characterised by ‘obsessions’ and ‘compulsions’.
Obsessions are repetitive, intrusive and unwanted thoughts or images which tend to make children with OCD feel distressed and anxious. Most children with OCD try to suppress (or ‘neutralise’) their obsessive thoughts and the distress they cause, by performing certain behaviours or rituals. These behaviours are called compulsions.
Sometimes the obsessions and compulsions are related to each other. For example, a child might have an obsessive thought that their family might get hurt, and as a result, they might keep checking where their parents are, or call them on the phone, to check that they are safe. At other times the obsessions and compulsions in OCD are completely unrelated. For example, a child might have an obsession that there are germs on their food, and then feel a compulsion to count to 8 five times before eating as this makes them feel that there is less chance that they will get sick.
Unfortunately, performing the compulsive behaviour only produces short-term relief from anxiety. When the obsessive thought returns, so does the anxiety, and a compulsion is felt to repeat the routine all over again. In the long term, compulsions maintain anxiety as the child learns to believe that their obsessions will come true and that only compulsions can prevent this.
Often children with OCD know that their obsessions and compulsions make no sense, but they can’t ignore them. Parents may try to get their children to resist the urge to perform the compulsive behaviour, or stop it all together, however this usually produces great distress for the child and their family.
Common obsessive thoughts in child OCD
- Fear of dirt, germs, or bodily fluids/waste
- Contracting a disease or illness
- Fear of thinking immoral or evil thoughts that may be violent or sexual in nature
- Hearing repetitive songs or sentences
- Worrying that themselves, parents, or another person will be harmed
- Fear of doing or saying something offensive or criminal
- Religious, superstitious or magical ideas
Common compulsions in child OCD
- Repetitively washing hands or showering
- Decontaminating or cleaning things before touching them
- Avoiding touching things that might have germs on them
- Counting things repeatedly, or counting things a certain number of times
- Checking things (e.g., that the house is locked or that the stove is turned off)
- Touching, tapping or rubbing objects
- Lining things up so that they are symmetrical or even
- Needing things to be arranged in a particular way or evenly
- Doing things in a particular order or manner at specific times
- Hoarding things: saving bits of things (e.g., string, buttons, used bits of paper, etc)
- Seeking reassurance from others excessively (e.g., asking parents questions repeatedly)
Treatment for Child OCD:
Research has shown that child OCD is best treated using Cognitive Behaviour Therapy (CBT). This involves the following strategies:
Stress management techniques:
OCD tends to become worse during high levels of stress, so reducing sources of stress, learning strategies to manage stress and problem solving is important.
These skills help to decrease arousal when anxious, and include deep breathing and learning to release muscular tension in the body.
This technique involves testing out how realistic the obsessive thoughts are, and replacing any unrealistic thoughts with more realistic ones. This is more effective when combined with a behavioural strategy called ‘Exposure and response prevention’ (discussed below), so that the child can test out how valid their fears actually are. Other cognitive strategies include learning to have distressing thoughts without necessarily acting on them.
Children suffering from OCD tend to avoid situations or triggers that make them feel anxious, and in some cases they may stop socialising or wanting to do their usual activities and their school-work can decline. Behavioural strategies for child OCD involve taking a gradual approach to help the child face the situations and triggers that are anxiety-provoking for them.
Exposure and response prevention:
This technique involves gradually exposing the child to situations and triggers that make them feel anxious and at the same time stopping them from performing the usual compulsive ritual or routine. This way they can test out how bad their anxiety really is when they don’t do the compulsive behaviour, and they can also test whether the things they have been worrying about actually come true. It also provides the child with experience tolerating difficult emotions (e.g., anxiety, distress, disgust, uncertainty) that are triggered, and gives the child time to develop important coping skills.
This ‘exposure’ is always done in a gradual way. For example, imagine that a child who is fearful of germs washes their hands 10 times after using a public toilet. For that child, the first step might be to use a public toilet and to only wash their hands 5 times. The subsequent step might involve only washing 3 times, and so on. Later steps might involve them using a public toilet and not washing their hands for 20 minutes and so on, until the fear of germs is conquered. ‘Exposure’ is most effective when each step is practiced repeatedly before moving onto the next, more challenging, step. It is important that exposure tasks are slightly anxiety-provoking, but not so overwhelming that the child is unable to attempt them. The child is always involved in devising these steps so that they are in control of their treatment and progress.
If you would like to find out more about our treatment for Obsessive Compulsive Disorder (OCD) in children, or to book an appointment with one of our child clinical psychologists who provides treatment for this condition, please email or call the clinic on 0405 430 530.