Written by: Joey Ong
Edited by: Windy Huang
Obsessive-compulsive disorder (OCD) is a common mental health disorder that affects about 1 in 40 adults in the United States, with a lifetime prevalence of 2.3% of U.S. adults having OCD at some point in their lives (Obsessive-Compulsive Disorder (OCD) - National Institute of Mental Health (NIMH). (n.d.)). OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are recurrent and persistent thoughts, urges or images that are intrusive and unwanted, whereas compulsions are behaviors or mental acts that an individual feels driven to perform as a response to an obsession (American Psychiatric Association, 2013). The mean age of onset in the United States for OCD is 19.5 years, with typically a gradual onset (American Psychiatric Association, 2013). Patterns of symptoms in adults are seen to be stable over a time period, which makes them more identifiable and easily recognized. However, what about noticing symptoms in adolescents? Are they as stable and easily recognizable as young adults?
Routines and rituals are normal throughout the growth and development of a child’s life. They are used to establish schedules around meals, bathing, waking up, and bedtimes. These routines are useful in helping to stabilize a child’s view of the world around them and give them a sense of expectancy for what is to come. Rituals can help children learn the rules of a game, such as in sports or in hobbies where social engagement is promoted. In children who do not have OCD, when these routines are disrupted, they are able to adapt to the situation without immense distress. They may be disappointed or sad, but heavy dysfunction is not created. When a child has OCD, they have strong obsessive thoughts that are unwanted and can cause fear which leads to compulsive behaviors in an attempt to control the fears. Disruption in routines may cause anxiety and distress in the child and can trigger repetitive behaviors that may last up to hours. Behaviors that can suggest OCD in children are: fear of dirt, germs, and contamination from people/surfaces, doubts about household safety, preoccupation with presentation, appearance, and organization, anxiety about hurting others, superstitions that bad things will happen if seemingly unrelated behaviors are performed; while compulsions may include: cleanliness, rituals, rigidity about mornings or bedtimes, a need to repeat words or prayers, reassurance-seeking from figures of authorities, and avoidance of situations in which the child thinks that something bad will happen (Obsessive-Compulsive Disorder in Children > Fact Sheets. (n.d.)). When these obsessions and compulsions get to a point where they cause distress for the child and the family, it becomes a “disorder,” and it is recommended to visit the child’s pediatrician.
Identifying symptoms may be harder for parents to do since children may become secretive about their compulsions or they may disregard the symptoms as the child is just ‘growing up’ or changing their preferences (Obsessive-Compulsive Disorder (OCD) in Children. (n.d.). Cedars-Sinai). A child may also not recognize why their thoughts can be considered to be distressing and perform compulsions just to make themselves feel better. These intrusive thoughts can lead to the child purposely hiding their symptoms from those around them, in an attempt to appear ‘normal.’ Additionally, compulsive behaviors are not always necessarily physical, they can also occur mentally. A parent may not realize when their child is counting in their head, or having repetitive intrusive thoughts. Detecting OCD in young children is difficult due to all of these factors, which is why parents play such an important role in being able to identify symptoms in their child’s everyday life. Being able to identify the early warning signs of OCD symptoms and labeling them as signals of OCD instead of personality traits is essential in diagnosing OCD in a child. This allows for the creation of a positive support system and an understanding for why a child is behaving in a certain way. It is also vital to be communicative with a child to reassure them that the obsession that they have is not true and to lessen their worries and stress about performing a compulsion. Early identification will help the child grasp a better understanding and control of their intrusive thoughts.
Children with OCD benefit from a form of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP). CBT treatment involves efforts to change thinking and behavioral patterns. Some strategies might include: gaining a better understanding of the behavior, using problem-solving skills to cope with difficult situations, facing one’s fears instead of avoiding them, role-playing to prepare for potential interactions, and learning to calm one’s mind and relax one’s body (What is Cognitive Behavioral Therapy? (n.d.)). Collaborating with a therapist, a child with OCD will work together to create an individualized plan on how to recognize and confront obsessions that trigger anxiety and discomfort. “ERP works by helping children face the things that trigger their anxiety in structured, incremental steps, and in a safe environment” (Guide to OCD in Children: From Symptoms to Treatment., 2024). Small amounts of exposure at a time will help children experience anxiety and distress at low levels without having to resort to compulsive behaviors. Over time, with increasing levels of exposure, distress and anxiety levels lessen with a better understanding of their intrusive thoughts. ERP treatment may take up to 12-15 weeks with 1 session a week to show effective results. Parents also have an important role in the treatment of children with OCD. By showing support, understanding the treatment sessions through participation in therapy sessions, and learning with the clinician/therapist, the parent can continue minimal amounts of exposure in a more casual and comfortable setting, such as their home. With more severe cases of OCD, children may utilize a combination of CBT and medication. An antidepressant called SSRIs, or selective serotonin reuptake inhibitors, can be used to help reduce a child’s anxiety, which can increase responsiveness in therapy (Guide to OCD in Children: From Symptoms to Treatment., 2024).
It is important to be able to recognize symptoms of OCD as a parent since earlier treatment can reduce the severity of the disorder and prevent it from developing into adulthood. Addressing obsessive thoughts and compulsive behaviors allows children to develop coping mechanisms to cause less dysfunction in everyday life. By understanding the signs of OCD and seeking professional advice, parents and caregivers can ensure that their child receives the necessary support that they need to thrive in their childhood and later on in life.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC. https://doi.org/10.1176/appi.books.9780890425596
Guide to OCD in Children: From Symptoms to Treatment. (2024, October 11). Child Mind Institute. Retrieved November 10, 2024, from https://childmind.org/guide/parents-guide-to-ocd/
Obsessive-Compulsive Disorder in Children > Fact Sheets. (n.d.). Yale Medicine. Retrieved November 10, 2024, from https://www.yalemedicine.org/conditions/obsessive-compulsive-disorder-in-children
Obsessive-Compulsive Disorder (OCD) in Children. (n.d.). Cedars-Sinai. Retrieved November 10, 2024, from https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/o/obsessive-compulsive-disorder-ocd-in-children.html
Obsessive-Compulsive Disorder (OCD) - National Institute of Mental Health (NIMH). (n.d.). National Institute of Mental Health. Retrieved November 10, 2024, from https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd
What is Cognitive Behavioral Therapy? (n.d.). American Psychological Association. Retrieved November 10, 2024, from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
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