Does my child have Obsessive-Compulsive Disorder (OCD)?
Cleaning, Checking, Counting, and Children
It is normal for children and young people to go through developmental stages of worrying about things and exhibiting certain behaviours. For example, it is normal for children to worry that something will happen to their parents, insist that they eat their food in a certain order, for young boys to behave as if girls have “girl germs” and for young people to worry about whether they are going to pass their exams. But for children and young people with obsessive-compulsive disorder (OCD), they can’t stop worrying, no matter how much they want to. And those worries make them behave in certain ways over and over again.
What is OCD?
OCD is one of the most common anxiety disorders affecting children and young people. It is estimated that around 1 child in 200 has OCD, although some studies suggest it could be as high as 3-4%. Studies that favour the lower totals do, however, suggest that up to 3% of young people will be having obsessional symptoms that will be irritating, even alarming, but are not disabling and interfering with their lives. However, it is also common in young people for vaguely obsessional symptoms to be socially acceptable within the peer group, so it is often not easy to identify OCD.
Many children will develop OCD early, starting between ages 7 and 12. Since these are the years when children naturally feel concerned about fitting in with their friends, the discomfort and stress brought on by OCD can make them feel scared, out of control, and alone. Before the age of 12, OCD is more common in boys than girls.
OCD has two parts to it – the first part is called “obsessions”, which is another word for worrying thoughts. The second part is called “compulsions”, which is another word for the actions that OCD makes people think they need to do.
Children with OCD become preoccupied with whether something could be harmful, dangerous, wrong, or dirty — or with thoughts that bad stuff could happen. With OCD, worrying, upsetting or scary thoughts or images, called obsessions, pop into a person’s mind and keep on going around in their head and don’t leave them alone, no matter how hard they try to ignore them. Children with OCD also might worry about things not being “in order” or “just right.” They may worry about losing things, sometimes feeling the need to collect these items, even though they may seem useless to other people.
It is important to know that obsessions cause children and young people a great deal of anxiety and stress. For example, a child with OCD might have disturbing thoughts that their parents will contract a terrible disease and die. This thought goes around and around and around in their head and won’t go away.
The most common obsessions among children and young people with OCD include:
• contamination (worries about coming into contact with germs, getting sick, or getting others sick after touching “dirty” or “contaminated” items, sticky substances, or chemicals e.g., household cleansers).
• coming across unlucky numbers or words
• doubting (becoming convinced they haven’t done something they are supposed to do even though they have done it)
• fear of illness or harm coming to oneself or relatives (for example, worrying that if they don’t clean their shoes properly and there are still germs on them other people might get sick because of them)
• doing or thinking something bad (vivid images of killing or hurting a loved family member)
• recurrent fears that certain activities have not been completed properly (even after countless repetitions)
• blasphemous thoughts
• a fear that important things may be lost unless extreme care is taken
• weird or frightening visual images.
Obsessions that focus on contamination are the most commonly reported obsessions in children. Fears of contamination by dirt and germs lead to avoidance of things they think could contaminate them and excessive washing. They may wash in a particular manner, more frequently, or for excessive lengths of time.
What Obsessions are not…
It is normal for children to have occasional thoughts about getting sick or about the safety of loved ones.
Compulsions are actions or behaviours that children feel a very strong urge to do, in order to reduce the anxiety caused by the obsessions – to stop something dreadful happening, or make extra sure that things are safe, clean, or right in some way. For example, a child with OCD might say that he or she needs to arrange all their teddy bears from smallest to biggest or else something bad will happen to their mum. In this case the child feels personally responsible for doing the action so that nothing bad happens. Even though the child might be aware that what they are doing ‘doesn’t make sense’, they feel extremely anxious and stressed if they don’t follow through with the action.
The most common compulsions among children and young people with OCD include:
• grooming rituals (washing hands until they are red and chapped; brushing teeth until gums bleed)
• checking (checking doors, locks, or appliances, to make sure everything is turned off or unplugged. Some children and young people will check to make sure that everyone is okay e.g. calling family members to “check” that they are safe)
• ordering or arranging objects (arranging items in specific ways, such as bed clothes, stuffed animals, or books in the school locker or book bag e.g. a child might need to line up all the shoes in the closet so that they all face forward, and are matched by colour)
• repeating/redoing (performing a mindless task repeatedly until it “feels right” such as going in and out of doorways, re-reading something; redoing a task that has already been acceptably completed, such as erasing letters on a page until the paper wears through and re-writing)
• counting (counting of steps while walking; insistence on performing a task a specific number of times)
• symmetry, order, and precision (a need to have items ordered in a certain way e.g. according to color, size, or facing a certain direction)
• rituals to undo contact with a “contaminated” person or object
• touching (having to touch things a certain number of times e.g. needing to touch a door four times before leaving a room)
• mental rituals (not all children and young people 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 young person might have a bedtime prayer that he or she mentally repeats over and over again until it “feels right”).
OCD: Spotting the Signs in children
Adults with OCD usually know they have a problem. They are able to separate their obsessive-compulsive thoughts and behaviours from normal, healthy thoughts and behaviours, which is considered the first step on the road to recovery. Children, however, generally do not have enough life experience or self-awareness to make this critical distinction. When they find themselves performing bizarre or repetitive rituals, such as washing their hands over and over, they are often ashamed, confused and feel like they are going crazy.
Children might keep the symptoms hidden from their families, friends, and teachers because they’re embarrassed. This is why it is so important that parents (and other adults coming into contact with children) are aware of OCD and knowledgeable enough about the symptoms to detect it in children. As a parent, you will need to guide your child through the acceptance and recovery processes step-by-step.
As a parent, you may notice the following:
• a desire to have his/her room tidied in a particular way, with everything perfectly aligned
• repetitive hand-washing or prolonged, repeated showering/bathing
• raw, chapped hands from constant washing
• unusually high rate of soap or paper towel usage
• worrying excessively about their handwriting and neatness of his/her schoolwork
• unproductive hours spent doing homework
• holes erased through test papers and homework
• a continual fear that something terrible will happen to someone such as parents, siblings, friends or pets
• constant checks of the health of family members
• going to extreme lengths to protect the family home by repeatedly checking locks and taps
• feeling the need to count whilst they perform certain tasks, sometimes in multiples of a particular number
• refusing to let go of or discard seemingly useless or old items
• worrying excessively about becoming ill or catching specific diseases
• requests for family members to repeat strange phrases or keep answering the same question
• repeating a certain phrase or sentence over and over again
• taking an exceptionally long amount of time getting ready for bed.
What other things do children with OCD do?
Avoidance: Children and young people with OCD often spend a lot of time and effort trying to avoid anything that might trigger their OCD. For example, children and young people with contamination fears might avoid touching door knobs or shaking hands with people. Sometimes their avoidance will be severe, and include avoidance of school or even leaving the home.
Reassurance seeking: A very common behavior among children and young people with OCD is asking for reassurance from family members, especially parents. Typically, they will ask for reassurance about whether they “correctly” completed a ritual (for example, “Is it clean? Are you sure?”).
Getting family involved in rituals: Once of the most frustrating aspects for parents is the amount of rituals family members become involved in. That is, children or young people can become so distressed and anxious about their compulsions that they have their family members also follow certain rituals. For example, asking parents to wash in a particular way (e.g., cleaning hands with bleach) or making family members call home repeatedly so they knows that mum and dad are safe.
The good news is that OCD, in adults as well as children and young people, is highly treatable.
Talk to your child if you think you may be on to something — he or she may well be relieved you have noticed and could be eager to tell you what’s going on. If not, you will still glean information based on his or her reaction. Then it’s time to get help.
It is best to treat OCD early. The longer it goes untreated, the more entrenched the symptoms become. They invade more and more of the child’s life and make OCD more difficult to treat.
If you are concerned that your child or adolescent may have OCD, make an appointment to see our child psychologist, Nicole Letch, as soon as possible. 8364-3811 or email us