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Obsessive Compulsive Disorder (OCD)

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What is obsessive compulsive disorder OCD)?
How common is OCD?
What causes OCD?
Common types of compulsions and behaviours
What should we do if we think our child has OCD?
Treatment
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William's Story Part 1 and Part 2

"He just can't stop washing..."

William enjoys hanging out with his friends and family, and is a great soccer player. But over the past few months, he’s been much more concerned about being clean. At first, his parents thought it was great, because he began showering more often. But now he needs to shower several times a day and will actually get upset and angry if he can’t have his shower. And in the past few weeks, he’s become so worried about germs that he won’t even touch door handles. And if he does, he has to wash his hands, and so now his hands are chapped, sore and bleeding from all the washing...

What is Obsessive Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is a condition where children or youth have obsessions or compulsions.

Compulsions: Are behaviours that a child or teen feels forced to do, to relieve distress related to the obsession. For example, some children or youth wash their hands over and over again to feel less anxious about being contaminated.

Many people are ‘perfectionists’, or a little obsessive about certain things. It can even be helpful when we have ‘just enough’ of these traits.

For example, someone who is obsessive about cleanliness will definitely be better at preventing the spread of germs and infections. But these habits become a disorder when they begin to get in the way of everyday life. With OCD, concerns about cleanliness can get so severe that children or youth may end up:

  • Avoiding touching family members because they are afraid of getting contaminated
  • Washing their hands so much that hands become chapped and bleeding
  • Avoiding going to school due to fears of contamination
  • Not being able to turn on the TV because others have touched it
  • Spending hours every day consumed with cleanliness related ritual

Obsessions:

Are distressing thoughts or images that won’t go away. For example, a child may worry about being dirty or contaminated.

How common is OCD?

Somewhere between 1 to 5 out of every 100 children and youth have OCD.

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What causes OCD?

Researchers believe that OCD happens when people don’t have enough serotonin (a brain chemical or neurotransmitter) in the brain.  

Common types of obsessions and compulsions

Types of Obsessions

A child or teen’s thoughts, feelings and actions

Cleanliness or contamination

Worries that things are dirty or contaminated. This leads to a compulsion of needing to wash or bathe over and over again, or avoid touching things that might be ‘contaminated.’

Symmetry and order

Gets upset or distressed if things aren’t exactly ‘just so’ or in a certain order. May spend a lot of time arranging or re-arranging things in one’s room, workplace or other places.

Numbers and counting

Having to count or repeat things a certain number of times, having "safe" or "bad" numbers.

Self-Doubt and need for reassurance

Fear of doing wrong or having done wrong, which may lead to repetitively asking others for reassurance, over and over again.

Guilt/need to confess

Needing to tell others about things that she or he has done.

Checking

Excessive checking things like doors, lights, locks, windows.

Perfectionism

Excessive time doing things over and over again until they are perfect, or ‘just right’.

OCD symptoms can lead to other problems like:

  • Troubles paying attention, because the child or teen is so focused on obsessions or compulsions
  • Anxiety and anger if OCD routines get interrupted
  • Lateness and fatigue from the time and energy needed for rituals
  • Withdrawal from usual activities and friends
  • Trying to get friends and family to cooperate with the OCD rituals.

Everyone in a family is usually affected by a child or teen’s OCD, so everyone has a role to play in helping to make things better.

What should we do if we think our child has OCD?

If you think that your child has OCD, bring your child or teen to a doctor to make sure there aren’t any medical problems that might be contributing to the problem. Your doctor may then refer you to a psychologist, psychiatrist or children’s mental health centre.

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How is OCD treated?

The good news is that there are many effective treatments and ways to deal with OCD. The two main types of treatments that can help OCD are:

1. Cognitive behaviour therapy (CBT)

CBT is a type of ‘talk’ therapy that helps children and youth learn new ways to think (“cognitive”) and new ways to do things (“behavioural”) to deal with the OCD. CBT is usually provided by a psychologist or psychiatrist. Many good books on OCD make it easier for children and youth with OCD and their families to learn how to use these approaches on their own (for example, “Talking Back to OCD” by John March).

2. Medications

Medicines (like specific serotonin reuptake unhibitors, or SSRIs) can help balance the amount of brain chemicals. medications can be helpful when other treatments aren't working. Medications may be needed for a short or long time, depending on your child's needs. In a very small number of cases, OCD is caused by a streptococcal infection (strep). In these cases, antibiotics can be helpful.

Cognitive-Behavioural Strategies for OCD

Cognitive behavioural therapy (CBT) is one of the most effective treatments for OCD. CBT includes ways to change thoughts and behaviours:

1. Cognitive (thought) strategies: OCD makes a child or youth have ‘OCD’ thoughts. Cognitive (thought) strategies help a child or teen to replace OCD thoughts with more helpful ones. For example, a child with cleanliness obsessions touches a school textbook and gets the automatic thought, “Now I’m all dirty and I’m going to get sick! I have to wash my hands!”

Cognitive techniques help children and youth come up with more helpful coping thoughts, like, “I’m not going to let the OCD push me around! So what if I’ve just touched the book? I’m not going to get sick. And if I do, well, then maybe I can miss school.”

Event: Hand touches book

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2. Changing behaviours one step at a time...

OCD Hierarchy 

A hierarchy is a way of deciding which OCD behaviours to work on first.

Your child or teen can rank compulsions on a scale of ‘easy’ to resist, to ‘very hard’ to resist.When starting to work on OCD compulsions with a therapist, it is usually best to start working oneasier to resist compulsions at first.For example, one person’s hierarchy might look like this...

 

 

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Exposure with response prevention:

Exposure means exposing your child or teen to the (feared) situation that triggers the OCD.

For example, if you have a child whose hand washing rituals are triggered by touching “contaminated” objects, then you would expose the child to “contaminated” objects. Exposure is always done bit by bit, in a gradual way that the child can tolerate, like going up a flight of stairs.

Response prevention means preventing the ‘response’ (or ritual) that the OCD tries to ‘boss’ your child into doing.

For example, children with hand washing compulsions would feel an urge to wash their hands after touching objects they feel are dirty or “contaminated”. Response prevention happens when children agree ahead of time, that if they touch something, that they will try to avoid the typical response of hand washing. Although this causes anxiety at first, the more often they avoid hand washing, the easier it becomes over time to stop hand washing (or other compulsions). Naturally, it is usually not possible tocompletely stop the compulsions all at once; it is done gradually,step-by-step...

For example, if a child’s compulsion is to wash hands four times, then the next step would be only to wash three times. Once that is successful, then the child goes to the next step of only washing hands two times, and so on...

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 Narrative strategies for OCD

Narrative therapy is a powerful way to deal with problems by talking about them in a certain way. Many therapists will use both narrative and cognitive behavioural strategies in treating OCD in children and youth.

 1. Make the OCD the problem, not the person with OCD: 

This helps you to join forces with your child or teen, to work together against the OCD.

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Although OCD symptoms can be very frustrating and cause conflict with families, remember that it is not your child or teen that is the problem, it is the OCD. A powerful way to do this is to talk about the OCD as a ‘third person’.

2. Naming the OCD: Although teenagers are usually happy to call their symptoms ‘OCD’, younger children often like to give it their own name.

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3. Agree with the child on the goal, like getting rid of the OCD: When faced with OCD symptoms like hand washing, it’s natural for many adults to simply try to stop the child from hand washing. But since children and youth may not have the same insight as adults, they may get upset if adults suddenly try to stop them from their OCD rituals. From the child’s point of view, stopping the rituals is going to make them feel worse in the short-run. Adults must help the child to see that things would be better in the long-run.

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Here's another example of this:

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4. Blaming it on the OCD doesn’t take away responsibility: Some parents get worried that if we blame the symptoms on the OCD that the child might not take responsibility for dealing with the problem. For example, if a child with OCD gets into a fight and hits his sister because she interrupted him during his rituals, he simply says, “Well, it’s not my fault, it’s the OCD!” To make sure that responsibility still stays with the child, a therapist (or parent) might say something like this:

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5. Ask your child how you can support her:  You might say things like:

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6. Praise your child for ‘bossing back’ the OCD: All children and youth need praise, especially those struggling with OCD. A child struggling with OCD often hears a lot of criticism or negative comments from others.

You might start with:

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“William is doing much better now...”

William’s parents brought him to see his family doctor, who recommended a psychologist. After seeing the psychologist, William and his parents learned all about cognitive behavioural therapy and ways to ‘boss back’ his OCD. His parents learned strategies too, and how to support William in fighting the OCD. Interestingly, William’s father realized that he had had minor symptoms of OCD all his life too, and he had just as much benefit from learning about OCD as William did. But back to William – with all the help, his showering and hand washing are almost back to normal… How ironic life is, thought his mother -- who would have thought that one day I’d actually be praising my son for NOT showering!

    Where to find help

    Eastern Ontario

    • In a crisis? Child, Youth and Family Crisis Line for Eastern Ontario, 613-260-2360 or toll-free, 1-377-877-7775
    • Looking for mental health help? eMental Health has resources for Ottawa, Eastern Ontario and Canada.a bilingual directory of mental health services

    Ottawa and Eastern Ontario

    Support Groups

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    More information

    Useful websites

      Books 

      For a list of recommended books on this topic click here to visit the OCD section of the Kaitlyn Atkinson Family Resource Library.

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