What is it?
Obsessive-compulsive disorder or OCD features two related types of experiences: obsessions and compulsions.
Obsessions are distressing and unwanted thoughts, urges, or images.
Obsessions often make you afraid that something bad will happen or make you feel “not-right”.
Obsessions may seem important, strange, scary, or inappropriate.
Often, the more you want obsessions to go away, the more they seem to happen.
Concerns about cleanliness or infection (worries about dirt, germs, becoming ill)
Fears of bad things happening (you or a loved one getting hurt, causing a fire)
Unwanted "bad" or "inappropriate" thoughts (about sex/sexuality, about death or suicide, about god or hell)
Concerns about your identity or morality (being a bad person, losing sense of who you are, not looking “right”)
Feeling “incomplete” or not “just right" (needing things to be even, in a certain order, perfect or exact in some way)
Compulsions are things done over and over again to try to make obsessions go away or not come true.
Compulsions often have to be done a certain way, follow certain rules, or until it feels “just-right”.
Compulsions can feel hard to stop, even when they are unwanted or annoying.
Often, compulsions work for a time, but have to keep being repeated because obsessions keep coming back.
Washing and cleaning (hands, clothes, objects/surfaces, bathroom habits)
Checking (locks, wanting to be told you’ll be okay, paying attention to body signals)
Repeating (ordering and arranging things, touching and tapping, erasing and rewriting, making things even)
Mental patterns (counting, telling yourself you’ll be okay, getting stuck on a thought, getting rid of doubt or uncertainty)
Avoiding triggers for obsessions (places, words, objects, people)
Causing others to act in certain ways (getting others to do, or help with, any of the above examples
OCD can look different for everyone. Here are some common experiences for children and youth with OCD:
- Most have more than one type of OCD symptom and the way the symptoms look can change over time.
- Some, particularly younger children, may not be able to identify their obsessions, or may be afraid or ashamed to do so.
- Some may have trouble controlling their emotions and can become extremely angry when triggered.
- Some may not see their obsessions or compulsions as unreasonable or may deny that OCD causes them problems.
How do I know?
Everyone has unwanted, unplanned, or unusual thoughts at times. We may wonder if our food has gone bad or think "maybe I'll jump off this bridge". Similarly, lots of people have things they do often or in particular ways (routines, preferences, habits). This does not mean they have a disorder.
The difference for people with OCD is that these experiences are more intense (happening often and distressing) and harder to manage, dismiss or ignore. As a result, these experiences get in the way of living and enjoying life. For example, the disorder may impact your child:
- emotionally (feeling overwhelmed, down, and tired of being distressed; not able to enjoy hobbies)
- physically (dry and cracked hands,not eating enough, feeling sick often)
- socially (avoiding friends, quitting after-school activities, being seen as unusual by peers)
- at school or at work (struggling to concentrate, work takes much longer, difficulties attending or succeeding)
- with family (fighting, stress, negative impact on others well-being)
Symptoms tend to get worse during times of stress, illness or tiredness and slowly get worse over time as people have to rely more on compulsions to try and make obsessions go away. However, sometimes symptoms can also appear quickly.
What disorders can go along with OCD?
Children and youth with OCD often have other mental health challenges at the same time. The most common disorders include:
- anxiety disorders (generally worrying about a lot of things, feeling afraid around other people, often feeling tense/on edge)
- depressive disorders (feeling down, hopeless, or tired; struggling to take care of oneself)
- tic disorders (having unwanted movements or sounds that are hard to control; note: more often in boys than girls)
- attention-deficit/hyperactivity disorder (ADHD) (having trouble paying attention or controlling urges)
- OCD-related disorders (disorders that share certain features or patterns with OCD)
- Body dysmorphic disorder (BDD): People with BDD become extremely concerned with a feature of their appearance (for example, nose or skin) that they see as being “wrong” even though others cannot see it or think it is only minor. Because of their concern, people with BDD become fixated on trying to hide or correct the “flaw” and might constantly compare their appearance to others, spend too much time looking in the mirror, grooming, or hiding; or avoid being around others at all.
- Hoarding disorder: People with hoarding have serious problems with collecting items or struggle to get rid of possessions they already have leading to major problems with clutter in their living environments. They often have strong beliefs about the importance of possessions (keeping memories; potential to need it in the future), struggle to make decisions, and experience distress with the idea of parting with their possessions.
- Body focused repetitive behaviours (BFRBs): The most common BFRBs include skin-picking (excoriation disorder), hair-pulling (trichotillomania), and nail-biting. Individuals tend to do these behaviours when experiencing uncomfortable emotional states (anxious, stressed, bored) or in response to specific triggers (uneven skin, loose hairs). For most people, BFRBs are not necessarily problems. However, when intense, they can be difficult to control and result in increased distress (guilt, embarrassment), physical harm (missing hair, scabs, infections), and problems in life (social difficulties, costs to conceal), at which point they are considered as a disorder.
Looking for more information on BFRBs? Check out this book on overcoming body focused repetitive behaviours.
Over time, challenges from having OCD (such as feeling distressed, not seeing friends, dropping out of sports or struggling in school) can increase the chance of having other mental health challenges at the same time, like depression or developing a substance use problem.
What can be done?
There are two main treatments that are proven to be helpful for children and youth with OCD. These treatments do not cure OCD, but they do help to manage and reduce the symptoms, and to improve quality of life at least half the time. The most common and effective types of treatment for obsessive compulsive disorder are:
1. Cognitive Behavioural Therapy (CBT) focused on Exposure and Response Prevention (ERP)
Cognitive behavioural therapy is a type of therapy that helps people understand how their thoughts, feelings, and behaviours are related and to actively practice changes that help them live a more enjoyable and fulfilling life. For OCD, the focus is on helping your child gradually face and tolerate their uncomfortable obsessions (Exposure) while resisting doing their usual compulsions (Response Prevention). The goal is not to make obsessions go away, but to change your child’s reaction to them by stopping compulsions. This type of therapy works very well for many people, especially those who are willing to try pushing back against their OCD. It has long lasting benefits with minimal side effects. That is why it is considered the first treatment to try for OCD.
Treatment is generally most successful when your child is working with an experienced therapist, either one-on-one, or in a in a group setting with other OCD-affected children or youth. Families can also benefit by working on this with their children with the support of websites or books.
As a parent or caregiver, you have an important role in treatment. It is key to limit ways in which you may unknowingly be making OCD stronger by allowing your child to avoid OCD triggers or by helping them to do compulsions (called family accommodation). Even if your child is not willing to participate in ERP, accessing help for yourself and other family members to decrease accomodations is very helpful.
2. Serotonin Reuptake Inhibitors (SRIs)
SRIs are a type of medication that can help to reduce the intensity of OCD symptoms (have thoughts less often, reduce distress). When children or youth have moderate to severe symptoms, especially when CBT progress is slow or unavailable, it is recommended that SRIs be used. SRIs take a few weeks to start to work and have been shown to be helpful for about half of individuals who take them when taken for at least 10-12 weeks. SRIs can have some side effects, although they are generally mild and are not permanent. Types of SRIs used for OCD include:
3. Other Options
Additional types of therapy might be recommended for children and youth who are experiencing other challenges that are getting in the way of treatment success (dialectical behaviour therapy [DBT] for related emotional dysregulation/rage, comprehensive behavioural intervention for tics [CBIT] for those with a tic disorder) and/or those who are still struggling even after trying CBT and SRIs. Acceptance and commitment therapy (ACT) may be helpful for children and youth with mainly unwanted ‘bad thoughts’ obsessions who have had limited success with CBT focused on ERP. Motivational interviewing approaches can be used for those who are unsure about their willingness to participate in CBT focused on ERP.
Where to from here?
Talk to your doctor and get help from a mental health professional by:
- Getting a mental health assessment and support through your local Child and Youth Mental Health team (through a walk-in intake clinic in your community).
- Contacting a private psychologist or counsellor with experience in conducting ERP therapy.
Looking for more information on this topic? Connect with a parent peer support worker at the Kelty Centre to discover additional resources, learn more about support and treatment options, or just to find a listening ear.