By Dr. Elaine Ducharme

OCD is a type of anxiety disorder. It is a brain illness. People with OCD have mental hiccups (obsessions) that make them feel anxious or uncomfortable. Their illness then tricks them into trying to eliminate that feeling by performing certain rituals over and over. These rituals are called compulsions. One in 200 young people suffers from OCD. This means that there are 3-4 youngsters in every average size elementary school and up to 20-30 in every high school. It is important to note that OCD is not just excessive worries about real life situations. Nor is it the fairly typical style of many children who like structure and routine. In order to qualify as true OCD the following criteria must be met:

There are recurrent obsessions or compulsions or both that are experienced, at some time during the disturbance as intrusive and unwanted and that in most individuals cause marked anxiety or distress. The individual recognizes that the thoughts are a product of his own mind.

The individual attempts to ignore or suppress such thoughts, urges or images or to neutralize them with some other thought or action (by performing a compulsion). These responses often must be applied rigidly.

The individual recognizes the obsessive thoughts or repetitive behaviors are excessive or unreasonable. (Not always so in young children)
These obsessions or compulsions take up more than one hour per day.

One of the problems with OCD is that the compulsions that kids do to feel better don’t seem to make much sense. Parents often try to use sensible measures to stop the OCD. They may try punishments or rewards that rarely work, because sensible measures don’t work very well against nonsensical OCD. As a result, parents, kids and everyone living in the household get frustrated. Sometimes, the obsessions and compulsions take up so much time that normal activities like eating a meal, getting to bed or getting up in the morning take hours to complete.

There is really good news, however, about the treatment for OCD. The most effective treatment for OCD is called Cognitive-Behavioral Therapy or CBT. John March, M.D. has written a wonderful book for kids and their families called Talking Back to OCD. Dr. March encourages parents to put their child back in charge of the OCD. Kids are encouraged to create a nickname for the illness in order to help them remember that they are separate from the OCD. They are then taught to make a symptom chart to identify the most mild symptoms to the most severe symptoms. This allows them to figure out where they can begin to fight back. They learn to develop a variety of tools that they can use to help them tolerate the anxiety that occurs when they ignore OCD’s instructions to perform rituals. This allows them to break OCD’s hold on them. Tools include such things as relaxation techniques, watching the episode pass like a cloud, shouting back at the OCD and even distraction. As the child realizes that when they do not listen to the OCD their anxiety generally decreases quite quickly they develop they emotional strength and self confidence to tackle more difficult OCD issues. Essentially, this type of treatment is known as Exposure and Response Prevention. It is important to understand that every time a person performs the ritual to decrease the anxiety, they are essentially increasing the overall anxiety. Simply put, the more they do the ritual the worse it gets. This is because they continue to reinforce the idea that if they don’t perform the ritual something bad will happen. Only when they don’t perform the ritual and see that nothing bad happens will they be able to stand up to the OCD. Most often kids and parents benefit from working with a psychologist or other mental health professional trained in the use of CBT.

It is important to know that some children with very severe OCD symptoms may need medication to help them decrease their anxiety levels to a point where they can really learn CBT. This, in no way, means the individual is a failure or not strong enough to “do it without meds”. Remember, OCD is a brain disorder. The obsessions and compulsions that we see among kids and adults alike are very similar. Typical themes include contamination, doubt, order, impulses to do bad things and sexual imagery.
One more point. Occasionally a child develops very severe symptoms of OCD, practically overnight, after being ill with a Strep infection. It is important to consult your physician whenever your child has a sudden change in behavior. In this way, you can be certain your child receives the most appropriate treatment.

Here are some great resources for both parents and kids:

https://www.anxietybc.com/sites/default/files/resourcesocd.pdf
http://www.upmc.com/Services/behavioral-health/ocd/Pages/resources.aspx

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