Obsessive-Compulsive Disorder

Compulsions are defined as repetitive behaviors or mental acts that an individual engages in to get rid of the obsession and decrease their distress. OCD is typically diagnosed in childhood or adolescence and can be impairing in academic, social, and family settings. When obsessions and compulsions become so prevalent as to take up more than an hour a day, and get in the way of everyday functioning, a diagnosis of OCD can be made by a licensed mental health clinician.

Common Obsession Themes

OCD has common themes, like:

• Harm Avoidance: In OCD, harm avoidance refers to fears of causing harm to oneself or to others, either intentionally or accidentally. These obsessions often elicit intense anxiety, guilt and distress, and can lead to feeling responsible for preventing harm, even when the likelihood of these incidents is quite low. Rituals that may be associated with harm avoidance obsessions might include excessive checking (of locks, or appliances), excessive reassurance seeking from 
  others, confessing things to others that may or may not lead to harm, and avoidance of situations that OCD might define as risky.
• Incompleteness: Incompleteness in OCD refers to symptoms that are not associated with fear of harm or 
  contamination, but rather are more about the need for things to feel “just right” or complete. While this type of 
  obsessional content can be difficult for patients to articulate, it is often associated with an urge to repeat or continue with a ritual until they get a feeling of completeness, that can be described as “just right”. This can include sensory based discomfort with asymmetry, unevenness or perceived imperfections in the immediate environment. Rituals that may be associated with incompleteness symptoms might include repeating tasks such as re-reading or re-writing, putting items in a certain 
  order, tapping rituals, and mental rituals such as counting or repeating words or phrases. The inability to get a just right feeling is often associated with feelings of irritability and frustration.

Evaluation and Diagnosis

OCD can be diagnosed anytime in childhood or adolescence and into adulthood. Early assessment and treatment is important for children’s development, particularly given the risk of OCD going untreated, which can contribute to the development of additional psychiatric symptoms, like depression. Untreated OCD can also have a negative impact on social and academic development as well. If you think your child has OCD, your child may need a comprehensive psychiatric evaluation or psychotherapy evaluation.

Treatment

The optimal treatment for OCD is a combination of a type of therapy called exposure with response prevention, in conjunction with anti-depressant medication such as Selective Serotonin Reuptake Inhibitors or SSRIs. Exposure therapy is a form of cognitive behavior therapy that supports a child’s gradual and supported confronting of feared situations, objects, or thoughts while resisting urges to engage in rituals or avoidance behaviors. Clinicians work with kids to build a hierarchy where kids rate exposures from the least difficult to the most difficult and then support kids in gradually facing their fears, starting low on the hierarchy and moving gradually higher with support and encouragement. 

Exposure therapy is most effective when family members are included in the treatment, given the way OCD tends to recruit family members to provide reassurance, accommodate OC related demands, and avoid situations that bring up their child’s core worries and fears. Treatment can guide family members to support their child to engage in exposure work, including in day-to-day situations that provide naturally occurring exposures, as when a child might have a strong reaction to a peer at school who is ill, and seek to avoid school due to fear of germs or vomiting. Family based treatment for OCD can help families develop a shared understanding of effective ways to support an exposure consistent reaction to feared stimuli as they occur in real time. Another area of impact for children and adolescents is in their education. If OCD is affecting the child’s ability to learn, adjustments may need to be made in their education program.

Learn more about mental health treatment