OCD

If you are living with OCD, you know that it can impact all areas of your life and pose unique challenges. Whether you are diagnosed with OCD, a family member, or a loved one, there are resources available to help you manage and find support.

OCD can start at any time from preschool to adulthood.

Although OCD can occur at any age, there are generally two age ranges when OCD tends to first appears:

• Between ages 8 and 12.
• Between the late teen years and early adulthood

The average age at which OCD usually appears is 9–10 years old.

There are also at least 1 in 200 – or 500,000 – kids and teens that have OCD. This is about the same number of kids who have diabetes.

That means four or five kids with OCD are likely to be enrolled in any average size elementary school. In a medium to large high school, there could be 20

What is different about Ocd in children?

The symptoms of OCD are the same whether you are an adult or a child, but OCD in childhood can be more difficult to recognize for a variety of reasons. Children may not recognize that what they are going through is out of the ordinary, and may not think to ask for help.

OCD in children can easily be mistaken for behavior and attention issues such as ADHD, especially when the symptoms interfere with schoolwork. Kids and teens may also be more likely to involve family members in their compulsive behaviors and rituals. For example, a child may demand that his or her family join in lengthy washing rituals around mealtimes or may refuse to go to bed until a parent joins in a checking ritual. When OCD begins in childhood, there is also a higher likelihood of the child having other disorders as well, such as tic disorders, attention deficit hyperactivity disorder (ADHD), and other anxiety disorders. Genetics may also play a larger role in OCD if it first appears earlier in childhood.

How OCD Can Impact Relationships: Examples

Example #1: Joshua’s Story

Joshua’s problems with obsessive thoughts about violence began when he was a teenager, but when he and his wife, Rachel, brought their firstborn daughter, Amy, home from the hospital things worsened dramatically. He began having intrusive thoughts of harming his beloved infant on a daily basis. Thoughts about punching the baby, dropping her down the steps, and even putting her in the microwave, came to mind and created an enormous amount of distress. Of course, Joshua loved his baby with all his heart and never acted on any of these thoughts. They were the exact opposite of his usual personality. Still, Joshua believed he was an awful parent for having these thoughts and was at a loss for what to do. He couldn’t tell anyone about the obsessions — they’d surely lock him up! — so he avoided having anything to do with his baby. This was a disappointment to Rachel, who didn’t know what was happening and soon resented that she was changing all the diapers, doing all the feedings, and giving all the baths without any help from Joshua. Joshua and Rachel’s relationship went downhill. They had endless arguments over caring for Amy, and the level of stress in their relationship became very high. This added stress of course exacerbated Joshua’s OCD symptoms. Joshua even moved in with his parents for a short time.

Mary, who had suffered from OCD since childhood, married her high school sweetheart, Tom, at the age of 21. Her obsessions focused on the fear of contamination from germs from strangers. She was specifically afraid of contracting the AIDS virus. Her compulsive rituals included washing, showering, and changing her clothes whenever she thought that she might have been exposed to HIV, and she involved Tom in many rituals as well. For example, she would ask Tom for reassurance about the chances of getting AIDS from doing activities such as touching a doorknob or using a public restroom. Tom helped Mary wash off all mail and groceries that were brought into the house. At times, Mary would call Tom in the middle of the day to leave his job and come calm her down. Tom complied willingly with Mary’s compulsive urges — after all, he couldn’t stand to see Mary suffer. What if she had a “nervous breakdown” or something? He ended up doing just about everything possible to prevent Mary from ever having to suffer from obsessional fear. When Tom and Mary came to our clinic for therapy, Tom was performing compulsive rituals for Mary almost as often as Mary was performing them herself.

Example #2: Mary’s Story

Both Joshua’s and Mary’s stories show how OCD can negatively impact close relationships such as marriages and partnerships. Joshua’s story is rather straightforward. His symptoms led directly to avoidance, which angered his wife and led to arguments and havoc in his relationship. But Mary’s story is a little less straightforward. She and her husband, Tom, rarely had arguments over OCD. Tom showed his love for Mary by keeping her as anxiety-free as possible. But OCD had become a part of their relationship. Their life as a couple was centered on helping Mary complete her rituals and avoid being in distress. It was like OCD was another family member. On the surface this kind of caretaking might seem like a wonderful way for Tom to show his love for Mary, but the fact was that that this pattern only made Mary’s problems with OCD worse. As much as Tom hoped that Mary could get over her problems, and as much as he reassured her that she was not in any danger from getting AIDS, Mary continued to suffer. Ironically, Tom’s accommodation of Mary’s symptoms played a large role in why Mary continued to suffer with OCD.

Treating OCD When it Affects Relationships

Cognitive behavior therapy (CBT) using the techniques of exposure and response prevention (ERP) is the most effective treatment available for OCD — it often leads to a 60% to 70% reduction in obsessions and compulsions. 

• In ERP, kids learn to face their fears (exposure) without giving in to compulsions (response prevention).
• A licensed mental health professional (such as a psychologist, social worker, or counselor) will guide them through this process, and children will learn that they can allow the obsessions and anxiety to come and go without the need for their compulsions or rituals.

Psychiatric medication may be considered if the child’s symptoms are very severe and/or not helped by ERP alone.

Explaining ERP-Exposure and response prevention

A specific kind of antidepressants known as serotonin reuptake inhibitors (SRIs) have been found to be helpful in reducing OCD symptoms in children and teens, making ERP easier to do and more effective

There are 2 main ways doctors and therapists help kids with OCD. Exposure and response prevention (ERP) therapy is one way to help you with your OCD. Medication is the other way. Taking medication is not the best idea for everyone, and your doctors can tell you and your parents more about whether certain medicines might be good for you. A lot of times, doctors recommend trying ERP first. This article describes what ERP is like and how it can help.

Doing ERP for OCD is sort of like going to class to learn about OCD from an OCD expert. Actually, expert OCD therapists are like teachers and coaches. They can help you and your parents:

• Learn what OCD is
• Learn how OCD tells lies and plays mean games with you to get you to feel bad about things you shouldn’t feel bad about at all
• Learn how to say “no” and disobey OCD so that you feel better
• Practice disobeying OCD at home (and maybe even at school) so you can feel better there, too

OCD usually feels even scarier when kids and parents don’t know much about it. In ERP, your therapist will teach you about OCD. He or she will tell you the symptoms of OCD, what might cause OCD, and who gets OCD (which can be everyone from adults to kids, teenagers, grandmothers, and grandfathers — you are not the only one with these kinds of thoughts). Learning about OCD can help you understand how OCD makes people scared. It can also help you understand the ways experts help people with OCD and what you and your parents can do about OCD so that you feel better.

OCD can trick you by telling you that you should feel worried and guilty about the weird thoughts that sometimes pop into your head. Sometimes OCD even tries to convince you that you are a bad person. Your therapist can teach you and your parents how OCD fools people. Your therapist will also show you and your parents how to spot OCD’s mean games on your own so that you and your parents can see how OCD is making you feel scared and guilty when you don’t deserve it!

One of OCD’s biggest games is to trick you into doing things that will make your OCD thoughts go away (things like washing your hands over and over, asking your parents if everything is OK over and over again, or forcing yourself to read or write something over and over again), but that really make your OCD thoughts even worse. Doing these things might make you feel better for a few seconds, but not for very long.

For example, have you ever washed your hands until you thought they felt clean and felt better for a few seconds? But, did you then started worrying that you might not have done a good enough job washing them? And then, did you start worrying that you should go back and wash your hands again, even more than you did last time? Or, have you ever asked your mom if everything was OK, felt better for a while, but then thought of another reason that you had to ask her more questions later on? Or, did you ever check to make sure that you had put your homework in your schoolbag and felt better for a few seconds afterwards? However, did you start worrying that you might have made a mistake and didn’t really see the homework in your bag? Then you felt like you had to check your bag again — twice this time so you could be sure?

Doing what OCD tells you to can make you feel better for a few seconds. But after a while, the good feeling wears off, and the scary feelings come back even worse than before. This can make you feel like you have to do even more of what OCD tells you to do the next time. ERP teaches kids and their parents how to disobey OCD and stop doing the things it wants you to do over and over again. This may seem scary at first, but your therapist can explain why it is the right thing to do and why it doesn’t make you a “bad person” at all.

ERP will help you and your parents understand how to disobey OCD one step at a time so that you actually stop feeling scared and guilty all of the time. Your therapist will coach you and your parents to practice disobeying OCD. Then, the therapist will teach your parents how to coach you to disobey OCD at home. Your therapist will also explain to you and your parents which things your parents should not do because they can accidentally make OCD worse.

The idea of disobeying OCD can be scary at first, but it will help! Your therapist will know how to help you get through this. He or she will help you and your parents practice saying “no” to OCD until you are able to do it all by yourselves. It takes some practice, but most kids think it is worth it in the end!

Learning and practicing ERP is sort of like riding a bike. It can be scary at first, but with help and practice, most kids get so good at it, it feels automatic, and they can’t even remember what it was like to need help with it.