By Kathryn Millán
Obsessive-compulsive disorder (OCD) is a diagnosis that describes a pattern of extreme anxiety and obsessive thoughts in an individual that result in repetitive actions to manage distressing emotions.
Unfortunately, when a person has OCD, these compulsive actions do not directly address underlying anxiety. Compulsions only make life more difficult over time, and may stop a child from enjoying everyday life.1
Just a few common fears that children with OCD exhibit may include fears that somehow their actions or lack of actions could hurt their loved ones, fears of germs or contamination, or fears that they may suddenly behave in violent ways. These fears are often not logical, but children with OCD still try to relieve their anxiety through compulsive behaviors.
Oftentimes, these behaviors do not actually do anything to realistically change the things the kids worry about. For instance, a child who is afraid of illness may feel a compulsion to touch his left arm every time he even accidentally touches his right arm (symmetry compulsions) or he may obsessively organize his toys in an attempt to restore calm feelings (cleanliness compulsions).1
Compulsive behaviors in OCD may include, but are not limited to hand washing, lock-checking, over-organizing or repetitive movements. Children with OCD may exhibit slightly different behaviors than adults. Along with the same symptoms adults with OCD experience, children with OCD may:
- Constantly ask parents or others for reassurance
- Seem irritable, stubborn or resistant to change
- Anxiously arrange toys or objects until they seem “just right”
- Become very frustrated when asked why they exhibit repetitive behaviors
- Develop nervous movements, such as lightly touching objects or their bodies in symmetrical ways
- Appear to be bound by rules and inflexible about change
Children who have OCD often do not recognize that their fears are illogical. They may lack the vocabulary to describe their anxieties, or they may not understand the thoughts that drive their compulsions.
Children may not be able to understand the link between increases in their anxieties with real-life stressors such as moving to a new city or school and experiencing traumatic events or stressful school situations. Also, they often do not understand that OCD may run in families and manifest itself in many different ways.1
Rule Out Other Disorders: Is It OCD or Is It PANDAS/ PANS?
In many cases, it can take some time to determine if a child has OCD or another condition. It is very important to obtain a full diagnosis for your child before determining that he or she has obsessive-compulsive disorder. Thyroid issues, vitamin-intake issues and many other treatable health conditions may cause increases in anxiety. Autism and related conditions may also lead to OCD-like behavior.
One condition that may be confused with childhood OCD is known as PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. PANDAS is a very unique condition that occurs when OCD or a tic disorder suddenly appears in a child who was not anxious before.
PANDAS occurs in a small number of children after they are exposed to strep throat (streptococcal bacteria — a bacterium that is also related to scarlet fever). PANDAS usually has a sudden “out of the blue” onset, and it may cause your child to exhibit many symptoms associated with OCD.2
PANDAS occurs when a child’s immune system mistakes normal body cells for strep bacteria and attacks healthy cells. At this time, research indicates that this disorder appears to occur in children under the age of 12 and is still a very rare condition.2
If you are concerned about PANDAS or any other health-related disorder, your pediatrician or clinical team can help. Often, simple testing and a full background history provide clear information about the best way to proceed with any successful treatment.
Using Cognitive Behavioral Therapy to Treat OCD
Children and adolescents can experience great relief from OCD with the right treatment. Cognitive Behavioral Therapy (CBT) is a proven method that has been used successfully in children, adolescents and adults who struggle with obsessions and compulsions.
Cognitive Behavioral Therapy works because it is led by a licensed mental health provider who helps children explore, identify and understand their thoughts more clearly. It empowers children with new skills to understand which behaviors are helpful and which behaviors are not helpful. Through play, art and talk therapy, children become aware of their coping mechanisms and build new, better ways to handle anxieties. CBT also helps children identify which fears are rational and which are irrational, so that they can adjust their reactions to fear through self-soothing and use of their support system.3
OCD and Your Child
As a parent, you want your child to have the healthiest, happiest life possible. It can be incredibly distressing to see your child struggle with anxiety and compulsions. You don’t have to worry alone. Treatment for children and their caregivers can help your entire family build skills and methods that will help ease stress for everyone in your household.
1 Child Mind Institute. OCD: What is It? Nd. Web. Retrieved 8 Apr 2018.
2 National Institute of Mental Health. PANDAS—Questions and Answers. Nd. Web. Retrieved 8 Apr 2018.
3 Aarhus University. Cognitive behavioral therapy for children and adolescents with OCD works in the long run. ScienceDaily. 14 November 2017.