Parents often ask me whether their child’s behavior is typical or something more significant such as Obsessive Compulsive Disorder (OCD). In my clinical experience, OCD is a term that is often misused in ‘pop’ culture. For example, I often work with parents who describe themselves as “OCD” because they are organized or meticulous in their everyday lives. These behaviors may be orderly or repetitive, but they do not necessarily indicate obsessions or compulsions. Another example is the junior high school or high school perfectionist I counsel who wants to have straight A’s and becomes upset if this does not occur. Again, this is not OCD although many individuals with OCD tend to have some tendencies toward perfection. Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you or your child have obsessive-compulsive disorder. Many people have mild obsessions or compulsions that are strange or irrational, but are still able to lead their lives without much disruption. In the case of obsessive-compulsive disorder, these thoughts and behaviors cause tremendous distress, take up a lot of time, and interfere with friendships, school functioning, employment, or relationships. Thus, the amount of disruption that occurs and the amount of settings (at least two) that are affected in one’s life help to define true OCD from someone who is orderly, ‘anal,’ or a perfectionist.
When it comes to determining the presence of OCD in children, the following need to be considered:
Children and adolescents with obsessive-compulsive disorder (OCD) suffer intensely from recurrent, unwanted thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these rituals, however, provides only temporary relief, and not performing them markedly increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person’s life.
It looks like this:
The Sequence of OCD Symptoms:
1) Evoking Event
2) Obsessing Begins
3) Distress & Anxiety
4) Urge to Ritualize
6) Relief and Self-Criticism
While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD. However, the symptoms of other disorders, such as ADD, autism, and Tourette’s syndrome can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made. It is also important to note that OCD is an anxiety disorder, and in children, the symptoms of anxiety usually change over time. So a child with OCD symptoms will not necessarily have OCD as an adult. What is most important is to make environmental and behavioral changes to help reduce your child’s anxiety and provide support, yet do not give in to the anxiety or change your routine significantly in response to it. Remember, some anxiety is good..it tells us when we need to fight or flee. Making too many accommodations for your child’s anxieties will only serve to reinforce the fears. As the old saying goes: If you see a ghost in a graveyard, you should run toward it. This is the essence of exposure and response prevention treatment for OCD, which will be detailed in future blog postings.
Dr. Mark Bowers is a Licensed Pediatric Psychologist at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.