OCD in children

Most clinicians won’t see many children with OCD, which leads us to believe that many young people must be suffering in silence. Treatment is effective and can make the world of difference to a young person’s quality of life. If you have concerns, my advice is seek some help.

Dr Sabina Dosani - MBBS, MSc, MRCPsych

What is OCD?

Obsessive Compulsive Disorder is a serious anxiety related condition where individuals experience frequent obsessional and intrusive thoughts (or obsessions), often followed by uncontrollable urges and compulsions.

Perhaps the most frustrating thing for children with OCD is that they often know that their fears are irrational, but simply can’t control them.

The World Health Organisation have classified OCD in the top 10 of disabling illnesses because the condition can be so powerful that normal daily life can be impossible.

What are obsessions?

Obsessions are persistent thoughts or worries that can be disturbing in nature and interfere with a child’ ability to perform daily tasks. The obsessions can be so powerful that are impossible to ignore and children with OCD can feel compelled to act out the compulsions (see below).

A key part of obsessions is that they are accompanied by extreme anxiety, making the child experience:

• Dizziness
• Nausea / vomiting
• Racing heart beat
• Low mood / depression

Common obsessional thoughts and fears in children include excessive:

• Fear of contamination from other people, objects, clothes, books or food
• Fear of harming someone else
• Concerns about the appearance of homework or themselves
• Doubts about shutting doors, switching off lights, packing school bags etc
• Superstitions that something bad will happen if a certain behaviour is not carried out
• Arranging of items such as shoes, food, toys, items in bedrooms

What are compulsions?

Compulsions are the second component of OCD and are repetitive physical actions or behaviours, which once carried out alleviate the extremely anxious feelings that the obsessions create.

Common compulsions in children and adolescents include:

• Repetitive washing of hands, hair or the whole body
• Touching certain parts of their body in a ritualised or specific pattern
• Avoiding certain situations
• Cleaning religiously and often starting again if the individual believes they haven’t done a good enough job
• Arranging objects in a certain manner or pattern – disruption of which can be hugely traumatic
• A ritualised bed time routine
• Repetition of certain words, phrases or counting (this can be in audible or silently to themselves)
• Seeking continuous reassurance

OCD is a vicious cycle

One of the reasons OCD can be so hard to tackle without professional help is that compulsive behaviours provide only temporary relief from the obsessional thoughts and may end up reinforcing the anxiety cycle.

This is because they reinforce the idea that if the compulsion is carried out, the obsessional fear won’t happen. This cycle is very hard to break without support, which is why we would always urge parents who have concerns about their children to seek help.

How can I help my child with OCD?

Parents and children often feel relieved to have a diagnosis of OCD, as they have often suffered for a long time. The good news is that effective treatment for OCD in children is available.

The first step in helping your child is to make sure they receive a thorough diagnosis, as often the OCD can accompany another condition, such as autism or depression.

CBT, talking therapies and medication can all be used to help children and teenagers with OCD. CBT is a highly effective at treating OCD. Specially trained therapists will work with your child to gently increase their tolerance, through various exposure techniques, in a process called habituation. Whilst this might sound scary, in practice the exposure starts very slowly and builds as your child gains more confidence.

We offer parenting support and family therapy to help support the whole family through the treatment process. Research has shown that this can significantly improve the recovery rate for the child or teenager.

When I assess children with OCD, there are sometimes other conditions present as well. It’s important for me to get a full idea of the struggles your child is going through, as sometimes the anxiety cannot be dealt with properly until any other conditions are being managed.

Dr Sabina Dosani

MBBS, MSc, MRCPsych

Consultant Child & Adolescent Psychiatrist

London

Dr Sabina Dosani is a highly experienced Consultant Psychiatrist currently working for the Anna Freud Centre looking after Children and Adolescents. She has a Bachelor of Medicine and Bachelor of Surgery as well as being a member of the Royal College...