When my son was little, I pictured his teenage years as a period of angst and rebellion as he matured through period self-discovery and independence. What I was unprepared for was the life-changing diagnosis of obsessive compulsive disorder (OCD). By sixteen, Sean was supposed to worry about girls and colleges. Instead, he is immersed in anxiety and ritual.
OCD is an anxiety disorder characterized by repetitive thoughts and compulsive behaviors. It is a chronic illness that is both difficult to diagnosis and treat.
It is estimated that 1 in 200 children suffer from OCD.1It is hard to know, exactly, what causes OCD in children. Some researchers speculate it is genetic, others think it is environmental or related to brain chemistry, and still others are exploring the possibility OCD can be caused by a prior strep infection.
Regardless, children who exhibit OCD behaviors ruminate in anxious thoughts and wish to relieve those thoughts through compulsive, repetitive behavior. In Sean’s situation, he is a compulsive hand-washer. At first, his diligence to the hand washing was admirable. His Father and I thought nothing of his conscientious effort to keep clean. Over time, however, true compulsive behavior becomes uncontrollable. No longer was his washing his hands pre or post meal, he was washing them after picking up the remote control or a few times through dinner. He started taking 4-5 showers a day and restricted his outings to avoid being gone to long without a possibility to wash or shower.
Some kids, like Sean, do benefit for cognitive behavioral therapy (CBT). This is a process by which patients attempt to retrain their brains to actively manage the disorder. The execution is intensely difficult and can be frustrating for the parent and child. In some CBT, patients are instructed to expose themselves to the anxiety (like germs) and then train themselves to delay or negate the compulsive for a period of time (like hand-washing). The belief is that the OCD will not go away, but rather, become more manageable over time.
Some practitioners will also suggest medication, such as an anti-depressant. In Sean’s case, this has been helpful to lessen the stress of the OCD – enough so that he can focus on the CBT. Unfortunately, medication in the pediatric OCD realm is tricky, since many practitioners believe children require higher doses than typical for treating depression alone. Although medication has side effects, each parent needs to decide the risk/benefit of treating a child with their physician.
OCD occurs much more frequently in our community than is discussed. Perhaps because it is not easily identified by casual observers or because it is misunderstood, it is not mentioned nearly as much as diabetes – although the rate per child is about the same. Some people believe it is simply an exaggeration of eccentric behavior, I assure you – it is not. OCD can be like a prison of the mind for a suffering child, and can be a terrible ordeal of accommodation and shame for the family. There are online communities and resources available, such as http://obsessivecompulsiveanonymous.org. With the right support, OCD can be better managed for both you and your child.
1March, J. & Benton, C. (2007). Talking Back to OCD. (pp.10-11). The Guilford Press.