Obsessive Compulsive Disorder

Obsessive Compulsive Disorder in Children & Teens

Description: If your child or adolescent appears to “get stuck” with specific thoughts or behaviors that may appear random, they may be experiencing Obsessive Compulsive Disorder (OCD). “Obsessions” typically present as unwanted or intrusive thoughts or images. Obsessions typically are associated with feelings of anxiety, distress, or discomfort.

“Compulsions” are behaviors that your child may feel compelled to engage in to lessen the distress they feel from the unwanted thoughts. Compulsions can be behaviors that can be seen, such as excessive hand-washing or needing to have items lined up perfectly, or they can be mental behaviors, such as counting or repeating certain phrases silently in their head.

Your child may resist your well-intended suggestions or may argue as they attempt to continue to engage in their compulsive behaviors, or as they attempt to avoid situations that they think will trigger their obsessions. Many children experience high anxiety, frustrated emotion, or panic attacks if they are prevented from completing their compulsions or if they are interrupted while performing a compulsive ritual. Your child may insist on completing the compulsion before they can move on or transition into the next activity.

Symptoms: There typically is a pattern, category or “theme” of unwanted thoughts and behaviors that are experienced with OCD. Some children may experience one category of OCD symptoms while other children may experience symptoms from several categories of OCD. OCD symptoms may also “morph” over time. For example, it may seem that your child has just recently conquered his germ obsession, but then obsessions related to fears of “not being polite enough” appear.

Some examples of symptoms your child may experience include:

  • Your child is fearful of germs and refuses to touch certain items that others touch such as doorknobs, stair railings or toilet handles, or your child washes his hands excessively throughout the day or depletes soap/hand sanitizer more quickly than expected
  • Your child has a sense of “over responsibility” for other peoples’ safety and believes that because a specific thought “popped into their head” (such as “My uncle might get into a car crash” or “grandma might get cancer”), they need to perform an action to “make sure the bad thing doesn’t happen” (such as placing an object into a “just right” position or saying a specific prayer silently until it “feels like I prayed enough”)
  • Your child fears they aren’t “polite enough” and that “something bad might happen because I wasn’t polite enough”; they may attempt to “make sure the bad thing doesn’t happen” by saying certain phrases aloud a specific number of times (such as needing to say “thank you” five times before being able to leave the interaction), repeatedly apologizing for their perceived infraction, or asking for your reassurance numerous times to make sure they didn’t hurt someone’s feelings
  • Your child is fearful they have a rare disease; they may repeatedly seek reassurance from you by informing you about every sensation they notice in their body or they may insist on going to the doctor for a medical evaluation frequently

Treatment: Our therapists use a combination of Cognitive Behavioral Treatment (CBT) and Exposure/Response Prevention (E/RP) to successfully treat OCD. We teach your child about OCD using age-appropriate language to help them realize that their symptoms are “not their fault” and to empower them with knowledge so they can “stand up to OCD”. Your child will learn body and mind calming tools to help them better manage the distressing physical and mental symptoms they may be experiencing.

An essential component of treatment for OCD includes Exposure with Response Prevention (E/RP) exercises. Exposure exercises are designed to help your child overcome their fears as they learn to gradually minimize compulsive behaviors in the presence of an obsession. The clinician will carefully monitor the pace of the exposure exercises to ensure that your child feels a sense of confidence in their ability to manage their own distress. This evidence-based treatment results in a lessening of symptoms and increased self-confidence.

Parental Involvement: Depending on the age of your child, treatment may involve parents and other family members. Parents of younger children will be more involved in guiding their child through treatment than parents of adolescents. It is common for OCD to affect the entire family as children try to avoid situations that may trigger obsessions, engage in excessive reassurance seeking, or take forever to leave the house due to repeated washing rituals. These behaviors can create discord within the family (and also continue to reinforce your child’s OCD). Our expert clinician will provide guidance to your family to help you disentangle from your child’s compulsive behaviors and teach you the best ways to support them for long-term recovery.

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