Kelly Scott Moroz, April 2011Obsessive Compulsive Disorder in Young Children
This edition of Practical Child Psychology surrounds a self-reflection school assignment submitted by a twelve year old female client; she receives psychological support through our office to help manage her Obsessive-Compulsive Disorder symptomolgy. Though this article by no means attempts to address the complexity of the recommended treatment for this population, Exposure plus Ritual Prevention, it is intended to highlight a few key principles that need to be considered to both detect and then assist these individuals in overcoming their condition.
What is OCD? OCD, in other words Obsessive-Compulsive Disorder, is when people have thoughts that go through their minds, and they don’t go away. In some cases, people develop a routine and it is very hard to get rid of. They only do the routine to get a thought out of their mind, like, “I am going to get sick if I don’t blow my nose,” and that is how the routine gets started.
Why do kids get OCD? OCD is very common. It is not something that is contagious but it’s something you are born with. Metaphorically speaking, your brain had a glitch. This glitch lets bad thoughts in to your brain and does not know when to let the thoughts go.
OCD tricks. OCD almost seems like something in your brain telling you to do all these things. The first trick is “sound the alarm.” It’s like a reflex when something bad is about to happen. You feel that you need to make sure that you’re safe and that routines will accomplish this. The second trick is “the maybe game.” The maybe game is when something pops up in your head like, “What if there are germs on my hands?” and then you start thinking, “Maybe then I might get sick,” and so on. Then your mind tricks you into washing your hands, perhaps several times.
OCD tricks continued. The third trick is the disappearing “just right” feeling. Usually people don’t notice how it feels to sit in a chair or hold a doorknob etc. People with OCD do notice these things, and they have to make sure it feels just right. They have to do it over and over again until it does feel right.
The Tools. People with OCD don’t want to live the rest of their life like this. There are tools to overcome OCD. The first tool is “I spy.” OCD tries to hide with your other thoughts and turn them into something else. I spy is when you have to find out where OCD is hiding and catch it. The second tool is “talk back.” Talk back pretty much explains itself, but when OCD is trying to pop up in your brain, you talk back to it and tell it off. The third tool is “showing OCD you’re the boss.” OCD is always telling you what to do. Boss it back by saying “No, you’re not the boss I am.”
OCD is a slow learner. When people have OCD, it’s very hard to get rid of. It takes time and small steps. Step by step you have to resist the urge to do what OCD is telling you to do. Eventually you will be totally capable of handling OCD by yourself. You will not need to use the tools, but you’ll always have them in case OCD comes back.
What I have overcome. I have overcome OCD. When I was younger I didn’t really notice as much, but I did notice that there was something in my head telling me what to do. This past September, our beloved Bernese Mountain Dog, Jasper, paced away. We were very upset. I’m not positive, but I think this might have triggered the OCD. So I started a very, very long routine which included looking under the bed, looking in the closet, looking in the window seat, looking out the window, and more. I had to get all these things perfect and it was very hard. I told my parents about all these odd behaviours and we went to our family doctor and he suggested a psychologist. The psychologist has helped me so much. I don’t look under the bed, in the closet, in the window seat or out the window any more. I don’t have many routines anymore. There are a few little things, such as counting on my fingers, but I use breathing to help me overcome the urge. I have practically overcome OCD, but I need to keep aware of the possibility that it can come back at any time.
There are a few key principles that must be highlighted in examination of this self reflection writing piece. With the superstitious nature that surrounds this challenge, I find that the development of the therapeutic relationship is of even greater necessity when working with this population. The techniques utilized to help the client gain his or her life back require them to necessarily do the opposite of their intuition, and face feared situations head on. It forces the client to risk the very dangers that their own behaviours have been designed to avoid.
Another thought generated from this report is how absolutely heterogeneous this population tends to be. Though there are some definite commonalities among these clients (most notably, that they tend to engage in particular behaviours so as to reduce their stress levels in the immediate moment), the types of thoughts that they endure and the mental or behavioural compulsions that they engage in to reduce these stress levels are unlimited. With children and teens, however, I notice an obvious increase in worries about the health and safety of pets and family members. There tends to be an increase in compulsive behaviours and rituals surrounding bedtime routines or the placement of objects in their own bedrooms. Some of these routines involve looking at or touching objects until it ‘feels right’ to them.
The speed with which this disorder can take over somebody's life can be astounding. I notice that, prior to the onset of their OCD symptomology, these children and teens tend to worry differently than clients who later present with more typical forms of anxiety. Though it can be challenging and even unproductive to search for the precise initial event or trigger, it often seems the case that one particular incident can drastically magnify these thoughts and resulting compulsive behaviours. Parents are often put into a difficult position of unknowlingly contributing to the escalation of the problem by continouslt providing reassurance or even helping their child engage in the ritualistic behaviours. Continuing to engage in these routines is like drinking salt water to quench one’s thirst; every sip of this water puts the individual even further away from their goal.