For some parents, having a child who is neat, organized, cautious, and careful would be a dream come true. Obsessive-compulsive disorder (OCD) is diagnosed when your child takes the positive qualities of neatness, organizational skills, being careful, or cleanliness to the extreme. With this mindset, she is trapped in a pattern of time-consuming, repetitive thoughts and behaviors and she cannot necessarily accomplish what you might think she should. For instance, she will take an hour-long shower that she is hoping will give her a cleaner body; unfortunately, instead she will get red, raw skin, and might walk out of that shower still thinking she needed to clean herself more. Young children find it difficult to recognize their behavior as useless, but older children are more aware but still find the pattern impossible to stop. These maladaptive obsessions (thoughts) and compulsions (behaviors) can easily imprison your child, and sometimes, your entire family.
Obsessive-compulsive disorder usually starts between the ages of six and fifteen for boys, while for girls it often begins later, between the ages of twenty and thirty. It affects between 1 to 2 percent of children.
There is no evidence that OCD is learned or caused by childrearing choices. Interestingly, OCD is more common among people of higher education, IQ, and socioeconomic status. When in adolescence or older, men and women are affected equally.
An obsession is an unwanted thought or impulse that repeatedly occurs in the mind of the child. Repeatedly, the child experiences a disturbing thought, such as, “My teeth are yellow, I have to brush them”; “I think I left my homework on my desk at home, I am going to fail this class”; or “I am going to mess up this relationship with my friend, I know it.” These beliefs are felt to the point of being intrusive, consuming, and unpleasant. The obsessions seem uncontrollable to your child and if she does not manage the thoughts through behaviors, she feels she might lose control of herself. Obsession with germs or body fluids and reoccurring doubts are among the most common.
Compulsions are repetitive behaviors that are clearly excessive, but temporarily lessen the tension and anxiety caused by the obsession. Compulsions can include hand washing or checking behaviors, such as repeatedly making sure their belongings are where they should be, hoarding objects, counting, repeating words, or praying. Because compulsions become rituals, they take long periods of time, even hours, to complete (particularly if interrupted), which can feel very frustrating to the parent or others who don't understand the child's behavior.
Children who engage in repeated hand washing intended to lessen anxiety about contamination commonly end up with raw skin and dermatitis. Lip-licking and sucking on hands or fingers can have similar results. Be sure to treat these signs early on.
Being able to recognize if your child has obsessive-compulsive disorder can be challenging. Sometimes your child's behaviors will appear obstinate or even lazy. When children obsess, it makes it hard for them to get anything done, especially if there are many items on a list, like chores. All you see as a parent are the hours they spend in the bathroom, or their bedroom, without much being accomplished. At home, children with OCD may have a combination of the following symptoms along with those presented earlier for generalized anxiety:
Intrusive thoughts and repetitive behaviors
Extreme distress if their rituals are interrupted
Difficulty explaining their behaviors
Seeking repeated reassurance about safety
Attempts to be secretive about their obsessions or compulsions
Feelings of shame about the compulsion
Feeling they can't stop the obsessions or compulsions
Thinking they might be “crazy” because of their thoughts
At school, the teacher might see:
Isolating or withdrawing from friends
Low self-esteem socially or academically
When a child has OCD, peer relationships, school functioning, and family functioning may all suffer. Depression, hair pulling, constantly feeling sick, anorexia or bulimia nervosa, panic disorder, GAD, or social anxiety disorder may develop. For some children, social isolation may increase because of extreme anxiety and a need to limit activities may result. Some children may have thoughts of self-harm.
Because your child may feel ashamed and embarrassed about his OCD, it might be hard for him to talk about. When it all stays in his head, it becomes even more difficult to stop his thinking and your child may even start to wonder if he is crazy. With OCD patience really is a virtue, and that means you will need to take care of yourself as well. See Appendix B of the book for a Web site that will connect you with other parents who also have children with OCD to gain the support you need.
Environmental stressors such as abuse, changes in living situation, illness, occupational changes or problems, relationship concerns, and school-related problems can worsen OCD symptoms.