“Something’s different about Johnny…”
Johnny used to be a happy-go-lucky, active boy, who enjoyed spending time with his friends and doing well in school. In the past few months, however, he has lost interest in what he used to enjoy.
While he has always been into being healthy, things took a turn for the worse after he heard about virus outbreaks on the news and has since become obsessed with getting sick. He has begun to take multiple daily showers and has also taken to washing his hands so often that it is to the point that his hands are raw to the touch and on the verge of bleeding.
Going out into public has become nearly impossible for Johnny, as he fears contamination from contact with people, doorknobs, restroom faucets, etc. He has since begun to avoid going to school, has started to give any excuse he can muster up to not see friends and has even quit his favourite sports teams.
When it comes to childhood-onset of OCD the case of Johnny is illustrative of a number of things, many of which relate to these five words—The Power of the Mind. The brain has many functions, one that is particularly relevant and important is that of helping to protect us from harm. Things can take a turning point, much like the case of Johnny, when the thoughts that are intended to be protective, self-serving, and full of goodness become obsessional.
Obsessive Compulsive Disorder in childhood
To set things straight…having “just enough” obsessive compulsiveness or perfectionism can be helpful in the right situations. However, whenever such symptoms get so severe that they:
- make no sense,
- cause distress,
- lead to a person no longer feeling in control,
- and ultimately become so time-consuming that they negatively interfere with a child’s daily life…
→ the condition that may be present is that of a type of anxiety disorder, known as, Obsessive Compulsive Disorder (OCD). OCD is said to be childhood-onset if symptoms such as obsessions and compulsions occur before puberty.
What is OCD?
In a nutshell, those with OCD become preoccupied with upsetting or scary thoughts or images (called obsessions), which pop into their mind and are really hard to shake. Obsessions can be thought of as an ‘Oh no, oh no” panic-stricken type of experience. This, in turn, leads to a rise in anxiety that is so strong that one feels strong urges to do certain things repeatedly, over and over again (called rituals/compulsions), in order to try and do away with the scary thoughts. Such compulsions, by turn, can be thought of as an ‘Ahhhhhh’ relief-laden type of experience.
Common forms of Obsession in Children and Teens
While Johnny’s obsessions involved a fear of germs, contamination and contraction of illness, there are many other common forms of obsessions found among children and teens, including:
- A need for symmetry, order, and precision
- Sexual and/or aggressive thoughts
- Marked over-concern with the appearance of homework assignments
- Fears of accidentally harming a parent, sibling, or friend
- Superstitious fears that something bad will happen if a seemingly unconnected behaviour is done
Common Compulsions experienced by children and teens with OCD
Johnny’s effort to do away with the obsessional thoughts of germ-contraction took the form of him washing excessively and avoiding any situation that would pose as a risk. Other common compulsions experienced by children and teens with OCD include:
- Counting rituals
- Compulsive reassurance-seeking from parents/teachers about not having caused harm or made a mistake
- Repeating rituals: such as going in and out of doorways, rereading, erasing, rewriting, and/or needing to move through spaces in a special way
- Compulsive repetitions of certain words or prayers to ensure that bad things don’t occur
- Avoidance of situations in which they think ‘something bad’ might happen
The OCD cycle
Many children have a hard time explaining a reason for their rituals. Explaining that they do them ‘just because’, or that ‘they need to’. Herein, lies the sticky business of OCD…
- While compulsions/rituals do decrease the anxiety, they do so only temporarily.
- In actuality, compulsive behaviours reinforce and sustain what-ifs. The more one acts on a repetitive urge to do away with obsessive thoughts/images, the more one creates a self-perpetuating cycle of fear and avoidance.
Since kids naturally feel concerned about fitting in with their peers, the discomfort and stress brought on by OCD can make many feel out of control, scared, shameful, and alone. To make matters even more higgledy-piggledy, many who have OCD often have secondary conditions, such as ADHD, Tourette’s syndrome, learning disabilities, and/or depression.
Help for the child struggling with OCD
Let it be clear that OCD is not a result of something that a child, parent, or others did wrong.
Watching your child struggle with OCD can lead to many parents feeling helpless. While there is no ‘cure’ for OCD, there is still hope because OCD is very treatable!
One such form of treatment is that of therapy. When providing therapy to children who present with obsessive-compulsive symptoms, my aim is to ultimately help a child:
- regain a sense of control over the OCD by means of helping them to discover what rules, triggers, and impacts the OCD has for them, and begin to make way for preferred developments** This takes the form of helping a child reconnect with times in their life where the OCD did not take control over their mind and behaviour to then open the door for discoveries of more helpful thoughts and more purposeful behaviour.
- learn ways to boss away their obsessions and find ways to cope with uncertainty, worry, and similar such experiences in such a way that leaves them feeling as calm as can be, rather than overtaken by distress.
- ….. and ultimately, to work towards having a child walk away with a sense of how their mind really is a wonder and how they can use it to their advantage!
Your child’s future success does not have to be limited by OCD.
Online Resources about Childhood onset of OCD
For those of you who are interested in learning more about childhood onset of OCD, here are a few online resources to get you started:
- OCD in Kids: ocfoundation.org/ocdinkids
- International OCD Foundation: iocdf.org
- Canadian Institute for Obsessive Compulsive Disorders: ictoc.org
- Tourette Syndrome Foundation of Canada: tourette.ca
- ACCAP – American Academy of Child and Adolescent Psychiatry: aacap.org
Contact Toronto Psychological Services at 416-531-0727