Obsessive-Compulsive Disorder

27 Aug

    From Your Anxious Child: Emails to Parents by Edward H. Plimpton, PhD                                    

                                              Obsessive-Compulsive Disorder

The condition commonly called OCD is not the same as being “obsessed” with football, gardening or “Dancing with the Stars”. To have a strong, consuming interest is not the same as having OCD. In OCD there is an intense preoccupation, which causes considerable distress, and which the individual seeks to get rid of through a series of actions which are known as rituals.  Because of the excessive and often time consuming nature of these rituals, or compulsions, and the emotional distress involved, they begin to interfere with everyday life. Perhaps the most well-known OCD ritual is hand washing, which can be carried out to such an extreme that the hands become red and chafed. But rituals can also take on the form of questions which are repetitive such as, “Are you sure you know the way home?” or, “Are you sure I don’t have cancer?” in which no amount of reassurance seems to put the matter to rest. And with some rituals there is a clear superstitious or magical element, as when a child might tap his foot a certain number of times.  Some rituals do not involve an overt behavior but rather consist of having to have a “good thought”  in order to undo a” bad thought.”  There are several sources for the distress that this condition causes. First, the awareness that the rituals do not make sense and that other people don’t share their concerns. Second, with intrusive thoughts, the child might feel, “If  I am having these bad thoughts I must be a bad person.” Third, the intense discomfort that occurs from the obsessions and consequently the difficulty in not acting on them. The rituals really do provide some momentary relief and consequently become quite compelling. The unfortunate problem is that the rituals begin to act like an addiction so that the more you do them the more you have to do them.

There are a number of good books for parents on this topic: Tamar Chansky  Freeing Your Child From Obsessive-Compulsive Disorder, John March with Christine Benton Talking Back to OCD, and Dawn Huebner What To Do When Your Brain Gets Stuck: A Kid’s Guide to Overcoming OCD,  to name just a few.  And don’t get discouraged if your child appears to be dealing with OCD. It is actually one of the more treatable anxiety disorders providing the therapist is trained in cognitive behavior therapy using exposure and response prevention.  There is some emerging evidence that children who receive treatment for OCD may not necessarily retain their symptoms into adulthood, or at least the severity will be greatly diminished.  The reason to take action is simple: we don’t want the child to accumulate the hours of practicing the OCD habits that will then create an entrenched way of doing business, and early intervention can interrupt the development of this habit.  Additionally, don’t be surprised to discover that some of your best intentioned efforts to help your child, while they may have provided short term relief, actually made the problem worse over time. Our default reaction as parents is to provide comfort and reassurance when there is distress, but in the landscape of OCD such reassurance is not helpful. This is not to say that you should stop being empathic and caring with your child, but rather that there are skills that need to be learned. It is not straight forward, but then again neither is OCD.

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