Jayshree loved music and dance. She liked to be with friends and participate in contests. However, a gradual change was observed in her attitude. She was unhappy with her performances and would spend a lot of time in perfecting her posture. She began to take more time in small tasks in her attempt to be perfect. She started avoiding her friends and spent more and more time brooding and worrying. Soon she became engrossed in her own world of getting things right, and numbers became her solace. She had to repeat routine activities a specific number of times like arranging books thrice, erasing her school work and redoing the same thrice; and her work never got completed.
Sruja, a 15-year-old girl, is studying in class 10. Her parents observed that she had become extremely argumentative, worried, and slow to complete tasks. Her mood remained irritable and she would fight with her sibling for no reason at all. As a child, she was said to be overactive and mischievous. But now, she was perennially found checking doors and windows, arranging shoes in order, taking a long time to bathe and avoiding eating dinner with family. Sruja preferred to eat alone to hide certain rituals she did while eating.
Why do Sruja and Jayshree think so much; why do their thoughts disturb them; what will be the outcome of such disturbing thoughts; are they suffering or are they just whiling away their time; can they control and get over these thoughts? Many parents must be having such questions of their own children.
Obsessive-Compulsive Disorder (OCD) is the name of the condition that causes children to behave this way. It is estimated that 1 to 5 out of every 100 children and youth have OCD in varying degrees.
What is OCD?
Obsessive-Compulsive Disorder (OCD) is a condition where children or youth have obsessions or compulsions.
Compulsions are behaviours that a child or teen feels forced to do, to relieve distress related to the obsession. For example, some children wash their hands over and over again to feel less anxious about being contaminated.
Obsessions are distressing thoughts or images that won’t go away. For example, a child may worry about being dirty or contaminated.
Researchers believe that OCD happens when people don’t have enough serotonin (a brain chemical or neurotransmitter) in the brain. Many things can contribute to OCD, like family history, stress, and in rare cases, a bacterial infection, usually a streptococcus or ‘strep’ infection.
Parents need to suspect underlying OCD, when their children are seen
- Avoiding touching family members because they are afraid of getting contaminated
- Washing their hands so much that hands become chapped and bleed
- Avoiding going to school due to fears of contamination
- Not being able to turn on the TV because others have touched it
- Spending hours every day consumed with cleanliness-related rituals.
As a result, children may have trouble paying attention, because the child or teen is so focused on obsessions or compulsions
- Have anxiety and anger if OCD routines get interrupted
- Display tardiness and fatigue owing to the time and energy needed for rituals
- Withdraw from usual activities and friends
- Try to get friends and family to cooperate with the OCD rituals.
- Everyone in a family is usually affected by a child or teen’s OCD; so everyone has a role to play in helping make things better.
If you think that your child has OCD, bring your child or teen to a doctor to make sure that there are no medical issues that might be contributing to the problem. Your doctor may then refer your child to a psychologist, psychiatrist or a children’s mental health centre.
How is OCD treated?
The two main types of treatment that can help OCD are:
Cognitive behaviour therapy (CBT)
CBT is a type of ‘talk’ therapy that helps children and youth learn new ways to think (‘cognitive’) and new ways to do things (‘behavioural’) to deal with the OCD. CBT is usually provided by a psychologist or psychiatrist.
For example, a child with cleanliness obsessions touches a school textbook and gets the automatic thought, “Now I’m all dirty and I’m going to get sick! I have to wash my hands!”
Cognitive techniques help children and youth come up with more helpful coping thoughts, like, “I’m not going to let the OCD push me around! So what if I’ve just touched the book? I’m not going to get sick. And if I do, I may miss school.”
As part of the therapy, your child or teen can rank compulsions on a scale of easy-to-resist, to very-hard- to-resist. When starting to work on OCD compulsions with a therapist, it is usually best to start working on easier-to-resist compulsions at first.
Medicines (like specific serotonin reuptake inhibitors, or SSRIs) can help balance the amount of brain chemicals. Medications can be helpful when other treatments aren't working. Medications may be needed for a short or long time, depending on your child's needs. In a very small number of cases, OCD is caused by a streptococcal infection (strep). In these cases, antibiotics can be helpful.
“Sruja is doing much better now”
Sruja’s parents brought her to the family doctor, who recommended a psychologist. After seeing the psychologist, Sruja and her parents learned all about cognitive behavioural therapy and ways to ‘boss back’ her OCD. The parents also learnt how to support Sruja in fighting the OCD. Sruja became less obsessed about perfection and numbers and is now considerably happier!
Interestingly, Sruja’s mother realized that she had had minor symptoms of OCD all her life, and now she benefited as much as her daughter by learning about OCD.
“How ironic life is,” thought her mother. “Here I was, constantly getting tensed up if the floor was not 100% clean and fine, and yet I suspected that my daughter was not alright!”
Parenting style is important
The child can get OCD:
- If we are overprotecting as parents
- If we give a lot of importance to cleanliness
- If we give more than necessary emphasis on order
- If we treat the child as an adult
Children must be treated according to their age; they should fall down to learn what getting up means; they should get dirty to learn how to clean up; they should face failure to experience the joy of success.
If children are treated as adults in their childhood, they may end up with adult-like issues. High expectations from parents that children should behave and remain silent in front of guests, that children should always be squeaky clean, that children should maintain discipline and follow certain ritualistic procedures, may all create conflict in the child’s mind.
If the child is unable to maintain these expectations, he may start feeling guilty and compensate with other acts to reduce the guilt. This now becomes a habit and the child cannot be comfortable without comforting rituals of his own.
Sometimes, parents also talk about sin or illness when certain religious procedures are not fulfilled by the child. Here the child starts feeling that he may be punished for neglecting God. So whenever the thought of neglect intrudes his mind, in order to escape the sense of foreboding, he gets into the habit of repeating some numbers or some actions.
My advice to parents would be to let their children grow without the restrictions of moral policing or fear of infection or health issues. Parents should remain calm in front of children, and avoid revealing their anxieties to children.
Common obsessions and compulsions
Obsession cleanliness or contamination
Child's Reaction: worries that things are dirty or contaminated. Leads to a compulsion of needing to wash or bathe over and over again, or avoid touching things that might be ‘contaminated’
Obsession symmetry & order
Child's Reaction: gets upset or distressed if things aren’t exactly ‘just so’ or in a certain order. May spend a lot of time arranging or re-arranging things in one’s room, workplace or other places
Obsession numbers & counting
Child's Reaction: counts or repeats things a certain number of times, having ‘safe’ or ‘bad’ numbers
Obsession self-doubt & need for reassurance
Child's Reaction: fear of doing wrong or having done wrong, which may lead to repetitively asking others for reassurance, over and over again
Obsession guilt/need to confess
Child's Reaction: needs to tell others about things that she or he has done
Child's Reaction: excessively checks things like doors, lights, locks, windows
Child's Reaction: excessive time spent doing things over and over again until they are perfect, or ‘just right’
Dr S Jayanti is a practising clinical psychologist from Hyderabad.