Written by Dr. Joshua Harwood
Josh is a chartered clinical psychologist specialising in working with children and families.
Many children have rituals and routines as part of their everyday life. They may want the same story to read each night repetitively, or they may want to drink with the same cup or wear the same t-shirt. These behaviours are normal. However, when rituals begin to interfere with school or home life, or start to cause distress it may be a sign of Obsessive Compulsive Disorder (OCD).
It’s an unhelpful myth that OCD is about perfectionism or liking to have things super-clean. OCD can be extremely distressing and have a major impact on family life. OCD is distressing for the child experiencing it, but it is also extremely stressful for parents and carers. If you believe your child or teenager may be struggling with OCD and the associated anxiety, it’s important you seek appropriate professional support
In the meantime, you may find it helpful to learn a bit more about OCD and some tips and tools you can use to help your child manage their condition.
How do I know if my child has OCD? Signs and symptoms to look out for
The most common symptoms of OCD in children and teenagers are obsessive, unpleasant thoughts, compulsive behaviours and high levels of anxiety.
What are obsessions?
Obsessions are repetitive and controlling thoughts, urges or images that are intrusive, unpleasant and unwanted. These thoughts might be understood as being irrational, but they are also very real, repetitive and uncontrollable. Your child may believe the only way to stop the thoughts and the anxiety they cause is to undertake certain behaviours (or compulsions). Common obsessions in children and teenagers are:
- Symmetry - needing things to be visually symmetrical or performing behaviours to both sides of the body.
- Germs and contamination.
- Harmful events - believing that bad things could happen to loved ones or that the young person might cause harm to a loved one.
- Disgust at bodily waste or secretions.
- Order and exactness.
- The need to tell or confess intrusive thoughts.
- Religious obsessions, such as “am I being true to my religion?”
- Sexual obsessions, such as “am I gay?”
What are compulsions?
Compulsions are the visible behaviours of OCD. They are repetitive or ‘ritualised’ behaviours or mental acts that your child feels they must do as a response to their obsessive thoughts. These ritualistic behaviours are performed to prevent an objectively unlikely event resulting in harm, which otherwise might happen, and thus reduce the anxiety or distress that results from the intrusive thoughts. However, the relief gained is only temporary.
Compulsions may be visible actions or behaviours, or invisible within the mind or thoughts.
Common visible compulsions in children and teenagers include:
- Repetitive hand washing
- Checking switches
- Walking through doorways multiple times
- Having to touch certain objects a specific number of times or in a specific way
- Constantly seeking reassurance
- Putting clothes on in a specific order
- Going through very set routines that cannot be changed.
Common invisible compulsions include:
- Counting in the head, counting steps
- Repeating phrases or words
The compulsions your child may experience are often excessive or not logically linked to preventing the obsessive thought. They may be time-consuming and cause your child to struggle with school and family life. They will be neither enjoyable nor useful.
If your child or teenager is not able or allowed to perform the compulsion, they might experience high levels of anxiety and distress. In young children this may be exhibited as tantrum behaviour.
OCD can be extremely distressing for your child. They may be able to recognise that the compulsive behaviour is not rational, or they may enlist family members in the compulsion or through reassurance. They may try to conceal these behaviours in public, which can make it worse at home. This doesn’t mean that these behaviours are voluntary or not indicative of OCD.