OCD in children : Debunking myths

child ocd
Children with OCD experience thoughts which are called obsessions and their behaviours in response to those thoughts are called compulsions. (Photo: Shutterstock)
Sometimes children might do things that do not make a lot of sense, and that is because they may occasionally have thoughts they feel like they should do something about. For example, they might insist on wearing a certain “lucky” shirt, otherwise their day would be filled with bad luck. اضافة اعلان

However for some children, these thoughts and the resulting actions are persistent and no matter how hard they try, they cannot make them go away. If so, then that may be the case of a child with obsessive-compulsive disorder (OCD).

What is OCD?

According to the Centers for Disease Control and Prevention, children with (OCD) experience “unwanted thoughts, and the behaviors they feel they must do because of the thoughts, happen frequently, take up a lot of time (more than an hour a day), interfere with their activities, or make them very upset”.

Children with OCD experience thoughts that are called obsessions and their behaviors in response to those thoughts are called compulsions.

For any thought, image, or idea to be considered an obsession, it must be unwanted, persistent, and extremely distressing and worrying for those experiencing it. As for compulsions, they must be done repeatedly in an attempt to relieve the anxiety experienced as a result of these upsetting and intrusive thoughts.

OCD remains a wildly misunderstood psychiatric disorder; even its classification has changed over the years, as we begin to understand more about it. During the previous edition of the DSM (the Diagnostic and Statistical Manual of Mental Disorders), it fell under the class of anxiety disorders due to the severe levels of anxiety it can bring, as well as the compulsions or rituals performed as an attempt to relieve such anxiety. However under the fifth and latest edition of the DSM, it now falls under its own class of “obsessive-compulsive and related disorders”.

There are many myths surrounding OCD in children, and the longer they prevail, the more difficult it is to battle this difficult disorder. Therefore it is vital to debunk some of these myths and update our knowledge on OCD in order to be able to be of service to those who have it, and not add to their anxieties. Here are some myths surrounding OCD in children:

‘OCD is not that common in children’

According to Jeff Szymanski, one of the world’s leading authorities on OCD and the executive director of the International OCD Foundation, at least one in every 200 children and adolescents has OCD. He even suggests that the age of onset can be as young as 4 years old. To put it in perspective, that is the same number of children with diabetes, and no one considers diabetes to be rare. Moreover, in half of the adults with OCD, the onset came before the age of 15.

There are no reported studies focused on OCD in Jordanian children, which only goes to prove how far behind we are in its research and, consequently, treatment.

Proper support for children with OCD should start with investing in regional and national research, and having available statistics that accurately reflect the reality of OCD in our region.

‘OCD is a result of childhood trauma’

Some people believe that a child who develops OCD had to have grown up in a dysfunctional and/or abusive home, or that he experienced some kind of major trauma that resulted in them developing OCD. The truth is that what happens to you in your childhood plays an insignificant role in having OCD.

While the cause of OCD is not yet known, research suggests that it may be a combination of brain problems and genetics. Most researchers believe that OCD tends to run in families. Studies have shown that people with OCD lack a chemical called serotonin in their brain.

‘OCD is all about being a neat freak and wanting things clean’

While it is true that obsessions with cleanliness are common in children with OCD, researchers argue that a cleanliness complex can also be a personality trait that one has control over. The only way for cleanliness to be classified as OCD is if it results in absolute debilitating and unrelenting anxiety that disrupts daily functioning. The same goes for wanting things to look neat. Not every child with OCD experiences obsessions and compulsions with tidiness and cleanliness.

Some other common obsessions that children with OCD may experience are: fear of sickness, with some developing specific obsessions related to the death of their parents, preoccupation with order and symmetry, violent images and unwanted thoughts of causing harm to others or themselves, trouble with any thought that may go against their personal and religious beliefs, and spending long periods touching things and thinking about numbers and sequences.

Some common compulsions can range from repeated handwashing, hoarding, counting and recounting, repeating after others, asking the same questions over and over again, making rude or obscene gestures, or checking and rechecking to make sure that the door is locked.

‘COVID-19 is causing OCD in children’

Although difficult to believe by some, and much like stress, COVID-19 has not been a cause for OCD in children. What the pandemic did cause, however, was an exacerbation of existing symptoms in children and adolescents with OCD.

The first recorded study to look at the immediate effects of COVID-19 on children and adolescents with OCD found that in both distributed groups, one with children newly diagnosed and the other with children who have had a diagnosis for years, participants experienced a “worsening of their OCD, anxiety, and depressive symptoms”.

‘We are all a bit OCD at times, it is not that big of a deal’

This myth about OCD may be one of the most harmful. Belittling or disregarding the experience of people, specifically children, with OCD can lead to catastrophic results. OCD is classified as a disorder for a reason, and the brains of children who have it have been proven to be wired differently. It is not a character trait or some trending personality quirk; it cannot be “switched off”, and millions of children around the world have their lives and their development continuously disrupted because of it.

‘There is a test that can detect OCD’

Unfortunately there are no known tests that can detect OCD. The only way to obtain an official diagnosis is through a licensed child psychiatrist. The process of diagnosis happens through a full mental health evaluation of the child and through making sure that the child is in fact experiencing persistent and involuntary obsessions and compulsions that are severe and disruptive to their daily living. The main criterion is for rituals or activities such as handwashing or checking that the door is locked to take up more than an hour every day.

Adults with OCD, in most scenarios, can at least realize that their actions are not normal to a certain extent, but that is much harder in the case of children who do not realize how irrational and abnormal their thoughts and actions are. When those around them do not understand their need to perform such rituals to rid themselves of such thoughts, their levels of anxiety worsens and they feel misunderstood and even unsafe in their environment.

‘You cannot treat OCD’

While there is no known cure for OCD, different treatments are available and have shown promising results. Treatment will of course differ depending on the child’s age, symptoms, and other factors concerning their general health. The first line of treatment recommended by professionals is therapy using cognitive and behavioral methods that focus on the child identifying and understanding their fears. Then they focus on behavioural methods that aim to teach the child how to cope with those fears and as a result learn to better resolve them. The therapist will, for example, set rules or set a limit to the number of times and the length of time that a child may wash his/her hands.

Exposure therapy is a psychological treatment in which the child must face their fears. It is preferable for exposure therapy to be done by a professional therapist. You must never attempt to do exposure therapy on a child without the supervision of a mental health professional. Therapists will sometimes give specific instructions to a child’s parents or caregivers on how to continue with exposure therapy at home.

Another available treatment option is medication, such as selective serotonin reuptake inhibitors (SSRIs), to help boost serotonin levels in the brain.

It is important to know that the earlier the intervention the more likely you can play a key role in easing the symptoms and enhancing normal development. Understanding that this is a debilitating illness, especially for children, and keeping open channels of communication with your child will significantly improve the quality of their day-to-day living.

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