I had always known the 10-year old was an anxious child. Her parents had referred her for therapy as they felt she lacked confidence, was falling behind at school and seemed very secretive. I had spent many sessions with her, building trust and developing a relationship, and we had talked about her worries at school, the conflict between her parents at home.
But it took some months before she finally confessed to me that she thought she was “weird”. Thoughts invaded her mind and she couldn’t ignore them, upsetting thoughts that bad things might happen.
Specifically, she felt she had to check and recheck that she had tightened the tap after she washed her hands, as she couldn’t shake the feeling that she might leave the tap open and cause a flood. This need to close taps and tighten them, to the point she would hurt her hands, had extended to her glue lid, the cap of her juice bottle – in fact to all items that needed closing.
She was very ashamed of her thoughts and behaviours and was sure she was a “freak”. “I just can’t stop myself,” she whispered. “What if I don’t check the tap and I flood the house?”
It was then that I knew that she wasn’t simply a nervous child, but was suffering from a serious form of anxiety disorder called Obsessive Compulsive Disorder (OCD).
It is estimated that about 1 in 200 children has Obsessive Compulsive Disorder (OCD) and that 80% of adults with OCD have had significant symptoms before the age of 18.
In children and adolescents OCD involves obsessive thoughts about things like:
- contamination, dirt and germs,
- putting things in order, arranging things symmetrically,
- lucky or unlucky numbers,
- the possibility of hurting others or causing something bad to happen,
- danger to family or friends, and
- losing or breaking things.
Children with OCD can’t simply choose not to think these thoughts; they cannot just put the ideas out of their mind and think positively. The thoughts feel intrusive and overwhelming and cause enormous distress to the child.
Children with OCD generally ‘deal with’ these obsessional thoughts, anxiety and preoccupations by carrying out particular repetitive actions. These actions quickly become compulsive rituals, examples of which are checking, hand washing, counting things, performing an action in exactly the same way every time, repeating a behaviour a specific number of times, and collecting and hoarding things.
It’s as if the child believes that the rituals will undo any possible harm and magically reduce anxiety and make things feel right. But in truth these compulsions are enormously time-consuming and increasingly interfere with all aspects of the child’s life.
Experts are not exactly sure what causes OCD, which can run in families. Some theories suggest that it involves serotonin, a chemical in the brain also called a neurotransmitter. When something blocks the flow of serotonin, the brain overreacts and misreads information. Instead of ordinary thoughts being filtered out, the OCD mind lingers on them and sparks off fear or worry like an overactive alarm system.
OCD can be a difficult condition to treat. Early diagnosis is not easy as children are often secretive about their obsessions and compulsions. But if untreated, childhood OCD tends to persist into adulthood and is associated with long-term negative outcomes, so it’s worth being proactive if you start to suspect your child is showing features of the disorder.
Below are some of the positive steps you can take.
Consult an expert
As with most difficult mental health issues, the support and expertise of an expert is often vital. First, this person will help you to distinguish between what is manageable anxiety and what is OCD. Second, even children with the most knowledgeable and accepting parents will often withhold certain worries and acts from them, but talk about them with an expert.
A combination of psychotherapy and medication might be suggested by a professional, but first do some research and inform yourself thoroughly before deciding how to move forward.
Prepare the family
If everyone in the family understands what OCD is and that the behaviours that come with it are part of the condition, this creates a more understanding home environment. Also try to run a fairly structured home so that compulsive rituals don’t stand out as much and are less exacerbated by chaos.
Talk to your child
This is obvious. Be honest and open about the condition and talk about it with your child, without ever forcing the issue. You are a parent with a family to run and limits to set, not a psychologist. The more difficult work of dealing with OCD might need to be dealt with by an expert.
Deal with school
For the OCD child, stresses at school are usually worse than at home. Adults who teach your child will not be as well informed as you learn to become, and other children are often not tolerant or understanding. Therefore, meet all those who will come into contact with your child and help to educate them.
Managing and treating OCD is a challenge but possible – as the famous 18th century writer, OCD and Tourette’s sufferer Dr Samuel Johnson said, “Great works are performed not by strength, but perseverance.”
For useful links to resources in South Africa and internationally I can recommend the website of the South African Depression and Anxiety Group (SADAG) – http://www.sadag.org