I feel fortunate to have been able to recently attend the 24th annual International OCD Foundation conference in San Francisco, California. This conference gives treating professionals (such as psychologists) as well as children, teens and adults who struggle with OCD, the most up-to date information on effective and evidenced-based treatments for OCD and other anxiety disorders.
Pediatric obsessive compulsive disorder is a fairly common neuropsychiatric condition that can cause significant problems for children and teens, as well as their parents and families in many areas of their life. According to an OCD-fact sheet included in this article, 1 in 200 children have obsessive compulsive disorder. As noted on this sheet, this would look like 4-5 children in an average elementary school and 20 teenagers in a large high-school. Recent research, included in an article by *Marien, Storch, Geffken and Murphy (2013), indicates a 1.3-4% prevalence rate of OCD among children and adolescents.
There are many misconceptions about obsessive-compulsive disorder. Some people state “I am so OCD”, or “you are so OCD” meaning that the individual is overly organized and/or somewhat rigid. These statements miss the truth and reality of what OCD is and how it effects those who really suffer from it.
OCD is usually considered an anxiety disorder with two components: obsessions and compulsions.
Obsessions are unwanted, intrusive and repetitive thought, images or impulses that result in intense anxiety, and/or distress.
Compulsions are actions that are meant to decrease the above noted anxiety. They are generally repeated behaviors and/or mental actions.
For example a child or adolescent may have repetitive and intrusive thoughts about germs…germs causing death to himself/herself and/or his/her loved ones. This may lead to excessive washing to rid the self of germs, and or avoidance of places and items which the child/teen may feel are more likely to be contaminated with germs. Marni L. Jacobs (**Chapter 4-Recognizing Obsessive Compulsive Disorder, in Understanding OCD a guide for parents and professionals, Lewin and Storch 2017) identifies several themes that are present in pediatric OCD. These include: Aggressive obsessions, Checking behaviors, Contamination concerns, Counting symptoms, “Just right” obsessions and need for symmetry or exactness, Ordering/organizing/arranging symptoms, Religious obsessions/scrupulosity, Repeating rituals, Sexual obsessions, Somatic obsessions and Magical thinking/superstitious fears. Though there can be variations in the intensity of the thoughts and obsessions, the thoughts and obsessions tend to interfere with functioning in home, social and school environments. Avoidance of anxiety is typically also involved in the maintenance of OCD symptoms.
Parents and family members of those with OCD may feel confused and at a loss of how to help their child/teen with OCD. In an effort to help their child or teen they may become involved in the obsessions and/or compulsions of their child/adolescent. The conference I attended discussed the hopefulness of treatment for those who suffer. **Storch and Lewin (2017) state, “Two types of effective treatment have been established. These include a form of psychotherapy called cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) as well as a group of medicines called serotonin reuptake inhibitors (SRI’s).” (**Understanding OCD: A guide for parents and professionals, Lewin and Storch, 2017). Lewin and Storch’s book is a great resource for parents who have questions about treatment(s) they may be considering for their child or teen.
CBT/ERP is a specific treatment that includes helping the child or teen slowly go toward their anxiety in a hierarchical fashion and with skills and support. It includes practice in not engaging in their compulsive behavior(s). Children and teenagers are also taught how to accept their anxiety provoking thoughts, label and/or externalize them, talk back to them, and not act on them in the same way. Generally the parent(s) are included in this treatment. They are taught how to best help, which may be different than how they previously responded, in order for their child/teen to improve and better manage their anxiety and symptoms. For example, a trained therapist can help a parent(s) who has become a part of a ritual, slowly disengage from this role. Also, because it is sometimes difficult for a child/teen to engage in CBT/ERP a psychologist/therapist may at times help the parents develop a behavioral reward system for home-based exposure practice. A treatment provider who is trained in CBT and ERP can be helpful to the child/teen and the family. There are also treatment programs (inpatient and intensive outpatient) that utilize CBT/ERP.
On a separate note, as part of the IOCD conference I was able to watch the premier of an amazing movie called “Unstuck: An OCD Movie”. It followed the lives and treatment of brave young people with various types of OCD. It offered a window into the struggles, the treatment and the hope in recovery for children and teens with OCD. The film demonstrated the individuality as well as some common bonds of those with this struggle. Additionally, I loved that the youth were able to address the myths of how people in the general population see OCD and talk instead of what OCD really looks like and feels like. It also demonstrated how CBT/ERP helped with positive functioning.
For your information I have included the (1)***OCD Fact Sheet that can be found on the IOCD website, (2) Two trailers for “Unstuck: An OCD Movie”, and (3)*** A link for the IOCD website, iocdf.org, for more information about Obsessive Compulsive Disorder.
*Intensive Family-Based Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder: Applications for Treatment of Medication Partial-or Nonresponders. Marien, Storch, Geffken and Murphy