Young boy sitting on floor playing with wooden bricks

Obsessive-Compulsive Disorder (OCD)

September 21, 2021

Team Mindsum

About the author: This article is written by our team of researchers and writers. Our content is published after careful review and approval by the editorial board.

‍ What is OCD?
Signs of OCD in children and young adults
Causes of OCD in children and young adults
Managing OCD
What types of professionals are involved?
The journey of managing OCD
How can parents/guardians support their child with OCD?
Useful resources

What is OCD?

‍Obsessive-compulsive disorder (OCD) is when the child or young person continues to have recurrent obsessional thoughts and/or compulsions which are behaviours they feel driven to do. OCD does not just mean that people like to wash their hands regularly and be tidy. It is a serious condition that often makes everyday life extremely hard to cope with.

For example, a child or young person may have intrusive thoughts that their parents might suddenly die. They might repeat numerous behaviours convinced that this will stop it from happening such as checking the stove is switched off. It is this overwhelming feeling of responsibility that is a marker of OCD.

Children and young people living with OCD can feel very anxious, lonely and isolated. The obsessive thoughts are sometimes very disturbing, and they can leave them feeling shameful and out of control. The compulsions can also take a long time to complete and it can be seen as strange by others.

Causes of OCD

‍The specific cause of OCD is not known. It is likely due to a combination of genetic and environmental factors. These are some risk factors to consider:

Runs in families
Physical, sexual or emotional abuse
Childhood trauma
Bullying
During and after pregnancy (e.g. unwanted thoughts of hurting the baby)
Existing learning disorders

The symptoms of OCD

‍There are different possible symptoms of OCD. The symptoms can affect each child or young person differently. All symptoms include either obsessive thoughts or sometimes compulsions.

Obsessive thoughts are unwelcome and intrusive thoughts or images that repeatedly appear in the mind. For example:

Worries about becoming sick or contaminated
Worries about the sudden death of loved ones
Unwanted thoughts and urges to hurt people
Forbidden thoughts (e.g. unwanted violence or sexual acts)
Superstitious fears (e.g. that there are bad numbers)

Compulsions are repetitive acts that the person feels like they need to perform to manage the thoughts. These can be mental or physical acts. For example:

Repetitive washing of surfaces and/or themselves
Checking (e.g. locked doors, electrical items, gas)
Ordering or arranging
Repeating special words, counting, tapping
Avoiding (e.g. numbers, people, objects)

OCD can have a co-morbidity with mental health problems, such as depression and anxiety. OCD is extremely difficult to live with often causing shame for the child/young person.
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“Ally is a 10 year-old-girl. Recently, she has had many thoughts that her parents will suddenly die. She feels terrified when this happens. She doesn’t know why she has these thoughts but says it goes away if she taps on a flat surface 20 times. She recently had one of these thoughts while she was outdoors, and Ally had a severe panic attack as she could not find any flat surfaces nearby. Ally’s parents decided that it was time to speak to a mental health expert.”

Managing Obsessive Compulsive Disorder

‍CBT

A type of therapy that focuses on how we think and act and how this affects how we feel. There is strong research evidence to support the use of CBT for the treatment of OCD.

The idea behind CBT for OCD is to target the unhelpful thoughts and behaviours that keep the OCD going. The child or young person will learn to gradually confront uncomfortable thoughts and feelings until they are no longer a problem.

Exposure and Response Prevention

CBT for OCD usually involves a behavioural treatment, known as exposure and response prevention (ERP). ERP is also referred to as a treatment on its own. This is where the child/young person will work up a hierarchy of difficulty of reducing their behaviours when an intrusive thought occurs. It teaches the child or young person to recognise that the obsessional thought will not come true if they do not perform compulsive acts and to tolerate the fear that comes with it, knowing that eventually, it will subside.

When working with children or young people, the therapist might have parents/carers involved in the process. Parents might be asked to assist with different tasks outside of the therapy sessions as co-therapists.

Medication

Your doctor may prescribe medication for OCD. This can be offered alone or in combination with therapy. Medication can include:

Selective serotonin reuptake inhibitors (SSRIs), an anti-depressant.
Clomipramine is another anti-depressant that may be offered when SSRIs are not effective.

Both can be effective in reducing OCD symptoms.

What types of professionals are involved?

‍Different professionals may or may not be involved throughout the treatment process of OCD for children and young people. These might include counsellors, psychotherapists, doctors/psychiatrists and social workers. The main difference is in the training that each of these professionals has received.

In the UK, there is not much of a distinction made between counsellor and psychotherapist. However, there are some slight differences between these two professional terms. These are outlined below.

Counsellors

Compared to psychotherapists, counsellors tend to have had shorter training and they help people deal with their issues on a more short-term basis. There may be school-based counsellors available that children and young people can approach at their school if they feel they need support with their difficulties. Here at Mindsum, we have counsellors who are available to provide support.

Psychotherapists

Psychotherapy training tends to be longer and they can give counselling but their approach to talk therapy is more in-depth. They explore the history and causes of certain behaviours and emotional issues. Here at Mindsum, we have psychotherapists who are available to provide support.

It doesn’t mean that one professional is better than the other. All professionals in this field go through intensive training before they begin to practice. Also, many counsellors seek additional training throughout their careers.

Doctors

‍These are professionals who are trained in medicine. This will likely be the family GP, who might find it necessary to prescribe certain medications that might help to cope with OCD, especially if the OCD is severe.

Psychiatrists

These are professionals who are also trained in medicine. However, they also specialised in the field of psychiatry. So they can provide consultation and medication for a wide range of mental disorders such as anxiety, depression, and bipolar affective disorder.

Social workers

Workers trained in protecting vulnerable individuals might also be involved with the child or young person. Social workers might provide support or arrange the appropriate care for the child or young person.

The journey of recovery from OCD

The journey of recovery from OCD can look different for each child or young person. It also depends on the severity of the disorder. However, some things are expected when going through therapy for OCD.

Assessment

This is an important phase, where the therapist will get a feel of what is going on. The therapist will identify the severity of the disorder along with other important background information. At this stage, the therapist will need to ask many questions. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful.

Therapy sessions

These sessions will take place regularly. An important aspect of the therapy session is the relationship the therapist will build with the child or young person. This will create a safe space that will allow the child or young person to confront the feelings of discomfort that form part of OCD. The sessions might include activities such as talking, role-playing, exposure practice, completing worksheets, and feedback.

Homework

This can be an important part of treatment for OCD. This is because OCD usually affects everyday situations in the child or young person’s life. So, homework tasks will help the child or young person to practice techniques they have learnt in therapy. This will help them to develop a sense of achievement and mastery over the OCD.

Progress and setbacks

When having treatment for OCD, there will be progress and there may be setbacks. For example, a child might not complete an exposure exercise because the feelings of anxiety may be too overwhelming. It is important not to feel discouraged when this happens, as these types of setbacks can be quite normal when dealing with OCD. These situations provide opportunities to discover new ways to move forward together with the therapist.

Ending therapy

The therapist will eventually prepare the child or young person and their parents for the end of therapy. This is a very important phase because the child or young person needs to become confident in coping with OCD without relying too much on the professional. The end of therapy will take place once the child or young person has made a lot of progress from OCD. The child or young person will leave therapy with many skills that they can use without the help of the therapist.

Follow up

There might be an agreement with the therapist to have a follow-up meeting. This is to check how the child or young person is coping. If they are doing well, there will be no need for more support. But if they continue to have challenges with OCD or any other issues, this will be an opportunity to have extra support.

How can parents/guardians support their child with OCD?

Understand OCD

It is a good idea to read as much information on OCD as you can. Understanding OCD and how it works will help to recognise the ways that your loved one is affected, and the ways that you can help.

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Help them feel supported

It is common for someone to feel ashamed and isolated as they try to cope with OCD. Your attitude towards their difficulties can make a difference.

Show acceptance

Their difficulty in controlling their obsessions and compulsions might make them feel like they are flawed. For this reason, it is important to let them know that they are not flawed, and that they are loved and valued no matter what.

Give validation

The OCD might be something that is difficult for you to understand, but it is a real problem for them. Acknowledge the ways that OCD is an issue for them with an attitude that is non-judgmental and non-critical.

Be patient

The OCD might make it difficult for them to do certain activities. It will take some time before they can learn to overcome this disorder. Be patient and continue to show your support without putting too much pressure.

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Help them to find the right support

You can encourage them to find support through a GP or a therapist. If this involves your young child, you can contact these services. You might:

Help them to book an appointment with a GP or a therapist.
If they are over 18 they will be able to access Talking Therapies. For some services, they just need to be over 16.
Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)
Help them search for support groups or self-help resources (e.g. leaflets, mindfulness apps, relaxation sessions)
Encourage them to keep attending sessions and to not give up
Remind them to take their medication
Give them small reminders to do their homework assigned by the therapist

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Talk openly about OCD

It is good to engage your loved one in open conversations about their difficulties with OCD as there can be a lot of shame around OCD symptoms.

Being able to talk about it means that your loved one does not have to feel ashamed. This might also help you to discuss different strategies that you can try together, to overcome some of their difficulties.

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Help them to live as normally as possible

Encourage them to continue to do activities even if some might cause them to feel a bit anxious. For example, try not to stop inviting friends over to the house because of the fear of germs.

Help them to live life as normally as possible instead of accommodating the fear, however, be understanding of the anxiety that can come with OCD and discuss with the therapist if you are finding barriers to this.

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Set limits

When it comes to our loved ones, it makes sense to do whatever it takes to help them cope with OCD. But this is not always a good thing. It is important to set limits on how much reassurance you can give when they feel anxious.

You might have a conversation with them or discuss with their therapist how much reassurance you can provide. This might seem a bit harsh, but it helps your loved one to learn how to tolerate feelings of discomfort and overcome OCD.

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Point out their strengths

It is good to remind your loved one of the things they are good at. It can be easy to focus on all the ways that they struggle with OCD and can’t do certain activities. Point out their strengths and the areas where they do well. This will help them to build their self-esteem and remind them that they are separate from the disorder.

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Look after yourself too

You'll need to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your well-being too. To do this you might:

Get other family members also involved in supporting your loved one
Schedule some time off for yourself
See a professional that can support your mental health

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