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What follows is part 1 in a series of 3 articles. Part 2 will focus on OCD in adults, with part 3 offering an introduction to olfactory reference disorder (ORD), a lesser known but related condition.
Obsessive compulsive disorder (OCD) is not about a few habits, fears or quirks. Some young children go through phases of “particularness,” such as preferring certain colors of clothing or preferring one parent at bedtime, says Dr. Lauren Webb, a psychologist and Assistant Professor of Psychology in the Department of Clinical Psychiatry at Weill Cornell Medicine.
Parents may express concern about potential early signs of OCD when their children want something done in a particular way or express certain preferences, such as rolling their socks perfectly. While this may indeed be an early symptom of the disorder, it may also just be normal little kid behavior—a way of “standing their ground and learning how to set their own boundaries,” she says.
So, what exactly is OCD? Read on for answers to your FAQs about the nature, causes, symptoms and treatment options for a disorder that can be distressing for all concerned but is highly treatable.
To unpack OCD, let’s start by defining the two main parts of the equation.
Obsessions are “intrusive thoughts, images, urges or feelings that come up again and again,” Dr. Webb says, “while compulsions are things kids do or think to find relief from these obsessions. The ‘disorder’ part comes in when these obsessions and compulsions interfere with their lives and cause significant distress.”
OCD can take many forms, she says. In pop culture, it is often portrayed as a fear of germs, but the disorder is far more complex than that.
“You might see kids having this real fear of someone harming them, or harm coming to the people they love or care about. You might see kids getting stuck on religion or some type of moral scrupulosity. You might see them having a lot of health concerns that go beyond just germs. It can range so much,” she says.
A perfect storm of factors can come together to cause the disorder, including:
“We see two peaks of onset,” she says. “The first peak comes between the ages of 8 and 12. The second comes during late adolescence, usually in the person’s late teens or early 20s.”
The gold standard treatment is exposure and response prevention (ERP), which falls under the umbrella of cognitive behavioral therapy (CBT).
Here’s how it works. Children learn to face their fears in a slow, gradual way (i.e., the exposure part of ERP) while delaying or not engaging in the compulsions (i.e., the response prevention part of ERP) that brought some temporary measure of relief in the past. For those with moderate to severe OCD, the best approach is to combine ERP with medication—typically an SSRI (selective serotonin reuptake inhibitor).
“You don’t have to wait for things to get really bad,” Dr. Webb says. “If you suspect that something may be going awry with your child, you can always come in for an evaluation.”
OCD really does improve with treatment, she says. “I see many children and teenagers heal from OCD. You are not destined to live your life with it.”
Good treatment always includes a discussion of relapse prevention strategies. It’s about figuring out and identifying any signs that OCD might be flaring up again. That way, “you never have to be in a place where OCD is as bad as it was before you started receiving treatment for it. We can look for the warning signs, and you can come in for ‘booster’ sessions, if needed.”
OCD is unique, Dr. Webb explains, because it tends to suck everyone in. “It’s painful for the person who’s directly affected by it, but it’s also incredibly painful for parents, siblings, the extended family and even for teachers. There can be a lot of frustration.
“There can also be a lot of accommodation of symptoms,” she continues. “A parent may ask, ‘My child is in so much pain. How can I not provide them with a lot of hand sanitizer, for example?’ But ultimately, to help someone with OCD, we have to take a hard line and try not to accommodate it.”
A great way to start taking it down a peg or two is to externalize OCD, as if it were another person in the room. For little kids and also older ones, “we’ll have them give their OCD an actual name—Bob, for example! Families can say, ‘it sounds like Bob is being a bully right now. How can we turn the volume down on Bob? How can we fight Bob together?’ That approach can also ease parents’ frustration and understand that it isn’t their child wanting to behave in this way; it’s OCD that’s bullying them into doing it.”
At Weill Cornell Medicine, Dr. Webb works in the Pediatric OCD, Anxiety and Tic Disorder (POCAT) Program. “We offer private pay options, but we also have an insurance-based track.”
POCAT offers OCD and anxiety treatment for children, teens and young adults. Their program offerings include regular outpatient therapy, an Intensive Treatment Program (ITP), and an insurance-based OCD Track on the WCM/NYP Adolescent Partial Hospitalization Program.
Try to gradually reduce accommodating your child’s OCD. That’s what “exposure therapy” is all about. If you can cheerlead your child into pushing back against what their OCD is telling them to do, that’s a great place to start.
To learn more, tune into our Kids Health Cast podcast episode on Understanding OCD in Children.
Make an appointment for a consultation with a pediatric OCD specialist at Weill Cornell Medicine here.
