OCD Deconstructed: Commonalities with Anxiety, How to Spot the Symptoms and Ways to Support Your Child or Teen
Parents tend to be really good at recognizing the symptoms of anxiety when they arise in their kids, and this is for good reason: We ALL know what anxiety looks like because we have experienced it firsthand. Obsessive Compulsive Disorder (OCD) can be more difficult for parents to spot, depending on the theme of the OCD and the nature of the compulsions. Unless a parent has a succinct working knowledge of OCD, gained from personal experience, therapy and/or psychoeducation, most parents mistake OCD for anxiety. Although the operating principle behind each is pretty much the same, they function differently on a behavioral level. It is important for parents to be able to recognize the nuances, as early intervention is a key component to effective treatment.
Most of us have gained our knowledge about OCD from movies and television shows, which are notorious for inaccurately portraying mental health disorders. While one valid theme of OCD is contamination, which looks like the excessive handwashing most of us are familiar with, OCD has many themes, and they tend to wax and wane, as well as shift, as children move through the developmental spectrum. Parents can be looking out for the wrong things, and as a result they may miss the big picture entirely.
If OCD runs in your family, you need to be aware that your child can be at risk for developing this disorder. Mental health disorders, just like physical health illnesses, carry a genetic predisposition. On top of genetics, OCD carries a fundamental behavioral component, known as compulsions, which can be observed, learned and internalized. While I am not suggesting that OCD can be “caught,” I am saying that two family members can learn how to compulse from one another, if each of them have OCD. For this reason, parents have to make sure that family members with OCD are being treated by a trained therapist, as this disorder can get out of hand quite quickly.
Read on to learn more about this disorder, how it presents in children and teens and ways to help your youngster manage their symptoms:
What’s the difference between anxiety and OCD? Anxiety and OCD have similarities and variations. Both disorders occur, in part, due to a hypersensitive amygdala. The amygdala’s job is to keep us alive. It does this by paying close attention to potential threats in our environment and alerting us when the amygdala senses a potential peril to our safety. Once a threat is registered, the amygdala springs our bodies into action so that we can either run away from the danger or fight for our lives. This is known as the fight-flight response. Because the job of the amygdala is so critical to our existence, it often makes mistakes, as it would rather err on the side of caution than risk making an ill-informed judgment that could cost us our lives. When mistakes occur, we think there is danger when there is none, resulting in anxiety and/or OCD. The main difference between anxiety and OCD is the introduction of a rule that sounds something like, “You must either do this or avoid that to escape an unfortunate outcome.” The rules are usually repetitive, illogical and excessive, and the behaviors associated with the rules tend to inconvenience family members, as they can be time consuming and rigid. If OCD spots one deviation in the routine, its victim has to go back to start and begin again. This is a frustrating disorder for those experiencing it and the family members observing it, as everyone is inconvenienced.
What are the components of OCD? OCD involves obsessions and compulsions. An obsession is a thought that gets “stuck” in the brain and a compulsion is a repetitive act one feels compelled to do in order to escape the discomfort they are experiencing. Compulsions come in all forms: handwashing, reassurance-seeking, and thought avoidance are examples, just to name a few. Some compulsions are observable, while others are managed mentally or in private. In all cases, compulsory actions increase the number of obsessive thoughts, and this is what maintains the vicious cycle that OCD creates.
What is co-compulsing? Co-compulsing occurs when a child or teen needs their parent, or other individual, to help them manage their obsession. OCD has many demands, and in order to meet those demands others often have to get involved. Consider this as an example: A child fears they are a bad person. Their OCD tells them that they have to ask their parents hourly if they love them, otherwise they are “bad.” The child complies with OCD’s demands, and the parents unknowingly oblige their child’s OCD by saying, “Of course we love you!” each time their child asks. OCD has effectively roped that child’s parents into the obsessive-compulsive cycle, and now the parent is helping their young one meet OCD’s demands, or co-compulse. When the experts say OCD is a family affair, they aren’t exaggerating.
What symptoms should parents look out for? Parents should look out for behavior that appears odd or excessive. If you notice that your child is touching an object numerous times for no apparent reason, this could be a compulsion. If your child asks you the same reassurance-seeking questions time and time again, especially when they know the answer, it’s possible that your youngster’s OCD is prompting these questions. Keep an eye and ear out for behavior that doesn’t make sense or fit within the given situation. When in doubt, ask your child about the behavior you are observing in an objective and non-judgmental way.
What are the themes of OCD? OCD has many themes, and they tend to glom onto the developmental stage a child or teen is at. It is important that parents are aware of the different themes so they can keep a watchful eye and address behaviors when they begin. Here are some of the common themes to look out for:
Contamination OCD
Sexuality OCD
Moral or Scrupulosity OCD
Just Right OCD
Symmetry OCD
How can I help my child, tween or teen? The best way you can help your youngster is by starting the conversation and seeking the advice of a trained therapist who specializes in OCD. While the shame associated with anxiety seems to have dissipated over the course of the past decade or so, there is still quite a bit of embarrassment around the topic of OCD. By naming this disorder for your young one, you are combating the stigma they may be facing outside of your home.
What role do parents play in treatment? Most parents think that once their child has an OCD diagnosis that therapy is the only answer, and while it is true that therapy is important, parents need to be the alternate experts, as they are the ones on the front lines on a daily, hourly and minute-by-minute basis. Your child’s therapist should be able to provide you with psychoeducation about what OCD is, the vicious cycle OCD creates and how to respond to obsessions, but parents can, and should, seek out resources on their own. If your child had asthma, you would never rely on the doctor’s help alone. You would learn about what asthma is, identify the symptoms to look out for, and figure out how to provide your child or teen with treatment at home. The same is true of OCD: Parents are the captains of the team, and your child will follow your lead. If you turn a blind eye, so will they, and if you get mad at them, they will internalize their feelings. Parents have to know this disorder inside and out so that they can help their children outsmart it as opposed to feed into it.
Let’s face it: OCD scares people. Part of what makes OCD intimidating is the language others use to describe it and the notion that it is untreatable. Anything is untreatable without treatment, and unfortunately most people try to manage mental health disorders on their own before seeking help. With a good therapist and willingness to engage in treatment, kids and families can learn to manage the symptoms of OCD, as opposed to fearing their presence.
If you are interested in learning more, check out the links below for more information:
