Supporting Young People with Obsessive Compulsive Disorder

Written by Assistant of Psychologist:

Eleonora Fetter

My Psychology Ireland

When it comes to supporting young people with OCD, most people would feel fairly overwhelmed and lost. That is because OCD as a condition can be particularly tricky to spot. OCD can represent itself in a variety of symptoms that may not always look quite  typical. Moreover, OCD can show itself differently in the young people compared to the adult population.

One of the best ways to support the young person with OCD is to learn about the condition, its definition, symptoms, causes and available treatments. Once you understand a little bit more about it, you can then begin to implement strategies to reduce the impact the condition has on the young person. This article is aimed at providing you with this knowledge, however, to ensure best treatment outcomes seeking professional help is essential.

What is OCD?

OCD - obsessive compulsive disorder is characterised as a type of anxiety disorder. OCD is described by experiencing obsessions and/or compulsions that are time consuming, distressing, and/or interfere with normal routines, relationships or daily function. For example, going to school, completing homework, falling asleep at night and many other day to day ordinary tasks.

What are Obsessions? - they are persistent, unwanted thoughts, images or urges that intrude into a person's thinking and cause excessive worry and anxiety.

These thoughts, images or urges are distressing, uncomfortable and for some are scary.

What are Compulsions? - compulsions are covert mental acts or overt behaviours performed repetitively to relieve or prevent the worry or anxiety generated by the obsession.

Compulsions can be mental acts performed simply by thinking, performed entirely in the mind. Compulsion can also be represented as overt behaviours, behaviours that obsessive thoughts tell an individual to do.

What are the most common symptoms of OCD in young people?

These are the most common symptoms, however, each child may have different symptoms.

●      Preoccupation with dirt and germs, fear of being sick

●      Repeated doubt, not sure if door is locked, light is off

●      Intruding thoughts about hurting people, harming oneself, thoughts about violence

●      Strong attention to order or symmetry

●      Persistent thoughts about offensive or inappropriate sexual acts or forbidden taboo behaviours 

●      Struggling with thoughts of religious nature, contradicting thoughts about religious beliefs

●      Focus on memorising things exactly or need to know every detail, preoccupation with minor details

●      Too much attention to detail

●      Worrying too much about something bad happening

●      Need for certainty, for example, need to know for sure that everything will be okay

●      Aggressive behaviours and urges

Note: These are just the most common symptoms but there are many others, for example: obsessions about hoarding, saving, collecting; body image obsessions, health obsessions, miscellaneous obsessions, religious obsessions. Furthermore, there are other obsessions that may not appear as OCD. Many symptoms of OCD are similar to Anxiety or Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder. This is why it is important to seek professional diagnosis.

What are the most common compulsions a young person may experience?

Compulsions are behaviors the young person feels they ‘“must do” with the intention of getting rid of the upsetting feelings caused by the obsessions. A young person may also believe that engaging in these compulsions will somehow prevent bad things from happening, examples are below:

●      Excessive checking (re-checking that the door is locked, that the oven is off).

●      Excessive washing and/or cleaning.

●      Repeating actions until they are “just right” or starting things over again.

●      Ordering or arranging things.

●      Mental compulsions (excessive praying, mental reviewing).

●      Frequent confessing or apologising.

●      Saying lucky words or numbers.

●      Excessive reassurance seeking (e.g., always asking, “Are you sure I’m going to be okay?)

What causes OCD?

No one knows exactly what causes OCD, but researchers are piecing together the puzzle. It appears that OCD results from a combination of genetically inherited tendencies (genetics) or predispositions, together with significant environmental factors (life stressors, unfortunate events). 

Inherited tendencies (genetics) include subtle variations in brain structure, brain chemistry and connections made between various areas of the brain.

Environmental Factors include psychological and physical trauma, childhood neglect, abuse, family stress, illness, death, and divorce, plus major life transitions such as adolescence, moving out to live on one’s own, marriage, parenthood, and retirement. Inherited biological predispositions serve as a kind of a tinderbox, which, when combined with environmental lightning bolts, can ignite and activate OCD symptoms.

Neurological Factors: The most widely held biological theory of OCD is that it is related to abnormal functioning of the brain’s vital chemical messengers: serotonin. Serotonin plays a role in many biological processes, including sleep, appetite, body temperature, pain, mood, aggression, and impulse control. Serotonin dysregulation has been implicated in other mental illnesses, including depression, eating disorders, self-mutilation, and schizophrenia. For this reason, medication could be a viable option. Most recent studies indicate that the brain chemical glutamate may play a role in OCD. Like serotonin, glutamate is a brain neurotransmitter that is vital to optimal brain function. In addition to dysregulation of neurotransmitters, structural problems in the brain may play a role. Brain-imagining studies have demonstrated abnormalities in the several parts of the brain in people with OCD.

When Might Medication Be Considered for Young People with OCD?

Generally, many mental health professionals will try to avoid recommending medication for children and young people because their bodies are still in development. In the first instance, talking therapies such as CBT are recommended for young people and their families. However, for some individuals with severe OCD there is evidence that a combination of medication and talking therapy is most effective. Generally, it is considered on a case by case basis. Medication cannot be prescribed by your GP, your child would have to be referred to the CAMHS team to be reviewed by a psychiatrist.

Other Physiological Factors: Research found that certain autoimmune diseases, such as rheumatic fever, pediatric streptococcal infections, lupus, and Sydenham’s chorea, also may be related to some instances of OCD. In addition, some studies have shown an association between OCD and head trauma, brain tumors, epilepsy, hypothalamic lesions and von Economo’s Encephalitis. However, most cases of OCD don’t have such dramatic causes.

What are the 3 Main Strategies for You To Do?

When helping young people to overcome OCD there are 3 main strategies parents should use. 1. Distraction2. Delay 3. Do it Differently.

1.Distraction: During ERP treatment, it is important you can help your child to be distracted when they experience obsessive thoughts, urges and compulsions. For example, if you notice your child experiencing obsessive thoughts of washing their hands, you can offer and ask them to do an activity. Ideally it would be something that your child would enjoy or something that would help to shift their attention to something else. Board games, fidget toys, puzzles, and sudoku are all useful in occupying the mind. The activity should require focus meaning that it takes that focus away from the obsessive thought.

2.Delay: When your child is experiencing an obsessive thought and wishes to perform a compulsion, in an ideal scenario, you would encourage them not to engage in the compulsive behaviour. However, it is often not that straightforward or simple. In such cases, it is crucial you would ask them to delay the process of completing the compulsive actions. This technique is often used at the beginning of treatment to give a child a sense of confidence that they can tolerate the anxiety and also to train the brain through the process of habituation that nothing bad will happen.

3. Do it Differently: Another very effective and useful technique is to challenge the OCD. For example, an obsessive thought may tell a child to count to 100 every time they see a spider. What you could suggest and ask them is to count to 50, or 20, if they can tolerate this, then suggest 10. It is a matter of negotiating and encouraging the child to challenge their OCD as much as they can but to also do it gradually, meaning they are not overwhelmed but getting used to it at the same time.

How to get further support if you think your child has OCD:

●      Young people with OCD are sometimes reluctant to get help because they feel ashamed or embarrassed that they have this condition.

●      There is nothing to be embarrassed or feel ashamed about when it comes to OCD, it is a health condition with no difference to asthma or allergies.

●      See a GP-they will ask you about your child’s symptoms and they can refer you to a local talking therapies service if necessary.

●      Consider going to the hospital in case of moderate to severe OCD.

●      It's unlikely OCD will get better without proper treatment and support.