Imagine suddenly fearing that you might be a killer, and not being able to convince yourself that you’re not. That’s one way obsessive-compulsive disorder pops up. It can be terrifying, debilitating and very hard to diagnose, and kids can get it at very young ages.
OCD Awareness Week was observed Oct. 13-19, 2019, and OCD Washington wants to draw attention to the mental health disorder, which affects an estimated 1 in 200 children and teens in the United States as well as 1 in 100 adults. According to the International OCD Foundation, the condition tends to strike first between the ages of 8 and 12, and in the period between the late teen years and early adulthood.
(OCD can also hit new moms postpartum, when they might be faced with frightening obsessive fears, such as harming the baby.)
With OCD, a child or teen can be plagued by unwanted swirling thoughts and worries that include fears that one might be violent, or harbor criminal sexual interests, or accidentally cause great harm to another person. These thoughts can cause intense, preoccupying anxiety for the sufferer and can cause them to participate in time-consuming rituals and withdrawal from social situations, too. The obsessive thoughts can also be about losing control and hurting others or oneself, or carelessly causing harm to other people, or a fear of contamination which leads to excessive washing. Common obsessions often involve religion, unwanted sexual thoughts, or a fear of catching a disease or that one might be gay (even despite the person not being homophobic or having previously been interested in their own sex).
The compulsion comes in when someone with the condition gets stuck in a repetitive cycle trying to do something to undo the uncomfortable obsession until it feels “right” and the person feels reassured. It’s can be a ritualized thought process, counting, hand-washing, or checking to see that the stove is off over and over. A child or teen with OCD might ask others for reassurance repeatedly or have strange habits, like lining things up in a particular order or repeating movements.
When this cycle takes up lots of time and interferes with a person’s day-to-day life, that’s when it’s considered to be full-blown OCD.
Michele Loewy, a licensed marriage and family therapist in Bellevue who specializes in OCD and anxiety, notes that the condition can be quite hard to diagnose.
One clue that a child may be suffering from the condition is “asking for reassurance a lot,” said Loewy.
“Parents might say, “Oh, my kid’s asking the same question over and over again, maybe sometimes in different ways, but it seems like I'm answering the same thing and they’re still worried about it.’ And that's a really good sign that, yeah, that’s more likely OCD and not necessarily just general anxiety.”
Another clue can be when a child is “really particular” about shoes or food, she said, adding that picky eaters may just be fussy, but occasionally fussy habits can be masking a hidden OCD fear of contamination.
“A common one is kids being afraid that they're doing something wrong or bad, or having these unwanted thoughts or bad thoughts,” said Loewy. “Sometimes they're so uncomfortable that they don't even want to disclose them. And so they hold a lot of shame around them, and oftentimes in therapy those come out little by little.”
Parents might think it’s ridiculous when a kid says they feel afraid they might kill someone, but that’s also a warning sign.
“The kid actually really has this fear, and that can be an intrusive, unwanted thought, and those are very, very common,” said Loewy, “And some parents think, Oh, my kid’s really imaginative, or it’s just worrying, and it's no big deal because obviously they wouldn't kill somebody.”
That kind of worry is a good sign that your kid may have OCD and need help with unwanted thoughts, says Loewy.
If you think your child might be showing symptoms of OCD, Loewy recommends the website of the International OCD Foundation to find a therapist who specializes in OCD and uses Exposure and Response Prevention, a type of Cognitive Behavioral Therapy used successfully to treat OCD.
Another local resource is the OCD Intensive Outpatient Program at Seattle Children’s hospital.
If there is a sudden onset of OCD-like symptoms — intensely, seemingly overnight — it would also be wise to look into whether the strep-related conditions PANS or PANDAS might be the cause. These conditions seem to have a different cause and can be handled well with antibiotic treatment, in addition to Exposure and Response Prevention therapy, notes Loewy.