Impacting 1%-4% of children and adolescents, OCD disrupts a young persons daily routines and can lead to significant family conflict.
The two components of OCD are obsessions and compulsions.
1. Obsessions Obsessions are repetitive thoughts the young person is unable to stop thinking about. Though the young person tries to resist these thoughts, they occur so frequently and are so upsetting that it stops the person from going about their day-to-day routines. It is only when these thoughts are neutralised through compulsive behaviours (more detail below) that the sufferer can then function.
2. Compulsions Compulsions are behaviours the ‘must’ be done to reduce the distress associated with the obsessive thoughts. Compulsion rituals can be quite elaborate and when interrupted, need to be started again at the beginning. These compulsive behaviours are conducted until the sufferer reports feeling ‘just right’ and re not enjoyable for the young person to perform. The types of compulsions vary. For example, they can be repetitive behaviours, repetitive rituals or repetitive mental acts.
It is important to remember that compulsions are carried out to reduce anxiety however, this relief is temporary and leads to an increase in the OCD cycle.
Subtypes
Common themes of obsessive thoughts include:
– Contamination from dirt or germs
– Concern about personal safety or safety of loved ones
– Symmetry and order
– Thoughts inconsistent with the individuals values such as aggressive, sexual or blasphemous thoughts
Common compulsive behaviours or rituals include:
- Cleaning rituals, for example, washing hands or scrubbing household surfaces
- Checking, for example, checking whether doors and windows are locked or appliances switched off
- Ordering, for example, putting certain objects in a certain pattern
- Mental acts, for example, counting or reciting certain phrases
- Hoarding, for example, not being able to let go of large amounts of seemingly useless items
Causes
OCD can be triggered by a major event or it can occur gradually with no identifiable trigger. Research has demonstrated that factors linked to increased risk of developing OCD include:
- Family history of OCD, for example, a person is more likely to have OCD if they have a family member with this condition
- Personal psychological factors, such as a perfectionistic thinking style
- Neurological or biological factors: emerging research shows that the way the brain ‘switches off’ repetitive thoughts may be different between those with and without OCD
Treatment
Cognitive Behaviour Therapy (CBT), specifically exposure and response prevention (ERP), is the gold standard treatment of OCD. In ERP goals are developed to exposure the young person to the obsessions or compulsions that trigger the unwanted thoughts or repetitive actions. The young person then confronts these situations with the guidance of the psychologist. Through this process the young person learns to tolerate these thoughts and, as they do so, the distress and the obsessions decrease.