Obsessive Compulsive Disorder (OCD) is a debilitating disorder that impacts an estimated 1 to 2% of children and adolescents. While a frequently used way to describe neatness, organization, and germ-phobia, OCD is a severe disorder, so much so that The World Health Organization (WHO) ranked OCD in the top ten of the most disabling illnesses of any kind.
OCD is characterized by the presence of obsessions (thoughts, images, or impulses that occur over and over again and feel outside of the person’s control) and compulsions (repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away). While the average age of onset for kids is 10 years old, children as young as 3 can start showing symptoms.
There are many misconceptions regarding what OCD is and how it impacts people, particularly children. Below we challenge some of the most common misconceptions of OCD to give a better sense of how this disorder impacts children.
OCD is about neatness, order, and fear of germs
While there are subtypes of OCD that are called Contamination OCD and “Just Right” OCD, there are many types of OCD that expand outside of mainstream media portrayals of the disorder- including Relationship OCD, Magical Thinking OCD, Harm OCD, Counting OCD, and many others. People who have OCD can have several subtypes or just one. These subtypes bring different types of distressing obsessions and compulsions. Being aware of these other types of obsessions and compulsions can be helpful in appropriately identifying OCD.
Medication is the only course of treatment for OCD
OCD, like several other disorders, can be managed and treated with medication, but Cognitive Behavioral Therapy (CBT) is as effective as medication for treating mild to moderate OCD in kids. In CBT, therapists help children to challenge their irrational thoughts and push back against their OCD. Therapists also use Exposure and Response Prevention (ERP) to help children to gradually expose themselves to a fear and resist the urge to complete a compulsion. For example, children who may be anxious about touching doorknobs due to fear of germs will be encouraged to slowly work on exposing themselves to touching a doorknob and resisting the compulsion to wash their hands. Through small exposures (sometimes as small as thinking about touching a doorknob and not washing your hands) the child is able to fight back against OCD and slowly regain control over their thoughts and behaviors.
Children will have to attend therapy for the rest of their lives if they are diagnosed OCD
OCD is a chronic condition that is never “cured” but rather is managed. OCD can flare up at certain points throughout a person’s life. These flare ups typically happen during times of transition (moving, school related changes, family dynamic changes) or from a triggering situation (traumatic event). While they may need different levels of support throughout their lives, with the help of skilled providers and participation and adherence to therapy, children can manage OCD symptoms and be successful throughout their lives.
If a child is showing fear of germs, it must be because they have OCD
While this can be a potential symptom of OCD, anxiety around germs does not mean that a child has OCD. Looking for continued signals such as obsessions and compulsions around the fear (e.g. If I don’t wash my hands for at least 45 seconds then I will get sick), as well as the frequency of such behavior, are important factors when it comes to an OCD diagnosis. If you are worried or concerned your child might have OCD, talking to professionals is an important first step. Recording frequency, duration, and severity of the behaviors and thoughts with the child can help professionals to appropriately diagnose and support a child.