Obsessions are involuntary, repetitive and persistent thoughts, images or impulses. They cause the person intense anxiety and distress, as they are experienced as unwanted, irrational, unacceptable and distressing. The person usually makes every effort to ignore, suppress or 'neutralise' them with another thought or action, such as a compulsion.

Compulsions are repeated visible or mental acts, usually of a ritualistic nature. The individual performs them in response to an ideology or according to rules that must be strictly obeyed. They are intended to counteract the obsessions and reduce the anxiety they cause.  

Obsessive-compulsive disorder ideations:

• fear of infection (I will be infected by something I touched)
• perfectionism (excessive preoccupation with precision, order and symmetry)
• fear of causing harm to myself or another person
• doubts and fear of something bad happening (the kitchen eye, the unlocked door)
• Preconceived notions (lucky and unlucky numbers, if I don't do this...something bad will happen, etc.)
• unwanted thoughts of sexual, violent or blasphemous content (mostly teenagers) 

OCD compulsions:

• Frequent and excessive washing and/or cleaning, usually in a ritualistic manner
• Frequent and excessive rechecking (that he hasn't forgotten something)
• Tidying and precision of objects in a certain way that is always the same.
• Frequent and persistent reassurances (Nothing will happen to me..)
• Repeating the same actions (rereading or rewriting something,)
• Mental compulsions (prayer, counting)
• Excessive worry about trivial things and trivialities
• Putting objects in order or rearranging them until he feels a sense that everything is "okay"
• Accumulating items, thinking that they may need them in the future
• Sequence of specific behaviours
• Verbal compulsions 

Causes of OCD
OCD has a neurobiological basis, with studies showing that the brain functions differently in people with the disorder. An abnormality, or imbalance in neurotransmitters, is involved in the disorder.

What might be the warning signs of OCD?
The child/adolescent may:

• Be very late in completing a task even in simple activities
• Ask frequent and persistent questions about the health of family members
• Worries excessively about trivial things and unimportant details
• Reacts extremely to trivial things
• Has difficulty and/or delays going to bed to complete tasks
• Changes his eating habits
• Displays strong indecisiveness
• He/she has great difficulty in going about his/her daily life
• Spends an unreasonable amount of time on daily routines, such as personal hygiene, eating or dressing
• Repeating the same actions over and over again
• Persistently asks for reassurances and does not reassure easily
• He is a perfectionist, gets angry and easily loses his temper if he does not get something perfect
• His daily routine is very difficult to manage
• He tries to hide his strange behaviour, "disappearing" for a long time in the toilet or in his room
• Becomes extremely angry and upset when interrupted during a routine or daily activity 

How does OCD affect children and adolescents?
OCD can make everyday life very stressful for children. Rituals usually take a long time and children are often late for school or activities. This often leads to tensions or conflicts within the family. Children cannot enjoy time with friends or have fun when compulsions take up all their free time. At school, obsessions and rituals such as checking, crossing off and re-doing assignments affect attention and concentration, completion of assignments and school attendance. Older children and adolescents do not understand what is happening to them, they worry and work hard to hide their compulsions. Their days are busy and they often break their sleep schedules in order to complete their responsibilities. Consequently, they sleep late and are tired during the day. All this stress affects their emotions (sadness, anger, tantrums). 

How does OCD affect the family?
The family often suffers when a child presents with OCD. Initially, parents may be confused or frustrated by their child's odd behaviours. They may become frightened when their child becomes upset and seems unable to stop the compulsions.

Children may push their families to engage in OCD in many, different ways: They often seek reassurance by repeatedly asking their parents the same questions and demanding answers each time. They may need help from parents and siblings to complete their rituals. They may insist parents and siblings follow their compulsions. They may become very angry if they do not get their way. All this is very stressful for the family, who feel that they cannot relax and that life at home is very tense. Parents may feel that they have to change the family routine or give in to the child's demands to prevent the child's anger and anxiety. It is natural to go through many different emotions, such as fear, frustration, anger, guilt and sadness. They often worry about whether their child will recover and what their future will be like.

Can OCD in children and adolescents be treated?

Treatment of OCD depends on how the condition affects the person's functioning. Treatment includes:

• Psychotherapy
• Psychotherapy
• A combination of psychotherapy and medication 

What is Cognitive-Behavioural Psychotherapy (CBT) and how does it work?
Experts agree that CBT is the treatment of choice for children with OCD. Using a strategy called exposure and response prevention (ERP), children and adolescents can learn that they are responsible, not the disorder. They can learn to do the opposite of what the disorder tells them to do by facing their fears slowly in small steps (exposure), without giving in to rituals (response prevention). ERP helps them discover that their fears are not becoming reality and that they can become accustomed or used to the scary feeling, just as they might get used to cold water in the pool.

Medication in children and adolescents with OCD
The medication used to treat OCD in children is antidepressants called selective serotonin reuptake inhibitors (SSRI's). Medications should only be considered when symptoms are moderate to severe.

I think my child may have OCD, what should I do?
You have already taken an important step by making sure you are informed and reading this article. If the symptoms are upsetting your child and interfering with their daily life (school, friends, behavior, etc.), talk to them and seek help from a mental health professional. You are your child's best advocate. It is important to find the appropriate support you are looking for.

Aliki Kassotaki - Speech and Language Therapist MSc, BSc

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