Obsessive-Compulsive Disorder (OCD) is a psychiatric disorder that frequently starts in childhood and adolescence. While often misunderstood, OCD can be challenging to manage, but it is very responsive to treatment. OCD is characterized by anxiety-provoking intrusive thoughts (obsessions) and/or anxiety-reducing repetitive behaviors (compulsions). Individuals with OCD may spend an hour or more "stuck" on unwanted thoughts (obsessions) and/or rituals (compulsions); the obsessions and/or compulsions are frequently time and energy-consuming and interfere with daily activities that involve school, work, family and friends.
Most individuals with OCD recognize that the thoughts and behaviors are unwanted, but they find it very difficult to control them. Frequently family members may be pulled into the rituals (called accommodation) and, similar to enabling, this can perpetuate the severity of the symptoms. Fortunately, there are some very effective treatments for OCD and parents and families can learn how to help their kids with this condition.
OCD is a well studied and understood disorder and there are well-known and effective evidence-based treatments. Patients of all ages with OCD will frequently respond to a specialized form of Cognitive Behavioral Therapy (CBT) called Exposure with Response Prevention (ERP). It is important to find providers who have training in CBT/ERP, especially those who have experience working with children and adolescents. There are others who may try to sell their method of treatment, but as a parent, you should first start with an experienced CBT/ERP specialist.
The therapist will work with you and your child to provide education about how to recognize and treat OCD. They will serve as a coach and a guide, they will help you and your child develop effective skills and help foster your child's independence. While CBT/ERP may not be the perfect fit for your child, an experienced therapist will be familiar with other techniques and should be open to finding the right fit for your child.
It can be challenging for patients to separate themselves from the OCD. Patients and/or their family members often believe that the OCD is just their personality. But, in reality, individuals with OCD do not want these symptoms and would never wish the symptoms upon themselves or others. Research has demonstrated that OCD is a brain disorder, like Tourettes or epilepsy, that is separate or external from the individual. Personalities and temperaments do not change when people treat their OCD - rather, patients are more able to be themselves as the condition becomes less restrictive and intrusive.
"Externalizing" the OCD means that the patient and their loved ones accept that the symptoms are coming from a real illness, like diabetes or epilepsy, and are unwanted. It can be very helpful to give the OCD a name, draw a picture of it or write a letter to it. It’s also helpful for the patient and family/friends to call it out for what it is: a bully!
Once you have accepted that OCD is unwanted and is an illness like diabetes or epilepsy, it is important to work together to "boss back" the OCD. Much like a bully, OCD can enter your life and boss you around, tell you what to do and say, often pulling family members and friends into the mix.
An effective treatment for OCD is to question intrusive thoughts and repetitive behaviors, and to determine whether they are due to the OCD or not. If thoughts are unwanted, uncomfortable and get stuck, then they are probably coming from the OCD. If behaviors are repetitive, hard to control, they are probably coming from the OCD. It can be helpful to give the OCD a name, such as Mr. Bossy or Ms. Bully, and for patients and family members to question, "Is that me/my child talking or is that Mr. Bossy/Ms. Bully?" and if so, "We are not listening to you," and, "You are not going to boss us around anymore."
OCD will frequently try to boss the patient, their family members and friends. For example, if OCD tricks you into thinking that you will become sick or contaminated or just grossed out if your clothes are dirty, then the OCD bully may insist that clothes are washed every day or even more frequently. When parents listen to the OCD they are accommodating the OCD and we have learned that this can make the OCD stronger (just like giving in to the bully).
Parents/family members/friends can learn to recognize when the OCD bully is talking and pushing you around and can learn to confront the bully and not accommodate its demands. With guidance/support from a therapist, the patient and family members can learn to do this at a comfortable pace. They will learn very quickly that the bully gets weaker and weaker and eventually runs away.
As with most bullies, it can take OCD some time to retreat. Studies have consistently demonstrated that CBT/ERP is effective and that parent/family involvement in the treatment can go a long way toward enhancing treatment effects. Facing fears and tolerating change can be scary and uncomfortable for everyone but it works. It is important to surround the family with support, including an experienced therapist. Hang in there - it will get better!
OCD happens to be a disorder with well-established effective treatments so don't feel internal or external pressure to stick with the first provider if they do not have training in ERP. Reach out to the International OCD Foundation (IOCDF), an outstanding and reliable organization that can provide you with connections to experienced providers.
People with OCD are not doing it on purpose. They do not like the intrusive thoughts that are so uncomfortable and anxiety-provoking. The only reason they are engaging in the repetitive behaviors is to try to alleviate the discomfort from the obsessions; they would rather spend their time doing something else. It can be helpful to learn to externalize the OCD in order to change this experience.
Don’t give in to all of the demands of OCD. Work with your child’s therapist to put together a strategy. It may take a little time to get comfortable with this - confronting a bully can be scary at first. However, you’ll likely find once you get started that your worst fears do not come true and that the bully gets weaker and weaker, eventually running away. For example, if the OCD bully is telling patient and parents to wash clothes over and over again because of possible dangerous germs, tell the bully that you are not going to do this anymore. Since this can be very scary at first, have an experienced OCD therapist work with you to develop your bully-fighting plan and to provide guidance and support throughout the process.
Parents, family members, friends and teachers can all fall into the trap of accommodating the OCD: answering a reassurance-seeking question, washing contaminated clothing, providing hand sanitizer/soap - while these clearly reduce anxiety/discomfort for everyone in the short term, they serve to perpetuate OCD symptoms in the long term. Recognize when the OCD is talking and stick to the plan to not listen to the OCD and to boss back the OCD. This is treatment and, despite some discomfort at first, will become more natural and easier over time.
OCD will push your buttons and try very hard to undermine treatment. Never give up the fight - it is worth it to you and to your child!
OCD can be a very challenging disorder for both patients and their loved ones but it’s important to remember that OCD is highly treatable. As you seek professional help and begin engaging in treatment, it can be helpful to identify the OCD as an external bully, whose demands you learn to ignore. Surround your family with lots of support, including an experienced therapist, and learn to boss back the OCD!
More expert advice about Obsessive-Compulsive Disorder
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