Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) involves excessive, irrational, or unreasonable fear and anxiety. OCD is characterized by distressing thoughts and images in which specific obsessions and compulsions as well as distorted patterns of thinking cause significant amounts of distress. While many thoughts are experienced in the form of language, it is also common to experience thoughts as images or pictures in the mind. Obsessions often concern the possibility of danger, harm, or responsibility for danger or harm. Childhood OCD can be episodic in presentation and is frequently reactive to stress in that children and teens experience symptom exacerbations during times of psychosocial challenge, such as the start of the school year or moving to a new home. Anxiety is typically associated with the anticipation of future negative events. For example, “what if I get sick?”

In OCD, children have unwanted thoughts (obsessions), and urges to perform certain behavioral or mental rituals (compulsions). Obsessions induce anxiety or distress and compulsions reduce the anxiety and distress temporarily and the compulsion as a way to neutralize anxiety is maintained through a process called negative reinforcement. In the short term, the compulsive behavior or mental ritual reduces anxiety. However, the gain is temporary as it prevents the child or teen from learning that the anxiety or worry they experience can be tolerated. Thus, engaging in compulsions because a way to cope with obsessions.

Obsessive-compulsive symptom expression can differ across age groups, which may be in part to due to developmental factors including cognitive development. Therefore, developmental differences in symptom expression should be considered when assessing child and teen OCD. In children, compulsions without expressed obsessions are common, and the compulsive behaviors themselves may be different than those observed in teens or adults. Younger children with a diagnosis of OCD, unlike older children or adults, have challenges differentiating obsessional thoughts from other, nonintrusive, recurring cognitions or images. Additionally, they may not be able to identify the connection between obsessional thoughts and subsequent compulsions, or to effectively express this pattern to others. Thus, it is critical that a developmental understanding and knowledge is incorporated into the psychological assessment and psychotherapeutic process.

Intrusive, unwanted thoughts that resemble obsessions are experienced by everyone. That is, people without a diagnosis of OCD experience the same kinds of unwanted and intrusive thoughts as people with OCD. We have many thoughts so it would be expected that we will, at times, focus on some thoughts that are not logical. There are differences in how people with and without OCD interpret their unwanted negative thoughts. Children and teens without OCD seem to dismiss their unproductive thoughts as meaningless. In response to such a thought, they might automatically say to themselves, “that is not going to happen.” However, children and teens with OCD misinterpret their intrusive thoughts as highly meaningful and threatening. Thus, the main difference between children and teens with and without OCD is in the importance that they attach to their intrusive thoughts and not the thoughts themselves.

There are a variety of psychological approaches including ERP that can be used to treat children with OCD to not only reduce symptoms, but help the child with self-esteem, and social functioning.  A Clinical Psychologist with specialized experience in treating children and teens with OCD is important as the training and experience will allow for developmental considerations and comprehensive approaches which are critical to achieving the best outcomes.


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