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Recognising and coping with OCD

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By Halina Boniszewskateacher and writer

It is believed that obsessive-compulsive disorder (OCD) affects up to one pre-adolescent child in 200. Recognising the signs of OCD is the first step in helping a child overcome this distressing disorder

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What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is an anxiety disorder. People who have OCD are troubled by obsessive thoughts and ritual compulsions. They can’t stop themselves from thinking about certain things, however bad these thoughts make them feel. They are unable to stop themselves from giving in to a very strong urge to do something (for example, wash their hands three times after every visit to the toilet).

These obsessions and compulsions can be so severe that they interfere with everyday life. Sufferers often believe that if they do not carry out these rituals, something terrible will happen, either to them or someone else. Some research suggests that children may have up to five different obsessions and up to five different compulsions during their period of illness.

OCD is often accompanied by depression that may be partly due to the experience of OCD.

Who can get OCD?

OCD can affect people of all ages. Problems often start in childhood and may continue into adulthood if left untreated. It is believed that OCD affects up to one pre-adolescent child in 200, although some studies suggest it could be as high as three to four per cent. Most studies show that in the case of child OCD, male sufferers exceed female sufferers in the ratio of 3:2.

How does a child with OCD feel?

Most people with OCD feel very stressed and anxious. The severity of OCD varies from person to person, but in some cases it takes over people’s lives. The acute anxiety that a child may feel about not carrying out a ritual properly can lead to feelings of panic: sweating, trembling, feeling faint, shortness of breath. It can also manifest itself in the shape of tantrums.

Tell-tale signs of OCD

Many children have mild obsessions and compulsions at some time or other (for example, not stepping on the cracks in the pavement or having to organise their toys in a special way). Such behaviour does not necessarily mean that a child is suffering from OCD; it may be the result of anxiety caused by stress or change. As young children very often describe their obsessions as worries or fears, it can be difficult to assess whether these are actually obsessions or the kind of worries that are normal to the child’s stage of development.

Practitioners who are worried that a child’s behaviour may be the beginning of OCD should ask themselves the following questions:

  • Is the child upset by the compulsions?
  • Do the compulsions interfere with the child’s everyday life?

If the answer to these questions is `yes’, it may be that the child has OCD. If this is the case, the school should refer the child to the local Child and Adolescent Mental Health Services (CAMHs) or a child psychiatrist.

Common compulsions in children with OCD
  • washing
  • repeating activities
  • checking
  • putting things in order
  • counting
  • touching
Common obsessions (fear/worries) in children with OCD
  • a catastrophic family event (for example, death of a parent)
  • contamination (through germs)
  • bodies (for example, shape, size, physical feature)
  • sexual fears
  • doing the right thing

Case study: Susie

In the very first week of Year 3, Susie got into trouble for blocking the school toilets. She had filled the toilet pan with lots of toilet paper and empty toilet rolls. A week later she did it again. Around the same time an astute teaching assistant noticed that Susie’s hands were red and raw. It turned out that she had been washing them obsessively: ten times every time that she used the toilet. She was terrified of catching germs. This obsessive fear meant that every time she touched something in the school toilets – the flush handle or the door handle – she felt the compulsion to wipe her hands clean with toilet paper which she then threw down the toilet. Before using the toilet she would line the whole seat with toilet paper.

The special educational needs coordinator (SENCO) at the school contacted Susie’s parents who reported that Susie had blocked the toilet at home. They explained that the family had recently moved house and that Susie had become very anxious. The SENCO explained about OCD and the parents agreed for Susie to be referred to the local Child and Adolescent Mental Health Services (CAMHs).

Susie was initially assessed by a child psychiatrist. During the course of the assessment it came to light that Susie had developed other obsessive compulsions, for example, saying ‘goodnight’ three times and lining up her toys in a certain order. The psychiatrist then arranged for her to have a course of cognitive behaviour therapy (CBT) with a clinical psychotherapist. Her parents attended the sessions and worked with the therapist to find ways of helping Susie to resist her rituals. Susie’s obsessive handwashing abated after only two sessions.

What causes OCD?

Scientists are unsure of the cause of OCD. One theory is that it may be the result of an imbalance in the brain chemical serotonin. Some experts believe that OCD may be triggered by trauma, such as abuse. Some believe that a perfectionist tendency can make a person prone to OCD. There is a tendency for OCD to run in families.

What is the treatment for OCD?

Cognitive behaviour therapy (CBT) is the most common treatment for OCD. CBT is a type of therapy that tries to work out the connections between the sufferer’s thoughts, feelings and behaviour. It aims to help sufferers change the way they think. CBT helps the sufferer develop practical skills to manage his/her obsessions and compulsions. Some children may also be given a type of medication called Selective Serotonin Reuptake Inhibitor (SSRI).

What can the school do to help the child?

The most useful thing that school staff can do is identify the disorder quickly and refer the child to Child and Adolescent Health Services (CAMHs) as soon as possible. The waiting list is often very long and the longer the behaviours are allowed to continue, the more deeply entrenched they become and the longer the course of therapy required.

Useful websites

Three booklets about OCD can be downloaded for free from the OCD UK website. Copies of the booklets can also be posted to your school free of charge (although they request that postage is paid for if a large number is asked for).

www.mind.org.uk

www.youngminds.org.uk

www.anxietycare.org.uk

www.rcpsych.ac.uk

www.wellatschool.org

Reviews

  1. vivb
    on 8 April 2011

    OCD

    Thank you for highlighting this over looked condition. In my experience however the case study is far too simplistic. To get through the stages outlined takes time and tenacity. We only got support from CAMHS after the parent wrote to her M.P. Even then access to CBT was not forthcoming. It continues to be under diagnosed and to wreck young and family lives.

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