Obsessive Compulsive & Related Disorders
If your child or adolescent appears to “get stuck” with specific thoughts or behaviors that may appear random, they may be experiencing Obsessive Compulsive Disorder (OCD). “Obsessions” typically present as unwanted or intrusive thoughts or images. Obsessions typically are associated with feelings of anxiety, distress, or discomfort.
“Compulsions” are behaviors that your child may feel compelled to engage in to lessen the distress they feel from the unwanted thoughts. Compulsions can be behaviors that can be seen, such as excessive hand-washing or needing to have items lined up perfectly, or they can be mental behaviors, such as counting or repeating certain phrases silently in their head.
Your child may resist your well-intended suggestions or may argue as they attempt to continue to engage in their compulsive behaviors, or as they attempt to avoid situations that they think will trigger their obsessions. Many children experience high anxiety, frustrated emotion, or panic attacks if they are prevented from completing their compulsions or if they are interrupted while performing a compulsive ritual. Your child may insist on completing the compulsion before they can move on or transition into the next activity.
There typically is a pattern, category or “theme” of unwanted thoughts and behaviors that are experienced with OCD. Some children may experience one category of OCD symptoms while other children may experience symptoms from several categories of OCD. OCD symptoms may also “morph” over time. For example, it may seem that your child has just recently conquered his germ obsession, but then obsessions related to fears of “not being polite enough” appear.
Some examples of symptoms your child may experience include:
- Your child is fearful of germs and refuses to touch certain items that others touch such as doorknobs, stair railings or toilet handles, or your child washes his hands excessively throughout the day or depletes soap/hand sanitizer more quickly than expected
- Your child has a sense of “over responsibility” for other peoples’ safety and believes that because a specific thought “popped into their head” (such as “My uncle might get into a car crash” or “grandma might get cancer”), they need to perform an action to “make sure the bad thing doesn’t happen” (such as placing an object into a “just right” position or saying a specific prayer silently until it “feels like I prayed enough”)
- Your child fears they aren’t “polite enough” and that “something bad might happen because I wasn’t polite enough”; they may attempt to “make sure the bad thing doesn’t happen” by saying certain phrases aloud a specific number of times (such as needing to say “thank you” five times before being able to leave the interaction), repeatedly apologizing for their perceived infraction, or asking for your reassurance numerous times to make sure they didn’t hurt someone’s feelings
- Your child is fearful they have a rare disease; they may repeatedly seek reassurance from you by informing you about every sensation they notice in their body or they may insist on going to the doctor for a medical evaluation frequently
Our therapists use a combination of Cognitive Behavioral Treatment (CBT) and Exposure/Response Prevention (E/RP) to successfully treat OCD. We teach your child about OCD using age-appropriate language to help them realize that their symptoms are “not their fault” and to empower them with knowledge so they can “stand up to OCD”. Your child will learn body and mind calming tools to help them better manage the distressing physical and mental symptoms they may be experiencing.
An essential component of treatment for OCD includes Exposure with Response Prevention (E/RP) exercises. Exposure exercises are designed to help your child overcome their fears as they learn to gradually minimize compulsive behaviors in the presence of an obsession. The clinician will carefully monitor the pace of the exposure exercises to ensure that your child feels a sense of confidence in their ability to manage their own distress. This evidence-based treatment results in a lessening of symptoms and increased self-confidence.
Depending on the age of your child, treatment may involve parents and other family members. Parents of younger children will be more involved in guiding their child through treatment than parents of adolescents. It is common for OCD to affect the entire family as children try to avoid situations that may trigger obsessions, engage in excessive reassurance seeking, or take forever to leave the house due to repeated washing rituals. These behaviors can create discord within the family (and also continue to reinforce your child’s OCD). Our expert clinician will provide guidance to your family to help you disentangle from your child’s compulsive behaviors and teach you the best ways to support them for long-term recovery.
Body Dysmorphic Disorder
Description: AS they develop and grow our children experience tremendous changes in their bodies. It is normal for a child to experience some anxiety and concerns about their bodies at times. However an excessive focus on body appearance can be a sign of the Obsessive Compulsive related disorder of Body Dysmorphic Disorder (BDD).
BDD consists of obsessions (repetitive thoughts or images) related to body or appearance and compulsions (physical or mental behaviors or avoidance of situations), which function to reduce the anxiety, your child experiences as a result of his or her body-focused obsessions.
Symptoms of Body Dysmorphic Disorder include:
- being preoccupied and distressed with a perceived appearance-related defect or flaw
- frequently and negatively comparing their own appearance with peers or celebrities
- getting “stuck” in front of mirrors or reflective surfaces
- repeatedly asking for reassurance about their appearance
- extreme difficulty deciding which clothes to wear
- wearing the same clothes repeatedly and refusing to wear different clothing
- exercising excessively
- engaging in excessive grooming routines
Treatment & Parental Involvement: Along with the treatment provided for Obsessive Compulsive Disorder, treatment for BDD may include “perception retraining”. This involves retraining your child’s self-perception through viewing themselves in the mirror during structured exposure exercises while also narrating their appearance with neutral terms. Your child’s experienced therapist at the Anxiety and Depression Center will identify the appropriate treatment components that will help them to minimize anxiety and reduce their BDD symptoms.
Hair Pulling (Trichotillomania)
Description: Trichotillomania (also referred to as “Trich”) is an Obsessive Compulsive related disorder that involves the pulling of hair from the scalp, eyebrows, eyelashes, or from other body parts. Children who experience trichotillomania are often able to hide this disorder from family and friends until the pulling behaviors result in bald spots on the head, eye area or other parts of the body.
Trichotillomania consists of obsessions (repetitive thoughts and images) and compulsions (repetitive behaviors) typically related to desire for symmetry, perception that the hair strand “doesn’t feel right” in texture, attempts to pull the hair in a certain manner, sensation of “itchiness or tingling” in the area of the hair-pulling or examining/manipulating the hair strand extensively after it is pulled, which may include rolling it into a ball or pulling it between one’s teeth. Your child may feel extreme anxiety and distress if you attempt to prevent them from engaging in these hair-pulling actions.
Your child may suffer from Trichotillomania if you notice that your child:
- spends extensive amounts of time alone in their bedroom or bathroom
- leaves unexpected loose hairs on furniture, the floor, in the wastebasket
- has bald spots on his or her scalp, eye area, or other body parts
- complains of stomachaches or nausea (possibly due to swallowing excessive hair strands)
Treatment: Exposure therapy for Trichotillomania may include having your child spend time in the area that typically triggers hair pulling while systematically and purposely not engaging in hair pulling behavior. Treatment may also involve having your child learn and engage in alternative benign strategies (to replace the stimulating sensorial sensations they receive from hair-pulling and to provide alternative activities for the hands and fingers), such as playing with silly putty, “fidget” toys such as fidget spinner, “koosh balls”, etc. Your child may also learn a number of anxiety management coping strategies that will enable them to engage in these exposure exercises.
Skin Picking (Excoriation)
Description: Excoriation (Skin-Picking) Disorder is an Obsessive-Compulsive related disorder. Excoriation Disorder, sometimes referred to as Dermotillomania, involves recurrent skin-picking behavior and typically is focused on acne, scabs, or perceived imperfection in skin such as around the nail area. The recurrent picking behavior typically results in lesions (which may also result in infections and scarring).
Many children and adolescents engage in skin-picking due to boredom, anxiety, or a perception that the area of focus “isn’t right”. Your child may use his or her fingernail or an instrument such as tweezers or a pin to engage in the skin picking behavior.
Your child may be struggling with Excoriation Disorder if he or she:
- spends excessive amounts of time alone in their bedroom, in the bathroom, or in front of mirrors
- experiences significant distress related to acne or skin imperfections
- has repeatedly attempted to cease skin-picking, but is unable to stop the behavior
- suffers lesions, infections, or scarring related to their picking
- refuses to attend events due to the condition of their skin
- attempts to cover up the perceived skin imperfections and feels shame related to their perceived skin imperfections
Treatment: Exposures for Excoriation may include limiting time spent in front of mirrors, along with other exposures your child’s experienced therapist will identify. Treatment may also involve having your child learn and engage in alternative benign strategies (to replace the stimulating sensations they receive from skin-picking or to provide alternative activities to engage the hands and fingers), such as playing with silly putty, “fidget” toys such as fidget spinner, “koosh balls”, etc. Your child may also learn a number of anxiety management coping strategies that will enable them to engage in these exposure exercises.