OCD: When Once is Not Enough

By Annabella Hagen, LCSW, RPT-S

OCD: When Once is Not Enough“Say good-night mommy, say good-night,” pleaded Johnny every night. It wasn’t as if he had not already read several books, been tucked in, and kissed good night. Johnny’s pleas continued every night.

After the third or fourth nagging requests, she would get irritated and say, “I am done! This is the last one. Good night!” Johnny would cry and ask for more “good nights.”

Mom didn’t know it at the time, but she was reinforcing Johnny’s need for reassurance. One “goodnight” was not enough, but neither were ten.

Ritualized hand-washing or other grooming compulsions were absent. There didn’t seem to be any checking compulsions. If there had been, Johnny’s parents probably would have sought professional help sooner than they did. They only noticed his “neatness habits” were getting in the way of completing his math homework in a timely manner. He would erase the numbers several times until they felt just right.

Sometimes, too, he would get into arguments with his siblings and he always wanted the last word. He felt the desperate need to be “right.” Temper tantrums occurred and his parents attributed them to his stubborn personality. There were occasions when he would ask a lot of questions, and his parents would reassure him — unwittingly reinforcing his obsessive-compulsive disorder (OCD).

Little signs popped up as Johnny grew up. His parents worried at times, but those would dissipate as they noticed all of Johnny’s positive behaviors. He was a straight-A student. He not only showed self-discipline but also self-motivation to excel in school. He enjoyed Little League soccer, baseball, basketball, and other activities.

Then, Johnny became depressed. His mental obsessions and compulsions had finally taken hold, and his parents found professional help. Johnny had been suffering in silence for years. He was too embarrassed to tell his parents what was really going on in his head. He had kept his ordeal a secret. He didn’t want his parents, siblings, or other relatives to think he was “crazy,” even though he really did feel like he was going crazy. The anxiety-inducing thoughts would not go away. The more he tried to stop them, the stronger they became.

So why didn’t Johnny’s parents do something before he got depressed? Were they careless, uneducated, and unaware? The answer to these questions is important.

In short, there are two conditions in the OCD experience: the obsessions (thoughts the individual has) and the compulsions (what the person does in order to decrease the anxiety he or she is experiencing). This is where the misunderstanding occurs.

For example, you may guess or believe a friend has OCD when she compulsively washes or cleans. You may think a relative has OCD when he excessively checks the locks, stoves, and appliances to ensure there won’t be a fire or a robbery. Repetitive rituals such as rereading or rewriting and counting are also types of OCD most people recognize. But what about those who have obsessions, and neutralize the initial disturbing thought with a thought that relieves anxiety? Do they have OCD? Not from the outside, which can lead to confusion and misdiagnosis.

In Johnny’s case, most of his compulsions were silent. His parents couldn’t possibly be aware of them. He felt ashamed, guilty and embarrassed about his thoughts. Research indicates one in 200 children suffer Obsessive Compulsive Disorder. This is according to the reported and correctly diagnosed cases. Unfortunately, there are still many adolescents and children suffering in silence or being misdiagnosed.

OCD Signs in Children: How to Help

It is essential for parents to be involved in helping their children. Unfortunately, sometimes parents believe they are helping when they are actually enabling. For instance, does your child get really upset because she wants you to stand in a certain spot while she brushes her teeth? If you move, does she become unglued? What will you do? Do you do what she’s asking so she can go to bed in peace?

There are instances when the whole family gets sucked into the rituals, and the whole family suffers. There is resentment and stress in the home. Often, parents are not even aware that their child needs help. They may believe they child just has a strong, stubborn personality, like Johnny’s parents did.

Below is a list of typical behaviors of children with OCD. It is always recommended that you consult a professional experienced in working with children and specifically trained to treat OCD.

  • Excessive temper tantrums when interrupted from an activity.
  • Wearing certain clothing or objects all the time. Does he believe it keeps him or others safe from harm?
  • Ordering and arranging rituals driven by need to have things even, balanced, or “just so.”
  • Average or above-average intelligence.
  • Obsession with or avoidance of certain numbers.
  • Showing certain rituals when separating from parents.
  • Following certain rituals at bedtime and excessively upset if interrupted or not allowed to follow them.
  • Involving parents or siblings in rituals and getting upset if they don’t do them as instructed.
  • Having the need to “be right” or “win” arguments.
  • Tries to continue the topic even when others have moved on to another subject.
  • May not necessarily show washing, cleaning or checking rituals.
  • Asking questions and trying to ‘figure things out’ and not feeling satisfied with the answers given.
  • Whispering compulsions while watching TV; appearing preoccupied and distracted when talking to you.
  • Too neat or too messy.

Children experiencing OCD may also exhibit other disorders such as ADHD/ADD, Tourette’s Disorder, autism, depression, separation anxiety or generalized anxiety disorder.

Consult a mental health professional, medical provider or a psychotherapist so they can help you find the right treatment for your child.

 

APA Reference
Hagen, A. (2012). OCD: When Once is Not Enough. Psych Central. Retrieved on October 21, 2014, from http://psychcentral.com/lib/ocd-when-once-is-not-enough/00012596
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.

 

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