Developing rituals in childhood can be normal, however it is important to differentiate these from rituals associated with OCD (Obsessive Compulsive Disorder) by examining the timing, content, function, and related impairment related to rituals. OCD in childhood occurs in 2-4% of children and adolescents, making it a relatively common mental disorder of childhood.

Dr. Sarah Nunes, PhD and Registered Psychologist, writes the following guest post on OCD in childhood:

Many of us have a propensity for tidiness or like to do certain tasks in a particular way. These individual preferences are very different from the neurological disorder called Obsessive Compulsive Disorder (OCD). OCD includes two characteristics:

1. obsessions- which are recurrent and persistent thoughts, images or impulses that are experienced as intrusive, unwanted, and cause distress;
2. compulsions- which are repetitive behaviours, thoughts or images that a person feels compelled to perform in response to an obsession.

A child with OCD can spend significant time each day suffering from obsessive thinking, and/or performing compulsions, which can cause impairment in their functioning.

Some examples of obsessions and their accompanying compulsions in children are:

1. contamination followed by washing/cleaning,
2. concern about harm followed by checking/reassurance,
3. moral obsessions followed by confessing/telling.

Developing rituals in childhood is normal. It is important to differentiate these from OCD rituals by examining the timing, content, function, severity and related impairment. The lifetime prevalence of OCD is about one in fifty people, and the onset is usually in childhood or early adulthood.

Treatment typically involves antidepressant medications, and psychological therapy. Sometimes people engage in both treatment modalities or use just one.  The most empirically supported psychological therapy is called Exposure and Response Prevention (ERP). This treatment involves engaging in exposure situations (either in real life or via imagination) that trigger distress. In these situations a person is then encouraged to refrain from doing any compulsions (or rituals) that reduce the distress. A person learns that:

1. their distress does not last forever
2. refraining from compulsions does not cause feared events to happen
3. they can accept negative thoughts and feelings rather than continually trying to get rid of them.

Children with OCD may have difficulty regulating their emotions, may be oppositional, or deny that they have a problem. Because children have less insight than adults, it may be harder for them identify their obsessions, or they may not recognize the link between obsessions and compulsions. Children toward more “magical” thinking which may influence their obsessions.

Parents of children with OCD may (unintentionally) reinforce the child’s obsessions or compulsions, therefore it is important parents understand the principles of the treatment and make efforts to support therapy. Interference in therapy could involve enabling and participating in OCD rituals, being over-involved or taking control of therapy, being under-involved in therapy, or punishing their child for his or her OCD symptoms.

References

Foa, E, Yadin, E & Lichner, T., (2012) Exposure and Response Prevention for OCD Therapist Guide, Second Edition.

Foa, E. (2014). Intensive Workshop in Exposure & Response Prevention (Ex/RP) for OCD.

Centre for the Treatment and Study of Anxiety, Perelman School of Medicine, Universityof Pennsylvania.

Kaplan and Saddocks Synopses of Psychiatry

This article was authored by Dr. Sarah Nunes, PhD.