Obsessions and compulsions

Many children have obsessions and compulsions. They can be a normal part of children’s development. For example, your child might go through a stage of wanting his bedtime ritual to be exactly the same every night.

Obsessions are thoughts, images or urges that a child doesn’t want but can’t get out of her head. When a child has these thoughts, she might also feel very anxious or fearful.

Some examples of obsessions might be:

  • imagining loved ones getting hurt
  • being scared of getting sick from touching dirty handles
  • feeling that something terrible will happen if your books aren’t in the right order.

Compulsions are things a child feels he must do over and over. Sometimes children might do this to try to stop an obsessive thought. But sometimes children don’t know why they feel and behave this way.

Some examples of compulsions might include:

  • washing hands repeatedly
  • praying
  • hoarding – that is, not being able to throw anything away
  • counting or tapping
  • mildly superstitious behaviour, like always wearing the same t-shirt to dance class
  • pulling at hair or picking at skin.

Obsessions and compulsions that don’t get in the way of your child’s or family’s life aren’t usually anything to worry about. But if the obsessions and compulsions are getting in the way of your child’s and family’s life, it’s a good idea to talk with your GP.

When obsessions and compulsions become obsessive compulsive disorder (OCD)

If children have unwanted thoughts or compulsive behaviour, or both, which don’t go away and which interfere with daily life, they might have obsessive compulsive disorder (OCD).

You might think about having your child checked for OCD by a health professional if you notice your child has:

  • more severe obsessions and compulsions than her peers
  • obsessive thoughts and/or compulsive behaviour that upset her and stop her from enjoying life or that interfere with your family’s everyday activities
  • obsessive thoughts and/or compulsive behaviour that last for more than six months.

Sometimes a child with OCD will do a compulsive behaviour after an obsessive thought because he believes it will stop something from happening. For example, ‘Nothing bad will happen to Mum if I tap my fingers seven times’. After the compulsive behaviour, the child usually feels less anxious for a little while. But the anxiety peaks again the next time the obsessive thought comes into her mind.

Sometimes children with OCD don’t know why they need to do something, only that they need to do it. For example, your child might say, ‘My toys have to be this way’. He might line the toys up in order, but can’t say what will happen if they aren’t lined up.

Obsessive compulsive disorder won’t go away on its own. And sometimes children who have OCD go on to have other emotional health problems later in life. So getting professional treatment for your child with OCD is important.

How OCD affects children and families

Because obsessive thoughts and compulsive behaviour affect your child’s ability to relax and enjoy life, your child with OCD might have challenges like:

  • problems at school – for example, your child has trouble paying attention or doing homework
  • disrupted routines – for example, your child won’t go to school, come to dinner or go to sleep until her rituals are done
  • physical problems from feeling stressed or not getting enough sleep
  • social problems – for example, your child spends more time on her obsessions and compulsions than with her friends, or she feels ashamed of her OCD or has trouble dealing with other people’s reactions to her behaviour so she avoids social situations
  • self-esteem problems – for example, your child worries that she’s different from her friends and family or that she isn’t in control of her behaviour
  • other mental health problems – for example, anxiety or depression.

Sometimes families just get used to their child’s rituals and compulsions, and it can be hard to see how much impact the behaviour has on family life. If this sounds like your situation, you could try asking yourself, ‘How would our life be different if our child didn’t have these obsessions or compulsions?’

If your life would be changed quite a bit, or if obsessions and compulsions are stopping your child from having fun and doing everyday things, think about seeking help.

Getting help for your child with OCD

A first step to helping your child overcome OCD is getting a referral from your GP to a psychologistpaediatrician or a child psychiatrist. The health care professional you see will assess your child’s symptoms by talking with you, your child and possibly staff at your child’s school too.

Cognitive behaviour therapy (CBT) is the best way to treat OCD. This therapy helps your child develop skills to change his pattern of thinking and behaviour when he’s in a situation that makes him anxious.

For example, your child might be extremely worried that she’ll get sick if she doesn’t wash her hands all the time. A therapist might use CBT to help your child learn that nothing bad will happen if she stops this behaviour. This might involve getting your child to touch things she thinks are dirty and go for longer before washing her hands. The aim is to show her that it won’t make her sick and that she doesn’t need to wash her hands all the time.

In severe cases, medication might be used in combination with therapy. But there isn’t much information about how well medication works in children under seven years.

Your GP will probably talk with you about a GP Mental Health Treatment Plan for your child. Getting a plan doesn’t always mean your child has a serious problem. But if you have a Plan, you can get Medicare rebates for up to 10 sessions with a psychologist. You can also get Medicare rebates for visits to a paediatrician or psychiatrist. Your GP can help you find the right health professional.

Helping your child with OCD at home

Your child’s health professional will work with you to develop a management plan for your child’s OCD.

There are also a few things you can try at home to support your child. If you want to try any of these ideas, it’s always best to let your health professional know what you’re doing.

Supporting your child
It can be scary and lonely for a child to go through OCD. Children with OCD often notice they’re different from other children, which might make them think they’re alone.

So it can help your child to know he’s not alone. Tell him you’re there to listen when he wants or needs to talk about his worried thoughts.

Listen to your child without judgment, and let her know you’ve heard what she’s saying. For example, ‘It sounds like you feel really worried about what will happen to Dad if you don’t check you’ve closed the fridge door’.

It might be frustrating for you, but try to avoid criticising or getting frustrated with your child about his rituals.

Understanding anxiety
You can talk with your child about how anxiety and worry are helpful sometimes – for example, if you’re worried about a test, you’ll often study harder. But some worries are like a false alarm. The more your child listens to the worries and does the behaviour, the stronger the worries get and the harder it is to stop.

You can also help your child understand that she doesn’t have to do what her worries tell her to do. Bad things won’t happen. You could say something like, ‘How many of your friends have got sick from touching a dirty handle?’ or ‘Do bad things happen to other kids whose books aren’t straight?’

Managing anxiety
You can help your child put together some strategies for managing worries and facing fears. These strategies might include:

  • relaxation – for example, deep breathing, muscle relaxation and meditation
  • positive self-talk – for example, ‘I can stop doing this’, ‘I will be OK if I don’t do this’
  • distraction – your child does something else that he enjoys, like reading a book or shooting hoops, for at least 15 minutes
  • a worry box – for example, your child writes down or draws worries and puts them in the box to look at later with you
  • a calm place where your child can do activities that distract him from worries.

When your child is learning to manage anxious behaviour, it helps to start small. If she can’t stop the behaviour completely at first, break it down into small steps. For example, instead of turning the light on four times, turn it on only three times. Or if she has to check the door is locked, get her to wait one minute before checking.

You can set small challenges for your child, and use rewards to help him achieve them. When your child achieves the challenge, he gets an appropriate reward. For example, a child who compulsively washes hands can earn star stickers if he lets dirt stay on his hands longer before washing.

The aim is to gradually help your child cut down the compulsive behaviour. If you help your child keep doing the compulsive behaviour in the same way, it might make things worse.

It might be hard to understand your child. Sometimes you might feel like saying, ‘Just stop it!’ Finding someone to talk to can help you to stay calm and positive. You could try joining a face-to-face parent support group or online forum.

Causes of OCD

We don’t know what causes obsessive compulsive disorder (OCD).

It’s common for children to develop OCD if family members have a history of anxiety or if children have been through a stressful or traumatic event. In some rare instances, children develop OCD symptoms after a streptococcal infection (a bacteria that can cause throat infections).

It’s never a child’s or parents’ fault if a child develops OCD. Children with OCD will do their rituals even if they’re punished for doing them.