OCD and children, as described by Ellie Donnelly

Mymind.org.uk would like to thank Ellie Donnelly, CBT (Cognitive Behaviour Therapist) for giving permission to reproduce her words.  Ellie is founder and Head Therapist at Daisy Retreat, in Bali, and her advice is detailed below:

“Obsessive Compulsive Disorder or OCD is not uncommon in childhood. In fact most adults seeking treatment for this distressing condition can recall symptoms from their early years.

Superstitious thinking is normal and little ones have big imaginations. The world can be a confusing,  scary place and compulsive behaviour begins as an adaptive response to anxiety.

OCD works on a simple loop. An intrusive, repetitive, thought, image or impulse, initially causes discomfort. The child is naturally compelled to get rid of the feeling and so engages in safety behaviours. These behaviours initially reduce the anxiety and so each time the fear pops up the child repeats the pattern.

If your child becomes obsessed with germs and begins washing their hands repeatedly and avoiding situations they fear are unsafe, the natural parental instinct is to do everything possible to reassure your child and remove their discomfort. This does not work.  OCD will always find a way to undermine your reassurance.  For example “What if Mummy is wrong?”

OCD tends to increase in frequency and severity. The more your child engages in the compulsions, the less helpful they become. So hand washing gets worse, things have to be inspected and cleaned more and the world gets scarier and scarier.

All the attempts you make to calm your child could be exacerbating the condition.  Your child’s experience tells them that their compulsive behaviours work because at some point during the ritual their anxiety decreases.

This logical loop is simple: ‘If I don’t do this, the feeling will never go away’.  If they never experience the anxiety without their ritual, they never learn that anxiety will go away without it.  So, reassuring your child or aiding them in their rituals will negatively reinforce their obsessive beliefs and behaviours.  This process can affect and spread to other parts of their life.

The good news is this is treatable.  The bad news is it isn’t nice to watch your child’s discomfort and helping them requires you to do just that, at least briefly.

What can help ?

Exposure and Response Prevention is the most effective treatment for OCD.  It works on the principle of desensitization. For example, when learning to ride a bike, it’s scary at first but if you take the risk and stick with it you realise even if you do fall, it’s not so bad. If you never take the training wheels off, you will always be oversensitive to the idea of falling.

If your child is afraid of dirt, model a relaxed attitude.  Regularly expose them to dirt for prolonged periods of time without safety behaviours such as hand washing.

Go down the slide in the park yourself  instead of  telling your child the slide is safe; , so they can learn through your actions, words rarely help.  Have fun and joke about the fear. Say “Oh no not the dirt monster” and play act out an exaggerated [reaction].

Their distress will reduce, usually much quicker than you think, and eventually the loop will be broken.

Like any Fairytale Monster, OCD gets bigger the more you feed it. If you stop feeding it, it will shrink and eventually stop coming back.  If your child asks if something is safe, ask them what they think.  Encourage them to try things out and be prepared to get dirty.

Help your child identify their own fears and label them as an annoying monster.  Work out what feeds their OCD, for example: washing, checking, avoidance and reassurance seeking; and when they engage in any of these behaviours, remind them not to feed the monster and it will go away”

To read the poem written by Ellie Donnelly, click here

If you feel your child has OCD you can ask your GP or school nurse to make a referral to your local CAMHS team.

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