Obsession

Rituals are part of childhood development but when they become upsetting and start to invade family life there is a chance that it could be Obsessive Compulsive Disorder

Surveys show that one per cent of young people have Obsessive Compulsive Disorder (OCD). However, it frequently goes undetected and this may be due to a lack of understanding and awareness. Children develop normal rituals, which is all part of developing and growing up, for example, insisting on certain foods or being inseparable from a particular toy. Ritualising is typical in children aged three-seven years and so parents can often fail to notice if habits become more prolonged, intense or distressing.

Approximately half of adults began suffering with OCD as a child. It is often characterised by intrusive, repetitive, unpleasant thoughts (obsessions) and repetitive, senseless and annoying rituals (compulsions).

Causes

OCD is usually associated with a big change or trauma in a child’s life such as moving schools or parents splitting up. There can also be a genetic link, meaning that if a parent suffers from OCD there is a chance that the child will suffer from it too. It can also be passed down to the child if the parent has involved them in their OCD, for example got them to clean or check things excessively. The child may think that this is how they should behave.Signs of OCD

• Compulsively touching, counting, ordering, arranging or avoiding objects. A need for symmetry and order with things having to be precisely laid out and neat.

• Spending excessive amounts of time in the bathroom.

• Expressing superstitions about preventing bad events from happening.

• Excessively checking mistakes in schoolwork, leading to delays in starting schoolwork or school avoidance.

• Excessively praying in a way that is different from that recommended by your religion.

• Preoccupation with bodyweight.

• A fear of dirt, germs or contamination

If these behaviours cause the child distress or interfere with their life for more than one hour a day it may be OCD. Chartered psychologist, Heather Sequeira, says: "The important thing to remember is that all these things are normal and that everybody has them, but it’s the extent to which they are getting in the way of a child leading a normal life or having a normal school experience."

Effects

OCD can preoccupy a child’s time and prevent them from putting emphasis on the things that children do, such as homework or playing with friends. Other children may notice these rituals, which may potentially lead to bullying and in turn create other sorts of problems such as anxiety or stress, making the OCD worse.Help

OCD can go undetected for some time because children are often embarrassed and confused as they feel that their symptoms do not make sense.

If you are worried that your child may have OCD you should go straight to your doctor, explain the symptoms and express your concerns. Heather says: "It is very important to remember that there is no need to feel ashamed about it and it’s not the child’s fault. Maybe suggest to the doctor that they might have OCD and see what they say. Like most problems in life it’s really important that you start tackling it early rather than leaving it until later because these problems can get worse the longer you leave them and harder to treat so it’s really important to go early."

According to Dr. Isobel Heyman, Consultant Child Psychiatrist at Great Ormond Street, of the 50 per cent of adults who started with OCD as a child remember that they did not get the help they needed.

Diagnosing OCD may involve asking the child questions about obsessions and compulsions. The clinician will need to consider alternative diagnoses such as depression and other anxiety and developmental disorders. If there are uncertainties about the diagnosis, and if the child is impaired enough to need treatment, a referral to a child and adolescent mental health services is indicated.

Treatment

Dr. Heyman advises: "An important principle is to help the child see OCD as an intruder who is spoiling their life by seeking to control their thoughts and actions. Treatment is aimed at giving the child and the family effective means of controlling the intruder - saying ‘no’ to OCD."This externalising approach to the disorder, giving it a name, and learning how to fight it seems to be a useful technique in child and adolescent treatment."

Cognitive Behaviour Therapy

Cognitive Behaviour Therapy is a psychotherapeutic technique and several trials in adults have shown it to be an effective treatment for OCD. Data shows that CBT also works in younger age groups.

Young people are often curious about the process of CBT and worry that they will be asked to carry out tasks that will be too stressful for them. The young person designs the treatment programme with the therapist so little by little they can overcome their fears. CBT is not usually a long treatment and most children who respond do so in eight - twelve weeks.

CASE STUDY

Forty-five-year-old Dave from Coventry was diagnosed with OCD 18-months ago even though he has been a sufferer since eight years of age.

Dave recalls his earliest memory of obsessive behaviour: "I remember going camping with school and one of my friends told me I’d been lying in the tent most of the night saying, "the family the family." "I didn’t even realise I was doing it." Dave explains that he used to indulge in what is called magical thinking. This is something that is often used by OCD sufferers to try and prevent harm coming to their loved ones

It is thought that OCD is commonly brought on by a big trauma or change in a child’s life, but Dave believes the onset of his OCD was down to something his mother would tell him at an impressionable age. Dave says: "From a young age something that was said to me if I had an accident was that I’d tempted fate. Because of this I always thought that tempting fate on somebody meant that something bad would happen to them. It was such a strong feeling that, say for example I thought my mum was going to die in a car crash, the fear of that happening would stay with me until I used to say some kind of prayer in my mind. This kind of thing would go on until I had a good thought, and if I was saying these things and had a bad thought I would have to go through the whole ritual again."

These thoughts were encouraged even further after an incident that happened to Dave. "When I was younger I was walking down the road with my mother and grandma with my arm in my jumper. My mum told me I shouldn’t do that because people will think I’ve lost my arm and it’s tempting fate. Not long after that I had a bad accident where I put my arm through a glass window." Dave was in hospital for three weeks and still doesn’t have full use of his wrist, however he does now realise that this was an accident and not a result of him tempting fate.

He doesn’t blame his mother for his OCD, but has chosen to confide only in his wife, eldest son and sister-in-law about his condition. "I’m not sure if it’s because I feel embarrassed or because I don’t want to burden people with it. I certainly wouldn’t have liked to have told my mum when she was alive and put the blame on her because it wasn’t her fault."

After reading about OCD in a magazine a year-and-a-half ago, Dave went to his doctor and expressed his concern that he may be one of the one – two per cent of sufferers in the UK. He now has cognitive therapy to help him understand that thinking or talking about bad things can’t actually make them happen. Dave says: "The therapy is harsh but really helps."

His advice to parents who may be worried that their child is suffering from OCD is to go straight to a doctor who understands about the condition. Dave says: "My life would have been so different if I’d have received treatment at a younger age."