Obsessive-Compulsive Disorder in childhood: what parents need to know and how they can act

The diagnosis of Obsessive-Compulsive Disorder (OCD) in a child raises questions about how the family can act. Should they ignore or prohibit ritualized behaviors? Does engaging in the behavior with the children decrease anxiety or feed the need to perform it?

Being a mother and father is challenging in itself. When children present symptoms or are diagnosed with Obsessive-Compulsive Disorder (OCD), the difficulty increases and doubts arise. What do you need to know as a parent of children with symptoms of Obsessive-Compulsive Disorder?

OCD is associated with a biochemical imbalance in the brain, and the first symptoms can appear in childhood or adolescence. This disorder is characterized by the presence of obsessions - unwanted and persistent thoughts and/or images that cause discomfort and anxiety; and compulsions - avoidance responses manifested through impulsive behaviors and felt as necessary to neutralize the discomfort caused by obsessions. However, this sense of relief is temporary, and obsessive thoughts return.

You may wonder what thoughts are causing so much discomfort. The contents of obsessions are related to various themes, including death, violence, contamination, religion, inappropriate behaviors, or illness. The perceived threat leads the child to have compulsive behavioral symptoms (cleaning, checking, counting, arranging, hoarding, and praying) and cognitive symptoms (mental rituals, hypervigilance, worry). These rituals have a significant impact and significantly disrupt the child's and their family's daily functioning.

The areas affected are usually school (the child is delayed due to morning rituals that cannot be left undone and has difficulty concentrating in class); social (avoiding public places, birthday parties, going to friends' houses) and family (not completing tasks - or completing those inherent to their own rituals - and not adhering to schedules).

When they come to the Psychology consultation, some parents say, "we tell him not to think about it anymore!", "We've already said that he'll be punished if he doesn't stop washing his hands every minute." I recognize that the parents' intention is the best. Ultimately, the role they assume is to help their children. But the truth is that, unintentionally, they are invalidating emotions and feeding the persistent functioning of OCD. As I tell families seeking help in this battle, I need them to be an extension of therapy at home. By this time, they ask me: "How can we, as parents, act?"

I suggest some steps to implement:

• Stop helping the child perform rituals. Every time the child performs a ritual, OCD gains strength. We want to weaken it, and for that, we have to say "No." An example is not going back to make sure the door is locked.
• Criticism and punishment should be withdrawn so that feelings of guilt about obsessions and compulsions are not developed. The child needs to understand OCD and learn to control symptoms. Parents can help refocus attention during crises through breathing control exercises, for example.
• Help distinguish between the child and OCD - "This is an OCD behavior, not João's." João doesn't want to be washing his hands every minute; it's a rule imposed by OCD. I suggest giving OCD a name and using it when necessary. This way, you show that "The problem isn't you, it's OCD."
• During the learning and implementation period of strategies to reduce symptoms, anxiety may increase because compulsions are not performed. Parents can validate the child's emotions and demonstrate understanding - "I understand it's very difficult not to pay attention to OCD; you're being very strong!"

In cases of separated parents, both should act in the same way regarding the symptoms presented and show consistency so that the child does not feel a difference between the two households.

Receiving a diagnosis of Obsessive-Compulsive Disorder brings daily challenges to all family members and becomes imperative to combat symptoms to live a healthy and fulfilling life. Pharmacological therapy and psychotherapy help not only the child but also their support network.

Remember that the child lives in permanent contact with the rules imposed by OCD and fights a daily battle against the anxiety it causes. It is very important to feel unconditionally understood and validated by their family.

Article published on Sapo 24

Maria Guerreiro

Clinical Psychologist for Children, Adolescents and Young Adults