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Obsessive-Compulsive Disorder (OCD)is a common and debilitating disorder that affects many children and adolescents (roughly 1-4%). The disorder usually involves the child’s experience of obsessions which are intrusive thoughts, images or impulses that are quite distressing and for some children this leads to compulsions which are rituals that are performed repeatedly in an effort to alleviate the distress that comes from the obsessions. Both obsessions and compulsions can take up a significant amount of the child’s time and often gets in the way of daily functioning at home, school and in their peer relationships.
OCD, even more so than other anxiety-based disorders, tends to impact significantly on families and this is particularly because so many of the obsessions and compulsions often take place within the home environment. Parents often get pulled into the OCD experience with the child, whereby they begin to perform rituals with the child or for the child. This process is called Family Accommodation. Parents and other family members do not accommodate because they believe the OCD rules are true, however in an effort to prevent high levels of distress and an often chaotic response from the child suffering with OCD, they make massive adjustments to the way the family would typically function. Family accommodation increases the experience of stress within the family and unfortunately makes the child’s OCD more severe over time.
Fortunately, there have been significant advances over the last decade in our understanding of OCD, the factors that maintain it and how best to approach treatment. In working with children with OCD I take an evidence-based approach which is Cognitive-Behavioural Therapythat specifically involves Exposure and Response Prevention. In this form of therapy, I work with the child to take small gradual steps towards facing their OCD fears (the Exposure), while not engaging in the rituals which OCD tells them is necessary to alleviate the distress (the Response Prevention). In the process of treatment, children learn to tolerate distress and they also learn to let go of beliefs they may have about their responsibilityfor things that in reality are not within their control. For example, through treatment a child may learn that engaging in a 1-hour bedtime routine will not prevent something bad happening to a beloved parent, the child will also learn to tolerate the anxiety that comes from such a thought, and they will learn that the anxiety will pass on its own without any need for rituals.
Because OCD impacts so much on family functioning, I get the whole family on board from the very start, providing good education about OCD and how it works, then getting the whole family to make a commitment to work together as a team to fight the OCD. This treatment approach is dynamic and flexible and very often can be incredibly fun for the young person even while they face some of their most challenging fears. At times, I may do sessions in the child’s home since for many children the OCD is centred around the home environment. We want to make the treatment experience as similar to the child’s daily experience with the OCD as possible.
The role of parents and other family members in treatment is just as important as the role I play as a therapist. It can be challenging for parents to decrease accommodation, especially when it has become an automatic part of the way the family works. However, even making small changes every day makes a big difference in the long run. It is often an incredible experience for children with OCD and their families to re-discover aspects of life which they had been missing out on for so long because of OCD. OCD is challenging, but there is solid evidence that a good dose of treatment can go a long way and overtime it is possible for a child with OCD to be OCD free! For more information about OCD and treatment options please feel free to contact us at Drop of Life Psychology Clinic.
By: Matthew McKenzie, B.Sc. (Hon.), M.Sc. (Dist.)
Provisional Psychologist, Drop of Life Psychology Clinic