As a psychotherapeutic counsellor working with children, teens, and families, I have seen firsthand how debilitating OCD can be—not just for the young person struggling with it, but for their entire support system. OCD isn’t just about being overly clean or particular; it’s a distressing condition that can take over a child’s thoughts, behaviors, and emotions. The good news? With the right therapeutic approach, children and teens can learn to manage OCD, regain their confidence, and live a fulfilling life.
What is OCD?
Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by the presence of both obsessions and compulsions:
- Obsessions: Persistent, unwanted thoughts, images, or urges that cause significant anxiety or distress. These may include intrusive thoughts about harm, contamination, or fears about making mistakes.
- Compulsions: Repetitive behaviors or mental rituals performed in response to the obsessions, often aimed at reducing distress or preventing a feared event. Compulsions may provide temporary relief, but they ultimately reinforce the anxiety cycle and may interfere with daily life.
While OCD can manifest in various ways, common types of OCD include:
- Contamination Fears: Excessive handwashing or avoidance of certain places due to fear of germs or dirt.
- Checking Behaviors: Repeatedly checking locks, appliances, or other objects to ensure safety.
- Reassurance-Seeking: Constantly asking for reassurance from parents, teachers, or peers about their fears or concerns.
- Intrusive Thoughts: Unwanted thoughts that may be disturbing, even though the child recognizes them as irrational or unacceptable.
- Magical Thinking: Believing that performing a ritual (e.g., tapping, counting) can prevent something bad from happening, even though there’s no logical connection between the behavior and the feared outcome.
OCD is not just a quirk or a personality trait—it is a psychological disorder that can severely impact a child’s ability to function in daily life. These symptoms can interfere with school performance, social relationships, and overall quality of life. The good news is that with early intervention and the right treatment approach, children can learn to manage these symptoms.
How Do I Know if My Child’s Worries Are a Problem?
It’s normal for children to experience occasional worries or habits, but OCD becomes problematic when these behaviors:
- Take up excessive time: More than an hour per day spent on rituals or compulsions.
- Interfere with daily life: The child avoids certain activities, people, or places due to anxiety or fear.
- Cause significant distress: The child expresses frustration, shame, or fear about their intrusive thoughts or compulsive behaviors.
- Create a sense of helplessness: The child struggles to stop engaging in compulsions, despite wanting to do so.
- Trigger family accommodations: Parents may feel pressured to accommodate their child’s rituals or offer constant reassurance, which can unintentionally reinforce the behaviors.
The Psychology of OCD: Why Does It Happen?
Understanding the psychological and neurobiological mechanisms behind OCD can help both parents and children feel more empowered to address the condition. Research has shown that OCD is often driven by an overactive cortico-striato-thalamo-cortical (CSTC) circuit in the brain, which is involved in the processing of anxiety and the regulation of behaviors. When this circuit is hyperactive, it leads to heightened anxiety responses and an increased need to perform rituals to relieve that anxiety (Fineberg et al., 2018).
OCD is also linked to cognitive distortions, such as:
- Overestimation of threat: Children may perceive certain situations as much more dangerous than they actually are.
- Need for certainty: OCD often revolves around a need to be certain that nothing bad will happen, even when there’s no logical reason to worry.
- Magical thinking: A belief that engaging in certain behaviors can prevent something catastrophic, even if there’s no connection between the action and the feared event.
How Therapy Can Help with OCD
Therapy plays a critical role in helping children and teens develop the tools they need to manage OCD. An effective treatment plan typically includes a combination of approaches to address the various aspects of OCD:
Exposure and Response Prevention (ERP)
ERP is the gold standard for treating OCD (Krebs et al., 2017). It involves gradual exposure to feared situations or objects while resisting compulsions. This process allows anxiety to decrease over time as the brain learns that the feared event is unlikely to happen and that the compulsions are unnecessary. Through ERP, children can regain control over their OCD and reduce the distress it causes.
ACT-Based Skills for Unhooking from Thoughts
Acceptance and Commitment Therapy (ACT) focuses on teaching children to accept their intrusive thoughts instead of struggling against them. ACT encourages individuals to notice their thoughts without attaching meaning or judgment, which can help children reduce their emotional reactivity to obsessive thoughts. Research has shown that ACT can help individuals with OCD increase psychological flexibility and reduce the urge to engage in compulsions (Twohig et al., 2010).
Compassion-Focused Therapy (CFT)
Many children with OCD experience shame or self-criticism due to their thoughts and behaviors. CFT focuses on building self-compassion and nurturing a supportive inner voice. By activating the brain’s soothing system (Gilbert, 2010), children can learn to treat themselves with kindness instead of judgment, reducing feelings of guilt and shame.
Art and Play Therapy
For younger children, art and play therapy can provide a safe and indirect way to process emotions. Through play, children can externalize their OCD fears, making them easier to talk about. Techniques like drawing, storytelling, and role-playing can help children make sense of their anxiety, process intrusive thoughts, and develop problem-solving skills (Malchiodi, 2020).
Risk Assessment and When to Seek Help
OCD can significantly impact a child’s well-being, and it’s important to seek professional support if:
- The child’s OCD symptoms are severe or worsening.
- There is a noticeable decline in academic performance, social interactions, or overall functioning.
- The child is expressing feelings of hopelessness or despair.
- The family is experiencing increased stress or conflict due to accommodating the child’s OCD rituals.
A trained therapist can assess the severity of OCD and provide a tailored treatment plan to support the child and family.
Tips for Parents: Supporting Your Child Without Reinforcing OCD Behaviors
It’s natural for parents to want to help their child feel better, but it’s important to avoid accommodating the compulsions or offering constant reassurance, as this can reinforce the anxiety and make it harder for your child to break the OCD cycle. Here are a few tips:
- Educate Yourself About OCD: The more you understand OCD, the more you’ll be able to offer support without inadvertently reinforcing compulsions. Psychoeducation can help you distinguish between normal childhood worries and OCD.
- Set Boundaries Around Rituals: While it may be difficult, try not to give in to requests for reassurance or help with rituals. Instead, encourage your child to face their fears gradually (with support from their therapist) and resist the urge to perform compulsions.
- Model Self-Compassion: Show your child how to treat themselves with kindness when they experience distress. By modeling self-compassion, you help them build resilience and reduce feelings of shame.
- Support Their Therapy Process: Encourage your child to engage fully in their therapy, whether it’s ERP, ACT, or any other therapeutic approach. The process may be challenging, but progress is possible with consistency and patience.
Moving Forward: Hope for the Future
OCD can feel overwhelming, but it does not have to define your child’s life. With the right approach, children can learn to manage their worries, build resilience, and live a meaningful life beyond OCD.
If you’d like to explore how therapy can support your child, feel free to get in touch. I am a BACP-registered Children and Young People Psychotherapeutic Counsellor based in West London, Chelsea, offering private therapy for children and teens struggling with OCD. I work with clients online across the UK and worldwide, integrating ACT, ERP, CBT, and CFT, alongside art and play techniques, to support young people in overcoming OCD in a way that fosters self-compassion and long-term well-being.
References:
- Twohig, M. P., et al. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705-716.
- Fineberg, N. A., et al. (2018). The neurobiology of obsessive-compulsive disorder: Emerging treatment approaches. International Journal of Neuropsychopharmacology, 21(1), 20-36.
- Gilbert, P. (2010). The compassionate mind: A new approach to life’s challenges. New Harbinger.
- Krebs, G., et al. (2017). Cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: Predictors and moderators of treatment outcome. Journal of the American Academy of Child & Adolescent Psychiatry, 56(12), 1036-1043.
- Malchiodi, C. A. (2020). Trauma and expressive arts therapy: Brain, body, and imagination in the healing process.Guilford Press.