Parents can impact the success of their child’s OCD treatment

What is OCD and how many kids struggle with OCD?

Before you can help your child through their treatment, you must first understand what OCD is.

Obsessive-Compulsive Disorder (OCD) is a brain-based anxiety-related disorder that causes considerable suffering and can interfere with all areas of life. OCD has many symptom profiles, also called OCD subtypes or OCD symptom dimensions.

OCD affects between 1 and 200 children and teens around the world (stats from IOCDF website). On average it can take eleven years to receive an OCD diagnosis and seventeen years to receive the proper treatment. (Stats from advanced interventions UK)

OCD consists of anxiety inducing intrusive thoughts or images, that can only be relieved by completing a compulsion, also known as a ritual.

Compulsions can be somatic (physical): needing to breathe a certain number of times, needing to wash their hands a certain way, needing to check to see if they really did lock the door, or needing to brush their hair a certain way. Somatic compulsions are not limited to this list, somatic compulsions can be anything.

Compulsions can also be entirely mental (sometimes called "pure-O""). These Pure-O compulsions can be much harder to identify, as the person experiencing them is experiencing them internally. They may be silently praying repeatedly, they may be mentally reviewing past events to find evidence that their intrusive thoughts are true, they may be reassuring themselves that they are good, or that their thoughts aren’t true.

How is OCD treated?

The gold standard treatment is a type of cognitive behavior therapy called Exposure, Response, Prevention (ERP)

ERP works by having people with OCD face their fears/intrusive thoughts.

OCD thrives on uncertainty, which is often why people with OCD ask seek reassurance from friends and family.

In ERP therapy, the person will be given various tasks to do, for example:

• If they are anxious/uncomfortable touching a doorknob, their therapist may have them touch the door knob a once a day.
• If they seek reassurance, their therapist may tell them they are no longer allowed to ask for reassurance.
• If they have intrusive thoughts “am I bad?” they may be told to respond to the thoughts with “am I bad? Maybe I am! Who care!”
• If they need to wash their hands, their therapist may tell them not to wash their hands anymore, or to delay washing their hands for as long as possible.

An experienced OCD professional will never start with exposure treatments that cause too much anxiety.

They will determine which exposures to start with based on the severity of anxiety relating to OCD compulsions.

Your OCD expert should determine which obsession and compulsions is the least stressful and the most stressful and then start with the least stressful, gradually working their way up to the most stressful over time, and only when the patient is ready.

How can a parents role make or break the success of ERP treatment?

ERP tasks will not only be completed during therapy sessions – the therapist will also assign ERP homework.

Parents come into the treatment equation when it comes to ERP homework. The success of ERP treatment is contingent on how much the patient adheres to ERP homework assignments in between therapy sessions.

For treatment to be successful, the parents, siblings, extended family, and close friends, all need to be aware and on board with the homework that their loved one has been assigned.

ERP can be very difficult emotionally for both the parent and child. It is hard witnessing your child struggle, but it is often necessary.

Parents can inhibit the treatment process by:

• Offering reassurance when their child asks for it
• Carrying out rituals and compulsions for their children/teens (for example, opening a door for their child that the child thinks is contaminated)
• Purchasing special handwashing supplies and making handwashing stations to prevent hands from becoming dry and cracking – don’t supply these things!
• Changing family schedules and living arrangements for their children
• Allowing their child to stay home from school because they want to stay home
• Allowing them to avoid siblings because they feel they are “contaminated”
• Tolerating delays due ritual completion (being late for school because your child needs to brush their hair just right, etc.)
• Decontaminating clothing or living spaces
• Trying to rationalize their OCD or apply logic and reasoning to their OCD
• Negotiating with them
• Questioning their child’s OCD expert and their approach to ERP – your child’s therapist wants to help

It can be hard for parents to know the difference between enabling their child’s OCD and offering comfort. It is important that parents listen to their child’s OCD expert and follow through on the homework assignments no matter what.

A child’s anxiety may get worse before it gets better – but parents must buckle down and persevere through it.

Contact an OCD Expert