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Unidad de PaidopsiquiatríaChild and Adolescent PsychiatryChild and Adolescent PsychologyPediatric clinical psychology
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What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder (OCD) can appear in childhood and adolescence, and is characterized by the presence of obsessions, rituals and compulsions.

It is a condition in which the child or adolescent experiences intrusive thoughts that generate anxiety, together with repetitive behaviours carried out to try to reduce this distress.

Although many people have occasional intrusive thoughts, in OCD these become persistent, distressing and difficult to control, interfering with daily life.


Symptoms of OCD in children and adolescents

Obsessions

Obsessions are recurrent, intrusive, and unwanted thoughts or impulses that generate intense anxiety.

Main characteristics:

  • They are experienced as bothersome or unacceptable.
  • They generate fear, guilt or constant doubt.

Compulsions

Compulsions are repetitive behaviour's or mental acts that the child or adolescent performs to reduce the anxiety caused by obsessions.

They may include:

  • Excessive handwashing or cleaning rituals
  • Repeated checking
  • Extreme ordering of objects
  • Praying, counting or mentally repeating words
  • Magical thinking (rituals to prevent harm to oneself or others)
  • Hoarding
  • Counting or number of rituals.
  • Rituals to break contact with a person or object perceived as contaminated.

Although they generate immediate relief, they do not solve the problem and maintain distress in the long term.


How OCD works: the obsession-anxiety-compulsion cycle

OCD is maintained through a cycle:

  1. An obsession appears
  2. It generates intense anxiety
  3. A compulsive action is performed to relieve it
  4. Anxiety decreases temporarily
  5. It is learned that the ritual "works", reinforcing the problem

This cycle can take up more than one hour a day in rituals and affect school performance, family life, and social relationships.


Role of the family in childhood OCD

Family is the key to recovery.

It is recommended that parents:

  • Maintain a calm and understanding attitude.
  • Do not participate in the child's rituals.
  • Avoid facilitating and reinforcing compulsions (for example, by facilitating washing or checking), without prohibiting or punishing them.
  • Collaborate actively with psychological treatment.

Treatment of OCD in children and adolescents

OCD has effective treatment based on scientific evidence.


Cognitive-Behavioural Therapy (CBT)

It is the first-choice treatment according to international clinical guidelines. It includes:

  • Psychoeducation
  • Understanding what OCD is and how it works.
  • Symptom hierarchy: A progressive list of feared situations is prepared, from least to greatest difficulty.
  • Exposure with response prevention (ERP): The adolescent learns emotional regulation and relaxation techniques and, very gradually, is exposed from lesser to greater intensity to the situations that generate anxiety without performing the ritual, learning to tolerate distress until it gradually decreases.
  • Anxiety management and emotional regulation strategies.
  • Tools to reduce the emotional impact of obsessions.
  • Work with families
  • An essential element to consolidate therapeutic progress.
  • Pharmacological treatment: In some cases, the support of pharmacological treatment may be necessary, always under the supervision of child and adolescent psychiatry.
  • Pharmacological treatment

In some cases, especially when distress is intense and disabling, it may be advisable to complement psychotherapy with psychopharmacological treatment supervised by specialists in child and adolescent psychiatry.


Prognosis of OCD

With adequate treatment, the prognosis of OCD in children and adolescents is generally very favourable.

The objective of treatment is not to eliminate all intrusive thoughts (which can appear in anyone), but to ensure that:

  • They do not generate significant distress
  • They do not interfere with daily life
  • The child has a better quality of life and recovers their school, social and family functioning

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