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OCD and Related Disorders

What is OCD?

OCD stands for Obsessive Compulsive Disorder. As indicated in its name, OCD is made up of two kinds of symptoms: obsessions and compulsions. 
 
Obsessions are thoughts that get stuck repeating in someone’s head that they try to get rid of. These thoughts are intrusive and persistent, and they cause distress. Obsessions often make the person worry that something bad will happen or make them think something feels wrong. Obsessions can be about any  topic, not just the ones people commonly think of such as germs or counting. 
 
Compulsions are repetitive acts that people do to try help themselves feel better. Compulsions can be single actions, complex routines and rituals the person feels the need to do, or even things they do in their head. Checking, counting, saying certain things, and trying to make things perfect are examples of compulsions. Children typically heavily involve their parents in their compulsions, needing their parent to say certain things or do certain things in a very specific way in order to feel okay. People with OCD believe the compulsions are the only way to reduce their distress or to stop their feared outcome from coming true. 
 
Children and teens with OCD experience either obsessions, compulsions, or both. OCD is incredibly impairing for the person experiencing it. OCD can consume a tremendous amount of time and energy (often hours a day), leaving the person depleted of energy or joy for other things in their lives. It can distract from and/or interfere with getting places on time, finishing tasks, learning in the classroom, being mentally or physically present with family and friends, and participating in extracurricular activities. Families are often confused about why their child is consumed by these thoughts, or why their child is so insistent upon completing these actions.

Treating OCD with Exposure and Response Prevention (ERP)

 

OCD is treated with a form of therapy called Exposure and Response Prevention (ERP) that involves learning coping skills and then drawing on those skills. ERP involves creating a hierarchy of feared behaviors, and learning to face each situation without getting stuck on those obsessive thoughts and without acting on OCD urges or relying on rituals. OCD is like a brain trick making people think bad things will happen if certain actions are not thought or done, and ERP helps you take back charge over your thinking, feelings, and actions. 

  • Exposure involves facing the fears or concerns head on 
  • Response Prevention involves using coping skills to resist the compulsions and beat OCD 

 

Treatment Delivery Options 

  • Weekly Therapy– ERP can be provided in weekly individual or family sessions. Even if a child or teen is being seen for individual treatment the caregiver(s) will be heavily involved in treatment. Practicing exposures outside of session is critical to making sustainable progress.  
  • Intensive Treatment- For some children and teens having more frequent or lengthier sessions helps them make progress more quickly. Intensive treatment might consistof treatment sessions being held anywhere from twice a week to daily. Session length for intensive treatment could be 2-5 hours in duration with breaks woven in as needed. 

Body Focused Repetitive Behaviors (BFRBs)

Some children show repetitive behaviors that involve doing something to their body such as pulling hair out (Trichotillomania) or picking at their skin (Excoriation), or nail biting.

These BFRBs are treated using a form of behavioral therapy called Habit Reversal Training (HRT). HRT involves building motivation to change the behavior and building substitute behaviors to replace the unhelpful BFRB. 

HRT is generally provided in an individual therapy format with heavy parent involvement. Sessions are generally held weekly can be more frequent based on severity. 

PANS/PANDAS

Sudden Onset OCD or other mental health challenges

Children affected by PANS/PANDAS develop mental health symptoms literally overnight after being sick. Strep is the most common illness that those who have heard of PANS or PANDAS think of, but there are more illnesses besides strep that can trigger these reactions. PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections. This is the condition associated with strep. PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. PANS can be caused by other forms of infection and metabolic issues. The common thread is that both are autoimmune and cause inflammation in the brain (encephalitis). This means that the antibodies that normally attack illnesses within our body attack our own body instead, and with PANS and PANDAS the area attacked is in the brain (basal ganglia). When the basal ganglia portion of the brain is impacted it affects a child’s thoughts, feelings and behavior. 

 Treatment for PANS/PANDAS generally involves blood tests (to diagnose the infection), antibiotics or other medicines for fighting infections (sometimes a long course), anti-inflammatory medicine (to reduce the swelling in the affected brain areas), and cognitive-behavioral or behavioral therapy (to address the emotional and behavioral symptoms as they do not tend to resolve with medical treatment alone). 

When the presentation involves Anxiety or OCD a form of CBT called exposure therapy is used to treat it. The form of exposure therapy used to treat OCD is called Exposure and Response Prevention (ERP). For tics and body-focused repetitive behaviors a form of behavioral treatment called Habit Reversal Training (HRT) is used. If problem behaviors are the main presentation behavioral treatments that heavily involve the caregivers such as Parent-Child Interaction Therapy (PCIT) or other forms of Parent Management Training (PMT) can be used.

Where do the parents fit into the treatment?

Parents are critical to the treatment process. Our practice emphasizes teaching parents how to help their children apply their skills outside of session in all of the treatment approaches we use. We want parents to feel ready, willing and able to support their child or teen in successfully tackling whatever challenges arise.

There will be times the clinician meets with just the parent and times the parent is included with the child/teen in a portion of a session or even an entire session.

OCD & RELATED DISORDERS | Kurtz Psychology