This article contains a translation of the original written by its author, Dr. Ben Furman, psychiatrist, psychotherapist and professor of the Solution-Focused approach to preventing and treating mental health problems in both children and adults.
Although it is especially aimed at helping people who are in charge of raising girls and boys with (OCD) to children, all of these ideas are also applicable to adults.
First, it suggests ways to explain OCD to little ones and describes some ineffective and often counterproductive methods that children often use to try to manage their worries. It then presents six creative strategies that you can teach your daughter or son to help them manage the problem.
What is OCD?
Obsessive-compulsive disorder (OCD) is the medical term for a disorder, or thinking malfunction, in which a person suffers from obsessions, which are often linked to compulsions. Obsessions are intense, stubborn worries that something terrible has happened or will happen. Compulsions are repetitive acts that a person performs to try to manage intense worries. Examples of compulsions include repetitive checking, cleaning, ordering, and superstitious rituals.
OCD affects approximately two percent of the population. It is slightly more common in women than men and often begins in childhood, usually between the ages of seven and ten.
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Obsessions and compulsions
An obsession is an apprehension, or a distressing fear that something terrible has already happened or will soon happen because of something the person has done or has not done. An obsession is a stubborn worry that occupies a person’s mind and torments them even if they try their best to overcome it.
Compulsion is the term used for the ineffective methods that people with OCD use to try to overcome their stubborn worries. Imagine this thought appearing in your mind: “My hands are dirty” (even though you washed them a moment ago). You can try to get rid of that worried thought by washing your hands again. If you wash your hands repeatedly, washing is a compulsion that you use to overcome your persistent and exaggerated worry that your hands are dirty.
Another example: an intense worry occurs in a child’s mind that something bad may have happened to his mother while he is at school and his mother is at home. The child may try to get rid of the worried thought by calling her mother to make sure she is well and alive. If the worry reappears soon, and the child feels that he needs to repeat the checking, we can say that the checking is the compulsion with which the child tries to control the worry “something bad may have happened to my mother.”
Standard Treatments for OCD
The two most used treatments for OCD are medication and (CBT).
Psychiatrists readily prescribe psychotropic drugs, even for children, but their effectiveness is very marginal. At best, medication can reduce or mask some of the symptoms of OCD by reducing the but most of the time the side effects of psychiatric medications outweigh their potential benefits.
Cognitive behavioral therapy (CBT) is considered the gold standard for the treatment of OCD in children and adults. Although good results have been reported in clinical research studies, in real life, the effectiveness of CBT appears to be overrated. A large percentage of people who have undergone CBT still suffer from OCD symptoms after they have completed their treatment.
In this article, I propose a way of thinking about OCD and an approach to helping children struggling with the condition, based on the core principles of CBT. However, this approach adds a creative layer that makes it more fun and engaging for the child. My inspiration is mainly derived from the traditions of , andc.
Explaining OCD to children
It’s not surprising that OCD is difficult to explain to a child, because even experts have no idea why some people have this condition and most don’t.
One possible way to help the child understand his problem is to use “externalization,” an explanation commonly used in narrative therapy with children. It means you tell your child that there is an imaginary creature, perhaps sitting on our left shoulder, whose job it is to make us worry. Children usually respond well to this metaphor. Then, you can help your child find a name for the creature and you can also ask him or her to draw it. In this article I will call the creature the “worry gremlin.”
An alternative way to use externalizing is to explain that there is a special region in the human brain that is responsible for generating worry. You can call that area our “worry generator” or “worry core.” The same methods I describe in this article for dealing with the Worry Gremlin can also be applied to dealing with core worries.
Of course, there are no gremlins sitting on our left shoulders bombarding us with stubborn worries, nor are there specific regions of the brain responsible for generating worries. However, metaphor can be very useful for children, not only because it allows them to understand their distressing experience, but also because it helps them to be more creative and astute in inventing ways to cope with their worries.
You can explain to your child that we all have a worry gremlin and we must all learn to accept or live in harmony with it. Sometimes, if the worry gremlin gets excited and goes into overdrive, we need to find ways to calm it down. It is also important to explain to the child that some ways of trying to calm the Gremlin’s overexcited worry work better than others.
Ineffective ways to calm the Gremlin
As a mother or father, it may be helpful for you to understand some of the ineffective ways that children often try to accept their worries. These methods include reasoning, reassurance, verification, cleansing, ordering, repetition, superstitious rituals, avoidance, and distraction.
Reasoning
Children sometimes try to overcome their worries by starting an internal dialogue with their worry gremlin. The problem with this method is that it is almost impossible to overcome the gremlin. Consider this “conversation”:
“Could it be that your hands are dirty?” says the worry gremlin.
“No, they are not. “I just washed them a minute ago,” the boy responds.
“But they could still be dirty,” the worry gremlin insists.
“Why would they be if I just washed them?” the child tries to say.
“You washed them, but not properly. You didn’t wash between your fingers, did you?,” points out the Gremlin of concern.
“I did wash between my fingers,” the boy protests.
“You did it? You’re sure? You could have been careless. I bet your hands are still dirty,” the worry gremlin says now.
“My mother says that it is impossible to have 100% clean hands. There will always be some germs on the skin,” the child tries to reason.
“Right, and touching things that other people might eat can cause someone to get sick. Who knows, they might even die because of you,” the worry gremlin replies, and begins to scare the boy.
“Okay, I’ll wash them one more time just to make sure,” the boy says, giving in to the stubborn gremlin of worry.
Reasoning, or logical argument, means debating with the gremlin of worry. It is intended to silence the gremlin, but it does the exact opposite by unleashing endless counterarguments. The more the child tries to refute the concern, the more intensely the Gremlin will defend it against her. It is almost impossible to defeat the worry gremlin by debating it.
Reinsurance
It is not uncommon for children who suffer from OCD to ask their parents to convince them that their worry is unnecessary. Parental reassurance may offer a temporary respite from anxiety for the child, but the relief is often short-lived. By assuring a child with OCD that there is nothing to fear, parents are doing the child a disservice. Instead of calming him, this well-intentioned reassurance ends up stimulating the child’s great worry, while at the same time increasing the child’s dependence on his parents’ reassurances.
Child: Will someone in our family die during the night while we sleep?
Father: No, no one will die during the night. I have told you many times.
Child: Are you sure no one will die? How can you be so sure?
Father: We will all sleep well and wake up fresh in the morning.
Child: But what if someone dies at night? Please tell me one more time that no one is going to die. Say it again please!
Check, clean, sort and repeat
Some concerns can be overcome by checking. If you’re taking your child to school and they suddenly start to worry that you’ve left the front door unlocked, you can go back and make sure the door is, in fact, locked. Or if your child starts to worry that you might have left the oven on, you can walk over to the oven together to make sure it’s off.
Checking more than once is not a good way to overcome worries. Like reassurance, it only provides temporary relief to the child, while paving the way for renewed doubt and the need to check again. “Yes, it’s true that you already checked it, but did you do it correctly?” the Worry Gremlin asks sarcastically, forcing you to check again and again. Instead of helping the child overcome his worries, checking tends to make the worry more stubborn.
If the concern is related to dirt, it makes sense to try to overcome it through cleaning. Likewise, if the child is worried that something bad will happen if things are not placed exactly the right way, or if activities are not carried out in the correct order, it is understandable that he or she will try to overcome the worry by spending time placing things just that way, or repeating an activity over and over again until you can feel that the sequence was done correctly. As we all know, these types of compulsions can consume enormous amounts of time and do little to help the child overcome underlying concerns.
Superstitious rituals
Humans…