Expert Answers: Five-year-old is becoming obsessive

All children have worries and doubts. But those with obsessive-compulsive disorder (OCD) often can’t stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again.

OCD is a type of anxiety disorder. Children with OCD become preoccupied with whether something could be harmful, dangerous, wrong, or dirty – or with thoughts about bad events that might happen.

With OCD, upsetting or scary thoughts or images, called obsessions, pop into a person’s mind and are hard to shake. Children with OCD may also worry about things being out of “order” or not “just right”. They may worry about losing “useless” items, sometimes feeling the need to collect these items.

Someone with OCD feels strong urges to do certain things repeatedly – called rituals or compulsions – in order to banish the scary thoughts, ward off something dreaded, or make extra sure that things are safe or clean or right. Children may have a difficult time explaining a reason for their rituals and say they do them “just because”. But in general, by doing a ritual, someone with OCD is trying to feel absolutely certain that something bad won’t happen.

Think of OCD as an “overactive alarm system”. The rise in anxiety or worry is so strong that a child feels like he or she must perform the task or dwell on the thought, over and over again, to the point where it interferes with everyday life. Most children with OCD realise that they really don’t have to repeat the behaviors over and over again, but the anxiety can be so great that they feel that repetition is “required” to neutralise the uncomfortable feeling. And often the behaviour does decrease the anxiety, but only temporarily. In the long run, the rituals only worsen OCD severity and prompt the obsessions to return.

Doctors and scientists don’t know exactly what causes OCD, although recent research has led to a better understanding of OCD and its potential causes. Experts believe OCD is related to levels of a normal chemical in the brain called serotonin. When the proper flow of serotonin is blocked, the brain’s “alarm system” overreacts and misinterprets information. Danger messages are mistakenly triggered like “false alarms”. Instead of the brain filtering out these unnecessary thoughts, the mind dwells on them – and the person experiences unrealistic fear and doubt.

For more information visit www.ocduk.org

Tell-tale signs to watch for

Parents can look for the following possible signs of OCD:

Raw, chapped hands from constant washing

Unusually high rate of soap or paper towel usage

A sudden drop in test grades at school

Unproductive hours spent doing homework

Requests for family members to repeat strange phrases

A persistent fear of becoming ill

A dramatic increase in laundry

A continual fear that something terrible will happen to someone

Reluctance to leave the house

Paul Charlson

GP from Brough

I am sorry that your health visitor didn’t seem interested. I think you do need to discuss it with a health professional and I would have another try with the health visitor. If that fails speak to your GP. To be honest it does not sound a particularly severe issue at present but does require exploration. Sometimes OCD symptoms, including hair pulling, are signs of emotional distress and you need to ensure that this is not the case. Is it that your daughter is having problems at school such as bullying? Seek out and exclude any possible causes of distress that your daughter may have, If there are none try to play the situation down and hopefully it will pass. If not raise it again with your GP. It is rarely a good idea to try to prevent OCD behaviour as this simply increases the anxiety.

Elaine Douglas

A chartered psychologist who specialises in family and child relationships

Your description of what your daughter is doing leads me to believe that she may be one of those children who feel more comfortable with structure and routine. There is nothing wrong with all of that so long as you can help her along the way to understand that life isn’t always so well ordered and things can happen that upset routines. You can do this gently by switching things round from time to time. Reassure your daughter that this is OK because she may find it quite daunting. If she does get upset then comfort her but stick to your guns because she has to learn to cope with change and disruption. The hair pulling is a little more worrying because it can signify distress of some kind. I am assuming that your daughter will be at school; is everything there all right as far as you know? Have there been any changes or difficulties at home that might have made her feel insecure or upset? If there isn’t anything that springs to mind I would monitor the situation for a little while. If she continues to do this, then I would go and see your GP and see if you can get a referral to a child or educational psychologist.

Cary Cooper

Professor of Organisational Psychology and Health at Lancaster University

I am not a child psychologist, so it is difficult for me to give any professional advice here. Just to relieve the stress of uncertainty and concern, I would suggest you go and see a child psychologist, on your own, describe the behaviour and get some sound professional and diagnostic advice. He/she will then suggest what you should do next, whether your little girl is OCD or not.

Dr Carol Burniston

Consultant Clinical Child Psychologist

There are several possible reasons for your daughter’s behaviour only one of which is OCD. You don’t say whether this is behaviour which has just started or whether she has always had these traits, but it is important that you think about how to answer that question when it is asked. If it is a recent development it is more likely that she is reacting to something that has disturbed her, perhaps a change at home or at school?

If this behaviour has always been present, it could be suggestive of several things including anxiety or a developmental problem. The best course of action is to make an appointment to see your little girl’s GP and explain your concerns. They will be able to refer your child to your local Child and Adolescent Mental Health Service (CAMHS) where an experienced specialist will be able to talk to you and your daughter, help identify what the problem is and advise you how to deal with the situation.