Living with Severe OCD

Obsessive-compulsive disorder (OCD) is a condition that involves ongoing unwanted thoughts, worries, or images (called obsessions) and repeated behaviours or mental rituals (called compulsions). These symptoms can be upsetting, take up a lot of time, and interfere with everyday life at home, school, or work.

OCD can include strong urges to clean or wash, a need for things to feel “just right” or in a certain order, and distressing intrusive thoughts. A child or young person may experience more than one type of symptom, and these symptoms can change over time. OCD often begins between the ages of 9 and 10, and about half of all cases start during childhood or adolescence. Boys tend to show symptoms at a younger age than girls.

How is OCD diagnosed?

A diagnosis of OCD is made when obsessions and/or compulsions:

• Take up a significant amount of time
• Cause noticeable distress
• Interfere with daily life

Obsessions are unwanted and upsetting thoughts that keep coming back. Compulsions are repeated behaviours (such as washing, checking, or counting) or mental acts that a person feels driven to do to reduce anxiety or prevent something bad from happening.

OCD can sometimes begin after a stressful life event or trauma. In some children, symptoms may appear after certain infections, such as streptococcal infections. In rare cases, this is referred to as paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

Signs parents might notice

Parents and caregivers may notice:

• Cracked or sore hands from frequent handwashing
• Long pauses before answering questions, which may reflect anxiety or repetitive thinking
• Sharing excessive detail or needing things explained in a very specific way
• Bald patches or thinning eyebrows/eyelashes from hair pulling or picking
• Cuts or bites that do not heal because of repeated picking
• The presence of tics (sudden, repeated movements or sounds)

It’s important to pay attention to how much these symptoms affect your child’s daily life, including their learning, friendships, and family activities.

Treatment options

OCD is treatable, and early support can make a big difference. The main treatments include:

Cognitive Behavioural Therapy (CBT)

A specific type of CBT called exposure and response prevention (ERP) is especially effective. In ERP, children are gently and safely supported to face situations that trigger their worries, while learning not to carry out the compulsive behaviour. Over time, this helps them build confidence and learn that they can handle the uncomfortable feelings without performing rituals.

Medication

For moderate to severe OCD, medication may be recommended. The most commonly used medicines are selective serotonin reuptake inhibitors (SSRIs). In some cases, another medication called clomipramine may be considered. A healthcare professional can discuss the benefits and possible side effects with families.

Digital supports

There is growing evidence that online or app-based CBT programs can also be helpful and may make treatment more accessible for some families.

If you are concerned about your child, speaking with your GP and Psychiatrist is an important first step. With the right support, children and young people with OCD can learn to manage their symptoms and thrive.