Obsessive-compulsive disorder is a mental health condition
where repetitive intrusive ideas, images or impulses cause extreme anxiety.
In order to lessen the anxiety,
the individual engages in compulsions which serve to decrease their sense of distress.
Ritualistic behaviours can be a really normal phenomenon.
Parents may recall their children going through a period,
where for a short time in their life they became quite ritualistic.
They might, for instance, insist on lining all of their toys up in a particular manner,
or organising their bedroom and quite a strict routine
and that is a normal part of development that typically fades away.
There are a few key things that we have to think about in terms of deciding whether these behaviours have become OCD
and they focus on, firstly the time that it takes for the individual,
the simple maxim where you may need to start thinking carefully about it,
is if all the behaviours are taking up an hour or more per day.
The second area is around the amount of interference that the OCD is causing.
So for instance, the behaviours may be starting to have an impact on the child's ability to go to school,
or engage in their normal friendships or participate in everyday life.
If that's starting to become noticeable to a family or to teachers,
I think that's a cause for concern.
A common obsession is around germs and contamination,
for instance, a child might worry that they have bacteria or other contaminants on them.
That are going to cause them or people close to them to become unwell.
Children may worry about harm coming to themselves or loved ones in the form of illness,
injury or assault.
A lot of young people have obsessions that relate to symmetry and order,
wanting things to be in precise arrangements.
They may have excessive concern with an aspect of their body or appearance.
Themes around religion and spirituality are also very common.
For example, that you're an evil person or you've broken the rules
and if you don't engage in certain compulsions you'll go to hell.
Obsessive thoughts about violence or aggression
can be particularly troubling in young people with OCD,
as can thoughts of a sexual nature.
In younger children these may be intrusive thoughts of body parts such as breasts and penises,
or contact with body parts of pets.
The vast majority of people with OCD don't just have one symptom,
they typically have a range of obsessions and a range of associated compulsions.
Teachers or parents of someone with OCD,
might have noticed that the child or young person is actually quite typically generally a worrier.
Someone who has an inflated sense of responsibility for things
and generally finds that everyday life can be a little more stressful.
Some of the most common compulsions relate to obsessions around germs and contamination.
The young person might engage in drawn-out, ritualistic washing and cleaning behaviours.
Another form of compulsion is repeated checking in a compulsive manner.
This could be of switches or taps or frequently checking other people are safe.
Children might repeatedly ask parents or teachers and doctors for reassurance.
Is this clean? Is this safe to touch? Is my homework correct? Am I a good girl?
Some children may feel the need to compulsively confess details of their behaviour,
to check whether they have done something harmful or even illegal.
Other compulsions can include repeating actions or phrases, until things feel right,
or having to touch items a certain number of times.
Young people may be compelled to avoid places and items they perceive to carry germs,
such as public transport and public toilets.
As well as avoid situations which could trigger the need to carry out compulsions.
We know that stress is an important index for children who have subsequently developed OCD.
Key stressful life events that can happen in a child's life,
things such as bullying, house moves, divorce, deaths in the family,
can all be important factors that might tip them over the edge to developing OCD.
We know from good quality research that OCD is prevalent in all cultures.
What we also need to be clear about and parents and teachers need to think carefully about,
is supporting people from different communities seeking the right treatment.
People's own cultural factors can have a very important impact on how they understand treatments for mental health
and that might need to be thought about very carefully.
When a child starts to develop signs of symptoms that could be OCD,
I think it's important to really note those in your head and just take a watchful, waiting approach.
Over time those symptoms may dissipate but if you're careful and review them,
you can then perhaps flag them up if they become more of a concern in time.
It's really important that children with OCD get the right treatment, at the right time
and a number of people can make a referral.
Parents might want to go to their general practitioner
and ask for a referral to the CAMHS service or Child and Adolescent Mental Health Service.
Alternatively teachers or special educational needs coordinators in schools,
are people who can make direct referrals to their local CAMHS service.