About habits, obsessions and compulsions
Many of us have habits we follow every day. Having habits can be comforting, helping us to feel that there are some things that do not change. For example, using the same mug or sitting in the same chair at dinner time. Children and young people have similar habits, such as taking the same teddy to bed or sitting at the same desk in class. If the teddy can’t be found or someone else is sitting in their seat, it would not be unexpected for the child to have a tantrum or the young person to react negatively.
Some habits can become overwhelming or intrusive, particularly if the desire to carry out the habit is so strong that we cannot settle until it is done. This is when a habit can become a compulsive ritual, which often comes with obsessive and intrusive thoughts. Some examples of obsessive and intrusive thoughts are excessive worrying that something terrible might happen or persistent self doubts. Compulsions refer to the repetitive actions and behaviours that a person is driven to perform to reduce the anxiety caused by their obsessive thoughts. Some examples of compulsions are arranging objects in a specific way or picking at skin.
Children and young people are more likely to experience difficulties with obsessions and compulsions if they are feeling stressed, or if there has been significant change, such as bereavement. Often these obsessions and compulsions may start as a coping strategy during a difficult period but they can become unhelpful, intrusive and distressing. For a few children and young people, obsessions and compulsions may have a significant impact on day-to-day functioning, which may be Obsessive Compulsive Disorder (OCD).
Things to think about
If you think a child or young person might be experiencing obsessions and compulsions, it may be helpful to ask yourself the following questions:
- Are they taking longer to complete normal tasks such as getting dressed, washed or getting ready for bed?
- Do they appear to take longer to get started on tasks?
- Are they taking longer to complete work in school or are they anxiously re-checking work?
- Are they very concerned about putting things in a specific order, such as toys or pencils?
- Do they become very upset by disorder and mess?
- Are they showing excessive concern about order and symmetry?
- Do they show or describe an excessive fear of dirt and germs?
- Are they continually repeating particular behaviours like touching things such as light switches or door handles?
- Do they complain of constantly thinking about certain things, like words or numbers?
The most common misconception of obsessive thoughts and compulsive rituals is that in order for the child or young person to feel better, they need to continue them. In the long term, the only thing that will make them gradually feel better is stopping the obsessive thinking or compulsive behaviour.
Think about your response
These behaviours may be difficult for you to understand and can be frustrating to deal with. To best support a child or young person with obsessions and compulsions, it is important to respond without your own views and feelings affecting your response.
What you can do
- Reassure them that habits and intrusive thoughts are common and that we all experience these to some extent. Give an example of your own, e.g. checking the door is locked before bed.
- Ask them about anything that may be going on, e.g. exams, family problems or bullying.
- Remember that they may feel frightened or embarrassed by their obsessions and compulsions, so talk to them sensitively.
- Find out how intrusive and disruptive the thoughts or rituals are, and what areas of their life are affected. For example, ask how often and for how long they have been experiencing them.
- Tell them that you do understand how difficult it is to control these thoughts and behaviours.
- Gently explain to them, that in order to feel better, they will need to work on reducing their obsessive and compulsive behaviour. Also explain to them that continuing to act on their thoughts will encourage the obsessions and compulsions to become stronger.
- Encourage them to do their rituals less often or for shorter periods of time and support them with this.
- Remind them that they can avoid the thoughts and rituals by getting them to focus on times when they are not happening.
- Tell them that it is ok to feel anxious and explain that these feelings will reduce naturally as they stop carrying out their ritual.
- Suggest they practice relaxation. It is important that relaxation is not used when they are trying to avoid the ritual, as the relaxation could then become part of the ritual.
- With younger children use a star chart to help encourage and motivate them to stop their thoughts and rituals.
- If the obsessions and compulsions happen in school, it may be helpful to develop a joint plan between home and school. This may involve identifying a person in school the child or young person can go to for support.
What not to do
- Don’t trivialise their experience. What they are experiencing is very real for them.
- Don’t ridicule them or embarrass them about their rituals.
- Don’t encourage them to carry out their rituals, even if this makes them feel less anxious. In the long term continuing the rituals won’t help them get better.
- Don’t try to physically force them to stop or punish them for doing their rituals.
Other Resources
NHS Inform, Obsessive compulsive disorder (OCD) self-help guide: www.nhsinform.scot/illnesses-and-conditions/mental-health/mental-health-self-help-guides/obsessive-compulsive-disorder-ocd-self-help-guide
OCD Action, self-help website with helpline: www.ocdaction.org.uk
Who to contact if you're still concerned
For parents and carers
Please contact your health visitor, school, GP or other professional involved with your family.
For professionals
Please consult with other professionals involved or the named person, and to help identify the most appropriate support, go to: www.nhsfife.org/camhs-choosingtherightsupport
