Kelly ended up in a counselor’s office because her roommates at college were having difficulty living with her. Kelly was convinced that germs were everywhere—and that every time she touched something, she came in contact with those germs. She washed her hands multiple times each day, placed hand sanitizer on every table in every room, and even told her roommates to wash their hands as often as she did. Not only that, she insisted on cleaning the toilet seat after each use by a roommate, even if someone was waiting to use the bathroom.
Kelly had obsessive-compulsive disorder (OCD). “Her brain was telling her that germs were everywhere,” the counselor explained. Kelly developed her behaviors to try to get rid of her intrusive thoughts.
Jake had a routine for everything. He was one of the few teenage boys who was highly organized, neat, and clean. But because he had obsessive-compulsive personality disorder (OCPD), he had a hard time finding a job. People with OCPD have overly rigid ways of viewing the world.
Jake wasn’t able to keep his job at McDonald’s for very long because he insisted that the wrap papers be organized in a certain way: they had to be straight, squared with one another, and even. On top of that, the bags had to be facing the same direction.
His next job was in the construction business. His parents thought the job might be a good fit since there’s a need to be precise—and their son was precise. But Jake discovered that the construction company he worked for accepted less than perfection: angles could be off and things could be uneven. Jake would have an emotional meltdown when things weren’t straight and level. If there were six nails and there were supposed to be five, he’d correct the construction workers. Consequently, he lost that job.
While Jake was good with the younger kids at church, a job helping them didn’t work out either. The kids did a lot of arts and crafts projects, but according to Jake, there was only one way to do a project. So when kids were creative or got paint on their noses, he had to quickly clean them up. It didn’t take long before he lost that job, too.
He ended doing very well with a job at a clothing store because he was the one the owners could depend on to organize the clothes and put everything back on the right rack. And he was meticulous about folding. Jake is now on his way to engineering school.
After hearing about Kelly and Jake’s dilemmas, it’s probably not difficult to see how OCD and OCPD can sometimes provoke or aggravate suicidal thoughts and behavior. People afflicted with these anxiety disorders might be described as a kind of hyperperfectionist (though it is possible to be a perfectionist without being obsessive or compulsive). They live life under the shadow of words like should and shouldn’t. All of their actions are judged against a demanding and inflexible standard of correctness.
Scrupulous attention to detail and a genuine concern for excellence can be positive and advantageous qualities. The problem begins when your child crosses a line from simple conscientiousness into the realm of irrational obsession. At that point, the concern for getting things right becomes so oppressive that she loses the ability to function normally. That’s where OCD and OCPD kick in.
The intensity of OCD and OCPD symptoms can range from mild to severe. At the extreme end of the scale, a person’s focused and specific obsession creates attitudes and behaviors that make it hard to function in life.
Normal and Excellence versus Perfectionism and OCD
We want our kids to learn and pursue excellence. The line between excellence (what we’ll label as normal) and perfectionism and OCD is not easy to describe. In his book Hope for the Perfectionist, Dr. David A. Shoop offers a great comparison.1Take a look:
Probably the easiest thing to notice first is the self-talk. Listen for should and shouldn’t statements and thinking patterns. That’ll be your first clue of perfectionism and/or OCD thinking. Warning: The should and shouldn’t thinking so often sound correct and right. In either case, when you hear should and shouldn’tstatements, look deeper.
OCD and OCPD: What’s the Difference?
OCD is defined primarily in terms of specific behaviors. OCPD is better understood as an expression of an individual’s entire personality, philosophy, and worldview. Let’s take a closer look at each.
OCD is a condition of the brain often characterized by intrusive, anxiety-producing thoughts. Sometimes, these thoughts can become so disturbing, unrelenting, and paralyzing that a person with OCD will attempt suicide just to stop the intrusive thoughts. People with OCD develop repetitive or ritualistic behaviors in an effort to get rid of these thoughts and reduce their distress. Obsessions are the thoughts and urges associated with OCD, such as recurrent, anxious thoughts about germs or personal safety. Excessive handwashing or door-checking are common examples of compulsions (the behaviors associated with OCD). Adding a level of complication to the disorder is the fact that a person with OCD can have obsessions without compulsions, and vice versa.
Obsessive-Compulsive Personality Disorder
OCPD characterizes a person’s overall orientation toward life. In general, this perspective can be described as rigid, inflexible, and/or perfectionistic. A person with OCPD demands that everything be organized according to a particular system or method. He relies on rules and regulations, and order and control are matters of the utmost importance to him.
As a result, he often has difficulty with people who can’t or won’t abide by his standards. This in turn can sometimes make him stingy, miserly, judgmental, and withdrawn. It’s also common for an individual with OCPD to undertake projects with a great deal of initial energy and zeal only to leave them unfinished when obstacles and imperfections arise. The disorder is more common among men than women, and most psychologists agree that it cannot be accurately diagnosed until about eighteen years of age.
A person with OCD or OCPD sees things differently than the rest of us do. The filters through which her brain perceives the world are askew. In an important sense, she experiences another reality. As a result, it can be difficult to live with an individual who suffers from either of these disorders. In both situations parents can be tempted to either deny that the condition exists or cater to the obsession. Neither of these extremes is beneficial.
In families with a child who suffers from OCD, all aspects of life can be affected. Mom, Dad, siblings, and anyone else living in the household are impacted by anxiety, stress, disruptions to their routines, and difficulties at school and work. This is particularly true if one or both of the parents have ever struggled with OCD/OCPD. It’s difficult if not impossible for an anxious parent to help an anxious child. In such situations, the problem tends to worsen.
Responding to OCD/OCPD
The first and most important step in dealing with OCD/OCPD is to be aware of its presence. Most kids who suffer with the disorder don’t even know they have a problem, and most ignore the debilitating effects. Many parents of OCD children simply deny that the condition exists, but this can allow a child’s disorder to shape the entire household’s way of life. The key to correcting the problem is to get help as soon as you recognize the associated behavioral patterns.
It’s best, of course, to seek professional assistance if at all possible. Meanwhile, there’s also a great deal you can do to confront the issue at home. The important thing is to help your child see that the thoughts she’s experiencing are merely an intrusion or an obsession, and she doesn’t need to listen to them or act on them.
It’s crucial to help her replace the intrusive thoughts by redirecting her attention to some more positive form of behavior.
If you have a child whose brain is locked into some kind of compulsive, repetitive, and ritualistic behavior, you can help break the pattern by questioning the false reality that stands behind it. At every opportunity, do what you can to help her reframe her perceptions and reevaluate her thoughts.
For example, let’s suppose you have an elementary-age daughter who refuses to go to bed until she’s checked the front door at least ten times to make sure it’s locked. When she’s on her way to check the door for the fifth time, lay a hand on her shoulder and say, “You don’t need to do that again, honey. We already know the door is locked.” Don’t get angry if she contradicts you. Instead, gently hold your ground and show compassion by empathizing with her emotions: “You may feel as if it’s still unlocked, and I understand that those feelings make you anxious.
Five Steps to OCD Self-Treatment
Step 1: Be aware. The first step is to recognize the disorder for what it is. When problematic thoughts arise, tell your child (or yourself), “This thought is an obsession; this urge is a compulsive urge.”
Step 2: Relabel. Realize that the intrusive obsessive thoughts do not reflect reality, but are rather the result of OCD. Rename it as such: “You’re having an intrusive thought that is false.”
Step 3: Reattribute. Recognize that the intensity and intrusiveness of the thought or urge is caused by OCD. It may be the result of a biochemical imbalance in the brain.
Step 4: Refocus. Replace the obsession with a positive thought. Shift your child’s attention by having him do some constructive activity.
Step 5: Re-evaluate. Help your child refuse to take the OCD thought at face value. Disarm it by saying, “This is your OCD. It has no meaning.”
But there’s really no reason to be afraid.” Then prove your point by taking her to the door and trying the handle yourself.
If she comes back again, simply repeat the process. If you think it’s appropriate, you could try making light of the issue by turning it into a joke, saying something on these lines: “Don’t tell me—did that door just unlock itself again?” Adults with OCD often realize that their fears are unreasonable even though they find them irresistible. It’s not so easy for kids to make that distinction. Humor can sometimes provide the objective point of view that’s needed to break the chain.
It can also help to objectify the OCD by separating it from your daughter’s personality. In the case of a fairly young child, you might do this by selecting a stuffed animal from the toy box and dubbing it Mr. Annoying. When the child says, “Do you think I should go back and check the door?” you can respond, “No, that’s Mr. Annoying talking. You don’t need to listen to Mr. Annoying anymore.” With an older child, you can simple say, “You know that those worries aren’t valid. They’re the voices of your condition or disorder, and you have the power to tell them to go away and leave you alone.”
OCD/OCPD is almost certain to have a negative impact on a child’s academic performance. It can even disrupt his social life at school if the condition alienates his friends or leads to peer rejection. If you have a child with OCD, it would be a good idea to work closely with teachers, school counselors, and school administrators to come up with a plan best suited to address his needs.
Keep in mind that some kids with OCD can do a fairly good job of holding themselves together in the classroom all day long only to fall apart when they get home in the afternoon. If that’s your child’s situation, see that she’s given a safe place and some quiet downtime after school so she has a chance to safely fall apart, then pull herself back together again before joining the family’s activities.
If all else fails, medication can be another option in the treatment of OCD, but only after a thorough psychiatric evaluation. Counseling—both individual therapy and a family-systems approach—can be effective, so consider it a necessary first step before you look at more intensive drug-based types of therapy. Whatever you do, make sure both of you as parents are working together toward the same goals. And don’t get upset or worried if things don’t change overnight. There are many forms of therapy that can help your child overcome his obsessions and compulsions, but it’s likely to be slow going for a while.
Retraining the Brain
Here’s the good news: individuals who struggle with OCD/OCPD can learn to recognize intrusive and obsessive thoughts and feelings for what they are and come up with an active plan to resist them. With patience, repetition, and perseverance, your child can even change the chemistry of her brain through this life-affirming action. The result is liberation: true freedom from a pattern of behavior that might eventually turn self-destructive if left unchecked.