What Is OCD?

When families come to me distraught over the fact that they haven't been able to get rid of a child's or teenager's OCD on their own, I start by telling them that OCD does not respond to sensible solutions because it is not an ordinary problem of daily life. Kids with OCD are normal kids up against a not-so-normal challenge. OCD is an illness, and, like any serious illness, it makes life harder for everyone in the family. The child or teenager feels miserable about not being able to get control over the "silly ideas" and "crazy behavior" of OCD. Parents worry about the future and feel guilty that they don't know how to help. Often everyone is frustrated with each other.

The trouble is that it can be difficult to view OCD as an illness in the brain. Kids with OCD are well aware that their obsessions and compulsions make no sense. That recognition makes them think it should be a simple matter to talk themselves out of listening to the obsessions or acting on the compulsions. Their parents, too, know their kids aren't "crazy," and so they try commonsense means to get rid of OCD. They may try reasoning with the child, cajoling, or even disciplining the child. Upset by the pain their child is feeling, they give her reassurance, comfort, and lots of affection. When none of this eliminates OCD, everyone in the family feels helpless and increasingly hopeless, and OCD thrives when the blame game gets going.

A shift in perspective works wonders. OCD is not about good or bad behavior. When you understand that OCD is a true brain illness, you realize that having it is not a matter of choice and resolving it is not a matter of willpower, though it does require good intentions. OCD is no more a matter of choice than is diabetes or asthma. And, as with diabetes and asthma, there are strategies for making OCD better, for living a normal life that is not constantly restricted by the illness. This view of OCD does, however, have its limits. Although diabetes or asthma often requires family members to adjust the way they think, feel, and act, these illnesses do not cause the child to think, feel, and act differently than before the disease struck. OCD does, and the typical family of a child with OCD can't help being frightened by these changes and feeling at a loss to deal with them.

This is where another perspective comes to the rescue, one that professionals helping kids with OCD have adopted almost universally. Think of having OCD as like having a bad case of mental hiccups—the term aptly assigned to OCD by Judith Rapoport in her groundbreaking book The Boy Who Couldn't Stop Washing. No matter how hard your child and you try to stop them, the embarrassing and senseless obsessions of OCD keep popping up, and your child keeps feeling as if he must perform certain repetitive actions in response. Like the hiccups, OCD may not seem so bad at first. But as time goes on, the hiccups get harder and harder to live with. If you had hiccups that not only refused to go away but got worse, it probably wouldn't be long before you felt as if you were trying to fit in breathing, speaking, eating, and every other function between hiccups. As you undoubtedly know, that's the way kids and families challenged by OCD often feel. You may feel like you're squeezing your ordinary lives in around the demands of OCD, wherever OCD will let you.

WHAT TO SAY TOO YOUR CHILD ABOUT OCD

"OCD hiccups bugging you again?" Remembering that OCD is an illness—not some personal flaw, naughtiness, or craziness—and responding skillfully whenever you see that your child is being plagued by obsessions or compulsions will go a long way toward changing everyone's perspective about OCD.

Billy is a 9-year-old third grader who came to us with severe OCD. Billy's father had had OCD as a child and, as an adult, recognized it right away, so he brought Billy in for treatment. Nonetheless, Billy felt to blame for not being able to control OCD, saying angrily, "I can't make my mind do what I tell it." Once OCD was renamed as a hiccup in his brain, not something he was responsible for, Billy brightened up considerably, asking spontaneously, "OK, how do I make these stinking hiccups stop?"

The first step is to understand what OCD is and how it operates. With that knowledge as your foundation, your child and you will learn how to respond skillfully to obsessions and compulsions so that they get weaker and weaker and you all get your lives back.

OCD Is Everywhere

One of the most important things for all of you to know is that you're not alone. As is the case with other medical illnesses, such as diabetes and asthma, kids with OCD are all over the place. The latest statistics tell us that as many as 1 in every 200 children or teenagers has OCD today—about the same number of kids who have diabetes. That means that four or five kids with OCD are likely to be enrolled in any average-size elementary school. In a medium to large high school, there could be 20 students struggling with the challenges imposed by OCD. In adults, OCD is third among the most common forms of mental illness, almost three times more common than schizophrenia. Most of these adults had OCD as children, and back then they didn't have access to programs like this one. (If they had, maybe they would not be so troubled by OCD as adults.) In children and teens, OCD is also among the more common forms of mental illness, about a sixth as common as ADHD or depression, for example.

Knowing that your family is not alone in having to deal with OCD should make it easier for all of you to keep working together to help the child with OCD get better. You can help your child understand this by saying something like what appears in the sidebar.

WHAT TO SAY TOO YOUR CHILD ABOUT OCD

"Did you know that there are other kids around you at school who are struggling with OCD just like you? In fact, the student sitting next to you in class is about as likely to have OCD as diabetes. Four or...