Children, Rituals, and OCD

by teerapun,

by teerapun,

 This post is originally from November 2011:

When my daughter was about two or three years old, she had a bedtime ritual where she lined up ten of her dolls and stuffed animals on the floor. They had to be in the right order, at the right angle, touching or not touching each other in a specific way. If these “friends” were not arranged just so, she would get upset, and then have to adjust each and every one of them until she got it just right. Then she could go to sleep.

And she doesn’t have OCD.

Rituals are a normal part of childhood, and they play an important role in children’s overall development. Rituals create order for children as they grow and try to make sense of the world around them. For example, a bath, story time, and cuddles every night before bed give children structure and a sense of security. They feel safe; they know what to expect.  Everything is as it should be.

Wow. Rituals never sounded so good.  So how could something so wonderful cause so much distress?

Typically, children without OCD will be soothed and comforted by their rituals, whereas a child with OCD will experience only a fleeting calm. Anxiety and distress will always return, and the child will feel compelled to complete the ritual again. As I discussed in this previous post on rituals, this feeling of “incompleteness” is a telltale sign of OCD.

Another thing to watch for if you think your child might have OCD is the amount of time he or she spends ritualizing, and how much it interferes with his or her life. Typically, spending an hour or more a day completing rituals should raise some red flags.

Diagnosing OCD in young children is not always easy, as there are many ways the disorder can manifest itself. And OCD is tricky. Just when I was really starting to worry about my daughter, she began to care less and less about the arrangement of her “friends.” On the other hand, my son, who has never lined up anything in his life, developed OCD.

Recent research suggests that OCD often begins in childhood. I know this is no surprise to a lot of people, as I’ve often been told, “I’ve had symptoms of OCD for as long as I can remember.” I’d love to hear from those with OCD. When did you first realize you had the disorder, or that something was wrong? What were your “early” symptoms like? How did your families react? Chances are the more we share, the more people might see themselves or their children, and seek help.

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26 Responses to Children, Rituals, and OCD

  1. Interesting post, I’m not sure I ever really considered OCD was a part of my problem until fairly recently. I began to suspect some symptoms which can appear similar to paranoia and hearing voices were a form of OCD after watching a documentary on “pure o” the year before last, looking back it does seem to have been there since my teens at least, but definitely not what I would have thought to be ocd years ago. All the best

  2. Thanks for sharing, Jack, and certainly everyone has his or her own story. Wishing you all the best as well!

  3. grannyK says:

    I didn’t realize what was going on with me until my son was diagnosed with OCD. Then, lights went on and I suddenly had an explanation for all of the years that certain things just about drove me nuts! I always had to do everything in 4’s. Turn on/off lights, open drawers or jars. Cans lined up in rows of 4 x 4. If I deviated for any reason, I would go to school knowing something HORRIBLE was going to happen and it was all my fault. I am now 56 and still struggle with this. My son struggles with much more, but at least we now have an explanation, and somehow that makes it a little easier to deal with!

    • Wow, thanks for sharing GrannyK. I totally agree…an explanation makes everything a little easier (for you and your son), because now you know what you are dealing with, and better yet, how it can be treated.

  4. kirabauthor says:

    For me, I think I had a divide between warning symptoms and actual post-onset symptoms. Since I was very young I was considered very high-strung and I always needed attention and approval. I’ve been called things like that my whole life: moody, temperamental, etc. After I fully developed it (age 8), the big difference in rituals for me was that now the rituals, me having to do them, upset me as much as the obsession triggering them. A definite loss of innocence there.

    • Thanks for sharing, kirabauthor. It’s interesting to read how your OCD evolved, and yes, a definite loss of innocence once those rituals began to overtake you. I hope you are doing well now.

  5. KAREN VILLA says:

    looking back I noticed the signs, as a kid I would play with my barbies. Little People, cars and as all children had little scenerios while playing but I played the same scene over and over again, I hid the rituals so well until one day my mom saw me doing something when I was a teen, then I made sure I was more aware of my surroundings and made sure no one would notice,

    • Thanks for sharing, Karen. I’m so sorry that you, like so many others with OCD, felt you had to hide your rituals as a teen.It’s too bad you weren’t able to get help earlier, but so glad you are on the right track now.

  6. blog32114 says:

    Hi there! I’ve been following your blog for a few months now and it has definitely helped me in my own struggles with OCD, so thank you for that.

    I’m in my twenties, and my OCD really flared up probably around 11 or 12. As a younger child, there were “quirks” I had (for example, liking things in sets of 3) that in retrospect may have been early signs, but could have also just been childhood oddities. My OCD manifested itself in many different ways growing up. As you know, most people with OCD hide it very well. I’d say probably only about 10-20% of my OCD struggles were visible to others. I have amazing parents, and they had no idea what I was going through. My OCD issues would change over time and ranged from having to mentally pray probably close to 100X per day to having intrusive thoughts about loved ones to obsessively doubting everything from my sexuality to whether I was a good person. It was hard.

    Thankfully, apart from the horrible beast of OCD, other things in my life were good, and I was able to get through some of those really tough times. I worry about kids going through that who have additional struggles in their lives (unstable households, traumatic events, etc.).

    I’ve recently started getting help for my OCD, and life is SO much better. I’m still not comfortable talking about it with anybody other than my psychiatrist/psychologist, but someday I hope to be able to be more open about it. I think raising awareness is so important. I didn’t know that what I dealt with for well over 10 years was all due to OCD. Figuring that out was probably the biggest relief of my life.

    One way that I think OCD awareness can be spread is through incorporating it into health education in schools. Growing up in the public school system, we had health classes from 4th grade through high school that repeatedly discussed issues such as drug/alcohol abuse and sex education. We probably had brief mental health units as well, but I don’t recall OCD ever being discussed apart from perhaps a short paragraph in a textbook. I think if kids/teenagers can be exposed to what exactly OCD truly is, it can possibly be life saving for those struggling with it to realize that they’re not terrible people, and that it’s OCD and can get better.

    • Thank you for your kind words and for sharing your story. You certainly have been affected by OCD in many different ways. I think you bring up a lot of great points, including the relief OCD sufferers feel when they finally receive a diagnosis to the need for awareness and advocacy, particularly in our school system. I couldn’t agree more! Wishing you all the best and hope to hear more from you.

  7. Great description of the kinds of rituals that are comforting and the kinds that are not. I used to have a problem with having ANY sort of ritual in my life–I guess I feared them because it seemed too close to the kinds of OCD rituals that ruled my life. But now I am relearning the comfort of some ritual in life.

    • So interesting, Tina. Kind of an “all or nothing approach” for you because it must have been too scary to have anything to do with rituals. I don’t ‘think I’ve ever really stopped to think how important many rituals are for ALL of us, not just for children, and how difficult it can be to separate the “good” from the “bad”
      for those with OCD. Thanks for your insight!

  8. 71 & Sunny says:

    Really good points, Janet. OCD CAN be tricky, especially with youngsters, or even adults, who are not able to express their thoughts and feelings well.

    I’ve had anxiety for literally all of my life, showing signs as an infant (according to my mom). In a lot of ways, my anxiety symptoms just seemed kind of normal, as it was all I knew, and family members also had anxiety. Although as a child I began to notice that I worried about things so much more than everyone else. I was embarrassed about that, so I would make excuses to everyone that, “Sorry, I’m just a worrywart.” I would ‘tattle’ on myself all the time as a child. I hated the idea of having done something wrong and my parents not knowing about it. Though the OCD wasn’t full-fledged until I became an adult, GAD was ALWAYS a part of my life. Constant inner turmoil and feeling on edge, though there were times in my childhood that were still good and fun in spite of it. I was the ultimate good little girl, or at least I wanted to be. Ironically, when I became a teenager I could not stand the emotional straight jacket, and I went the opposite way, lying to my parents, doing stupid things I knew I shouldn’t have done. I realize now that I needed some kind of outlet for the stress and it was all I knew how to do. The anxiety sort of melded into the background until my late teens when it came roaring back and has never gone away since.

    In a lot of ways, I’ve just always felt different from others. Funny enough, since completing treatment and recovering a significant part of my health back, I actually like being different from everyone else!

    • Thanks for sharing your story, Sunny, and it really shows how ingrained anxiety can be. I mean, you were even anxious as an infant! I like that you are different from everyone else too!

  9. jstewart84 says:

    Thanks for sharing, Janet! I think my ocd started when I was in grade school, but definitely got worse as I got older. I used to think I was just a hypochondriac.. I would read a book about a girl with cancer and automatically think I had it too…etc. Now looking back.. it wasn’t just those fears, but a lot of other things too. I would check the doors multiple times at night.. pack my hamster in his travel case every night in case there was a fire… those types of things. Just very fearful and wanted to be in control of everything.

  10. Nancy says:

    My daughter officially was diagnosed around 12-13. We finally noticed her very red hands, went to the Internet and figured it out. I don’t recall very many anxieties that fall into the extreme catagory during her elementary school days. I think it really came out of left field for her and for us. Of course, we’ve spent lots of time trying to figure out where it came from, what was the cause. Are we all on the spectrum? Oh probably. Did my breast cancer (now cured) diagnosis nudge it into being? Nature? Nurture? I’m pretty sure most of that really doesn’t matter nearly as much as getting the right treatment does. She has been to a ERP program and it has helped.

  11. katherine querard says:

    We have an 11 year old who copes with both ADHD and OCD. Our initial focus, the first diagnosis, was the ADHD. It took us about 2 years but we are now at a good dosage (concerta in the a.m. and a bridge ritalin in the afternoon). He is a totally different person – grades are stellar, super social and successful in sports. With that comfort level, we “finally” noticed his struggles w/OCD. Reading your blog, i feel very late to the game! but, as i have read here, i won’t waste time berating myself (at least not too much – my husband already heard it, several times), and instead focus more on helping him get the right treatment. He has a good therapist that he sees but, again, belatedly, i am only now getting ready to ask of her the questions i apparently should have started with – what approach do you use, what success do you have, etc.! Based on what our son has shared, i am pretty sure that it is some form of ERP but will confirm. In the meantime, i wanted to ask you how appropriate it is for us parents to be involved? specifically, what parts of ERP can we mirror at home? Also, if we compiled a list of his OCD tendencies that we notice at home, can share w/the therapist to make a “global” list that, together w/T, we can then prioritize via his anxiety levels (as is done with the therapist).
    Assuming that this is appropriate for parents, the next question involves our attempts to mirror somehow the therapist’s efforts at home. Not being therapists, our basic instinct is that more constant, consistent assistance in reducing his rituals can only be to his benefit. Yes?
    i am asking the same of our therapist but i wondered if you or others followed a similar path?

    • Thank you so much for sharing, Katherine. I don’t think you are “late to the game” at all. Your son is only eleven, and with the right therapy and such a caring parent, I’d say he is “ahead of the game!”
      My son was 17 when he was diagnosed, so our parental involvement was different than it would be for an 11 year old. I certainly think you should meet with your son’s therapist to get a clear understanding of his ERP therapy, as well as to establish your role in your son’s treatment. You need to learn the best ways to help and support your son without enabling him, and I believe your son’s therapist should be your main resource. It is absolutely appropriate for you to be involved; it’s just a matter of figuring out what exactly that “involvement” should entail.
      You are on the right track! Please keep me posted as you move forward and I wish you and your son all the best!

    • Nancy says:

      I think it is imperative (not simply appropriate) for you to be involved. Someone who really knows ERP and kids with OCD should expect your involvement. In fact, lots of your involvement will be learning to not enable the OCD. I was involved with my 28 year olds treatment even though she didn’t live with us. Parents are most often the closest and most qualified to help! BTW- make sure this therapist has the specialized training for ERP. Many don’t really have that background. We spent too many years without a truly qualified therapist.

      • Thanks for sharing your thoughts, Nancy. I think you bring up an excellent point about making sure therapists really knows ERP. Unfortunately a lot of therapists say they do, but they really don’t. The IOCDF website suggests a list of questions to ask potential therapists, which is a good first step in the selection process.

  12. Grackle says:

    My OCD really began at 10, but I had signs and tendencies for years leading up to that. Good post.

  13. myocdvoice says:

    I think I have had symptoms since at least middle school or even late elementary school (one I can remember is having to say goodbye to my family in the morning following a certain “script” or something bad might happen.) However, I was only recently diagnosed at 19. I must have hid it pretty well. As I got older I began to speculate something was wrong but wasn’t sure what. Taking AP Psychology in school (at age 16-17) was actually the main wake up call for me. I know you aren’t supposed to diagnose yourself but it was pretty obvious to me that it couldn’t be anything else.

    • Thanks so much for sharing. I always find it interesting to hear how people were diagnosed. My son also diagnosed himself just by searching the Internet. it was obvious to him as well. Wishing you all the best!

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