OCD — Why Your Child Won’t Act on Their Intrusive Harming Thoughts

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My child is terrified he will act on his intrusive harming thoughts and does rituals to prevent something bad happening. Is it true that kids don’t act on their OCD thoughts?

Yes, it’s true. When an OCD thought occurs your child will feel an incredible urge to act on that intrusive thought (e.g., harming oneself or someone else); yet his feelings are not evidence that this will occur.

How can I help him?

What you can do is help him to understand that intrusive thoughts are not his fault, that they come into his mind automatically. Let him know that all kids (and grown-ups) get intrusive thoughts yet some are able to let them go and others are not. The ones who are not able to let them go have to learn how to do this with therapy and sometimes medicine. Tell him this is okay, and is similar to someone who has any other type of illness that needs the same kind of treatment.

What else can I do to help him see that OCD thoughts don’t come true?

Encourage your son to do the three A’s — Acknowledge, Accept and Allow. This means acknowledging those automatic unwanted thoughts are there; to accept they are there, because pushing them away makes them “louder”; and to then allow them to pass in their own time, meaning no rituals need to be done to make them go away or to prevent something bad happening.

But this will make his anxiety hit the roof!

As you’ll be aware, OCD is an anxiety disorder where children will naturally want to avoid upsetting triggers; yet compulsions settle their anxiety down for a short while only. By teaching them the 3 A’s they learn that it’s okay to do this, since doing otherwise increases the already exaggerated intrusive thoughts which has the whole OCD episode spiralling out of control. The 3 A’s can help keep your child in control of his emotional responses. In graded steps distress tolerance can then be achieved.

He says he needs his compulsions, how can I tell him nothing bad will happen if he doesn’t do them?

Let your son know that each time he gives into compulsions he never gets the chance to prove that his fear will not come true.

Is there any further proof to show him that he won’t carry out the nature of his thoughts?

First, while biologically generated intrusive thoughts makes your child feel a pressure to respond, this pressure is fear, not a true call to action, so do reinforce this with an explanation he will understand. A further explanation to prove that intrusive thoughts do not convert to action is for children to consider how the perception of body movements (kinaesthesia) work. This involves being able to detect changes in body position and movements without relying on information from the five senses. Even though this confirms that any obsessional urge will be automatically restricted it’s more important for your child to note that obsessions are not true pieces of information and therefore can be disregarded.

How does kinaesthesia differ from obsessional urges seen in OCD and those seen in impulse control disorder (ICD)?

An impulse seen in an ICD is challenging and dangerous in that the impulsive action could in all likelihood occur; yet, an impulsive urge seen in OCD is an obsessional fear. In other words your child may feel threatened that his urges will come true; yet, as discussed already, these do not materialise.

Can you clarify this with an example?

Yes, ICDs are a class of psychiatric disorders characterised by impulsivity, not obsessions. For example, one child with an ICD had an ongoing impulse to run across roads and reach the pavement before oncoming cars reached her. In contrast another child had an obsession to do a similar thing yet avoided going near roads. This clarifies the difference between harmful impulses seen in an ICD and avoidance of harm obsessions seen in OCD. The same goes for someone who steals impulsively, the impulse to steal is different to that of a child who has an obsessive urge to steal.

In a nutshell, how I can encourage my child to follow through with his treatment goals?

By having him agree and work with you to resist compulsions in graduated steps and to explain that this is what will help reduce his fears. This is known as exposure response prevention in which the new response is to prevent the usual compulsive behaviours during exposure to a triggering situation. Sometimes medication (noted earlier) is often also needed. The following article can help you gain the tools you need to support your child through exposure response prevention: Help Your Child Beat OCD with O.C.D.

Summary

It can be determined that impulsive urges within the obsessive-compulsive category are not acted upon. While no theory need be explained why obsessions cannot possibly come about kinaesthesia does provide an avenue of thought for those who desire some level of proof. In sum, an obsession is just that which means intrusive thoughts never come true. Impulses in the ICD group on the other hand can occur and kinaesthesia impairment is likely one of the causes.

© Carol Edwards 2018

Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management