OCD and the Anxiety Umbrella
This post is a condensed summary of our podcast about obsessive compulsive disorder (OCD) and the umbrella of anxiety related disorders. To listen to the full episode scroll to the bottom of the page or find us on all of the major streaming services.
Hello and welcome this post is all about obsessive compulsive disorder and the umbrella of anxiety related disorders. The reason I am not just talking about OCD is because that diagnosis is very specific and in my experience, particularly with children, there is usually a much broader manifestation of obsessive and compulsive type symptoms. I work with a lot of kids who have obsessive/compulsive symptoms and tendencies but that would not qualify for an OCD diagnosis.
So rather than getting into the dry diagnostic criteria for each of these diagnoses, I’m going to look at what these things actually look like in children and talk about what is going on in their brains and bodies from a neuro-development perspective.
So when looking at OCD, the first category is obsessive. Obsessions are usually going to be thoughts or impulses that kids experience over and over again that are usually not rational and that are fear inducing. In a true OCD diagnosis these usually take up a large portion of the day and people realize that they are not rational. In the kids I see, they may not take up such a huge chunk of time and the kids may not realize they are irrational. In fact, many of the kids I see get fixated on a thought or idea and believe that it is real; it can be very hard to have a rational conversation with them.
Obsessions can take any form. Common ones include:
fears of germs, poisons and dying
fears about people harming them, being angry with them, or leaving them
perfectionistic concerns like doing something perfectly or having things physically cleaned or lined up evenly
fears of making moral mistakes or “sinning” and upsetting God, f
fears about weather and natural disasters
There are a limitless number of things that can be an obsession but the underlying theme is that it is irrational, anxiety inducing and repetitive. The frequency and severity of these thoughts varies from kid to kid. Some have very mild symptoms and others are very extreme.
The next category is compulsions which are the actions that kids take in response to the impulsive thoughts. These also can vary widely, common ones include:
obsessive hand washing
repeating behaviors a set number of times
repeating the same questions
repeatedly checking on something like the time or the weather
repeatedly cleaning the same thing or being hyper focused on cleanliness or organization
being very rigid about a routine or a plan
I see a lot of things that fall under this category that aren’t true compulsions but are related, like being very rigid about a plan or routine. That’s not necessarily a compulsion but that intense inflexibility falls under this anxiety umbrella. This is true for a lot of other behaviors as well. Common anxiety related behaviors include:
and much more
The main thing to keep in mind with any of these things is that the root of all of it is anxiety. These obsessions, compulsions and behaviors are all ways that the brain is trying to cope with a dysfunctional stress response.
I think in order to really understand this we need to define anxiety and take a deeper look at it. Anxiety is a hot topic right now and it is something that is easy to overuse and over diagnose. It is important to keep in mind that anxiety is not an illness like the flu. Anxiety is a natural and normal physiological state designed to keep up alive and healthy in the right circumstances. Rather than looking at anxiety as a disorder, I think we should look at is as a disruption of normal development.
Here is what I mean:
During pregnancy and our early years our brain and nervous system is developing both physically and functionally. Just like we learn how to walk, how to read and how to think rationally, our nervous system learns how to function in many different ways. Our genetics and our experiences, particularly early on shape how these systems learn to work.
One of these systems is our stress response, or our fight-or-flight response. It learns how to interpret information about our bodies and our environment and how to prioritize and respond to these things properly. Our early experiences shape the way this works. For example, a baby whose mother experiences a lot of stress during pregnancy will have a nervous system that is more sensitive and reactive to stress.
From an evolutionary perspective this is pretty adaptive. The nervous system is responding to the environment in a way that “should” in quotes give the baby the best chances of surviving. This isn’t an illness like the flu this is complex biology at work. The problem comes in when our experiences, our culture, and our lifestyles don’t work harmoniously with these biological processes.
This is a big complicated problem with a lot of different factors. There are so many things that influence and shape the way our stress response develops: parental mental health, physical health, early attachments, trauma, danger, technology, social relationships, even our food all plays a role in how our body learns to respond to danger and stress.
Also our stress response doesn’t stop developing. It its constantly adapting to our circumstances and experiences, both positively and negatively. That is why you see things like PTSD in adults who experiences trauma even if they were relatively healthy before.
In normal healthy development, babies are born with a heightened stress response to the world. This helps them adapt to being born and learn how to interact with the world. This is easy to see in newborns. They are naturally very sensitive to things like loud noises and bright lights but as they mature this stress response lessens and they begin to react to their environment with more and more maturity. There are lots of things that can interrupt this process though. If you want to hear more details about this, then check out my post about complications and risk factors. Just know that certain experiences like stress exposure in utero, trauma, and birth complications change the way the nervous system matures. One of the ways that the brain respondes to these experiences is to hold on to the more reactive, immature version of our stress response. This stunts the normal maturity and leads to LOTS of different symptoms as kids get bigger.
I see a lot of kids in this situation that experience a lot of obsessive thoughts and compulsive behaviors. They show a lot of irrational fears, immaturity and general anxiety. The root of all of these symptoms is the same: their brain has not learned how to regulate their stress response appropriately. Thankfully our stress response is very dynamic and is designed to change and adapt. Just like traumatic experiences can negatively change our reactions, certain therapeutic practices can create positive changes. I would say that 80% of what I do in my practice is work on the stress response. The vast majority of the kids I work with have an immature fight-or-flight reaction that is at the root of most of their symptoms. When you change the way this internal system works these obsessive thoughts, compulsive behaviors, and general anxiety about the world start to disappear.
If you have a child with OCD symptoms or general anxiety symptoms then please check out my website or reach out to me to learn more. These are big red flags that your child has an immature stress response and there are things we can do to help this system mature and function properly. As always thank you so much for reading, I hope you learned something helpful.