Elena Fasan, LCSW, of the OCD Center of Los Angeles discusses how parents can teach their children concrete skills to navigate the COVID-19 pandemic, and how these same skills offer the added benefit of helping kids to cope more effectively with OCD.
help kids to manage OCD more effectively.
In so many ways, COVID-19 reminds me of OCD. The virus is an invisible enemy that triggers anxiety, much like OCD. Dread lurks beneath the anxiety. This underlying dread, an intense feeling that something terrible will happen, is the crux of OCD. Regardless of the content of the intrusive thoughts, those diagnosed with OCD fear a disaster is waiting to occur if they do not mitigate danger by excessively engaging in ritualistic behaviors, known as compulsions. OCD leads one to over-think, to be extra careful, and to be hyper responsible and hyper vigilant, as does the threat of COVID-19. OCD disrupts one’s life, well being, feeling of safety, and daily routine. So does COVID-19. Engaging in OCD compulsions sucks up time, energy, and attention. The same can be said of COVID-19. Experiencing OCD symptoms can be isolating. COVID-19 safety guidelines, including stay at home orders, wearing a mask in public, and social distancing are also isolating. As of yet, there is no cure for COVID, nor is there currently a cure for OCD. Whether one’s anxiety is caused by OCD, by COVID-19, or by both, a panoply of triggers await when venturing out into the world, away from the safe cocoon of one’s controlled home environment.
Although OCD and COVID-19 share many similarities, there are significant differences between the two. The feared consequences of OCD are either imagined or greatly overestimated, while the feared consequences of contracting COVID-19 are frighteningly real. The appropriate response to COVID-19 is to be somewhat compulsive when following recommended safety protocols, while the appropriate response to OCD is to resist compulsions. An effective, evidence-based treatment to combat COVID-19 has yet to be developed, but decades of rigorous scientific research and clinical practice have produced a highly effective, evidence-based treatment protocol to treat OCD. Mindfulness-based cognitive behavioral therapy with exposure and response prevention (ERP) offers OCD sufferers an opportunity to dramatically reduce the frequency, duration, and intensity of their symptoms.
Children and adolescents diagnosed with OCD are met with difficulties related to their OCD symptoms that are not experienced by adults diagnosed with OCD. Experiencing OCD during one’s youth can lead to missing important developmental milestones, arresting progression to the next developmental stage. The anxiety produced by OCD may disrupt sleep cycles. Lack of sleep or restless sleep can impair developing brains, affecting cognitive development and learning. Many children and even adolescents with OCD tantrum long past the age when it is developmentally appropriate to do so, adversely affecting their relationships with their parents and siblings, as well as their self concept. Young people diagnosed with OCD often have greater difficulty than others their age regulating their emotions and self soothing. The social development of those diagnosed with juvenile OCD can be affected, as others their age may reject them if they display odd and/or incomprehensible compulsive behaviors. Sometimes, they isolate themselves in an attempt to avoid OCD triggers, or to avoid the embarrassment of being observed by others while doing compulsions.
Just as children and adolescents face unique challenges engendered by living with OCD, they may be especially vulnerable to the effects of the response to COVID-19. While many parents can work from home, online schooling may negatively impact young people’s learning and academic progress. Important markers of achievement and shared peer rituals such as graduation, prom, science fairs, clubs, and school-based athletics have been cancelled, as have extracurricular activities and summer camps. These disruptions may create a shared sense of loss, isolation, and disappointment among young people.
Stay at home orders and online schooling greatly diminish the opportunity for children and adolescents to experience the value of face-to-face peer interaction. Parents certainly miss their friends, colleagues, family members, and others, but peer interaction is not central to their social development, as it is for young people. It is through regular peer interaction during childhood and adolescence that one learns how to build intimacy, gain autonomy, and how to negotiate societal rules and norms. Without regular and consistent peer interaction, their social development may be negatively impacted.
Despite the special challenges children and adolescents must endure in the face of COVID-19 and/or a diagnosis of OCD, it is heartening to know that they are incredibly resilient and possess a greater capacity for learning than do adults. Adult brains retain some plasticity, but can only change in function; after the age of around 25, brain structure is set like hardened clay. Only through concerted effort and repetition can adult brains be trained to perform more effectively and efficiently. Conversely, youngsters can train their brains to operate more efficiently and effectively far more readily than adults. In addition, they can actually change the structure of their brains, shaping the wet clay of their neurons and brain regions in ways impossible for adults.
Children and adolescents are less habituated in their behaviors than are adults, making it far easier for them to change and refine their behavior than adults. Finally, they lack full autonomy, so they can be positively influenced by the guidance and modeling of peers, parents and other adult figures.
There are powerful lessons to be learned from the experience of living through a global pandemic. Because OCD and COVID-19 share so many similarities, the way that parents help their children and adolescents who have been diagnosed with OCD navigate the crisis created by COVID-19 can have the added benefit of helping them learn to more effectively cope with OCD symptoms. The skills that parents teach such youngsters to develop during this time are the same skills that will lead to more effective OCD symptom management. The COVID-19 pandemic offers parents a rare opportunity. Young people diagnosed with OCD have the potential to emerge from the crisis of the pandemic better prepared to manage the crisis of OCD. To that end, here are some active steps parents can take during the COVID-19 pandemic to help their children and adolescents who are struggling with OCD.
Be Honest, But Not Alarmist
COVID-19 is scary, but there are steps one can take to minimize the risk of contracting the virus and spreading it to others. We are learning more each day about the virus and how to treat it. Being honest about the risk of contracting COVID-19 empowers children and adolescents, as awareness of the risk allows them to take steps to protect themselves and others. It is comforting for them to know that they can lessen the risk of contracting COVID-19 by changing their behavior.
OCD is scary, but highly treatable, and novel ways to improve treatment outcomes for those diagnosed with OCD are continually discovered. Occasionally, I speak to parents who are concerned about their child or adolescent being labeled by receiving a diagnosis of OCD. They may even go so far as to ask me not to share a diagnosis of OCD with them. They are concerned about stigmatization, which is understandable. Generally, parents would never consider asking a pediatrician not to share a diagnosis of asthma or diabetes with their child or adolescent. Asthma and diabetes are medical conditions, as is OCD. Naming is not labeling. One cannot begin to address a problem without naming it. Naming allows young people diagnosed with OCD to depersonalize from it. Once they view themselves as separate from OCD, they are better equipped to respond to intrusive thoughts and anxiety differently. It is a relief for those with OCD to know that there is an explanation for their intrusive thoughts and the accompanying feelings and sensations. The explanation is not that they are deeply flawed. Rather, they have been diagnosed with a highly treatable medical condition.
Being honest, while using age appropriate language, about COVID-19 and/or about OCD does not mean that one must be alarmist. Parents must temper their own fears and calmly present information, but only relevant information. It is not necessary for children and adolescents to be exposed to constant information about COVID-19, nor is it necessary for them to be presented with information about those with OCD who have not received help and have suffered all their lives. Despite the fact that it is overwhelming to experience OCD symptoms, and frightening to face the threat of COVID-19, those diagnosed with OCD at a young age are not doomed to a life of anxiety and an endless loop of compulsive rituals. Nor are we doomed to contract COVID-19 or to die from it if we do.
Tolerate Uncertainty
The uncertainty that accompanies life during a pandemic is palpable and ever present. We feel burdened by the mantle of uncertainty under which we are all shrouded. For parents, this uncertainty is compounded by worry about the health and safety of their children, elderly loved ones, and others to whom they are close who have conditions that put them at greater risk. Many parents are faced with uncertainty about their employment and may be under financial strain. Uncertainty is very uncomfortable, but it is a part of life; it is unavoidable. There are many things that are beyond our control, but there are few things that make us feel as out of control as the pandemic and the experience of having a child or adolescent with OCD.
OCD hates uncertainty. Those diagnosed with OCD engage in compulsions in a desperate attempt to find certainty. One of the core principles of the treatment of OCD is to teach those diagnosed with OCD to tolerate uncertainty. The path to doing so is through the use of mindfulness and acceptance principles and practices.
Mindfulness involves being fully aware in the present moment, without judgment of one’s experience. When one learns to live in the present moment without judgment, uncertainty about the future becomes far more tolerable. The concept of mindfulness is simple, but it is not easy to be mindful. Fortunately, one can practice skills that build present moment awareness without judgment. Relaxation breathing exercises, sensory grounding, and meditation all serve to foster mindfulness, as do slowing down and focusing on process over outcome. Engaging in mindfulness practices may seem simplistic and the immediate effects are subtle, leading people to give up on the practices. But if one sticks with it and incorporates mindfulness practices into their daily routine, the results become profound over time.
Loving kindness and compassion are also core concepts of mindfulness, as they allow us to be forgiving of ourselves when faced with difficulties and forgiving of others when they frustrate, disappoint, upset, or anger us. Responding to ourselves and to others with loving kindness and compassion offers us the opportunity to be less reactive and more reasonable. Simply stepping back and finding ways to be kind, loving, and compassionate soothes us and allows us to accept ourselves and others for who we are and what we are experiencing.
Acceptance is another simple concept that is not always easy to embrace. Acceptance means freely allowing what is being offered to us, rather than resisting it. We do not need to like nor to enjoy what we are experiencing in order to accept it; we merely need to allow it to be. Our experience will pass, as everything does, but it will pass with greater ease if we accept it for what it is.
The experience of living during a pandemic and/or having a child or adolescent with OCD bring great uncertainty, but mindfulness and acceptance offer an antidote. When parents themselves embrace mindfulness and acceptance practices and encourage their children and adolescents to do so as well, they can learn to live with the pandemic and to live with OCD.
Manage Stress and Anxiety
The reality of COVID-19 creates stress and anxiety, as do OCD symptoms. Focusing on self care will help to ease stress and anxiety. When describing the importance of self care to parents of children with OCD and anxiety, I often use an airplane metaphor. When flying, parents are asked, in the event of an emergency, to put their oxygen masks on before they put one on their child. If you are incapacitated, you cannot help your child. Likewise, if the stress and anxiety of living with COVID-19 and/or having a child or adolescent diagnosed with OCD incapacitates you, you cannot help them. Basic self care consists of eating well, being physically active, getting adequate sleep, and attending to one’s physical needs. Beyond these basics, self care includes tending to one’s own emotional needs and engaging in self nurturance. Self care also involves setting and maintaining appropriate boundaries in terms of work and relationships, so as not to overextend one’s self and burn out.
Parents may feel that they cannot find the time to focus on their own needs and that doing so is selfish. I believe it is the opposite. When parents take care of themselves, they are better equipped to manage their emotional and psychological reaction to living during a pandemic and/or having a child with OCD. Take care of your physical needs, and make time to engage in enjoyable and self nurturing tasks. Modeling is among the most powerful forms of learning, especially for young people. Modeling the importance of self care to your children and adolescents will lead them to follow suit and to take better care of themselves, lowering their levels of stress and anxiety.
If you are depressed, or if your anxiety goes beyond what is expected while living during a pandemic and/or parenting a child diagnosed with OCD, seek help. Seek therapy. Seek support from loved ones. Helping yourself will help your child or adolescent with OCD, as it will model to them that seeking expert help and support from loved ones when in crisis is a sign of strength, not of weakness. In turn, they will be more open to the idea of undergoing treatment for their OCD.
Appreciate the Benefits of Boredom
Many of my child and adolescent OCD clients have great difficulty managing boredom. In part, this is a product of the time during which they are being raised. Unlike when their parents were growing up, post millennials have seldom been offered the opportunity to experience boredom. Post millennials live busy, over-scheduled lives, have cell phones, and are offered a vast array of media choices with which to entertain themselves.
During the COVID-19 pandemic, children and adolescents, stuck at home, cut off from school and their peers, face boredom to a greater degree than they did previously. Boredom is uncomfortable, so parents attempt to minimize or eliminate opportunities for their youngsters to be bored. This is similar to how parents accommodate OCD symptoms in order to minimize the discomfort their kids with OCD are experiencing. Those with OCD have great difficulty tolerating discomfort. Boredom offers a wonderful opportunity to practice managing discomfort. It is perfectly acceptable for young people, especially those with OCD, to experience boredom. In fact, it is beneficial, as it teaches them to sit with discomfort. Learning to be uncomfortable while allowing obsessions and anxiety to pass and resisting the urge to compulse is a necessary component of OCD symptom management.
Boredom offers benefits beyond just learning to sit with discomfort. Boredom teaches us to embrace stillness, solitude, and silence, all of which are sorely missing in the modern age, and can bring contentment and joy through their simplicity. Boredom promotes reflection, which can lead to insight and self-knowledge.
Finally, boredom can spark creative thinking and lead one to discover and engage in novel activities that are enjoyable and enriching. Meaningful activities offer children and adolescents something to focus on other than COVID-19 and/or OCD. They are a means to resisting compulsive behavior. As compulsions are resisted, intrusive thoughts and anxiety will subside.
Connect as a Family System
OCD hijacks family systems. Family members become hostage to the irrational whims of OCD symptoms. COVID-19 has hijacked all of us, disrupting our lives and routines. Under the circumstances created by COVID-19 and/or by OCD, parents can choose to resist their current reality and become angry and/or despondent, or they can choose to accept and make the best of their reality by finding active ways to connect as a family.
One way for families to connect is to communally engage in household tasks. Families are home together far more often than usual, creating an opportunity to teach youngsters how to perform household tasks, such as cooking, cleaning, laundry, and pet care. Perform those tasks as a family and assign chores to children and adolescents. Sometimes, when their kids are experiencing OCD symptoms, parents lower their expectations. Assigning household chores teaches children and adolescents responsibility, allowing them to take responsibility for their OCD symptoms and management of those symptoms. When kids contribute to household upkeep, it takes the pressure off parents, allowing more time and energy to be expended on meaningful, enjoyable activities. When kids are expected to perform chores, they will learn that regardless of how they are feeling or how their OCD symptoms are affecting them, they are still capable of doing what needs doing. They may find that focusing on household tasks naturally pulls their focus away from OCD symptoms and offers much needed relief from those symptoms.
Shared family rituals are another way to connect as a family. Family meals, shared activities, family game night, and/or family movie night offer ways to slow down and connect as a family. Take a break from devices and media during shared family activities. Devices and media provide children and adolescents with OCD a distraction from their symptoms, promoting avoidance of experiencing and learning to manage those symptoms. Disengaging from devices and setting media limits lessens their ability to engage in said avoidance.
The stay at home orders and social distancing to which many of us are subject offer an opportunity for family members to slow down, focus on family values, and find ways to come together, helping to support your child or adolescent who is struggling to manage their OCD symptoms. Coming together as a family system in the face of a common enemy, whether it is COVID-19, OCD, or both, is powerful.
Seek Online Support
Prior to the pandemic, online therapy was not seen a reasonable option for children and for many adolescents. Therapists who specialize in the treatment of OCD and anxiety have, for the most part, embraced the necessity of online treatment, and clients are learning to manage their symptoms as a result. I am pleasantly surprised by how well the treatment protocol works in an online setting, even when treating young children. It has dramatically changed my view of the appropriateness of online therapy for juvenile OCD clients. Emergency declarations in various states have loosened the legal restrictions that normally limit the practice of online therapy across state lines, making it easier than ever to access the evidence-based treatment for OCD, especially if you live in a state or community where it is usually difficult to access such treatment.
In addition to seeking online treatment for your child or adolescent with OCD, look into peer support groups and online mindfulness classes. Many universities and colleges have mindfulness centers and offer online classes, resources, and programs. Meditation apps abound, and non-academic mindfulness centers are now, more than ever, offering online courses and programs.
Be Hopeful
Do not give up. Have hope. We can get through this time and youngsters can survive and thrive, despite being diagnosed with OCD. Perhaps the struggles with which we are faced because of the COVID-19 pandemic will make us stronger, more resilient, more empathetic, and more resourceful. The same could be true of your child or adolescent’s struggle. As a society, we cannot yet see how the circumstances under which we are currently living may end up being beneficial. Nor can parents see the potential benefit of their child or adolescent being diagnosed with OCD or anxiety. I often tell the parents of my young clients that, once it is managed, OCD can be viewed as a gift. When one has suffered, one is more sensitive to and empathetic of the suffering of others. When children have been brought low by OCD, they appreciate joy, contentment, and simple pleasures more than they would otherwise. Once the anxiety is reduced and the rigidity is lessened, the OCD brain offers conscientiousness, responsibility, detail orientation, and drive.
Be hopeful, and share your hope with your children and adolescents. Acknowledge how difficult it is to live under the specter of COVID-19. Acknowledge how difficult it is to experience OCD symptoms. Accompany that acknowledgment with your sincere belief that we will live on when this pandemic is over. Share your belief that they can learn to manage their OCD symptoms, and that their suffering will someday abate. If they have lost hope, buoy them with your hope.
Perhaps if the parents of young people with OCD embrace the lessons offered during this pandemic, they will someday look back and realize that this horrible time, when we were at the mercy of COVID-19, brought with it gifts that led their children and adolescents on the road to recovery from OCD.
- Elena Fasan, LCSW, is a psychotherapist at the OCD Center of Los Angeles, a private outpatient center that provides in-person and online therapy. Elena specializes in Cognitive-Behavioral Therapy (CBT) for the treatment of children and adolescents with OCD and related conditions. To contact the OCD Center of Los Angeles, click here.
