Obsessive Compulsive Disorder
What is Obsessive Compulsive Disorder?
Obsessive Compulsive Disorder (OCD) involves unwanted and disturbing thoughts, images, or urges (obsessions) that intrude into a student’s mind and cause a great deal of anxiety or discomfort, which the student then tries to reduce by engaging in repetitive behaviors or mental acts (compulsions). Often, compulsions are performed in a ritualistic, or very specific way (for example, counting to six each time an article of clothing is removed). The following table lists common obsessive themes and compulsive rituals:
Contamination. Fear or distress about coming into contact with dirt, germs, sticky substances, or chemicals (e.g., common classroom cleansers), or getting sick, or getting others sick after touching "dirty" or "contaminated" items,
Accidental harm to self or others. Fear of harming yourself or others through carelessness. For example, "What if I didn't clean off the desk properly and there are still germs on it, and the next student gets sick because of me!"
Symmetry and exactness. A need to have items ordered in a certain way (for example, according to color, size, or facing a certain direction). Students with this type of obsession are either anxious because "it just doesn't feel right" or because of a superstitious belief that something bad will happen (e.g., "If my pencils are not arranged properly, my teacher will die!"). Often, the content of obsessions sounds very odd or makes no sense. For example, a child with OCD might say that he or she needs to arrange all the classroom books from smallest to biggest or else something bad will happen to mom. Most children and teens are aware that these thoughts are strange; however, do not be surprised if the student doesn't think his or her thoughts are odd. Most younger children have no idea that their obsessions sound peculiar to others.
A need for perfection: Some students feel a strong need for things to be perfect or right. For example, your student might not be able to start her in class test until her books are all ordered and perfectly arranged, or cannot turn in an assignment until she is certain its perfect. Other students struggle to tolerate if something isn’t 100% right, focusing on doing the right thing all the time or thinking about every tiny mistake.
Forbidden thoughts: Entering into adolescence is a time of sexual maturity and most teens think about sex and sexual identity during this time. However, for some students they are plagued with unwanted thoughts and images about being gay when they know they are not, or thinking about engaging in sexual behavior that feels upsetting and even repulsive to them. Although this can be an alarming topic for teachers to handle, it does not mean your student has been abused or that there s/he is sexually perverse. Responding with empathy and understanding is critical.
Washing or cleaning. Washing hands excessively, sometimes until they are raw and bleeding. There are many other types of washing behaviors, although the most common ones seen in school are washing hands.
Checking. These types of compulsions can involve checking doors, locks, or backpacks, to make sure everything is safe and secure. Some students are constantly checking that their books are in their backpack. Other students check to make sure that everyone is okay. For example, texting a parent to "check" that they are safe.
Counting, tapping, touching, or rubbing. Compulsions can involve counting, touching, or tapping objects in a particular way. Some students have lucky and unlucky numbers involved in their rituals (e.g., needing to touch a door four times before leaving a room).
Ordering/arranging. This compulsion involves arranging items in specific ways, such as desk items, classroom blocks, or books in the school locker or book bag. For example, a student might get stuck transitioning from one activity to another due to a need to line up all the art supplies in order of color and type.
Mental rituals. Not all students with OCD will have compulsions that can be seen. Some perform rituals in their head, such as saying prayers or trying to replace a "bad" image or thought with a "good" image or thought. For example, a teen might have a school mantra that /he mentally repeats over and over again until it "feels right".
How OCD impacts the student in school
OCD includes a wide range of behaviours, some of which are so distinctive it can seem easy to identify a student struggling with OCD. For example, a student who refuses to share items with peers, has hands that are red and raw, is constantly asking to use the bathroom, and has a peculiar way of tapping everything around him/her in multiples of 2. Yet, other behaviours within OCD are invisible due to the rituals occurring within the mind, as well as some students feeling extreme shame and fear, and thus hide their rituals for fear others will label them as a “freak” or “crazy.” For example, an adolescent male who thinks he might be gay, yet knows he isn’t, spends time thinking of naked women in his mind to prove to himself that he is heterosexual. This in turn prevents him from concentrating effectively and focusing on assignments, so that his work is consistently far below his capacity. The following list (not exhaustive) highlights common signs of OCD in the classroom:
- Wanting to complete assignments “perfectly,” checking and re-doing for hours
- Having to get perfect A+ grades in absolutely everything and gets very upset if they don’t
- Rechecking or rewriting answers on exams so much that the student runs out of time and doesn’t get to answer all the questions despite knowing the material
- Worrying so much about accidentally cheating that the student leaves wrong answers on tests or leaves questions blank
- Constantly worrying about breaking school rules and getting into trouble (so that it interferes with paying attention in class)
- Erasing repeatedly until the paper has holes in it, the ink is smudged and the writing or drawing is illegible
- Reading letters, words or sentences repeatedly, repeating syllables until they sound right
- Peculiar walking patterns, or touching and tapping
- Over-focus on neatness. Lining up, ordering or arranging items on desks, in backpacks or lockers repeatedly
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