Pediatric obsessive compulsive disorder (OCD) affects .5-3% of children adolescents and is characterized by obsessions and compulsions. Obsessions are intrusive, unwanted thoughts or images that trigger intensely distressing feelings. Compulsions are behaviors an individual will engage to get rid of the obsession and/or decrease the distress.
The first-line treatment for pediatric OCD is exposure-based cognitive behavioral therapy (CBT), which has shown to have advantages over psychiatric medication in terms of safety and symptom reduction. The involvement of family in the child’s treatment has shown to increase rates of success as they provide transportation to sessions, encourage therapeutic homework completion, and bridge the gap between what the child is learning in therapy at home. For OCD in particular, parents play a key role in exposure exercises that can be anxiety provoking for their child. Thus, parents have to manage and tolerate emotional distress, while also deal with potential resistance.
OCD can be difficult to manage as many families report high rates of family distress, discord, and blame. OCD can impose a burden on both the affected child and their family, so it is not uncommon to experience a negative family dynamic to emerge. But what about positive family factors that can help? It has been found that family cohesion, support and encouragement can lead to higher levels of well being in the child. Also, families with lower levels of conflict and parental blame were more likely to have a child who responds well to CBT.
Engaging the family in therapy can teach everyone how to communicate, express their feelings, and learn ways to support each other. Understanding the emotional climate of your home is the first step in learning how it can become more encouraging for everyone to cope and manage. CBT that addresses blame, conflict, and cohesion may be important family targets for treatment, as family cohesion is the best predictor for success in treatment.