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Instructions: As
you read the paragraph in the box below, tell
yourself that you absolutely MUST count all the
times the letter "e" occurs in the passage. You
cannot read the passage and then go back and count
-- your compulsion is such that you must count as
you read. You can't keep track on paper or on your
fingers, either, because you don't want anyone to
know that you're having to count. And because you
have OCD, you will doubt yourself and worry that
maybe you made a mistake in counting, so you will
probably have to go back and start counting again,
because there's this unwelcome voice in your head
telling you that if you don't get the count exactly
right, something terrible is going to happen to
your child. You know it's irrational, but you can't
resist the thought and need to count.
OK, begin reading
and simultaneously counting:
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Children
who have OCD often have hidden or silent
compulsive rituals. These hidden rituals
often confuse teachers who may look at a
child and not realize what is going on
internally that may make it almost
impossible for the child to function
normally at times. Young children often
don't realize that what they are doing is
"abnormal," and older children, teens, or
adults are often embarrassed by their
rituals and won't tell you about
them.
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What Was It
Like?
How did you do? Would
you feel trying to read in school or at home? Might
you get frustrated, tired, irritable? Might you
give up?
Were you able to
process anything of what you were reading? If you
were a student and I was your teacher, and I called
on you or tested you on what you had read, would
you be able to tell me, or might I land up thinking
you had a reading comprehension problem and/or that
you were a very slow reader?
What you just engaged
in was a simulation of a mental ritual or
compulsion. Nobody would be able to know what you
were doing -- your compulsion was silent and
"hidden." Other compulsions may be quite obvious
such as having to turn a light switch on and off
repeatedly or having to touch things.
Does It Seem
Far-Fetched?
Creating an
emotionally safe environment for a child, family
member, friend, or student with OCD takes some
effort. Sometimes it may be difficult not to
visibly react to gruesome images or bizarre
obsessional thoughts, but if you want the person to
feel free to talk to you about what's going on,
practice a reaction that communicates empathy for
what they're going through without conveying in any
way that you think they're crazy or that you're
repulsed or "grossed out" by what they're telling
you. Depending on your relationship to the person
and the nature of the obsession or compulsion, this
can be challenging. In my own experience, I've
found that children and teens and adults generally
begin to tell me the contents of their obsessive
thoughts or rituals because my response is more
long the lines of, "Wow... that must be so
uncomfortable for you." In my conversations with
children and teens, I also make it very clear
that I am very familiar with OCD and that
I know that because people have these
troublesome worries or thoughts, it doesn't mean
that they're going to act on those thoughts. In
fact, it's usually the case that the child who has
obsessive worries that he's going to do something
terrible is not going to do that terrible thing,
and is anxious because the thought is so alien and
disturbing to his values and who he
is.
As with other topics
covered on this web site, obsessions and
compulsions can vary in their frequency and
severity. Children and adolescents with severe OCD
are at risk of school avoidance or school refusal.
In some cases, children with OCD may not get
to school due to direct interference from their OCD
symptoms. As one example, I once represented a
child who could not leave the house unless the
minute hand was exactly on the 12. He'd stand near
the door, waiting for it to reach 12, but would be
so anxious about not leaving if it was not yet on
the 12 that he would wait too long, miss the 12,
and have to wait another hour to leave for school.
This might go on for a few hours. Then, on his way
to school, he had to cross one intersection an
exact number of times (more than a dozen times). If
a car came through the intersection after he'd
started his ritual of precisely X crossings, he'd
have to start again. Some days, he didn't arrive at
school until after 1:00 p.m. Somewhat unhelpfully,
his school district did not support giving him a
special education program or any assistance. They
took the position that he was fine when he got to
school and it was the parents' responsibility to be
sure he got there.
Because OCD is
associated with increased risk for depression,
failure to treat moderate or severe OCD can
increase other problems.
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