My child is terrified he will act on his intrusive harming thoughts? Is it true that this does not happen in OCD? 

Yes, it’s true. When an OCD thought occurs your child will feel an incredible urge to act on that intrusive thought (e.g., harming oneself or someone else); yet his feelings are not evidence that this will occur.

How can you be sure?

There are no guarantees of anything; but what I can I say is that OCD thoughts are paradoxical to the person’s true desires. Despite this concept being accurate, children  unfortunately ignore it, mostly due to fear, doubts and “what-ifs?” plus erroneous beliefs seen in OCD.  Still, it is important to get this message across to your child and reinforce it, otherwise yielding to compulsions “just in case”, such as repeatedly praying for “safety” will continue to feed his fear-related obsession.

How can I help him do this?

What you can do is help him to understand that obsessions do not convert to action, and if this is true (which it is) then there is no need to do compulsions to “prevent” a bad thing from happening.

What else can I do to help him see that OCD thoughts don’t come true? 

Encourage your son to Acknowledge, Accept and Allow (3 As) the thoughts to pass instead of yielding to compulsions, which includes avoidance and escape behaviours.

But this will make his anxiety hit the roof! 

As you’ll be aware, OCD is an anxiety disorder where children will naturally want to avoid upsetting triggers; yet compulsions settle their anxiety down for a short while only.  By teaching them the 3 As they learn that it’s okay to do this, since otherwise amplifying the already exaggerated intrusive thoughts has the whole OCD episode spiralling out of control. The 3 As can help keep your child in control of his emotional responses. In graded steps distress tolerance can then be achieved.

He says he needs his compulsions, how can I tell him nothing bad will happen?

Let your son know that each time he gives into compulsions he never gets the chance to prove that his fear will not come true.

Is there any further proof to show him that he won’t carry out the nature of his thoughts?

First, while biologically generated intrusive thoughts makes your child feel a  pressure to respond, this pressure is fear, not a true call to action. A further explanation to prove that intrusive thoughts do not convert to action is for children to consider how the perception of body movements (kinaesthesia) work. This involves being able to detect changes in body position and movements without relying on information from the five senses. Even though this confirms that any obsessional urge will be automatically restricted it’s more important for your child to note that obsessions are not true pieces of information. This means while intrusive thoughts come into their consciousness they are none-the-less untrue, and so thoughts without foundation in factual evidence will never materialise.

How does kinaesthesia differ from obsessional urges seen in OCD and those seen in impulse control disorder (ICD)?

An impulse seen in an ICD is challenging and dangerous in that the impulsive action could in all likelihood occur; yet, an impulsive urge seen in OCD is an obsessional fear.  In other words your child may feel threatened that his urges will come true; yet, as discussed already, these do not materialise.

Can you clarify this with an example?

Yes, ICDs are a class of psychiatric disorders characterised by impulsivity, not obsessions. For example, one child with an ICD had an ongoing impulse to run across roads and reach the pavement before oncoming cars reached her. In contrast another child had an obsession to do a similar thing yet avoided going near roads. This clarifies the difference between harmful impulses seen in an ICD and avoidance of harm obsessions seen in OCD. The same goes for someone who steals impulsively, the impulse to steal is different to that of a child who has an obsessive urge to steal.

In a nutshell, how I can encourage my child to follow through with his treatment goals?

By having him agree and work with you to resist compulsions in graduated steps and to explain that this is what will help reduce his fears.  This is known as exposure response prevention in which the new response is to prevent the usual compulsive behaviours during exposure to a triggering situation. Sometimes medication is often also needed.  The following article can help you gain the tools you need to support your child through exposure response prevention: Help Your Child Beat OCD with O.C.D.

Summary

It can be determined that impulsive urges within the obsessive-compulsive category are not acted upon. While no theory need be explained why obsessions cannot possibly come about kinaesthesia does provide an avenue of thought for those who desire some level of proof. In sum, an obsession is just that which means intrusive thoughts never come true. Impulses in the ICD group on the other hand can occur and kinaesthesia impairment is likely one of the causes.

© Carol Edwards 2018

Impulse Control Disorders: Updated Review of Clinical Characteristics and Pharmacological Management

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