Eight year old Matthew, a handsome youngster in a Canucks jersey, appeared alert and polite, albeit a little anxious, when I greeted him in my waiting room. After settling Matthew into a drawing activity, I interviewed his parents regarding their son. They described Matthew, the eldest of three children, as succeeding in almost all aspects of his life- at school, with his peers, and in the hockey arena alongside his teammates.
Over the last several months, Matt had become increasingly worried about his health. That anxiety began shortly after Matt suffered a bout with the flu. Although he recovered within a few days, Matt continued to worry that he might be getting sick again. This anxiety had escalated to the point where Matt was now seeking repeated reassurance from his parents that he was in fact healthy. Bedtime had become especially difficult because Matt worried that he may become ill or even die during his sleep. Matt was also describing concerns about germs and he was avoiding specific foods that he feared might make him sick. His chaffed hands were evidence of excessive handwashing, an apparent attempt to avoid contamination.
His parents were becoming increasingly worried about how Matt’s fears were impacting his younger brothers as well as complicating Matt’s own life. They saw him investing time supervising his parents as they prepared his school lunch. He was also becoming reluctant to attend regular social events, most recently a team gathering and then a birthday party, because he was worried about what foods might be served or how others might react to his new concerns around foods. His parents felt confused and helpless in their efforts to support their previously happy and confident son.
When I interviewed Matt, he presented as attentive and capable. He described largely positive relationships with his siblings, parents and friends as well as typical interests- hockey and video games- and activities. Matt also described his worries in detail, and he became tearful when estimating how much time those anxious and unwelcomed thoughts cost him. He described feeling isolated in his worries- he didn’t know anyone else who suffered such thoughts.
Matt was pleased to be at my office and he hoped for a solution to his problem. He was further interested to learn that there were in fact names for the unwelcomed thoughts that distressed him as well as for the repetitive actions- asking his parents to confirm he was okay, refusing suspect foods, and washing his hands repeatedly- that in the end only briefly alleviated his worries. Matt was relieved to hear that other children also suffered persistent and disruptive thoughts, called obsessions, and related behavioral urges, called compulsions. He was visibly disappointed to learn that there was no straightforward solution or easy cure for obsessions and compulsions, but he again became encouraged when he heard that there were strategies he could learn to more effectively manage those behaviors.
Over the next few months Matt and his parents worked together to learn about obsessive- compulsive disorder and how that could be treated. They learned that obsessive- compulsive behavior is understood to be a type of anxiety disorder caused by a combination of biological, psychological and social factors, and that it is diagnosed in approximately 1% of all children. Matt and his parents also learned that the primary treatment for obsessive- compulsive behavior is a combination of behavioural and cognitive behavioral therapy. They were informed that in severe cases psychological treatment works best in combination with medication to alleviate obsessive- compulisve symptoms.
In therapy Matt learned to identify and address anxiety through physical relaxation and by addressing anxiety provoking thoughts. Matt was treated with exposure/ response prevention therapy that supported him as he faced his fears while using strategies to resist the compulsive behaviors that he had employed in the past to reduce his anxieties. Through counselling, Matt’s parents learned how to best support Matt in managing his obsessive- compulsive tendancies by helping him monitor his overall level of stress, by encouraging his use of new strategies and skills, and by being careful not to inadvertently enable his compulsive behaviors.
Four months after therapy began, Matt and his parents were reporting a marked decrease in his obsessive and compulsive behavior. Matt was feeling successful and increasingly confident in his ability to recognize and address intrusive thoughts and compulsive urges. Later on that year Matt’s worry did escalate in anticipation of a grade 3 Science unit on the human body but he was ultimately able to address his distress and complete that unit of study with his class. Today Matt is effectively managing his obsessive- compulsive tendencies.
It is not unlikely that Matt will be again challenged by disruptive thoughts and/ or compulsive urges in the future. However, should that occur, Matt will undoubtedly respond to that experience with improved understanding and skill.