Obsessive compulsive disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterised by intrusive, distressing, unwanted thoughts (obsessions) and time-consuming, senseless rituals (compulsions). OCD occurs in about one per cent of the population and is therefore fairly common, which means it is helpful for school staff to know about it.

OCD is commonly found in young people with Tourette syndrome, particularly in pupils of late primary school and secondary school age. Around 35 per cent of young people with Tourette syndrome also show obsessive-compulsive tendencies.

People with OCD are often embarrassed about it, and may not reveal their symptoms much at first. If symptoms become less controllable, OCD may present itself in school pupils in many different ways. One example is rituals, in that the young person has to write their work in a specific manner or arrange their books, pencils or belongings in a particular way. Other examples are repeatedly checking belongings or light switches or making sure that the taps are turned off in the school toilets. Cleaning and washing rituals are common. Other obsessions and compulsions may affect schoolwork directly, in that the pupil with OCD may need to destroy written work or reread reading work, repeating it until they feel it is exactly perfect.

The young person who suffers from OCD will experience intrusive thoughts, images or impulses (obsessions), which make them feel like they have to carry out certain behaviours to reduce anxiety. It is possible that he or she will not be able to explain to other people about their obsessions, particularly at a young age. Managing these thoughts and suppressing the behaviours can be distracting, exhausting and embarrassing. He or she may be very keen to keep their anxiety a secret, as they understand that OCD is irrational.

Research has shown that cognitive behaviour therapy and, in some cases medication, can be effective in helping the young person and their family manage OCD. If there are concerns that a pupil may have OCD and it is negatively affecting their lives, their family should approach their family doctor (GP) and ask for a referral to the local Child and Adolescent Mental Health Service.

It is likely that the pupil with OCD will experience difficulties in school. It is helpful for all staff in the school who have contact with the young person to have an understanding of OCD. It might be helpful to share this information sheet with all colleagues at school from classroom teachers to dining room staff. The greater the number of school staff that understand the pupil’s difficulties with OCD, the greater the likelihood that the treatment will be successful.

The following might be a reason to suspect that a young person has OCD (although they could all be signs of other difficulties) :

• School refusal
• Frequent lateness - carrying out rituals may mean the person is delayed for lessons
• Easily distracted with difficulties concentrating - he or she may be distracted by intrusive thoughts
• Checking and repeating work very frequently
• Separation anxiety from family members – if the obsession is that a family member is at risk
• Low self-esteem
• Problems getting along with peers
• Repeatedly asking to leave the room – they may be carrying out rituals outside the classroom
• Difficulties with sitting for a long period of time
• Poor handwriting
• Difficulties with consistent or flexible thinking

The best way to help a pupil in school with OCD is to ensure they are getting effective treatment from the local Child and Adolescent Mental Health Service. This is most likely to be a psychologist or psychiatrist, and help may be able to be given by devising strategies with the health professional who is working with them.

Partnership between teachers, parents and health professionals involved in the pupil’s care is the key. Consistent messages need to be given to the student at school and at home. Working with a student with OCD can be challenging, but managing the student’s behaviour so that he or she can work towards full potential can be very rewarding too.