Spotting the signs: identifying and supporting pupils with OCD

Diagnosable OCD – serious symptoms

Obsessive compulsive disorder (OCD) affects 1.2% of the population in the UK alone. This equates to around 12 in every 1000 people, and as many as 130,000 young people.

OCD is an anxiety disorder where a person experiences unwanted and repeated thoughts, feelings or images (obsessions) and uses compulsive actions or behaviours (compulsions) to try and control the obsessive thoughts.

This compulsive behaviour only brings temporary relief and the child or young person may feel compelled to do them repeatedly. Young people may describe attempting to resist the rituals as causing their anxieties to intensify.

Whilst it has become increasingly common to joke about ‘being a bit OCD’ about cleanliness or tidying, in its most severe form, OCD is deeply distressing and frightening.

Many of the associated thoughts and feelings experienced by sufferers can engender strong feelings of shame, disgust and worthlessness. Sadly, a child or young person may obsess about those things which they hold most dear. For example, an activity they particularly enjoy or fears about those they most love.

Whilst these fears may not appear plausible or real to us, they can be a profound source of distress, especially if they focus on hurting others or humiliating themselves.

The developmental context 

Experiencing mild obsessions and compulsions is a normal part of development for many children and young people during their lives. For example, having to organise their toys in a certain way, or checking that their clothes are straight.

Whilst this could be a normal reaction to stress or change, we need to be aware when a child or young person is having the same distressing thoughts and urges repeatedly, feeling unable to control them. 

Common symptoms of OCD amongst children and young people

• A child feels their mind being 'invaded' by horrible thoughts repeatedly.
• They feel scared, disgusted, guilty, tearful, doubtful or depressed.
• They feel a powerful urge to do something to stop these feelings.
• They feel temporary relief after rituals.
• They need to ask for reassurance or get people to check things for them.

Giving a pupil permission to leave a stressful situation gives them the chance to self-regulate before becoming acutely distressed

Identification: what are the signs to look out for? 

Impact of OCD in the school environment

• OCD has distressing symptoms which are not always obvious to others.
• It significantly reduces a pupil's capacity for concentration, working memory and reflective learning at times.
• It is likely to impact on learning and performance, especially in stressful situations like exams.
• Trying to keep symptoms ‘controlled’ in the school environment, can be all consuming and distressing.

Taking action: how can schools ensure the right support is in place?

Carefully planned time out strategies can be transforming. Giving a pupil permission to leave a stressful situation at the point their symptoms are beginning to escalate gives them the chance to self-regulate before becoming acutely distressed, reducing the time needed away from learning.

Supporting pupils to recognise this ‘tipping point’ helps build a sense of resilience. ‘I can have some control over my symptoms, rather than them controlling me.’

Small adjustments can make a real difference and significantly lower anxiety:

• having the same chair to sit in in lessons
• planning homework to minimise competing deadlines where possible
• flexible submission dates if needed – work may take significantly longer to do.

Establish and maintain clear links with your local CAMHS

If a pupil is under the care of CAMHS, they may be eligible for ‘special consideration’ from the examination board at GCSE and A level. Liaise with your local CAMHS in advance and advise them of the new rules around this type of evidence.

Negotiate access to phone consultation if you are concerned about significant risk or harm arising from OCD. You should request a mental health assessment when:

• a pupil has distressing and intrusive sexual, aggressive or death-related thoughts
• a pupil has thoughts of self-harm or suicide linked to their OCD symptoms
• their compulsive behaviour is causing them physical harm, such as skin being raw from over washing or exhaustion due to complex rituals
• their parents are knowingly or unwittingly supporting and potentially reinforcing their child’s obsessive compulsive behaviour, for example, when a parent is unable to manage their own obsessive compulsive behaviour
• other children in the family are becoming distressed by the OCD symptoms.

Where symptoms may involve a child or young person’s faith or religious beliefs, specialist advice and support should be sought, as this is often highly distressing for the individual concerned.

Remember a child or young person may have worrying and intrusive thoughts, without them being acted upon. Assessing this type of risk and intention is complex and a specific mental health assessment is needed.

How should pupils inform school about their OCD?

Teachers need to know how OCD impacts pupils individually, but pupils should be given the choice about what, how and whom information is shared with.

• A communication or concerns book may be a helpful way of sharing information between home and school.
• If a pupil becomes overly anxious about information sharing, this could contribute to worsening symptoms and take a step by step approach.
• Remember feelings of shame and self-disgust can be central to a child or young person’s struggle with OCD.

References and further reading

• OCD Youth
• Young Minds
• OCD Action
• NICE guidance for OCD
• Royal College of Psychiatrists – information for parents and young people