Childhood Anxiety: Coping with OCD and Fear of Germs

Child Psychology - Frequent hand washing, lip biting, fear of monsters?

Hello Doctor, I have a third-grade son.
Four years ago, his father and I divorced (mutual consent), and my son lives with his father, grandfather, and grandmother.
Three years ago, my ex-husband remarried and had a son with his new wife two years ago.
They all live together as a three-generation family.
According to my son, his new mother treats him well.
He has been taught by his father that as the older brother, he needs to grow up and be independent, so he understands that his father and new mother need to spend more time taking care of his younger brother.
He shares a room with his grandmother.
For my son's sake, I have remained single and told him that he can move in with me anytime if he is unhappy.
However, he says he does not want to transfer schools for now because he is well-liked and has many friends.
I regularly pick him up every other weekend to spend time at my house, and I maintain contact with him through phone calls during the week.
About a year ago, I noticed that my son has severe obsessive-compulsive tendencies, particularly a fear of unseen germs.
He refuses to touch his genitals when using the restroom, even after washing his hands, because he is afraid that germs will harm them.
He washes his hands very thoroughly, spending about three to five minutes each time, and insists on washing them whenever he feels they are sticky (even if I don’t perceive them as such).
He is also very meticulous when showering, scrubbing every part of his body, including his nostrils.
After washing his hands, he does not want anyone to touch them, and after bathing, he does not allow anyone to touch his body, even if they haven't bathed yet, including outer clothing.
He has expressed a fear that germs could penetrate his skin and cause his death.
Although I have explained that skin can block most germs and shown him videos explaining that white blood cells are the body's soldiers that can eliminate bacteria, he still remains fearful.
He also has an uncontrollable habit of picking at his chapped lips because he finds them uncomfortable and often causes them to bleed.
I can only provide him with lip balm to keep them moisturized.
Additionally, he is afraid to be alone in the bathroom and must be able to see me while using the toilet.
I have to talk to him; otherwise, he becomes anxious.
Even when washing his hands in the kitchen (which is open-concept), I must stay nearby, and I cannot be more than 200 cm away, as he needs to focus on washing his hands and is fearful of unseen threats.
He has no issues interacting with others or learning; he is still a cheerful child.
I am unsure how to help my son.
I understand his fears and am very concerned about him.
I have suggested that perhaps he needs to talk to a doctor to help address his concerns, but I do not want him to feel that he is sick.
My ex-husband has a severe nail-biting habit and has almost no fingernails.
When he runs out of fingernails to bite, he will bite his toenails at home.
He can be very kind when he is in a good mood, but when he is irritable, he can be extremely aggressive, which can be frightening for my son and me, especially since he is 183 cm tall.
I hope to provide this background for you and would greatly appreciate any advice you can offer to help my son.
Thank you very much.

Anastasia, 30~39 year old female. Ask Date: 2016/09/19

Dr. Liang Sunyuan reply Psychiatry

Hello, based on your description, the child's symptoms may indicate obsessive-compulsive disorder (OCD), characterized by an intense worry that leads to compulsively repeating certain ritualistic behaviors to achieve a sense of reassurance.
The child may be meticulously performing symbolic rituals to prevent feared events from occurring.
It seems that many family members are concerned about him, and you mentioned that the child has no issues with schoolwork or social interactions, and he remains a cheerful child.
These are his strengths and resources.
It is advisable to maintain a pleasant interaction with the child and provide him with more enjoyable and relaxing moments to dilute the intensity of his obsessive worries.
We can offer comfort and reassurance, but we should also accept that he may not be able to change immediately; he might wash his hands multiple times, but as long as it doesn't take up too much time, it shouldn't be a major concern.
However, if the symptoms worsen or if the child feels significantly distressed, it is recommended to seek medical assistance.

Reply Date: 2016/09/19

More Info

It sounds like your son is experiencing significant anxiety, particularly related to obsessive-compulsive behaviors and a fear of germs. This can be quite distressing for both him and you as a parent. Understanding the underlying issues and how to address them is crucial for his well-being.

Understanding Childhood Anxiety and OCD
Childhood anxiety can manifest in various forms, including obsessive-compulsive disorder (OCD). OCD in children often involves intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions) aimed at reducing anxiety. In your son's case, his fear of germs and the compulsive handwashing and cleaning rituals are classic signs of OCD. His fear of germs may stem from a need for control in an environment that feels uncertain, especially after the significant changes in his family dynamics due to your divorce and his father's remarriage.

Coping Strategies for Your Son
1. Open Communication: Encourage your son to express his feelings and fears. Let him know that it’s okay to talk about what makes him anxious. Validate his feelings without judgment, and reassure him that you are there to support him.

2. Education About Germs: While you have already provided some education about germs and the immune system, it may be beneficial to reinforce this with age-appropriate resources. Books or videos that explain how the body fights germs can help demystify his fears.

3. Gradual Exposure: Gradual exposure to his fears can be an effective strategy. This involves slowly introducing him to situations that trigger his anxiety in a controlled manner. For instance, you could start by allowing him to touch something he perceives as "dirty" and then gradually reduce the frequency of handwashing after such interactions.

4. Set Limits on Compulsions: While it’s important to be empathetic, setting limits on his compulsive behaviors is also crucial. For example, you could agree on a specific time for handwashing and encourage him to stick to that routine, gradually reducing the time he spends washing his hands.

5. Encourage Healthy Coping Mechanisms: Help him find alternative ways to cope with his anxiety. This could include deep breathing exercises, mindfulness practices, or engaging in physical activities that can help reduce stress.

6. Professional Help: Given the severity of his symptoms, it may be beneficial to seek professional help. A child psychologist or psychiatrist can provide a thorough assessment and recommend appropriate therapy, such as cognitive-behavioral therapy (CBT), which is effective for treating OCD in children. Therapy can help him learn to manage his anxiety and reduce compulsive behaviors.

7. Model Healthy Behaviors: Children often learn by observing their parents. Demonstrating healthy coping mechanisms for stress and anxiety can provide him with a model to emulate.

8. Family Support: Ensure that he feels supported by both parents. Since your ex-husband has his own anxiety issues, it may be helpful for both of you to work together in a way that provides a consistent and supportive environment for your son.

Conclusion
Your son’s anxiety and compulsive behaviors are serious and deserve attention. By fostering open communication, educating him about germs, gradually exposing him to his fears, and seeking professional help, you can help him navigate this challenging time. Remember, it’s essential to approach this with patience and understanding, as overcoming anxiety and OCD is often a gradual process. Your support and love will be key in helping him feel secure and understood as he works through his fears.

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