What Emotions Drive OCD Symptoms in Children and Teens?

What you need to know

• Fear, incompleteness, and disgust all play a role in pediatric OCD symptoms
• Incompleteness distinguishes OCD from anxiety disorders in youth
• Different emotions are involved in different types of OCD symptoms
• Understanding the emotions involved may help improve OCD treatment

Understanding the emotional drivers of OCD in youth

Obsessive-compulsive disorder (OCD) affects 2-4% of children and adolescents. It can be a very disabling condition, interfering with school, friendships, and family life. While effective treatments exist, they don’t work for everyone. To develop better treatments, we need to understand what drives OCD symptoms.

Traditionally, fear has been seen as the main emotion behind OCD. However, clinicians and researchers have long recognized that other emotions may also be involved. This study set out to examine the role of three key emotions in pediatric OCD:

1. Fear - feeling scared or anxious
2. Incompleteness - a sense that things are “not just right”
3. Disgust - feeling grossed out or repulsed

The researchers wanted to know: How much do these emotions accompany OCD symptoms in youth? Do different emotions relate to different types of OCD symptoms? And can these emotions help distinguish OCD from other anxiety disorders?

How the study was conducted

The study included 124 youth with OCD, aged 7-17 years. For comparison, it also included 27 youth with social anxiety disorder (SAD) and 28 with generalized anxiety disorder (GAD).

All participants were interviewed about their symptoms. Those with OCD rated how much they experienced fear, incompleteness, and disgust during their OCD symptoms. The SAD and GAD participants rated these emotions for their anxiety symptoms.

The researchers looked at three main types of OCD symptoms:

1. Aggressive symptoms - e.g. fears of harm coming to oneself or others
2. Symmetry symptoms - e.g. needing to order or arrange things
3. Contamination symptoms - e.g. excessive hand washing, fears of germs

Key findings about emotions in pediatric OCD

Fear is involved, but it’s not the whole story

As expected, fear played a significant role in OCD symptoms. It was especially high for aggressive OCD symptoms, like fears of accidentally hurting someone.

However, fear alone doesn’t explain OCD. Youth with OCD reported similar levels of fear during their symptoms as youth with other anxiety disorders did. This suggests that while fear is part of OCD, it’s not what makes OCD unique.

Incompleteness distinguishes OCD from anxiety disorders

A key finding was that youth with OCD reported much higher levels of incompleteness during their symptoms compared to youth with other anxiety disorders. Incompleteness refers to uncomfortable feelings that things are “not just right” and a need to continue behaviors until they feel complete.

Incompleteness was elevated across all types of OCD symptoms. However, it was especially high for symmetry symptoms, like needing to arrange objects in a certain way. For these symptoms, incompleteness was more strongly related to symptom severity than fear or disgust were.

This suggests that incompleteness may be a core feature of OCD that distinguishes it from other anxiety disorders in youth. Understanding and targeting incompleteness could potentially improve OCD treatment.

Disgust plays a key role in contamination symptoms

Disgust was most strongly related to contamination OCD symptoms, like excessive hand washing or fears of germs. For these symptoms, disgust was more strongly linked to symptom severity than fear or incompleteness were.

This highlights that different emotions may drive different types of OCD symptoms. Treatments may need to be tailored based on the primary emotions involved for each individual.

Implications for understanding and treating pediatric OCD

These findings suggest that OCD is more complex emotionally than previously thought. While fear is involved, incompleteness and disgust also play important roles. Different emotions seem to drive different types of OCD symptoms.

This has several potential implications:

1. Assessment: When evaluating youth for OCD, clinicians should ask not just about fear, but also feelings of incompleteness and disgust.

2. Treatment targets: OCD treatments may need to address incompleteness and disgust, not just fear. For example, exposure therapy for contamination symptoms may need to target disgust reactions as well as fear.

3. Treatment matching: Understanding the primary emotions driving an individual’s symptoms could help match them to the most appropriate treatment approach.

4. New treatment strategies: Novel treatment strategies targeting incompleteness or disgust could potentially improve outcomes for youth who don’t respond well to fear-based approaches.

5. Distinguishing OCD: Assessing incompleteness may help distinguish OCD from other anxiety disorders in youth when diagnosis is unclear.

Limitations and future directions

This study provides valuable insights, but also has some limitations. Emotions are complex, and this study relied on youth self-reporting their emotional experiences. Future research could use physiological measures or brain imaging to further explore emotional processes in OCD.

The study also focused on just three emotions. Other emotions, like anger or shame, may also play a role in OCD and warrant investigation.

Additionally, this study looked at emotions at one point in time. Longitudinal research is needed to understand how these emotions relate to the development and course of OCD over time.

Conclusions

• Fear, incompleteness, and disgust all play a role in pediatric OCD symptoms
• Incompleteness appears to be a core feature of OCD that distinguishes it from other anxiety disorders in youth
• Different emotions are involved in different types of OCD symptoms
• Understanding the emotions driving OCD symptoms could lead to improved assessment and treatment approaches

This research highlights the complex emotional landscape of pediatric OCD. Moving beyond a purely fear-based model may help us develop more effective, personalized treatments to help youth overcome this challenging disorder.