Obsessive Compulsive Disorder

What Causes OCD?

Researchers are still looking into what causes obsessive compulsive disorder. It appears abnormalities in brain structure and activation play a role, particularly with the CSTC (cortico-striatal-thalamo-cortical) circuit.

There is also a hereditary component to OCD, likely involving both genetics and a child's environment. A child has a higher risk of developing OCD if they have a parent or sibling with the condition. People with other neurodevelopmental conditions, such as attention deficit hyperactivity disorder (ADHD,) are more likely to also develop OCD.

OCD can also occur suddenly (overnight) in children who have a specific type of strep infection. This is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Antibiotics are the main treatment for PANDAS, though any lingering psychiatric symptoms can also be treated with standard OCD treatments (such as cognitive behavioral therapy).

What Are The Signs And Symptoms?

It is important to remember that everyone experiences odd, unwanted and/or repetitive thoughts and behaviors sometimes. The difference between these normative experiences and OCD is that with OCD, the relevant thoughts and behaviors are often unpleasant, highly distressing, and cause significant disruption to the person’s life. In youth, the symptoms will appear to be above and beyond what other children of the same age tend to experience.

Examples of common obsessions in children and adolescents with OCD include:

• Fear of germs, infection or specific illnesses
• Fear of losing or forgetting important things
• Fear of being harmed or causing harm to someone
• Fear of not following religious rules correctly, or of being a “bad” person
• Fear of saying inappropriate things in front of other people
• Urges to do things “perfectly” or “just right”
• Urges to arrange things symmetrically or in another specific order

A child’s compulsions may include:

• Spending an excessive amount of time cleaning or arranging his or her belongings or washing himself or herself
• Checking repeatedly (typically, more than once) to be sure he or she hasn’t lost or forgotten something, harmed someone else or themselves, or done something “bad”
• Repeatedly asking for reassurance from a parent or friend
• Counting or saying something over and over (either out loud or silently)
• Repeating actions, such as tapping, walking or reading, a particular number of times or in a particular way
• Having a specific or extensive bedtime ritual that may need to be repeated if not done the “right” way

Other behaviors that are common in children with OCD include:

• Inattentiveness
• Hyperarousal
• Inflexibility that causes extreme irritability or panic if things aren’t done “just right”
• Fear or worry surrounding social situations
• A desire to avoid specific situations
• A strong fear of being left alone

It can be difficult for parents and caregivers to identify a child’s obsessions and compulsions. Many children try to hide them, and sometimes OCD symptoms seem to get better or change completely. Often, a child’s obsessions or compulsions can be an extreme version of a typical behavior (e.g., handwashing more often or more intensely than one would expect).

OCD symptoms often intensify over time, particularly when the family has not noticed symptoms and has accidentally contributed to the child’s fears and worries. Families may not notice there is a problem until the problem has grown in severity and begins to significantly affect more people around the child.

How Is OCD Diagnosed?

Obsessive compulsive disorder is diagnosed by a mental health provider trained in OCD.

For a diagnosis to be made, the child must have obsessions and/or compulsions that:

• Cause distress
• Interfere with daily life
• Last for an hour or longer every day

The mental health provider may also use a screening measure or a more comprehensive assessment measure to confirm the diagnosis. The gold standard assessment for OCD in youth is the Children’s Yale-Brown Obsessive Compulsive Scale. This measure is administered by the provider and requires children to answer questions about his or her feelings and behaviors.

How Is OCD Treated?

Obsessive compulsive disorder is best managed with the help of a mental health professional.

Caregivers must also educate themselves and play an active role in the treatment process. Caregivers often participate in rituals and compulsions without being aware that these are symptoms of OCD: unknowingly strengthening the disorder over time. This is called family accommodation.

The most effective treatments for OCD are:

• Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). CBT for OCD is primarily behavioral in nature; in other words, the child learns by doing. The CBT intervention utilized is called ERP. ERP involves understanding a child’s symptoms, then engaging in behavioral “experiments” in which the therapist exposes a child to his/her obsessions while preventing him/her from engaging in the ritual. For example, a child who has germ concerns may touch something like a doorknob, and then not be allowed to wash his/her hands right away. This type of treatment tends to be very successful.
• Medicine. Different medications may be prescribed to manage OCD symptoms, including antidepressants or antipsychotics. Medicine tends to be most effective when combined with CBT.

Studies show that CBT can, in fact, change a person’s brain circuitry to significantly minimize symptoms, or at least help the individual learn how to best manage their symptoms.

When Should I Seek Help for My Child?

If your child shows signs of obsessive compulsive disorder, make an appointment with your family doctor or pediatrician to discuss your concerns. The physician will assess your child’s symptoms and conduct a physical exam to ensure another condition is not causing the symptoms.

If the doctor thinks your child has OCD, he or she can refer you to a mental health professional with experience in diagnosing and treating OCD.

Medical Reviewer: Sarah Amato, PsyD, and Elizabeth Vickery, PhD, Nationwide Children's Hospital

Date Last Reviewed:  7/22/2025

The information provided here is only for general reference and should not take the place of medical care or patient education. If you have any questions, please call your child's care team.