Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD) is a common mental disorder in which “obsessions” and “compulsions” cause extreme anxiety and daily life disruptions.

What is Obsessive Compulsive Disorder?

Obsessive compulsive disorder (OCD) is a common mental disorder in which obsessions and compulsions cause extreme anxiety and daily life disruptions.

  • Obsessions in OCD are repeated intrusive thoughts that aren’t wanted but can’t be controlled and cause great distress.
  • Compulsions are repeated behaviors that are done to calm or suppress the anxiety caused by obsessions.

According to the Anxiety and Depression Association of America, OCD affects about 1 in 100 children in the U.S. The disorder can begin in childhood or during the teen years. Boys often develop symptoms at an earlier age than girls.

A child with OCD may have signs and symptoms of obsessions, compulsions or both. While adults with OCD may be aware their obsessions and compulsions are irrational, children and teenagers with the condition may not realize this.

What Causes OCD?

Researchers are still looking into what causes obsessive compulsive disorder, but it appears that abnormalities in brain structure play a role.

Genetics also play a role. A child has a higher risk of developing OCD if he or she has a parent or sibling with the condition.

OCD can also occur suddenly (overnight) in children who have a strep infection. This is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Antibiotics are the main treatment for PANDAS, though some cases may benefit from standard OCD treatments such as cognitive behavioral therapy.

What Are The Signs And Symptoms?

It’s important to remember that everyone experiences repeated thoughts and behaviors sometimes. The difference between typical repeated thoughts and behaviors and OCD is that, with OCD, the thoughts and behaviors are often unpleasant and severely disrupt a child’s life.

Examples of common obsessions in children with OCD include:

  • Fear of germs or infection
  • Fear of losing or forgetting important things
  • Fear of being harmed or causing harm to someone
  • Fear of not following religious rules correctly
  • Fear of saying inappropriate things in front of other people
  • Urge to do things “perfectly”
  • Urge to arrange things symmetrically

A child’s compulsions may include:

  • Spending an excessive amount of time cleaning or arranging his or her surroundings or washing himself or herself
  • Checking over and over or a particular number of times to be sure he or she hasn’t lost or forgotten something or harmed someone
  • 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 a particular way

Other behaviors that are common in children with OCD include:

  • Inattentiveness
  • Inflexibility that causes extreme irritability or panic if things aren’t done “just right”
  • A constant need for reassurance
  • A desire to avoid particular things or 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 they 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). Also, OCD symptoms intensify over time, thus something somewhat small can grow into something that is impairing.

How is OCD Diagnosed?

Obsessive compulsive disorder is diagnosed by a behavioral health specialist trained in OCD.

In order for a diagnosis to be made, the child must have obsessions and/or compulsions that cause distress, interfere with daily life and last for an hour or longer every day.

The behavioral health specialist may also use a screening measure for OCD to further confirm the diagnosis. The most commonly used test is the Yale-Brown Obsessive Compulsive Scale. This measure requires children to answer questions about his or her feelings and behaviors.

How is it Treated?

Obsessive compulsive disorder is best managed with the help of a behavioral health professional. Parents must also educate themselves and play an active role in the treatment process.

Treatment for OCD includes:

  • Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). The behavioral health specialist works with the child to learn about OCD and ways to cope with the symptoms. CBT involves both working on obsessive thoughts and rituals associated with OCD. Therapy is most effective when it incorporates exposures. These are 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 door knob and not be allowed to wash his/her hands right away. This type of treatment is extremely successful.
  • Medicine. An antidepressant may be prescribed to manage OCD symptoms.

Although obsessive compulsive disorder can’t be cured, treatment can help children manage their symptoms effectively so they can live a full and happy life.

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. He or she will assess your child’s symptoms and conduct a physical exam to ensure another condition isn’t causing the symptoms.

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