What is obsessive-compulsive disorder in children?

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. Obsessions are recurring thoughts. Compulsions are recurring behaviors.

A child with OCD has obsessive thoughts that are not wanted. The thoughts are linked to fears, such as touching dirty objects. The child uses compulsive rituals to control the fears, such as excessive handwashing.

As children grow, rituals and obsessive thoughts normally happen with a purpose and focus based on age. Preschool children often have rituals and routines around meals, bathing, and bedtime. These help stabilize their expectations and view of their world. School-aged children often create group rituals as they learn to play games, take part in team sports, and recite rhymes. Older children and teens start to collect objects and have hobbies. These rituals help children to socialize and learn to deal with anxiety.

When a child has OCD, obsessive thoughts and compulsive rituals can become very frequent and strong. They may interfere with daily living and normal development. OCD is more common in teens.

What causes OCD in a child?

The cause of OCD is not known. Research suggests it’s a brain problem. People with OCD don’t have enough of a chemical called serotonin in their brain.

OCD tends to run in families. Genes can play a role. But it may also occur without a family history of OCD. In some cases, streptococcal infections may set off OCD or make it worse.

What are the symptoms of OCD in a child?

Each child may have different symptoms. These are the most common symptoms:

• An extreme obsession with dirt or germs

• Repeated doubts, such as whether or not the door is locked

• Interfering thoughts about violence, hurting or killing someone, or harming oneself

• Long periods of time spent touching things, counting, and thinking about numbers and sequences

• Preoccupation with order, symmetry, or exactness

• Ongoing thoughts about doing offensive sexual acts or forbidden, taboo behaviors

• Troubled by thoughts that are against personal religious beliefs

• A great need to know or remember things that may be very minor

• Too much attention to detail

• Too much worrying about something bad occurring

• Aggressive thoughts, urges, or behaviors

Compulsive behaviors are the repetitive rituals used to ease anxiety caused by the obsessions. They can be excessive, disruptive, and time-consuming. They may interfere with daily activities and relationships. They may include:

• Repeated handwashing (often 100 or more times a day)

• Checking and rechecking many times, such as making sure that a door is locked

• Following firm rules of order, such as putting on clothes in the very same order each day

• Hoarding objects

• Counting and recounting to an excessive degree

• Grouping objects or putting things in a certain order

• Repeating words spoken by oneself or others

• Asking the same questions again and again

• Repeatedly using four-letter words or making rude (obscene) gestures

• Repeating sounds, words, numbers, or music to oneself

The symptoms of OCD may seem like other health problems. Have your child see their healthcare provider for a diagnosis.

How is OCD diagnosed in a child?

A child psychiatrist or other mental health expert can diagnose OCD. They will do a mental health evaluation of your child. To be diagnosed with OCD, your child must have obsessions and compulsions that are continuous, severe, and disruptive. They must harm your child’s day-to-day living.

In most cases, the activities of OCD such as handwashing or checking the locks on doors use up more than 1 hour each day. They also cause mental health distress and affect how your child thinks. In most cases, adults realize that their actions are not normal to some degree. But often children can't see that their behavior is irrational and abnormal.

How is OCD treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for OCD often includes a combination of the following:

• Therapy with cognitive and behavioral methods. Cognitive methods help a child identify and understand their fears. They also teach a child new ways to better resolve or reduce those fears. Behavioral methods help the child and their family make pacts or rules to limit or change behaviors. One example is setting a maximum number of times a compulsive handwasher may wash their hands.

• Family therapy. Parents play a vital role in any treatment process. A child’s school may also be included in care.

• Selective serotonin reuptake inhibitors. These medicines help raise serotonin levels in the brain.

• Antibiotics. Your child may need these medicines if their OCD is found to be linked to a streptococcal infection.

Teens with OCD may also have one or more types of eating disorders. These will also need treatment.

How can I help prevent OCD in my child?

Experts don’t know at this time how to prevent OCD in children and teens. But if you notice signs of OCD in your child, you can help by getting an evaluation as soon as possible. Early treatment can ease symptoms and enhance your child’s normal development. It can also improve their quality of life.

How can I help my child live with OCD?

OCD can be treated, often with a combination of one-on-one therapy and medicines. You play a key supportive role in your child’s treatment. Here are things you can do to help your child:

• Keep all appointments with your child’s healthcare provider and your child's educational team.

• Talk with your child’s healthcare provider about other providers who will be included in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, school psychologists, psychologists, and psychiatrists. Your child’s care team will depend on what your child needs and how serious the OCD is.

• Maintain strong and open lines of communication with your child. Children with OCD can feel embarrassed about their disorder.

• Keep other children appropriately informed. Siblings worry about each other and the family. Understanding what is happening can help reduce their anxiety.

• Tell others who need to know about your child’s disorder. Work with your child’s healthcare provider and school to create a treatment plan.

• Reach out for support from local community services. Being in touch with other parents who have a child with OCD may be helpful.

Key points about OCD in children

• OCD is a type of anxiety disorder. A child with OCD has obsessive thoughts that are not wanted. The thoughts are linked to fears, such as touching dirty objects. The child uses compulsive rituals, such as handwashing, to control the fears. These rituals may feel rational or irrational to the person doing them. The child may not understand why they do these rituals. They may feel embarrassed that the behaviors occur and can't be controlled.

• The exact cause of OCD is unknown. Children with OCD don’t have enough of a chemical called serotonin in their brain.

• Obsessive symptoms include repeated doubts and extreme preoccupation with dirt or germs.

• Compulsive behaviors include hoarding objects and checking things often.

• A mental health evaluation is needed to diagnose OCD.

• Treatment includes therapy and medicine.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.