Obsessive-Compulsive Disorder (OCD)

What is it?

Obsessive-compulsive disorder (OCD) is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions). Children with OCD may compulsively wash their hands, lock and re-lock doors a set number of times, line up objects or touch parts of their bodies symmetrically in order to make themselves comfortable and less fearful. They may also repeatedly ask questions and seek reassurance.

Signs and Symptoms

Young children experience OCD differently than adolescents and adults. The disorder can show up as early as age 5, but a child may not realize his thoughts and fears are exaggerated (he also can’t control them) and why he feels compelled to perform a ritual; he just knows that it makes him temporarily feel good. For example, even though he knows it’s unrealistic, a child may feel that if he touches his left ear, he should touch his right so his mother is less likely to die in a car accident. These “rules” make the child appear rigid and his behavior interferes with daily life. Children and adolescents with OCD ask repeated questions about the future.

A child with OCD may have repeated thoughts or images about many different things, such as fear of germs, dirt, or intruders; hurting loved ones; or being overly tidy. Other signs include repeating the same rituals, such as washing hands, locking and unlocking doors, counting, keeping unneeded items, or repeating the same steps again and again. The child may spend at least an hour a day on the thoughts and rituals.

Diagnosis and Treatment

A clinician will make a diagnosis if your child has obsessions, compulsions, or both. Obsessions are unwanted thoughts or urges that cause a lot of anxiety and an effort on the child’s part to neutralize them by thoughts or actions. Compulsions are repeat, rule-based efforts to alleviate the anxiety and are not connected realistically with the thoughts they are designed to neutralize.

Mild cases of OCD are often treated with either cognitive behavior therapy or medication. If symptoms get worse, a combination of both may be the best approach. Cognitive behavior therapy and a technique called exposure and response prevention is the best treatment for OCD. The technique introduces a child to the objects of his obsession in incremental doses in a controlled environment, so he can experience his anxiety and distress without resorting to compulsions. A clinician works with the child to expose him to the easiest, least stressful trigger of OCD behavior up to the most dreaded.

If medication is required, as in more severe cases of OCD, SSRIs (selective seratonin reuptake inhibitors) can reduce anxiety and allow the child to be more responsive to exposure therapy.

What are the risk factors for children?

Children with more negative temperaments and behavioral inhibition are more likely to develop OCD; so are children whose first-degree relatives have OCD. Likelihood increases with relatives who had child-onset OCD. Children who have experienced abuse or other stressful or traumatic events are also more at risk.

Children with OCD are often diagnosed with depression; other disorders that frequently occur alongside OCD include eating disorders, panic disorder, and Tourette’s syndrome. Because of the intense stress and anxiety produced by OCD, it’s sometimes mistaken for another disorder.