Obsessive-Compulsive Disorder (OCD)

Caring for a child with Obsessive-Compulsive Disorder (OCD) can feel overwhelming. The effects of OCD are often disruptive to daily life and can cause kids and their parents or guardians to feel like they are not in control. The mental health experts at CHOC are here to help kids and teens learn how to manage their OCD, and to help parents and guardians learn how to best support their child.

 

What is Obsessive-Compulsive Disorder (OCD) in Kids and Teens?

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. A child with OCD can have obsessive thoughts, feelings and fears that are not wanted and/or do repeated behaviors called compulsions (also called rituals) to make those fears go away.

What are Obsessions?

Obsessions are recurring thoughts, feelings and images that can make kids feel anxious. These thoughts are not wanted, and a child typically can’t stop thinking about them. A child with OCD may realize their thoughts are not logical but still feel extremely anxious about certain things.

These fears might include obsessing over:

  • If they, or someone else, will get sick, hurt or die.
  • Having said a bad word, had a bad thought or made a mistake.
  • Feeling they have broken a rule, done a bad thing or sinned.
  • If something is clean, dirty or germy.
  • If something is straight, even or placed in an exact way.
  • If something is lucky or unlucky, bad or good, safe or harmful.

What are Compulsions?

Compulsions, also known as rituals, are recurring behaviors to relieve the stress and anxiety caused by obsessions. OCD causes kids to feel they must do rituals to ensure things are clean, safe, in order or just right. To kids with OCD, rituals seem to have the power to prevent bad things from happening.

Rituals include things like:

  • Repeated handwashing (often 100 or more times a day).
  • Often erasing things, re-writing, re-doing or re-reading.
  • Hoarding objects.
  • Going in and out of doorways several times in a row.
  • Checking to make sure a light is off, a door is locked or checking and re-checking homework.
  • Touching or tapping a certain number of times, or in a specific way.
  • Following firm rules of order, such as putting on clothes in the very same order each day.
  • Counting to a certain “good” number, avoiding “unlucky” numbers.
  • Repeating questions or words spoken by oneself or others.
  • Repeatedly using inappropriate words or making rude or obscene gestures.

How is OCD Different from Typical Childhood Routines?

As children grow, rituals and obsessions not related to OCD normally happen with a purpose and are based on age. For example, preschool age children may have routines around meals or bedtime to help provide comfort and predictability. Older kids may create group rituals as they learn to play games and sports, or develop hobbies that help them learn to socialize.

OCD is different from these typical routines. When a child has OCD, obsessive thoughts and compulsive rituals can become frequent and strong, and can interfere with daily life and development. Those with OCD cannot “snap out of” the obsessions or compulsions they suffer from. These disruptions also cause severe mental health distress and can affect how the child thinks. While adults with OCD may realize their actions are irrational, children often cannot. In most cases, the compulsions of OCD, such as excessive handwashing or checking locks on doors, can use more than one hour each day.

Causes and Symptoms of OCD in Kids & Teens

What Causes OCD in a Child or Teen?

The cause of OCD is not known. Research suggests it could be connected to a problem with the brain, where children with OCD have differences in brain structures and brain activity. People with OCD do not produce enough serotonin, a chemical found naturally in the brain that can affect mood and other physical symptoms.

OCD is typically more common in teens. It tends to run in families, so it may be genetic; however, it may also occur without a family history of OCD. In some cases, streptococcal infections may trigger OCD or make it worse. It is important to remember that what caused the OCD is not the child’s or parent’s fault.

What are the Symptoms of OCD in a Child or Teen?

Each child may have different symptoms, which may include the following:

  • An extreme obsession with dirt or germs.
  • Repeated doubts, such as whether 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.
  • Feeling troubled by thoughts that are against personal religious beliefs.
  • A strong 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.
  • Excessive asking, such as asking for reassurance.
  • A need to do things the “right” way.

The symptoms of OCD can sometimes seem like other health problems. Make sure your child sees their healthcare provider for a diagnosis.

What OCD Warning Signs Can Parents Look For?

Children can have OCD for a while before their behaviors are noticed. Some parents may notice a child experiencing difficulties in day-to-day activities as a result of OCD. The following are possible warning signs of OCD in children or teens:

  • Having trouble concentrating on schoolwork.
  • Feeling irritable, sad or anxious.
  • Having trouble deciding.
  • Taking extended time to do everyday tasks.
  • Feeling unsure if things are okay.
  • Losing their temper if something is not perfect or is out of place.
  • Avoiding saying and/or doing certain things.

Can I Prevent My Child From Getting OCD?

Experts do not know yet how to prevent OCD in children and teens. 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, enhance your child’s development and improve their quality of life.

How is OCD Diagnosed in Children and Teens?

A child or teen can be diagnosed with OCD by a child psychiatrist or a mental health expert, like a licensed professional counselor or a mental health counselor. They will begin by conducting a mental health evaluation of the child.

To be diagnosed with OCD, the child must have obsessions and/or compulsions that are continuous, severe and disruptive. They must interfere with your child’s day-to-day life. In most cases, the activities of OCD, such as handwashing or checking the locks on doors, takes up more than one hour per day.

 

Teenage girl washes hands

How is OCD Treated in a Child or Teen?

Treatment for OCD will depend on the child’s symptoms, age, general health and the severity of their condition. Treatment for OCD can include combinations of the following:

  • Exposure and response prevention. Exposure therapy helps a child identify and understand their fears through exposing them to thoughts, objects or situations that start their obsessions. Response therapy helps teach a child new ways to better resolve or reduce those fears. It can also help the child and their family make rules to limit or change behaviors. For example, setting a maximum number of times a compulsive hand-washer 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 (SSRIs). These medicines help raise serotonin levels in the brain.
  • Antibiotics. Your child may need these medicines if his or her OCD is found to be linked to a streptococcal infection.

How Can I Help my Child or Teen Live with OCD?

As a parent, you play a key role in your child’s treatment. Here are some things you can do to help your child:

  • Reach out for support from local community services. Being in contact with other parents who have a child with OCD can be a helpful resource and support system.
  • Make an appointment with your child’s healthcare provider and work to create a treatment plan.
  • Have strong communication with your child. A child or teen with OCD can feel embarrassed about their disorder, so continue to support and listen to them.
  • Participate in your child’s therapy. Learn what tips their provider is encouraging them to do and help support your child with these.
  • Communicate with your child’s healthcare provider and those who are included in their care. Your child may have a team that includes counselors, therapists, social workers, psychologists and psychiatrists.
  • Continue to learn more about OCD through external resources, such as the International OCD Foundation.

Mental Health Resources

 

If your child is struggling and needs pediatric mental health services, visit our mental health services page for more information and to make an appointment.