Obsessive compulsive disorder (OCD) is characterized by both obsessions and compulsions.
Obsessions are intrusive and unwanted thoughts, images, or urges that occur over and over again and feel outside of the child’s control. These obsessions are unpleasant for the child and typically cause a lot of worry, anxiety, and distress.
Common obsessions may include:
- Worrying about germs, getting sick, or dying.
- Extreme fears about bad things happening or doing something wrong.
- Feeling that things have to be “just right.”
- Disturbing and unwanted thoughts or images about hurting others.
- Disturbing and unwanted thoughts or images of a sexual nature.
Compulsions (also referred to as rituals) are behaviors the child feels he or she “must do” with the intention of getting rid of the upsetting feelings caused by the obsessions. A child may also believe that engaging in these compulsions will somehow prevent bad things from happening.
Common compulsions may involve:
- Excessive checking (re-checking that the door is locked, that the oven is off).
- Excessive washing and/or cleaning.
- Repeating actions until they are “just right” or starting things over again.
- Ordering or arranging things.
- Mental compulsions (excessive praying, mental reviewing).
- Frequent confessing or apologizing.
- Saying lucky words or numbers.
- Excessive reassurance seeking (e.g., always asking, “Are you sure I’m going to be okay?”).
An OCD diagnosis is warranted when these obsessions and compulsions become so time-consuming that they impair day-to-day functioning (e.g., social, school, self care, etc.). Typically, these symptoms have a gradual onset, developing over the course of several weeks or months.
OCD can start at any time from preschool to adulthood. Although OCD can occur at any age, there are generally two age ranges when OCD tends to first appears:
- Between the ages 8 and 12.
- Between the late teen years and early adulthood.
In rare cases, symptoms may develop seemingly “overnight” with a rapid change in behavior and mood and sudden appearance of severe anxiety. If this is the presentation, then consider a sub-type of pediatric OCD caused by an infection (e.g., strep throat), which confuses the child’s immune system into attacking the brain instead of the infection. This then causes the child to begin having severe symptoms of OCD, often seemingly all at once, in contrast to the gradual onset seen in most cases of pediatric OCD. The sudden appearance of symptoms is very different from general pediatric OCD, where symptoms appear more gradually.
This type of OCD is called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) if it is a strep infection, or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) if it is any other infection.