Obsessive compulsive disorder (OCD) is a disorder of the brain and behavior that often begins in childhood. OCD causes severe anxiety in those affected. OCD involves both obsessions and compulsions that take a lot of time and get in the way of important activities, such as school and extracurricular activities, developing friendships, and self-care.
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?”).
In general, OCD is diagnosed when these obsessions and compulsions become so time-consuming that they negatively interfere with the child’s daily life. Typically, the obsessions and compulsions become gradually more severe over time until they get to this point.
In rare cases, symptoms may develop seemingly “overnight” with a rapid change in behavior and mood and sudden appearance of severe anxiety. There is a sub-type of Pediatric OCD caused by an infection, such as strep throat, that 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 overnight. 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. Click here to learn more about PANDAS/PANS.
How is OCD different from other childhood routines?
It is common for children to have routines for meals, at bedtime, etc. OCD is different from these routines. Compulsions or rituals may become too frequent and/or too intense or upsetting for the child, and may begin to get in the way of their daily life.
OCD is not something a kid or teen can simply “snap out of.” The obsessions they suffer from and the compulsions they use to try to get rid of their bad feelings are often not easy to control.
It is important to remember that OCD is not a result of something that the child, parent, or others did wrong.
There is no “cure” for OCD, but OCD is very treatable with a type of therapy called exposure and response prevention (ERP) and medication. Your child or teen’s future success does not have to be limited by OCD!