Obsessive-compulsive disorder (OCD) occurs in people who have persistent thoughts they cannot control (obsessions) and/or perform certain actions repeatedly (compulsions) in an attempt to relieve anxiety. OCD causes severe discomfort and interferes with day-to-day functioning. This condition typically begins in early childhood or adolescence. About one in every 200 children has OCD, according to the American Academy of Child and Adolescent Psychiatry.

OCD is an anxiety disorder that is characterized by two major symptoms: obsessions and compulsions. Some children experience both of these symptoms, whereas others experience just one.

An example of OCD occurs when a child repeatedly worries about someone breaking into a bedroom and checks over and over to make sure the windows are locked. Or, a child may become paralyzed by fear of contracting a disease and may repeatedly wash the hands to get rid of germs.

Scientists do not completely understand the exact cause of OCD. However, growing evidence suggests that chemical imbalances in the brain play a major role in the disorder. Heredity is also believed to play a role in the development of the disorder.

Typically, parents or caregivers do not seek medical attention until their child’s behavior becomes disruptive to the child’s life. If a physician suspects OCD, the child may be referred to a child and adolescent psychiatrist or other mental health professional.

Obsessive-compulsive disorder (OCD) is an anxiety disorder in which people have recurrent, persistent thoughts they cannot control (obsessions) and/or an uncontrollable urge to perform certain actions over and over (compulsions). OCD typically begins in early childhood or adolescence, but it may not be actually diagnosed until adulthood. About one in every 200 children has OCD, according to the American Academy of Child and Adolescent Psychiatry (AACAP). Between 2 and 3 percent of people in the United States experience OCD by late adolescence, according to the Obsessive Compulsive Foundation.

Many children have a compulsive nature, such as those who are determined to keep their room especially tidy or to master a new sport or activity. Though such people may be labeled “compulsive,” this type of behavior does not qualify as a mental health disorder and may in fact be a key factor in building self-esteem and contributing to social success. In addition, children may find comfort in certain rituals, such as wearing “lucky” socks to an event or lining up stuffed animals during bedtime. These harmless activities are a normal part of child development and are not signs of OCD.

Children with OCD take these feelings and actions a step further, repeatedly engaging in obsessive thoughts and/or compulsive behaviors until the process becomes disruptive to their lives. For example, younger children may continually worry about someone breaking into a bedroom and may repeatedly check to make sure the windows are locked. Meanwhile, older children may become paralyzed with fear of contracting a disease and may repeatedly wash their hands to get rid of germs. These children may feel a sense of relief when they complete their rituals, but it usually does not last long before the next obsessive thought arises. As the discomfort returns, the child may feel compelled to repeat the obsessive-compulsive cycle again.

Over time, these rituals may take over a child’s life to an increasing degree and interfere with daily functioning. Children with OCD may have struggles with family, friends and at school. The stress of OCD is compounded by the fact that the disorder often prevents children from fitting in with peers. As a result, the child’s quality of life may rapidly deteriorate as obsessive thoughts and compulsive actions take up increasing amounts of time. Children with OCD also may be more likely to be bullied or made fun of by their peers as a result of their odd behavior. This can aggravate symptoms of OCD and lead to feelings of depression and loneliness in children with the disorder.

Adult patients with OCD usually understand that their thoughts and behaviors are irrational and excessive, but cannot free themselves from them. However, children with OCD are less likely to make this connection, especially young children.

The typical OCD patient is someone who has obsessions and/or compulsions for more than an hour each day, and the symptoms cause distress to the patient and are disruptive to their life. OCD can affect people of all age groups, and tends to affect men and women equally. Most patients experience both obsessions and compulsions. About one-third to one-half of adults with this condition first experienced symptoms during early childhood or adolescence, according to the Obsessive Compulsive Foundation. OCD in childhood tends to be diagnosed more frequently in boys than in girls.

Traditionally, scientists have not completely understood the cause of obsessive-compulsive disorder (OCD). There has been disagreement about whether the disorder is primarily biological in nature, or whether it is a result of learned behavior. Others have argued that OCD is a blend of these two factors.

However, growing evidence suggests that chemical imbalances may play a major role in the development of OCD. Recent studies have indicated that low levels of the neurotransmitter serotonin (a chemical that helps nerve cells communicate in the brain) may contribute to OCD. Many patients with OCD who take medications that boost serotonin levels show improvement in symptoms. In addition, people who have brain injuries sometimes develop OCD, which further suggests that a physical problem in the brain can cause the disorder.

OCD also appears to increase metabolism in the basal ganglia (region of specialized nerve cells) and frontal lobes (the upper brain area) of the brain. This may cause the repetitive movements, rigid thinking and lack of spontaneity in OCD. Finally, people with OCD have been shown to have higher than normal levels of the hormone vasopressin, which raises blood pressure and reduces excretion of urine.

Heredity is also believed to play a role in the development of the disorder. Children with close family members (e.g., parents) with a history of OCD also have a higher risk for developing the condition themselves.

Onset of OCD appears earlier in boys than in girls, and incidence levels first peak in puberty (between ages 10 and 12 years) and then again in a person’s 20s and 30s. Although scientists have not been able to trace any particular genes to OCD, people with close family members with a history of OCD have a slightly higher risk for developing the condition.

Obsessive-compulsive disorder (OCD) is characterized by two major symptoms: obsessions and compulsions. Some patients experience both of these symptoms, whereas others experience just one.

Obsessions are recurrent and persistent thoughts or impulses that a person cannot control. These thoughts may occur once in a while or may be almost constant, crowding the mind and preventing a person from concentrating on other tasks. Typical obsessions in children include:

• Fear of dirt, germs or environmental toxins
• Worry about catastrophic events
• Excessive concern with order, symmetry and exactness
• Religious obsession
• Obsession with lucky and unlucky numbers
• Sexual or aggressive thoughts
• Fixation on intrusive thoughts or words
• Concern about, or disgust with, bodily wastes and secretions

Compulsions are repetitive behaviors that a person engages in and cannot control. A child engages in compulsions as a means of combating obsessive thoughts, even though this action may seem irrational to the child and others. For example, children who are obsessed with a fear of germs may wash their hands compulsively to the point that the skin becomes raw to combat this fear. In other cases, the compulsive act is not as clearly associated with the obsessive thought. Many children also develop rules to follow that help control anxiety in the midst of obsessive thoughts, such as touching objects a specific number of times or counting to a certain number. In some cases, performing the compulsion does indeed relieve the anxiety, but only temporarily.

Typical compulsions in children include:

• Excessive washing of hands, showering or bathing
• Excessive grooming and brushing of teeth
• Repeatedly going in and out of doors or standing up and sitting down in a chair
• Repeatedly checking doors, locks, stoves or homework
• Rituals to avoid contact with contaminants
• Ritual touching or a pattern of tapping
• Counting rituals
• Hoarding and collecting certain items
• Cleaning rituals

In many cases, a child’s obsessions and compulsions are related to food. For example, children may feel compelled to limit their food choices to a restricted range of foods, which may impact their nutrition.

Children with OCD are likely to feel frustrated by and ashamed of their behavior. This may impact their self-esteem. Children with OCD may also have other mental health disorders. Studies have found that the most common of these are tic disorders (e.g., Tourette syndrome), depression and behavioral disorders.  Other conditions frequently diagnosed in children with OCD include other anxiety disorders (including phobias), learning disorders (e.g., dyslexia), oppositional disorder, attention-deficit hyperactivity disorder, adjustment disorder, compulsive hair pulling (trichotillomania) and habit disorders, such as nail biting and skin picking.

Children who have OCD typically develop symptoms so gradually that parents or caregivers may be unaware of them. In addition, many children hide their symptoms for as long as possible. Children may successfully hide their symptoms for months or even years.

However, certain signs should alert parents to the possibility that something is wrong. In some cases, children may require parents to participate in their rituals. For example, children obsessed with germs may continually ask their parents if they touched something infested with germs. If the parent says “no,” the child feels satisfied until the ritual begins again later. When parents refuse to participate in this way, the child may become difficult or upset.

Other signs of OCD in children include:

• Raw skin from excess washing
  
  
• High rate of soap and towel usage
  
  
• Sudden decline in test grades
  
  
• Holes erased through paper or homework
  
  
• Requests of other family members to repeat words or to answer the same question
  
  
• Persistent fears of illness
  
  
• Excessive amount of time preparing for bed
  
  
• Continual fear of bad events that might happen
  
  
• Reluctance to leave the house at the same time as other family members

Typically, parents or caregivers do not seek medical attention until their child’s behavior becomes disruptive to the child’s life. For example, children who obsessively wash their hands may develop a form of eczema (skin inflammation) that requires medical attention. Or, children who obsessively brush their teeth may damage the gums, causing bleeding. A greater percentage of children are first diagnosed with obsessive-compulsive disorder (OCD) sometime between the ages of 7 and 12 years.

Before diagnosing OCD, a physician will perform a complete physical examination and compile a thorough medical history. The medical history will include information regarding complications during the pregnancy and delivery of the child. Other developmental parameters such as height, weight, vaccinations, recent infections, and eating and sleep habits are also compiled. The physician will ask the child about the nature of the obsessions and compulsions. Consultation with parents, family and teachers may help reveal behavioral patterns that will lead to a more accurate diagnosis.

If a primary care physician suspects that OCD is present, the child will be referred to a child and adolescent psychiatrist or other mental health professional. These experts may ask the child or parents questions such as:

• Does the child have repeated unwanted thoughts that seem senseless?
  
  
• Does the child do things repeatedly in a way that seems excessive?
  
  
• Does the child have worries, thoughts, images or feelings that are upsetting?
  
  
• Does the child check things over and over again?
  
  
• Does the child count to a certain number or do things a certain number of times?
  
  
• Does the child collect things others might throw away?
  
  
• Does the child insist that things have a certain order or arrangement?
  
  
• Does the child have elaborate rituals prior to bedtime?

There is no specific laboratory test to diagnose OCD. It is usually diagnosed in children who have obsessive thoughts and/or who perform compulsive actions. In order for the diagnostic criteria to apply, the obsessive-compulsive thoughts should appear for more than an hour each day and cause marked distress and interruption of a child’s lifestyle.

Although there is no cure for OCD, certain treatments can help control symptoms. A combination of psychotherapy and medications is the most likely approach. Psychotherapy may take place in an individual or group setting. Cognitive behavior therapy can help children learn to use different thought patterns and routines that will steer them away from obsessive and/or compulsive behaviors. Parental or caregiver involvement in this therapy is often crucial to the child’s success in learning new techniques to keep OCD symptoms under control.

In addition, children may be asked to participate in a form of exposure therapy known as exposure and response prevention. In this therapy, the child is gradually exposed to the cause that triggers obsessive or compulsive thoughts and is taught new coping skills that do not include obsessive-compulsive behavior. For example, children with a fear of germs may be asked to dirty their hands and then to refrain from washing them for a specific period of time. This pattern is repeated over a long period of time until symptoms gradually decrease in frequency and intensity. The therapist assists the patient in managing any anxiety that is produced during this process. The treatment is difficult, but it can be a highly effective therapy for patients with OCD, particularly children and adolescents. However, the developmental stage of the child will influence treatment decisions, because young children do not yet have the ability to process information necessary for exposure therapy.

Some patients may also benefit from certain types of medication. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are most often prescribed for children with OCD. These drugs interfere with the recycling of the brain chemical serotonin and help to control the child’s symptoms. Just how this reduces obsessions and compulsions is not clearly understood.

Parents should be aware that the U.S. Food and Drug Administration (FDA) has advised that antidepressants may increase the risk of suicidal thinking in some children. As a result, all children being treated with them should be monitored closely for unusual changes in behavior. However, recent research indicates that the benefits of such medication in the treatment of OCD far outweigh the risks.

Antidepressant medications can vary regarding the length of time until onset of relief, and it may take between 10 and 12 weeks to determine whether or not these medications are effective. In addition, some children do not respond to one SSRI and may have greater success with another. Antidepressants are typically prescribed for at least 9 to 18 months after the OCD symptoms stabilize, and some patients will require medication indefinitely.

Preparing questions in advance can help parents and patients have more meaningful discussions with physicians regarding their or their child’s conditions. Parents may wish to ask the doctor the following questions related to obsessive-compulsive disorder (OCD) and children:

1. How can I get my child to talk about the obsessions and compulsions he/she appears to be hiding?
   
   
2. How will you diagnose my child’s OCD?
   
   
3. Should I alert the school or daycare staff about my child’s OCD?
   
   
4. What are my child’s treatment options?
   
   
5. Should my child take medications to treat his or her OCD?
   
   
6. What are the potential risks and side effects of these treatments?
   
   
7. Is there anything I can do to ease my child’s OCD?
   
   
8. What steps can I take to increase the odds that my child’s treatment will be effective?
   
   
9. How long will it take for my child’s condition to improve?
   
   
10. What signs might indicate that my child’s OCD is becoming worse or improving?