Obsessive-compulsive disorder is characterized by recurring, unwanted, intrusive doubts, ideas, images, or impulses (obsessions) and unrelenting urges to do actions (compulsions) to try to lessen the anxiety caused by the obsessions. The obsessions and compulsions cause great distress and interfere with school and relationships.
Obsessions often involve worry or fear of being harmed or of loved ones being harmed (for example, by illness, contamination, or death).
Compulsions are excessive, repetitive, purposeful behaviors that children feel they must do to manage their doubts (for example, by repeatedly checking to make sure a door is locked), to prevent something bad from happening, or to reduce the anxiety caused by their obsessions.
Behavioral therapy and medications are often used in treatment.
(See also Obsessive-Compulsive Disorder in adults.)
On average, obsessive-compulsive disorder (OCD) begins between 18 and 25 years, but about 25% of cases begin before age 14. The disorder often lessens after the age of 25.
Obsessive-compulsive disorder includes several related disorders:
Body dysmorphic disorder: Children become preoccupied with an imagined defect in appearance, such as the size of their nose or ears, or become excessively concerned with a slight abnormality, such as a wart.
Hoarding: Children have a strong need to save items regardless of their value and cannot tolerate parting with the items.
Trichotillomania (hair pulling)
Some children, particularly boys, also have a specific type of tic disorder called Tourettic OCD.
Genes and environmental factors are thought to cause OCD.
There is some evidence that infections may be involved in a few cases of OCD that begin suddenly (overnight). If the bacteria streptococci are involved, the disorder is called pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS). If other infections (such as Mycoplasma pneumoniae infection) are involved, the disorder is called pediatric acute-onset neuropsychiatric syndrome (PANS). Higher rates of OCD and tics were reported in children ages 5 to 11 with Covid-19 infections compared to those who did not get the infection. Researchers continue to study the connection between infections and OCD.
Pregnancy- and delivery-related traumas, such as the mother's use of medications and/or alcohol and mechanically assisted delivery, are thought to contribute to the development of OCD.
The gene networks of OCD are highly complex and are involved in many of the body's processes, including development of the brain and nervous system, the immune system, and the inflammatory system. Neuroimaging studies show some abnormalities in these networks.
Symptoms of OCD and Related Disorders
Typically, symptoms of OCD develop gradually, and most children can hide their symptoms at first.
Children are often obsessed with involuntary worries or fears of being harmed—for example, of contracting a deadly disease or of injuring themselves or others. They feel compelled to do something to balance or neutralize their worries and fears. For example, they may repeatedly do the following:
Check to make sure they turned off their alarm or locked a door
Wash their hands excessively, resulting in raw, chapped hands
Count various things (such as steps)
Sit down and get up from a chair
Constantly clean and arrange certain objects
Make many corrections in schoolwork
Chew food a certain number of times
Avoid touching certain things
Make frequent requests for reassurance, sometimes dozens or even hundreds of times per day
Some obsessions and compulsions have a logical connection. For example, children who are obsessed with not getting sick may wash their hands very frequently. However, some are totally unrelated. For example, children may count to 50 over and over to prevent a grandparent from having a heart attack. If they resist the compulsions or are prevented from carrying them out, they can become extremely anxious and concerned.
Most children have some idea that their obsessions and compulsions are abnormal and are often embarrassed by them and try to hide them. However, some children strongly believe that their obsessions and compulsions are valid.
OCD resolves after a few years in about 5% of children and by early adulthood in about 40%. In other children, the disorder tends to be chronic, but with continuing treatment, most children can function normally. About 5% of children do not respond to treatment and remain greatly impaired.
Diagnosis of OCD and Related Disorders
A doctor’s (or behavioral health specialist's) evaluation, based on standard psychiatric diagnostic criteria
Sometimes questionnaires about symptoms
Doctors base the diagnosis of OCD on symptoms. Several visits may be needed before children with OCD trust a doctor enough to tell the doctor their obsessions and compulsions. Doctors take developmental issues into consideration when evaluating very young children. Because anxiety often runs in families, doctors will also screen parents and other caregivers and make the appropriate referrals as needed.
For OCD to be diagnosed, the obsessions and compulsions must cause great distress and interfere with the child's ability to function.
If doctors suspect that an infection may be involved, they usually consult with a specialist in these disorders.
Great care must be taken to differentiate OCD from other disorders, such as early-onset psychosis, autism spectrum disorders, and Tourettic OCD (a neuropsychiatric disorder that combines features of Tourette syndrome and OCD). In Tourettic OCD, the children or adolescents may exhibit the compulsive behaviors of OCD without having any of the traditional obsessions. Instead, they experience physical discomfort that drives them the engage in compulsive actions. .
Treatment of OCD and Related Disorders
Cognitive-behavioral therapy
Sometimes medications
Cognitive-behavioral therapy, if available, may be all that is needed if children are highly motivated. The most effective form of this therapy involves exposing the child to the anxiety-inducing situation and preventing them from responding with compulsive behaviors. It is important to include parents or other caregivers in this therapy.
If needed, a combination of cognitive-behavioral therapy and a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) is usually effective for OCD. This combination enables most children to function normally. If SSRIs are ineffective, doctors may prescribe clomipramine, another type of antidepressant. However, it can have serious side effects. Other options are available if these do not work.(SSRI) is usually effective for OCD. This combination enables most children to function normally. If SSRIs are ineffective, doctors may prescribe clomipramine, another type of antidepressant. However, it can have serious side effects. Other options are available if these do not work.
If treatment is ineffective, children may need to be treated as inpatients in a facility where intensive behavioral therapy can be done and medications can be managed.
If streptococcal infection (PANDAS) or another infection (PANS) is involved, antibiotics are usually used. If needed, cognitive-behavioral therapy and the medications typically used to treat OCD are also used.
For Tourettic OCD, a combination of an SSRI (for the OCD) and other medications plus a technique called habit reversal therapy (for the tics) is used.
