Obsessive-compulsive disorder is an anxiety disorder in which a person has an irrational thought, fear or worry and sometimes tries to manage by performing a ritual activity to reduce the anxiety. Frequently occurring disturbing thoughts or images are called obsessions and the repeated rituals performed to try to prevent or dispel them are called compulsions.

During the normal growth and development of children and adolescents, rituals and obsessive thoughts normally occur with a purpose and focus based on age. Preschool children often use rituals and routines around mealtimes, bath and bedtime to help them stabilize their expectations and understanding of their world. School-aged children normally develop group rituals as they learn to play games, team sports and recite rhymes. Older children and teens begin to collect objects and develop hobbies. These rituals help children to socialize and learn to master anxiety. A child or adolescent with OCD has obsessive thoughts that are unwanted and related to fears (such as a fear of touching dirty objects) and uses compulsive rituals to control the fears (such as excessive handwashing). When OCD is present, obsessive thoughts cause distress and compulsive rituals can become so frequent or intense that they interfere with activities of daily living (ADLs) and normal developmental activities.

Who Is Affected?

While symptoms of OCD do occur in children, it is recognized as a relatively common mental health disorder in adolescents, with the average age of onset around 15 years old. Within the general population, approximately 1,000,000 children and adolescents have OCD. Unlike other anxiety disorders, twice as many males have OCD as females. 20% of children and adolescents with OCD also have another family member with OCD.

The following are the most common symptoms of obsessive-compulsive disorder. However, each child may experience symptoms differently. Symptoms may include:

• An extreme preoccupation with dirt, germs or contamination
• Repeated doubts (for example, whether or not the door is locked)
• Obtrusive thoughts about violence, hurting, killing someone or harming self
• Preoccupation with order, symmetry or exactness
• Persistent thoughts of performing repugnant sexual acts or forbidden, taboo behaviors
• Troubled by thoughts that are against personal religious beliefs
• An extreme need to know or remember things that may be very trivial
• Excessive attention to detail
• Excessive worrying about something terrible happening
• Aggressive thoughts, impulses and behaviors

Compulsive behaviors (the repetitive rituals used to reduce anxiety caused by the obsessions) can become excessive, disruptive and time-consuming, and may interfere with daily activities and relationships. Examples of compulsive behaviors may include:

• Repeated handwashing (often 100 or more times a day)
• Checking and rechecking repeatedly (i.e., to ensure that a door is locked)
• Following rigid rules of order (i.e., putting on clothes in the very same sequence every day, keeping belongings in the room in a very particular way and becoming upset if the order becomes disrupted)
• Hoarding objects
• Counting and recounting excessively
• Grouping or sequencing objects
• Repeating words spoken by self (palilalia) or others (echolalia), repeatedly asking the same questions
• Coprolalia (repeatedly speaking obscenities) or copropraxia (repeatedly making obscene gestures)
• Repeating sounds, words, numbers or music to oneself
• Spending long periods of time touching things, counting thinking about numbers and sequences

The symptoms of OCD may resemble other medical conditions or psychiatric problems, including Tourette's disorder. Always consult your child's physician for a diagnosis.

Specific treatment for OCD will be determined by your child's physician based on:

• Your child's age, overall health and medical history
• Extent of your child's symptoms
• Your child's tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference

OCD can be treated to help kids and their families feel better. The best way to help a child is to first have a doctor or therapist do a full check-up to understand what's happening.

Different Kinds of Treatment

There are a few ways to treat OCD. Sometimes, a child will talk one-on-one with a therapist. Other times, they might also take medicine. The treatment plan is made especially for each child.

Talking With a Therapist

Therapy for OCD often uses two main types of ideas:

• Cognitive therapy: This helps kids figure out what makes them feel scared or worried. Then, they learn new ways to handle those fears so they don't feel so big anymore.
• Behavioral bherapy: A therapist works with the child and their family to create rules or a plan to change certain actions. For example, a child who washes their hands too much might work with the therapist to agree on a set number of times they can wash their hands each day.

Medicine for OCD

The most common medicines for OCD are called SSRIs. They work by helping the brain use certain chemicals to feel better. Some examples of these medicines are Zoloft, Prozac and Luvox.

Sometimes, OCD is caused by a type of sickness called a strep infection. If this happens, a doctor might give the child special medicines called antibiotics to help.

Getting Help From Everyone

Treating OCD is a team effort! Besides talking to a therapist and possibly taking medicine, the family can also get help from a therapist. The child’s school can be part of the plan too. Most importantly, parents are a huge part of the process and can give lots of support.

Approximately 20-40% of adolescents with OCD also experience one or more types of eating disorders, which will also require treatment.