OCD: What to Look For

Young children experience OCD differently than adolescents and adults. The disorder can manifest as early as 5, but a child may lack the self-awareness to recognize that his thoughts and fears are exaggerated or unrealistic, and he may not be fully aware of why he is compelled to perform a ritual; he just knows that it gives him a “just right” feeling, at least momentarily. Later, what professionals call “magical thinking” emerges: Though he knows it is far-fetched, a child finds himself compelled, if he has scratched his left shoulder, to scratch his right shoulder, so mom will be less likely to die in a car accident, for instance. In any case, the response is highly structured and repetitive, making the child appear rigid and rule-bound and interfering with normal functioning. And while all children seek reassurance from adults, children and adolescents with OCD ask repeated questions about the future.

OCD obsessions fall in to a variety of categories: contamination (germs, waste, bodily fluids, chemicals, etc.), symmetry (lack of which could cause bad luck), fear of harm or responsibility for harm (the house will burn down, a parent will be hurt in an accident), aggressive (I might hurt the baby), among others. Since obsessions can be impulses as well as ideas or images, the compulsion in response to a dreaded impulse can be to avoid contact or problematic situations, or isolate oneself. Likewise, the rituals performed can be mental rather than physical, and go unrecognized by parents—and even the child.