What Is OCD?

Children who have OCD struggle with either obsessions or compulsions or both. Obsessions are unwanted and intrusive thoughts, images or impulses. Obsessions make kids feel upset and anxious. Compulsions are actions or rituals kids are driven to perform to get rid of anxiety.

To understand how OCD works, think about a mosquito bite. When you get bitten by a mosquito, it itches, so to make it feel better you scratch. While you scratch the bite it feels great, but as soon as you stop scratching, the itching gets worse. That’s how OCD plays out. When a child with OCD feels anxious he’ll do something to fix it temporarily, but that ritual makes it worse over time.

Kinds of obsessions and compulsions

OCD obsessions fall into a variety of categories, including the below list.

  • Contamination: Kids with this obsession are sometimes called “germophobes.” These are the kids who worry about other people sneezing and coughing, touching things that might be dirty, checking expiration dates or getting sick. This is the most common obsession in children.
  • Magical thinking: This is a kind of superstition, like “step on a crack, break your mother’s back.” For example, kids might worry that their thoughts can cause someone to get hurt, or get sick. A child might think, “Unless my things are lined up in a certain way, mom will get in a car accident.”
  • Scrupulosity: This is when kids have obsessive worries about offending God or being blasphemous in some way.
  • Aggressive obsessions: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. “What if I hurt someone? What if I stab someone? What if I kill someone?”
  • The “just right” feeling: Some kids feel they need to keep doing something until they get the “right feeling,” though they may not know why it feels right. So they might think: “I’ll line these things up until it just kind of feels right, and then I’ll stop.”

Compulsions can be things that kids actively do — like line up objects or wash hands — or things done mentally, like counting in their head. A compulsion could also be an avoidance of something, like a child who avoids touching knives, even flimsy plastic ones, because she’s afraid of hurting someone. Because compulsions are things that parents might notice, it is common for parents to be more aware of them than obsessions.

Kinds of OCD compulsions include (but are not limited to):

  • Cleaning compulsions, including excessive or ritualized washing and cleaning
  • Checking compulsions, including checking locks, checking to make sure a mistake wasn’t made and checking to make sure things are safe
  • Repeating rituals, including rereading, rewriting and repeating actions like going in and out of a doorway
  • Counting compulsions, including counting certain objects, numbers and words
  • Arranging compulsions, including ordering things so that they are symmetrical, even or line up in a specific pattern
  • Saving compulsions, including hoarding and difficulty throwing things away
  • Superstitious behaviors, including touching things to prevent something bad from happening or avoiding certain things
  • Rituals involving other persons, including asking a person the same question repeatedly, or asking a parent to perform a particular mealtime ritual