Quick Guide to Obsessive-Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is an anxiety disorder that can affect children and teenagers. Kids with OCD experience unwanted thoughts, worries or impulses called obsessions. Obsessions are very upsetting and hard to control. Children with OCD develop repetitive actions — called compulsions— to calm the anxiety caused by their obsessions.  

Often, compulsions are not connected to obsessions in a realistic way. For example, a child might have an obsessive fear that their parents will be in a car accident. To deal with that fear, they might turn a light on and off five times. Even if they know it doesn’t make sense, they feel that the ritual will keep their parents from getting hurt. Professionals call that feeling “magical thinking.” 

Children as young as five can develop OCD. At that age, they may not even realize that their thoughts and fears are exaggerated or unrealistic.  

A child with OCD may hide their rituals until they get to be too overwhelming. They may be able to suppress their rituals at school and then act out when they get home.  

Some children suddenly develop OCD symptoms, along with other disturbing symptoms, after they have had an infection, such as a staph infection. This is a disorder called PANDAS or PANS. 

Kids with OCD usually experience both obsessions and compulsions. They use compulsions to control the anxiety that obsessions cause. 

Common obsessions that kids experience include: 

• Fear of contamination (germs, waste, vomit, chemicals, etc.) 
• Needing everything to be even or symmetrical 
• Extreme worry about safety, like thinking that the house will burn down or a parent will get hurt 
• Fear that they might do something violent or terrible 

Common compulsions include:  

• Washing their hands repeatedly 
• Locking and relocking doors a certain number of times  
• Lining up objects or touching parts of their bodies symmetrically, like scratching both ears 
• Counting a certain number of times or repeating something mentally 
• Repeatedly asking parents for reassurance that something bad isn’t going to happen 

Compulsions can be thoughts instead of behaviors, so they can be hard to spot. For example, a child’s compulsion might be counting to 20 in their head. 

To be diagnosed with OCD a child has to have obsessions, compulsions or both. They must get in the way of the child’s normal life.  

The severity of the symptoms can be measured using a rating scale called Y-BOCS, or the Yale-Brown Obsessive-Compulsive Scale. 

The most effective treatment for OCD is a form of cognitive behavior therapy (CBT) called exposure and response prevention.  

In this therapy, the therapist exposes the child to small amounts of the thing that usually triggers their obsession. That way, the child gets practice dealing with their anxiety in a safe environment. The therapist helps the child avoid using their compulsion. Over time, the child feels less anxious, and they don’t need the compulsion anymore. The therapist can also train the child’s family to practice at home. 

More severe cases of OCD are often treated with a combination of CBT and medication. The most effective medication for anxiety is SSRIs, or selective serotonin reuptake inhibitors. The medication can reduce anxiety and help the child get more out of therapy. Once kids learn skills in therapy, they can take less medication or stop altogether. 

Kids with OCD will often return to their clinician in the years after their treatment for “booster sessions” to freshen up the skills they learned to control their anxiety.