Behavioral Health

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Obsessive-Compulsive Disorder

What Is OCD?

Obsessive-compulsive disorder (OCD) is a condition that causes kids to have unwanted thoughts, feelings, and fears. These are called obsessions, and they can make kids feel anxious. To relieve the obsessions and anxiety, OCD leads kids to do behaviors called compulsions (also called rituals).

What Are Obsessions?

Obsessions are fears that kids with OCD can't stop thinking about. They may realize their thoughts don't make sense, but they still feel anxious about certain things.

These fears might include whether:

  • they, or someone else, will get sick, hurt, or die
  • they said a bad word, had a bad thought, or made a mistake
  • they have broken a rule, done a bad thing, or sinned
  • something is clean, dirty, or germy
  • something is straight, even, or placed in an exact way
  • something is lucky or unlucky, bad or good, safe or harmful

What Are Compulsions?

Compulsions (rituals) are behaviors that kids with OCD do repeatedly. OCD causes kids to feel they have to do rituals to "make sure" things are clean, safe, in order, even, or just right. To kids with OCD, rituals seem to have the power to prevent bad things from happening.

Rituals include things like:

  • washing and cleaning
  • often erasing things, re-writing, re-doing, or re-reading
  • repeating a word, phrase, or question much more than necessary
  • going in and out of doorways several times in a row
  • checking to make sure a light is off, a door is locked, or checking and re-checking homework
  • touching or tapping a certain number of times, or a set way
  • having things in a specific order
  • counting to a certain 'good' number, avoiding "unlucky" numbers

Why Do People Get OCD?

Scientists don't yet know why people get OCD, but they know biological factors play a role. Kids may get OCD because it's in their genes or they had an infection. There may be differences in brain structures and brain activity in people with OCD. But whatever caused OCD, it's not the child's or parent's fault.

What's It Like for Kids With OCD?

Kids don't always talk about the fears and behaviors OCD causes. They may feel embarrassed or confused about their fear and keep it to themselves. They may try to hide rituals they do. They may worry that others will tease them about their fears and rituals.

Kids with OCD feel unable to stop focusing on their obsessions. They feel like they have to do the rituals to guard against bad things they worry could happen. For some kids, doing a ritual is the only way they feel "everything's OK."

What Might Parents Notice?

Many kids have OCD for a while before parents, teachers, or doctors realize it. Parents might only learn about the OCD if their child tells them, or if they notice the child seems overly worried or is doing behaviors that seem like rituals.

Sometimes, parents may notice other difficulties that can be a result of OCD. For example, OCD can cause kids to:

  • have trouble concentrating on schoolwork, or enjoying activities
  • feel and act irritable, upset, sad, or anxious 
  • seem unsure of whether things are OK
  • have trouble deciding or choosing
  • take much too long to do everyday tasks, like getting dressed, organizing a backpack, completing homework, or taking a shower
  • get upset and lose their temper if they can't make something perfect or if something is out of place
  • insist that a parent say or do something an exact way

How Is OCD Diagnosed?

If your child might have OCD, you'll meet with a child psychologist or psychiatrist, who will interview you and your child to learn more details. You and your child also may fill out checklists and questionnaires, which will help the psychologist or psychiatrist make a diagnosis. There are no lab tests to diagnose OCD.

When OCD is diagnosed, it can be a relief to kids and parents. OCD can get better with the right attention and care.

How Is OCD Treated?

OCD is treated with medicine and therapy. For kids who need medicines, doctors give SSRIs (selective serotonin reuptake inhibitors), like Zoloft, Prozac, and Luvox.

Therapists treat OCD with cognitive behavioral therapy. During this kind of talk-and-do therapy, kids learn about OCD and begin to understand it better. They learn that doing rituals keeps OCD going strong, and that not doing rituals helps to weaken OCD. They learn ways to face fears, cope with them, and resist doing rituals. Learning these skills helps stop the cycle of OCD.

Part of treatment is coaching parents on how they can help kids get better. Parents learn how to respond to OCD situations, and how to support their child's progress without giving in to rituals.

What Can Parents Do?

Talk with your child about what's going on. Talk supportively, listen, and show love. Say something that works for your child's situation like, "I notice you worry about your covers being smooth, your socks being even, and your shoes lined up. I notice it gets you stressed if you can't fix things just so."

Say that something called OCD might be causing the worry and the fixing. Tell your child that a checkup with a doctor can find out if this is what's going on. Reassure your child that this can get better, and that you want to help.

Make an appointment with a child psychiatrist or psychologist. Your child's doctor can help you find the right person.

Take part in your child's therapy. Learn all you can about how parents can help when their child has OCD. Overcoming OCD is a process. There will be many therapy appointments, and it's important to go to them all. Practice the things the therapist recommends. Encourage your child.

Get support, and give it. There are lots of resources and support for parents and families dealing with OCD. Knowing that you're not alone can help you cope. Sharing success stories with other parents can give you hope and confidence.

Reviewed by: Shirin Hasan, MD
Date reviewed: June 15, 2017