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Obsessive-Compulsive Disorder in Children

What is obsessive-compulsive disorder (OCD)?

Obsessive-compulsive disorder is an anxiety disorder in which a person has an unreasonable thought, fear, or worry that he or she 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 hand washing). When OCD is present, obsessive thoughts and compulsive rituals can become so frequent or intense that they interfere with activities of daily living (ADLs) and normal developmental activities.

What causes obsessive-compulsive disorder?

The cause of OCD is not known. Research indicates that OCD is a neurological brain disorder. Evidence suggests that people with OCD have a deficiency of a chemical in the brain called serotonin. OCD tends to run in families, suggesting a genetic component. However, OCD may also develop without a family history of OCD. Recent studies suggest that streptococcal infections may trigger the onset or increase the severity of OCD, in some cases.

Who is affected by obsessive-compulsive disorder?

While symptoms of OCD do occur in children, it is recognized as a relatively common mental health disorder in adolescents, with up to 2 to 3 percent of children and adolescents having OCD.

What are the symptoms of obsessive-compulsive disorder?

The following are the most common symptoms of obsessive-compulsive disorder. However, each adolescent 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

  • Spending long periods of time touching things, counting, thinking about numbers and sequences

  • 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/or 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 hand washing (often 100 or more times a day)

  • Checking and rechecking repeatedly (for example, to ensure that a door is locked)

  • Following rigid rules of order (for example, 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, and/or music to oneself

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

How is obsessive-compulsive disorder diagnosed?

A child psychiatrist or other qualified mental health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive psychiatric evaluation. Parents who note signs of severe anxiety or obsessive or compulsive behaviors in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

In order for a diagnosis of OCD to be made, the obsessions and compulsions must be pervasive, severe, and disruptive enough that the child or adolescent's activities of daily living and function are adversely affected. In most cases, the activities involved with the disorder (for example, hand washing, checking the locks on the doors) consume more than one hour each day and cause psychological distress and impaired mental functioning. In most cases, adults realize that their behaviors are unusual to some degree. However, often, children and adolescents do not have this critical ability to judge this type of behavior as irrational and abnormal.

Treatment for obsessive-compulsive disorder

Specific treatment for OCD will be determined by your adolescent's doctor based on:

  • Your adolescent's age, overall health, and medical history

  • Extent of your adolescent's symptoms

  • Your adolescent's tolerance for specific medications or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

OCD can be effectively treated, usually with a combination of individual therapy and medications. Treatment should always be based on a comprehensive evaluation of the adolescent and family. Individual therapy usually includes both cognitive and behavioral techniques. Cognitive therapy focuses on helping the child or adolescent identify and understand their fears and learn new ways to resolve or reduce their fears more effectively. Behavior techniques help the child or adolescent and their family establish contracts or guidelines to limit or change behaviors (such as establishing a maximum number of times a compulsive hand washer may wash his or her hands). Medications used most often to treat OCD are classified as selective serotonin reuptake inhibitors (SSRIs), medications that selectively affect neurotransmitters mechanisms in the central nervous system. If OCD is found to be linked to a streptococcal infection, then a series of antibiotic medications may be prescribed by your adolescent's doctor. Treatment recommendations may include family therapy and consultation with the adolescent's school. Parents play a vital supportive role in any treatment process.

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

Prevention of obsessive-compulsive disorder

Preventive measures to reduce the incidence of OCD in adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the adolescent's normal growth and development, and improve the quality of life experienced by children or adolescents with anxiety disorders.