Obsessive Compulsive Disorder (OCD) in Children & Teens

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Obsessive Compulsive Disorder (OCD) is a mental health condition that compels a child to perform the same ritualistic motions over and over again, or to regularly experience intrusive thoughts and ruminations. It typically develops in children between the ages of 10 and 14, though some children may exhibit symptoms at a much younger age. (Last & Strauss, 1989)

How many children have OCD?
It’s estimated that around 1-2% of children are affected by OCD. (Jones et al., 2013) Around 40% of children with OCD will still have the disorder in adulthood, whereas around 40% will qualify for remission, meaning they no longer qualify for a diagnosis. (Boileau, 2011)

Signs & symptoms of OCD in children & teens

OCD symptoms consist of two main components:

Obsessions: These are intrusive thoughts that pop into a child’s mind, often revolving around bizarre scenarios or taboo behavior. For example, a child might imagine what it would be like to stick her little sister in the oven, or to take off her clothes and walk naked into a room. They also might revolve around random curiosities that pop into their head, or deep-seated fears, such as imagining their parents in a coffin. All children experience random thoughts from time to time, but a child with OCD gets stuck on these thoughts, replaying them in their mind over and over again.

These obsessive thoughts may be related to their compulsions (for example, obsessions about germs leading to a compulsion for frequent hand-washing) but they can also be entirely unrelated. A child’s obsessions may revolve around a singular theme, or change depending on the situation and what a youth is thinking about.

Examples of obsessions experienced by kids with OCD:

  • Worrying about their parents or other loved ones dying or being hurt

  • Thoughts of doing something socially inappropriate, such as taking off their pants in class

  • Bizarre or taboo sexual behavior (even pre-teen children routinely experience obsessions focused around sexual behavior)

  • Fears of embarrassing oneself or losing control

  • Thoughts revolving around germs, contamination, or sickness

Compulsions

Compulsions are odd, often repetitive behaviors a child feels compelled to perform. For example, feeling a need to wash their hands when they just did so 30 seconds ago, or turning a light switch on and off 3-times every time they enter the room. If you interfere with a child’s ability to perform these rituals, they become anxious and distraught, or may even launch into full-blown meltdown mode.

Compulsions are often connected to the obsessions; for instance, a child’s obsessive thoughts about burglars leading to a compulsion of checking locks on doors. Or they can merely be habits a child has formed that they must perform in order to feel right about the world.

Examples of compulsions common to kids:

  • Constantly requesting reassurance from adults

  • Asking the same question over and over again despite having received an adequate answer

  • Needing to follow bedtime rituals in a precisely proscribed manner

  • Compulsively counting whatever items they come across

  • Making reflexive noises in response to a particular stimulus

In most children and teens with OCD, obsessions and compulsions are both experienced alongside each other. However, some youth with OCD may experience obsessions without the presence of visible compulsions. It’s a far less visible form of OCD, but one that can be every bit as disruptive.

Diagnosing OCD in children

In order to meet the criteria for an OCD diagnosis, your child must exhibit each of the following traits:

  1. The presence of obsessions and/or compulsions

  1. An understanding that these thoughts or behaviors are excessive, unrealistic, or senseless.

  1. Their obsessions and compulsions create distress or interfere with their ability to function normally.

  1. These thoughts and behaviors are not created by another psychological disturbance (such as an eating disorder or PTSD) and are not the result of medication or substance use, nor reasonably related to legitimate goals or experiences.

Psychologists are usually reluctant to diagnose OCD in kids younger than 8, because so much of what young children do looks obsessional or compulsive. As Jeffrey Kluger writes, “Inviolable nighttime routines (a certain story read a certain number of times in a certain chair) or seemingly pointless exercises (lining up toy cars in a precise sequence, messing them up and starting all over) are usually just normal rituals that help create a sense of order in a too big, too random world. The need for such rituals fades as kids begin to feel that they have some control over their environment. Only if compulsive behavior continues after that should eyebrows be raised.” (Kluger, 2010, p. 45)

Children with OCD
So what does it look like when a child has OCD? Though every child can present these symptoms differently, here are some examples of what OCD might look like in real life.

You may have seen the movie Signs, led by actor Mel Gibson, about an alien invasion that follows an outbreak of crop circles. The little girl in this movie provides a fictional portrayal of OCD in children. She obsesses over the thought that there’s contamination in her drinking water. So she’ll pour a glass and take a sip, and if it doesn’t taste just right, she assumes it must be contaminated. This then leads to a compulsive behavior, as she abandons glass after glass of drinking water, replacing it with a new one only to determine that it, too, is contaminated.

A ten-year-old girl displayed inability to complete her work and tasks in a timely manner at home and at school. Her obsessive compulsions have led her to be ostracized in the classroom and to have a strained relationship with her mother. She had a tendency to repeat activities ten times and an inability to control her thoughts.

A 12-year-old boy had complaints of academic decline. He reported 2 years of symptoms characterized by intrusive, unpleasant and repetitive gory images of people engaged in violence or soaked in blood. This interfered with his ability to study. He would have palpitations, tremors and fearfulness when he experiences these images. He stated they were contrary to his innate “peaceful nature” and “habitual thinking patterns.” He knew these were irrational but was powerless in stopping them. Techniques to counter them like chanting hymns did not provide relief. Other repetitive behaviors, like turning on and off switches repeatedly and counting objects in sets of five were being done by him as it “just didn’t feel right otherwise.” Of these, he clearly identified the repeated occurrence of the unpleasant images as the one that distressed him the most. His scholastic performance and his repetition had led to strained relations with his parents. Initial explanations by the patient that he was “unable to concentrate” did not satisfy his family. When he mustered enough courage to tell his mother the details about the repeated images, his parents decided to seek help for him. The child was developmentally normal. Physical examination was unremarkable. Other screening for were negative.

The effects & consequences of OCD in children
OCD can impact children in a number of ways, with consequences that can be quite severe depending on the severity of the condition. Children with OCD are frequently teased for their compulsions. Other kids may exclude them or target a child for bullying. If this goes on for an extended period of time, it can significantly alter their social development.

OCD can also interfere with a child’s schooling. Imagine trying to concentrate in class when your brain keeps forcing you to entertain the same intrusive thought over and over again rather than paying attention to what the teacher is saying. Children with OCD often struggle in class, and may be misdiagnosed as being ADD.

Then there are all the disruptions it causes. Children waste time on these compulsive behaviors instead of doing things that are more productive. It can hinder their ability to function in different situations. Parents probably know all too well the hassles that come with having an OCD child.

This is why it’s so important to address the issue early on. Left unchecked, the potential consequences keep piling up. The longer a child’s OCD continues, the more collateral damage is done to these other areas of development, and the more ingrained your child’s OCD habits will become.

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