Many people associated OCD with neatness and perfectionism, but the disorder is much more complex than that. Obsessive-compulsive disorder (OCD) is a condition that causes unwanted, intrusive thoughts (obsessions) and compels people to perform certain behaviors (compulsions) to alleviate their anxiety.
For children and teens with OCD, these obsessions and compulsions can interfere with daily life, making it hard to focus at school, build friendships, and enjoy everyday activities. Fortunately, OCD can be controlled with proper treatment. If you think your child has OCD, or you’re a teen who thinks you might have OCD, this article will guide you through the signs, causes, diagnosis, and treatment options for OCD in children and teens.
What is OCD?
Obsessive-compulsive disorder (OCD) is a mental health condition that causes unwanted, intrusive thoughts and repetitive behaviors. These thoughts, called obsessions, often revolve around fears, doubts, or disturbing images that cause feelings of distress, such as anxiety, disgust, or ‘not right’ sensations. To cope with the discomfort of these obsessions, people with OCD engage in compulsions – repetitive actions or mental rituals meant to reduce their distress.
While everyone experiences unwanted thoughts every now and again, people with OCD find their obsessions and compulsions overwhelming and disruptive to daily life. Kids and teens with OCD might struggle with basic tasks like attending school, focusing on homework, or enjoying time with friends. Their compulsions acn become so demanding that they interfere with normal routines and activities.
The good news is that OCD is a treatable condition. Like other mental health conditions, early diagnosis is key to proper treatment. The first step is to learn how to recognize signs of obsessions and compulsions.
Did you know? OCD used to be classified as an anxiety disorder, however under the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) it is classified separately from anxiety disorders.
What are obsessions?
Obsessions in OCD are persistent, unwanted thoughts, fears, or worries that cause anxiety and significant distress. For children and teens with OCD, these thoughts can feel overwhelming and impossible to control. No matter how much they try to stop thinking about them, the thoughts keep coming back over and over again.
There are many different types of obsessions in OCD, but common examples include:
- Fearing you will get sick or die, no matter what you do
- Worries that a loved one will get sick, hurt, or killed
- Fear that you have broken a rule and deserve to be punished
- Fear of touching items that might have germs
- Obsession with placing objects in an even, orderly manner
- Worry that doing something in an ‘incorrect’ order will lead to a negative outcome
- Colors or numbers that seem bad or unlucky
- Thoughts of things that seem bad, rude, or wrong.
While everyone experiences unwanted thoughts from time to time, obsessions in OCD are much more intense and long-lasting. Sometimes, obsessions become so overwhelming that kids can’t think about anything else.
What are compulsions?
Compulsions in OCD, sometimes called rituals, are repetitive behaviors or mental acts that people feel compelled to perform in response to their obsessive thoughts. For kids and teens with OCD, compulsions feel like a way to stop the thoughts, feel safe, or prevent a feared outcome. They can be actions or things they repeat in their head.
Kids with OCD will often feel a strong urge to perform these compulsions over and over again in a specific, rigid order, usually focused on cleanliness, order, or symmetry. If not done perfectly, many kids will start over, believing that something bad will happen if they don’t do the ritual properly.
Some common examples of compulsions in OCD include:
- Washing or cleaning things in a specific way
- Thinking a phrase over and over again until it ‘feels right’
- Checking and re-checking if doors or windows are closed or locked
- Walking in and out of doors several times in a row
- Having to erase and rewrite, redo, or reread things in a specific way several times
- Repeating certain words or phrases until they’re said an exact number of times or in the exact right way
- Chewing each bite on each side of the mouth equal times
- Placing all objects in a symmetrical, even order
- Touching, tapping, or stepping a specific number of times
- Counting items and objects to ‘good numbers’ and avoiding ‘bad’ or unlucky numbers.
While some of these behaviors might seem harmless, they can become disruptive when performed excessively. For example, checking homework once is helpful, but checking it over and over to the point where a child can’t focus on other tasks is problematic. Compulsions can significantly interfere with daily life and make it difficult for kids and teens to engage in regular activities.
OCD symptoms in kids and teens
Knowing how to recognize the signs and symptoms of OCD in kids and teens is the first step towards getting them the help that they need. The earlier you can intervene, the better the chances of a successful outcome.
OCD symptoms usually develop gradually over a period of time, which can make it difficult to pick up on symptoms when they first start appearing. It can also be difficult to distinguish between a normal everyday ritual, such as a bedtime routine, and an OCD compulsion. In most cases, when a ritual begins to impact daily functioning then it’s a sign of OCD.
Below are some common signs of OCD in kids and teens and things to watch out for.
Excessive handwashing
One of the best-known compulsions of OCD is excessive hand-washing. This is when kids feel an urge to wash their hands constantly due to obsessions related to germs, feelings of disgust, contamination, or fears of developing chronic stress or anxiety. Children or teens with this compulsion will often wash their hands dozens of times per day, leading to raw, bleeding, or peeling skin.
Repeatedly checking things
Many children or teens with OCD will repeatedly check things. This might include checking if doors are locked, lights are switched off, or homework is done correctly. Kids with this compulsion will repeat these actions over and over again to relieve anxiety and prevent potential negative outcomes.
Intense fear of contamination
This fear can manifest as excessive hand-washing or avoidance behaviors, such as refusing to touch certain objects or avoiding places they perceive as dirty or contaminated. These avoidance behaviors can become so strong that they interfere with a child’s social life and school work.
Intrusive thoughts
Many teenagers with OCD will experience intrusive, unwanted thoughts, ideas, or images that appear over and over again. These thoughts can be violent, sexual, or blasphemous in nature, causing significant anxiety and distress.
Order and symmetry
Another sign of OCD is engaging in rituals related to symmetry and order. Some teens with OCD might feel urged to arrange objects in a particular way, count or repeat certain actions a set number of times, or perform tasks in a specific sequence. These rituals are usually performed as a response to anxiety and give teens or kids a sense of power over their thoughts and fears.
Intense doubt and fear
It’s common for teens and kids with OCD to struggle with intense doubts and fears. This might manifest as seeking constant reassurance, doubting their own abilities, or worrying that something bad will happen if they don’t perform certain rituals. These doubts and fears can be so overwhelming that they affect daily functioning.
Excessive bedtime routines
Sometimes, intrusive thoughts or worries worsen at night and make it difficult to fall asleep. To counter this, children and teens with OCD often have specific bedtime rituals they need to perform before getting in bed. If the routines are disrupted or not performed ‘correctly’, they’ll have to start over. This can lead to a bedtime routine taking anywhere from 30 minutes to more than an hour, depriving kids of sleep and further impacting their daily life.
Rituals when leaving the house
Similarly, some children with OCD engage in excessive rituals when leaving the house that can slow the entire family down during outings. This might be anything from checking that all doors and windows are locked, all lights are switched off, and furniture or items are in the ‘right’ position before leaving. If you try to leave before the routine is finished, they’ll likely throw a tantrum.
What causes OCD?
OCD is a complex disorder that is usually caused by a combination of genetic, environmental, and psychological factors:
- Family history and genetics: If a close family member has OCD, there’s a higher likelihood of a child developing the disorder.
- Environmental influences: If a child is exposed to family members or others with OCD behaviors, they may learn and adopt these patterns themselves.
- Stressful or traumatic events: Stress and trauma can act as triggers for OCD, especially in kids with underlying vulnerabilities. That said, it’s important to distinguish between OCD and post-traumatic stress disorder (PTSD) as both can involve intrusive thoughts.
How is OCD treated?
There is no known cure for OCD, but several treatments can help manage symptoms and improve quality of life for both kids and teens with the disorder. Each child is different and may respond differently to treatments, so a comprehensive and personalized approach is important.
Below are some of the most common ways to treat OCD.
Cognitive-behavioral therapy (CBT)
Cognitive-behavioral therapy (CBT) is one of the most effective treatments for OCD. This method focuses on identifying and challenging obsessive thoughts while slowly reducing compulsive behaviors. While it can take some time to see results with CBT, it can significantly improve the quality of life for children and teens with OCD.
One of the key components of CBT is exposure and response prevention (ERP). This gradually exposes children to their fears or obsessions (e.g. germs) and helps them resist the urge to perform compulsive rituals (e.g. handwashing). Over time, this can reduce anxiety and break the cycle of OCD behaviors.
Since OCD can affect the entire family, it’s important for parents and siblings to be involved in treatment. Family therapy can teach parents how to best support their child and provide strategies for managing OCD at home. If a child is hesitant to see a therapist, parent-led approaches can show parents how to teach their child coping skills.
Medication
Some children may be prescribed medication to manage the obsessions and compulsions of OCD, usually selective serotonin reuptake inhibitors (SSRIs) or other antidepressants.
The most common medications used to treat OCD in kids and teens include:
- Anafranil (clomipramine): For children 10 years and older
- Fluvoxamine: For children 8 years and older
- Prozac (fluoxetine): For children 7 years and older
- Zoloft (sertraline): For children 6 years and older
If you’re considering medication for your child, be sure to discuss any risks and benefits with your child’s doctor and be aware of potential side effects. In many cases, medication is prescribed to enhance the effectiveness of CBT, and some children might eventually stop taking it once they’ve learned exposure and response prevention skills.
How you can help your child at home
If you have a child with OCD, you might be wondering how you can support them at home. After all, home is where they spend most of their time. Below are some ways you can support a child with OCD at home.
- Provide reassurance: Children with OCD can feel isolated and misunderstood. Being there to listen and provide emotional reassurance can help your child feel less alone in their struggle. At the same time, try not to go overboard. Many children with OCD seek constant reassurance and this can strengthen compulsions.
- Celebrate small wins: When your child resists a compulsion or successfully gets through an anxious moment, celebrate it. This can help build confidence.
- Normalize anxiety: Let your child know that anxiety is a natural emotion and everyone experiences it from time to time.
- Teach relaxation techniques: These simple exercises can help your child manage anxiety and reduce stress in the moment. Some ideas include:
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- Breathing exercises, such as inhaling deeply through the nose and exhaling slowly out the mouth
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- Progressive muscle relaxation, which involves tensing and relaxing muscle groups one at a time to ease tension caused by obsessive thoughts.
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- Encourage positive self-talk: Children and teens with OCD can benefit from positive self-talk, which challenges the negative and intrusive thoughts that fuel their anxiety. Have them repeat affirmations like, ‘I don’t need to do this ritual to be safe’, or visualize themselves facing and overcoming their fears.
- Use distractions: Try to divert your child’s attention by engaging them in fun activities, like creative hobbies or physical exercise.
- Create a worry box: This is a simple but powerful tool that can help your child externalize their fears. To do this, have your child write or draw their worries and place them in a designated worry box. This allows them to ‘contain’ their worries rather than dwelling on them all day.
What to do if you think your child has OCD
If you think your child or teen might have OCD, remember that early intervention can make a big difference in improving their well-being and quality of life. With the right care, your child can learn to manage their symptoms and feel more in control.
At BestMind Behavioral Health, we’re here to offer expert guidance and compassionate care tailored to your child’s unique needs. Reach out today to schedule a consultation and take the first step towards helping your child live a happier and more fulfilling life.
