Obsessive-compulsive disorder (OCD) is a mental health condition characterized by obsessive, intrusive thoughts and compulsions, or repetitive behaviors aimed at reducing anxiety. OCD often begins in childhood or adolescence and affects up to 2% of children. Understanding what OCD is, what causes it, and how it manifests in children and teens is key for parents seeking treatment and support.
What are the symptoms of child OCD?
OCD symptoms generally fall into two categories – obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images or urges that cause anxiety. Common obsessions in children and teens include:
- Fear of contamination by germs, dirt, etc.
- Need for symmetry, order and perfectionism
- Taboo or frightening sexual or religious thoughts
- Fear of harm coming to self or loved ones
Compulsions are repetitive behaviors or mental acts aimed at reducing the anxiety caused by an obsession. Common compulsions include:
- Excessive hand washing, showering, cleaning
- Arranging items in a particular order
- Compulsive counting or repeating words
- Checking locks, appliances, homework, etc. repeatedly
Additional signs of OCD in children may include:
- Spending over an hour a day on obsessive thoughts or compulsive behaviors
- Inability to resist or stop compulsions
- Significant distress or impairment in daily functioning due to OCD
- Bedtime or bathroom routines taking excessive amounts of time
What causes OCD in children?
The exact causes of OCD are still being researched, but both genetic and environmental factors are believed to play a role. Contributing factors may include:
- Biology: OCD may result from abnormal functioning in the frontal cortex and subcortical brain structures. Differences in brain chemistry and structure have been noted in imaging studies.
- Genetics: Having a first-degree relative with OCD increases risk. Certain gene mutations may contribute.
- Infections: OCD symptoms may be triggered by some infections like strep throat.
- Trauma: Stressful or traumatic life events appear to trigger onset or worsen OCD in some cases.
- Family environment: Chaotic home environments or criticism of OCD behaviors may exacerbate symptoms.
Are there different types of OCD in children?
Yes, OCD symptoms often fall into certain patterns or subtypes. Common OCD subtypes seen in kids and teens include:
- Contamination OCD – obsession with germs and dirt leading to compulsive hand washing
- Harm OCD – obsession with violent or horrific thoughts about harm coming to oneself or others
- Perfectionism OCD – need to have things symmetrical or in a certain order
- Religious OCD – obsessions around sacrilege, blasphemy or morality
- Sexual OCD – intrusive sexual thoughts that cause extreme distress
- Checking OCD – repeatedly checking locks, appliances, homework, etc.
OCD symptoms in children can also include hoarding, repeating rituals like in and out of doorways, or skin picking.
At what age does OCD start in children?
OCD typically begins between the ages of 7 and 12, though it can develop at any time in childhood. Some key points about OCD onset include:
- OCD onset before age 5 is rare.
- Symptoms often appear between ages 10-12.
- The condition affects boys and girls equally.
- Earlier onset is associated with increased OCD severity.
Keep in mind that OCD onset can be gradual or sudden. Slow onset OCD may go unrecognized for some time. Sudden onset is more likely to follow a stressful event or infection.
How is OCD diagnosed in children?
Diagnosing OCD in kids requires:
- Assessing symptoms – Clinicians will evaluate obsessions and compulsions by interviewing both parents and children.
- Considering duration – Symptoms should be present for at least one hour per day for a minimum of one month.
- Ruling out similar conditions – Other disorders like anxiety, depression, autism and ADHD can have overlapping symptoms.
- Using DSM-5 criteria – The Diagnostic and Statistical Manual of Mental Disorders lists criteria for an OCD diagnosis.
Rating scales like the CY-BOCS are also used to assess OCD severity. Additional testing like EEGs or neuroimaging can help rule out neurological factors.
What are the effects of untreated OCD in children?
Leaving pediatric OCD untreated can lead to a number of problems, including:
- Declining school performance due to obsessive thoughts and compulsions
- Isolation and loss of social activities
- Strained family relationships
- Depression or anxiety from coping with uncontrolled OCD
- Development of obsessive-compulsive personality disorder (OCPD)
- Other mental health issues like tic disorders or skin picking (excoriation disorder)
Early diagnosis and treatment helps minimize the impact of OCD on social, academic and emotional wellbeing.
How do you treat OCD in children?
First line treatments for pediatric OCD include:
- Cognitive behavioral therapy (CBT) – CBT helps kids reduce compulsions through exposure therapy. It also teaches coping strategies.
- Medication – Selective SRIs like fluoxetine (Prozac) are FDA approved for treating OCD in children over 7.
- Combination therapy – Using CBT therapy and medication together has a higher success rate than either alone.
Additional OCD treatments include family therapy, mindfulness techniques, and complementary approaches like acupuncture.
What medications treat OCD in children?
The main medications used to treat OCD in kids are:
- SSRIs like fluoxetine (Prozac), sertraline (Zoloft), fluvoxamine, and clomipramine (Anafranil).
- Antipsychotics like risperidone (Risperdal) or aripiprazole (Abilify) as additions to SSRIs.
Proper medication can take 8-12 weeks to reach full effect. Doctors usually start at low doses and increase gradually while monitoring for side effects.
What natural remedies help child OCD?
Some natural remedies that may help lessen OCD symptoms include:
- Probiotics – Restore gut microbiome balance
- Omega-3s – Reduce inflammation
- N-acetylcysteine – Amino acid that stabilizes glutamate
- Mindfulness – Yoga, meditation, breathing exercises
- Exercise – Releases endorphins, reduces stress
- Balanced nutrition – Whole foods diet supports mental health
Always check with your child’s doctor before starting any new supplements. Natural remedies work best paired with traditional OCD treatments.
What are tips for living with a child with OCD?
Parenting a child with OCD can be challenging at times. Here are some tips that can help:
- Learn as much as you can about OCD
- Work as a team with your child and their doctor
- Find support through counseling or OCD support groups
- Create an organized, low-stress home environment
- Encourage positive routines and behaviors
- Avoid criticism or frustration with OCD behaviors
- Make time for yourself and other relationships
- Celebrate small victories and progress
Is OCD curable in children?
There is no medical cure for OCD, but the right treatment can help children manage symptoms and achieve remission. About 1/3 of kids have their OCD resolve completely with proper treatment. Early, intensive therapy leads to better outcomes.
Can OCD go away on its own in children?
In some cases, mild OCD symptoms may lessen or go away on their own over time, especially with a supportive environment. But the majority of children with moderate to severe OCD require treatment to overcome symptoms. Leaving moderate-severe pediatric OCD untreated often leads to worsening.
When to seek emergency help for OCD
Seek immediate assistance if your child with OCD:
- Talks about suicide or self-harm
- Has delusions or seeing/hearing things (psychosis)
- Is violently aggressive due to OCD
- Stops eating or drinking due to OCD behaviors
- Takes dangerous risks due to OCD obsessions
Emergency psychiatric care or hospitalization may be needed to protect your child’s safety in these situations.
Conclusion
Obsessive compulsive disorder affects up to 2% of children, causing significant distress and impairment. With compassion, patience and proper treatment, children with OCD can overcome symptoms, build resilience, and thrive. Early diagnosis and therapy lead to the best prognoses by minimizing harmful effects on social and academic development. Multidisciplinary care that combines medication, psychotherapy, family support and school accommodations has the highest success rates. While OCD cannot be cured, the right treatment approach helps the vast majority of children achieve substantial symptom reduction and improved quality of life.