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Overview

Many children occasionally have thoughts that bother them, and they might feel like they have to do something about those thoughts, even if their actions don't actually make sense. For example, they might worry about having bad luck if they don't wear a favorite piece of clothing. For some children, the thoughts and the urges to perform certain actions persist, even if they try to ignore them or make them go away.

Children may have an obsessive-compulsive disorder (OCD) when unwanted thoughts—and the behaviors they feel they must do because of the thoughts—happen frequently, take up a lot of time (more than an hour a day), interfere with their activities, or make them very upset. The thoughts are called obsessions. The behaviors are called compulsions.

Signs and symptoms

Having OCD means having obsessions, compulsions, or both. These can include having:

• Unwanted thoughts, impulses, or images that occur over and over and cause anxiety or distress
• To think about or say something over and over (for example, counting, or repeating words over and over silently or out loud)
• To do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over, like whether a door is locked)
• To do something over and over according to certain rules that must be followed exactly in order to make an obsession go away

Children do compulsive behaviors because they have the feeling that the behaviors will prevent bad things from happening or will make them feel better. However, the behavior is not typically connected to actual danger of something bad happening, or the behavior is extreme, such as washing hands multiple times per hour.

A common myth is that OCD means being really neat and orderly. Sometimes, OCD behaviors may involve cleaning, but many times someone with OCD is too focused on one thing that must be done over and over, rather than on being organized. Obsessions and compulsions can also change over time.

It is not known exactly why some children develop OCD. There is likely to be a biological and neurological component, and some children with OCD also have Tourette syndrome or other tic disorders.

Treatment for OCD

The first step to treatment is to talk with a health care provider to arrange an evaluation.

• A comprehensive evaluation by a mental health professional will determine if the anxiety or distress involves memories of a traumatic event that actually happened, or if the fears are based on other thoughts or beliefs.
• The mental health professional should also determine whether someone with OCD has a current or past tic disorder.
• Anxiety or depression and disruptive behaviors may also occur with OCD.

Treatments can include cognitive-behavioral therapy and medication.

• Cognitive-behavioral therapy helps the child identify and cope with negative thoughts. It also includes gradually exposing children to their fears in a safe setting; this helps them learn that bad things do not really occur when they don't do the behavior, which eventually decreases their anxiety.
• Cognitive-behavioral therapy alone can be effective for the majority of children who experience OCD, but some children are treated with a combination of behavior therapy and medication.
• Families and schools can help children manage stress by being part of the therapy process and learning how to respond supportively without accidentally making obsessions or compulsions more likely to happen again.

Spotlight

Early diagnosis and access to services for children and their families can make a difference in the lives of children with mental health conditions. Learn more about treatment.

Resources

• – American Academy of Child & Adolescent Psychiatry (AACAP) fact sheet
• – AACAP health care provider guidelines for diagnosing and treating mental health conditions in children and adolescents
• ÐÇ¿ÕÓéÀÖ¹ÙÍø's Mental Health Homepage