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Understanding Obsessive-Compulsive Disorder

What is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is a complex condition that involves two separate yet related components: the private inner world of thoughts, urges, ideas, or images (obsessions) and external behaviors and symptoms (compulsions). The compulsive behaviors associated with OCD are not always perceivable to others as they may be intentionally hidden or carried out privately. Furthermore, compulsive symptoms can come and go or can be more prominent in one setting and non-existent in another. While environmental factors can affect the severity or prominence of the condition, OCD is primarily a biological and often hereditary condition that affects roughly 1-2 percent of children in the United States.

Diagnosing Obsessive-Compulsive Disorder in Children

Diagnosing obsessive-compulsive disorder in children can be a complicated process because of the two factors involved (internal obsessions and external compulsions). The presence of compulsive, rigid, or repetitive behaviors does not necessarily indicate a biological obsessive-compulsive disorder. A diagnosis of OCD may be determined over time and should include observations across settings, input from parents, caregivers, and educators, and an in-depth evaluation from a qualified mental health professional.

Obsessions: The Internal Component of Obsessive-Compulsive Disorder

Obsessions are fixations of the mind on thoughts, urges, ideas, or images. Obsessions are often persistent or recurrent and are unpleasant or distressing, sometimes even frightening.

Examples of obsessions include:

  • Fears of contamination (dirt, germs, illnesses)
  • Desires to hoard or save items (resulting in the collection of items in case they are needed in the future)
  • Fears of aggression or violence (of harming oneself or harming others, that something bad will happen to self or others, or of blurting out inappropriate comments or obscenities)
  • Magical thoughts (lucky or unlucky words, numbers or colors, including avoiding places or activities associated with certain attributes)

Compulsions: The Behaviors Associated with Obsessive-Compulsive Disorder

In obsessive-compulsive disorder, compulsions are a means to ease or reduce the fear or anxiety caused by obsessive thoughts or ideas. Compulsions are behaviors or rituals that one feels compelled to do, even if one has the knowledge or awareness that the behavior is not logical. The prevalence of these behaviors, or symptoms, may wax and wane. Under more stress or in certain settings, the symptoms may become more prominent, while they may be more easily hidden or even nonexistent during periods of less stress or in different settings. Children with OCD are sometimes able to keep their compulsions under control in a setting such as school, but are unable to do the same in their home environment.

Examples of compulsions include:

  • Excessive or ritualized handwashing, showering, or cleaning of items
  • Excessive checking (including locks, plugs/outlets, seatbelts, or placement of items such as toys or other belongings)
  • Excessive checking for mistakes, of one’s health, or that one did not or will not harm oneself or others
  • Repetition (rereading, erasing, or rewriting excessively)
  • Routine activities (up and down stairs or in and out of doorways a specific number of times)
  • Arranging (excessively organizing or ordering items and showing signs of distress if the order is disrupted)
  • Counting (for example, steps or words, or completing activities in specific number sets)
  • Saving, hoarding, or collecting items that do not have apparent significance such as pieces of string, paper, wrappers, or items from the street or trash
  • Superstition (such as touching an object a certain number of times, usually as a way to avoid or prevent something bad from happening or avoiding floors or days/months associated with a certain number)
  • Tics (blinking, throat-clearing, tapping, usually a specific number of times). Tics can also be a symptom of Tourette’s Syndrome which sometimes occurs along with an OCD condition.
  • Rituals that involve other people (in children, this most often is a parent) such as seeking reassurance, checking, or doing something a certain number of times (e.g., fastening a seatbelt three times before it is okay to go)

When to Seek Help

Parents concerned about the possibility of obsessive-compulsive disorder should seek the help and guidance of a qualified mental health professional. From our many years of experience working with children with OCD, we have learned that attempts by parents to alleviate discomfort for their child may not be the best way to help the child; therefore, it is equally important that treatment includes guidance and support for parents. As OCD is a complex condition, so is the intervention and treatment, especially in cases in which the obsessions and compulsions are interfering with a child’s wellbeing and ability to freely and comfortably take part in usual childhood activities.

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