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What Are Signs of OCD in Children and Teens?

All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can’t stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again. When this occurs, a diagnosis of Obsessive Compulsive Disorder (OCD) might be appropriate. OCD should be diagnosed by an appropriate mental health professional. At least 1 in 200 children and teens in the United States have OCD.

OCD involves excessive worrying or thinking about something despite efforts to stop thinking about it (obsessions) as well as having

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rituals, or things that one has to do in order to prevent something bad from happening (compulsions). OCD is similar to a false alarm, it causes a person with it to worry about something that is not harmful or dangerous.

Among kids and teens with OCD, the most common obsessions include:

  • Fear of dirt or germs
  • Fear of contamination
  • A need for symmetry, order, and precision
  • Religious obsessions
  • Preoccupation with body wastes
  • Lucky and unlucky numbers
  • Sexual or aggressive thoughts
  • Fear of illness or harm coming to oneself or relatives
  • Preoccupation with household items
  • Inrusive sounds or words

These compulsions are the most common among kids and teens:

  • Grooming rituals, including hand washing, showering, and teeth brushing
  • Repeating rituals, including going in and out of doorways, needing to move through spaces in a special way, or rereading, erasing, and rewriting
  • Checking rituals to make sure that an appliance is off or a door is locked, and repeatedly checking homework
  • Rituals to undo contact with a “contaminated” person or object
  • Touching rituals
  • Rituals to prevent harming self or others
  • Ordering or arranging objects
  • Counting rituals
  • Hoarding and collecting things of no apparent value
  • Cleaning rituals related to the house or other items

OCD in kids is usually diagnosed between the ages of 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with their friends, the discomfort and stress brought on by OCD can make them feel scared, out of control and alone.

OCD can be very impairing, however, there is treatment available that can significantly reduce symptoms and make them manageable. The best line of treatment for OCD involves medication, prescribed by a psychiatrist, and a specialized type of therapy called Cognitive Behavioral Therapy with Exposure and Response Prevention (CBT with ERP). ERP involves gradually exposing a person with OCD to thing that makes him/her anxious while providing him/her with the skills to cope with his/her anxiety but not allowing him/her to engage in his/her rituals Over time, the person begins to experience less anxiety and is able to cope better. Also, people who have completed ERP are able to determine what things are “worth” worrying about versus what his/her OCD deems worth worrying about. Many people who have completed ERP are symptom free following treatment.

Heather Yardley, PhD
Heather Yardley, PhD, is a pediatric psychologist at Nationwide Children's Hospital. She has a special interest in working with youth with type 1 diabetes and their families as well as youth with obsessive compulsive disorder. Dr. Yardley is on the board of the Society of Pediatric Psychology. Outside work, Dr. Yardley enjoys spending time with her husband and their two energetic dogs.

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