OCD (obsessive, compulsive disorder) is an anxiety disorder characterized by unwanted, uncontrollable, intrusive thoughts, images, or urges that cause distress, and repetitive behaviors or rituals a person feels compelled to perform in order to get rid of the distress and prevent bad things from happening. However, the signs of OCD may look different in children than they do in adults.

OCD can affect children as well as adults and start at any age, but symptoms most commonly begin to manifest between the ages of 8 and 12 or during the late teen years. The signs usually start small and intensify over time, and because of their gradual onset, may not be noticeable at first.

Are signs of OCD in children the same as signs of OCD in adults?

Signs of OCD in children are similar to those in adults, but younger children who have less developed cognitive skills are less likely to recognize that their obsessions and compulsions are unreasonable or excessive and may think that everyone else has similar thoughts and urges. Children are also more likely to have obsessive thoughts about the safety of their parents and to be afraid that someone they love might get sick or die.

What is the difference between picky behaviors and obsessions or compulsions?

Behaviors such as lining up blocks in a certain way, being a picky eater or fussy dresser, or having certain quirks or preoccupations may just be common phases of childhood. Obsessions and compulsions, however, are not the same thing. They are not a matter of personal choice, nor are they fleeting or short-lived.

Obsessions are repetitive, involuntary, fear-producing, thoughts that the child does not want to have but cannot stop thinking about or control, and that can have a paralyzing effect that prevents him or her from thinking about anything else.

These lead to compulsions, which are repetitive actions or rituals the child feels driven to perform in a certain way to stop the obsessive thoughts and prevent something bad from happening. If they are not done in a specific way, it causes the child to panic and repeat it until they get it right.

What are the diagnostic criteria for OCD in children?

According to the Centers for Disease Control and Prevention (CDC), many children are sometimes bothered by thoughts they may feel they have to do something about such as, for instance, wearing a favorite piece of clothing to avoid bad luck. For children with OCD, however, these thoughts and urges to act on them are not just occasional. They persist even if the child tries to ignore them or make them go away.

To be diagnosed with OCD, the unwanted thoughts and behaviors the child feels he or she must do happen frequently, take up a lot of time (more than an hour a day), interfere with his or her activities, or make him or her very upset.

What red flags may be signs of OCD in children?

• Needing to have their possessions organized in a particular way according to a precise, symmetrical pattern, with everything perfectly aligned, and getting upset if anything is touched or moved.
• Constant anxiety about making a mistake or doing something wrong that will cause something bad to happen.
• Fear of being contaminated by dirt or germs.
• Excessive hand washing that leaves skin scrubbed raw and bleeding.
• Repeatedly checking in on family and needing constant reassurance that they are safe and well.
• Needing constant reassurance that they haven’t hurt anyone.
• Repeatedly checking things such as light switches, windows, and doors before leaving the house and getting upset if forced to leave before completing their routine.
• Having certain rituals they need to perform exactly the same way each time to avoid something bad happening, such as counting steps a specific amount of times before entering a room.
• Checking things over and over to make sure they are done right.
• Worrying excessively about the neatness of their handwriting or schoolwork, and erasing, rewriting, or redoing things in a certain way over and over again until they look just right.
• Asking the same questions repeatedly in different ways to get reassurance that everything will be okay or a particular thing is safe.
• Having a specific bedtime routine that has to be done just so or they need to start all over again until they get it right.
• Performing repeated movements such as tapping objects in a repetitive order.
• Having a preoccupation with unlucky numbers, words, or colors, and linking them to bad things happening.

OCD can be devastating for a child but there are several effective, evidence-based treatment options available. The sooner the condition is diagnosed, the faster it can be treated, and the better the chance for a successful outcome.

If you would like to set up a risk-free appointment to meet with one of the faith-based counselors in Newport Beach, California, please give us a call at Newport Beach Christian Counseling.