Often, compulsions are not connected to obsessions realistically. For example, a child might have an obsessive fear that their parents will be in a car accident. To deal with that fear, they might turn a light on and off five times. Even if they know it doesn’t make sense, they feel that the ritual will keep their parents from getting hurt. Professionals call that feeling “magical thinking”.

What are the symptoms of OCD?

Kids and adolescents with OCD usually experience both obsessions and compulsions. They use compulsions to control the anxiety that obsessions cause. Specific symptoms of obsessions and compulsions include:

More about Obsessions	Common Obsessions
Obsessions are frequent and repeated thoughts, images, or urges that kids sometimes experience. Obsessions can interrupt daily activities and, often, people feel anxious about them, distressed, and they want them to stop. People attempt to suppress or ignore the thoughts, images, or urges, or to make them go away by thinking or doing something else.	Thoughts about being dirty or “contaminated” by germs, waste, vomit, chemicals, etc. Needing everything to be even or symmetrical Extreme worry about safety, like thinking that the house will burn down, or a parent will get hurt Ideas that one might do something violent or terrible
More about Compulsions	Common Compulsions
Compulsions are repeated actions (e.g., counting, praying, repeating words or phrases silently, etc.) or behaviors (e.g., checking, washing hands) that a person feels a need to do in response to an obsession or according to rigid rules The purpose of the repetitive acts or behaviors is to reduce or prevent the distress or anxiety, or to prevent a dreaded event, but they are not connected in a real way to what they are used reduce or prevent	Washing their hands repeatedly Locking, unlocking, and re-locking doors a certain number of times Lining up objects or touching parts of their bodies symmetrically, like scratching both ears Counting a certain number of times or repeating something mentally Repeatedly asking parents for reassurance that something bad isn’t going to happen

How is OCD diagnosed?

A child-adolescent psychiatrist will diagnose a child or teen with OCD after determining whether the obsessions and/or compulsions they are experiencing meet the diagnostic criteria; are time-consuming, taking more than one hour per day; and result in significant distress and impairment in other aspects of everyday functioning (e.g., social, academic, etc.).

The child-adolescent psychiatrist may interview and/or assess both the child and a caregiver in order to determine the specific nature of the child’s or teen’s obsessions and/or compulsions. Many practitioners also use specific questionnaires (e.g., Leyton Obsessional Inventory [LOI]) and scales (e.g., Children’s Yale-Brown Obsessive Compulsive Scale [CY-BOCS]) to support the diagnosis. The practitioner will also seek to determine that the child’s or teen’s symptoms are not related to something unforeseen.

OCD Facts
Worldwide frequency of the condition	OCD is present in between 1.1% and 1.8% of the world's population. There is no recent, specific epidemiological data for Greece.
Burden of the condition in Greece	OCD accounts for less than 0.03% for all disability adjusted life years (DALYs) lost to health conditions in Greece for 5- to 14-year-old children and adolescents.
Gender ratio	Male-female comparative data for OCD varies widely based on the severity and the broad range of obsessive or compulsive symptoms. Generally, males are more likely to be diagnosed than females during childhood; however, females are more likely to experience OCD in late adolescence and on.
Peak age of onset	The peak age of onset for OCD is estimated to be 14.5 years. This is similar to the peak age of onset for obsessive-compulsive disorders, in general, which is also 14.5 years.
Proportion of the condition that emerges before age 18	According to recent data, 45.1% of individuals with OCD will have been diagnosed by the time they are 18 years old. This is similar to obsessive-compulsive disorders, in general, where the proportion is also 45.1%.

What are the associated factors for OCD?

Some common factors associated with OCD are:

Genetic and familial factors. Most likely a combination of multiple genes that interact in a complex way with multiple environmental factors.

Complications during pregnancy. These include maternal tobacco use during pregnancy.

Environmental factors. These include adverse or stressful life events, such as abuse or other traumatic events, as well as parental overprotection.

Infections and immune response. Pediatric acute-onset neuropsychiatric syndrome (PANS) results from a bacterial or viral infection, triggering an autoimmune response in the basal ganglia of certain susceptible children. A pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is a specific subtype of PANS resulting specifically from a streptococcal infection. The symptoms of PANS and PANDAS are acute-onset tics, OCD symptoms, and mood lability.

What other disorders co-occur with OCD?

Even though each child and adolescent are different, children and teens with OCD might often have co-occurring mental health problems, including anxiety disorders (e.g., Generalized Anxiety Disorder [GAD], Separation Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, etc.), depressive disorders, and tic disorders.

How is OCD treated?

OCD is usually treated with psychotherapy or a combination of psychotherapy and medication. Caregivers and other family members are an important part of treatment since they can help kids and teens practice the skills they learn in therapy. It is also important to involve family members in psychotherapy for OCD, as they may be unknowingly perpetuating a child’s symptoms through reassurance and participating in ritualistic behaviors (e.g., cleaning).

The most effective treatment for mild and moderate cases of OCD is cognitive-behavioral therapy (CBT), especially the CBT technique called exposure and response prevention (ERP). In this therapy, the therapist exposes the child or adolescent to small amounts of the thing that usually triggers their obsession. That way, kids practice dealing with their anxiety in a safe environment. The therapist then helps them avoid using their compulsion. Over time, kids feel less anxious, and they do not need the compulsion anymore. Kids with OCD will often return to their clinician in the years after their treatment for “booster sessions” to freshen up the skills they learned to control their symptoms.

Children and adolescents with OCD tend to respond well to certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and fluvoxamine. Other medications, such as clomipramine and serotonin and norepinephrine reuptake inhibitors (SNRIs; e.g., duloxetine and venlafaxine), have been used to treat OCD, but evidence of their efficacy for kids is limited. Medications can have side effects, but they are safe for kids to use with proper monitoring by their child-adolescent psychiatrist and close supervision from their caregivers. A child or adolescent who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

The combination of CBT and SSRIs should also be considered, given some studies show evidence that the combination is the best treatment compared to either treatment in isolation in children and adolescents.

Where to find more information

If you need more information on obsessions and compulsions, as well as reasons for concerns, you can also go to "Obsessive thinking" and "Ritualistic behaviors and repetitive movements" [website link].

To learn more about the technical work conducted to develop this guide, please consult our reference list here (link to content below).

References

Clinical description, symptoms, and diagnostic information

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

Child Mind Institute. (2022, October 19). Complete guide to OCD. https://childmind.org/guide/parents-guide-to-ocd/

World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6B20 Obsessive-Compulsive Disorder. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1582741816

Facts

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: A systematic review and meta-regression. Psychological Medicine, 43(5), 897–910. https://doi.org/10.1017/S003329171200147X

Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington, Available from http:// vizhub.healthdata.org/gbd-compare. (Accessed 11/15/2022)

Associated factors

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

Arango, C., Dragioti, E., Solmi, M., Cortese, S., Domschke, K., Murray, R. M., Jones, P. B., Uher, R., Carvalho, A. F., Reichenberg, A., Shin, J. I., Andreassen, O. A., Correll, C. U., & Fusar‐Poli, P. (2021). Risk and protective factors for mental disorders beyond genetics: An evidence‐based atlas. World Psychiatry, 20(3), 417–436. https://doi.org/10.1002/wps.20894

Ayano, G., Betts, K., Maravilla, J. C., & Alati, R. (2021). The risk of anxiety disorders in children of parents with severe psychiatric disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 282, 472–487. https://doi.org/10.1016/j.jad.2020.12.134

Brander, G., Pérez-Vigil, A., Larsson, H., & Mataix-Cols, D. (2016). Systematic review of environmental risk factors for Obsessive-Compulsive Disorder: A proposed roadmap from association to causation. Neuroscience & Biobehavioral Reviews, 65, 36–62. https://doi.org/10.1016/j.neubiorev.2016.03.011

Child Mind Institute. (2023, February 23). Complete guide to PANS and PANDAS. Complete Guide to PANS and PANDAS. https://childmind.org/guide/parents-guide-to-pans-and-pandas/

Farhane-Medina, N. Z., Luque, B., Tabernero, C., & Castillo-Mayén, R. (2022). Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review. Science Progress, 105(4), 003685042211354. https://doi.org/10.1177/00368504221135469

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Kendler, K. S. (2013). What psychiatric genetics has taught us about the nature of psychiatric illness and what is left to learn. Molecular Psychiatry, 18(10), 1058–1066. https://doi.org/10.1038/mp.2013.50

Mahjani, B., Klei, L., Hultman, C. M., Larsson, H., Devlin, B., Buxbaum, J. D., Sandin, S., & Grice, D. E. (2020). Maternal Effects as Causes of Risk for Obsessive-Compulsive Disorder. Biological Psychiatry, 87(12), 1045–1051. https://doi.org/10.1016/j.biopsych.2020.01.006

Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7

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Co-occurring disorders

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

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Interventions

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