How to tell if your child has ocd

Obsessive-Compulsive Disorder (OCD) in Children

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What is obsessive-compulsive disorder in children?

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. Obsessions are recurring thoughts. Compulsions are recurring behaviors.

A child with OCD has obsessive thoughts that are not wanted. They are linked to fears, such as touching dirty objects. He or she uses compulsive rituals to control the fears, such as excessive handwashing.

As children grow, rituals and obsessive thoughts normally happen with a purpose and focus based on age. Preschool children often have rituals and routines around meals, bathing, and bedtime. These help stabilize their expectations and view of their world. School-aged children often create group rituals as they learn to play games, take part in team sports, and recite rhymes. Older children and teens start to collect objects and have hobbies. These rituals help children to socialize and learn to deal with anxiety.

When a child has OCD, obsessive thoughts and compulsive rituals can become very frequent and strong. They may interfere with daily living and normal development. OCD is more common in teens.

What causes OCD in a child?

The cause of OCD is not known. Research suggests it’s a brain problem. People with OCD don’t have enough of a chemical called serotonin in their brain.

OCD tends to run in families. So it may be genetic. But it may also occur without a family history of OCD. In some cases, streptococcal infections may trigger OCD or make it worse.

What are the symptoms of OCD in a child?

Each child may have different symptoms. These are the most common symptoms:

An extreme obsession with dirt or germs
Repeated doubts, such as whether or not the door is locked
Interfering thoughts about violence, hurting or killing someone, or harming oneself
Long periods of time spent touching things, counting, and thinking about numbers and sequences
Preoccupation with order, symmetry, or exactness
Ongoing thoughts about doing offensive sexual acts or forbidden, taboo behaviors
Troubled by thoughts that are against personal religious beliefs
A great need to know or remember things that may be very minor
Too much attention to detail
Too much worrying about something bad occurring
Aggressive thoughts, urges, or behaviors

Compulsive behaviors are the repetitive rituals used to ease anxiety caused by the obsessions. They can be excessive, disruptive, and time-consuming. They may interfere with daily activities and relationships. They may include:

Repeated handwashing (often 100 or more times a day)
Checking and rechecking many times, such as making sure that a door is locked
Following firm rules of order, such as putting on clothes in the very same order each day
Hoarding objects
Counting and recounting a lot
Grouping objects or putting things in a certain order
Repeating words spoken by oneself or others
Asking the same questions again and again
Repeatedly using four-letter words or making rude (obscene) gestures
Repeating sounds, words, numbers, or music to oneself

The symptoms of OCD may seem like other health problems. Have your child see his or her healthcare provider for a diagnosis.

How is OCD diagnosed in a child?

A child psychiatrist or other mental health expert can diagnose OCD. He or she will do a mental health evaluation of your child. To be diagnosed with OCD, your child must have obsessions and compulsions that are continuous, severe, and disruptive. They must harm your child’s day-to-day living.

In most cases, the activities of OCD such as handwashing or checking the locks on doors use up more than 1 hour each day. They also cause mental health distress and affect how your child thinks. In most cases, adults realize that their actions are not normal to some degree. But often children can't see that their behavior is irrational and abnormal.

How is OCD treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for OCD often includes a combination of the following:

Therapy with cognitive and behavioral methods. Cognitive methods help a child identify and understand his or her fears. They also teach a child new ways to better resolve or reduce those fears. Behavioral methods help the child and their family make pacts or rules to limit or change behaviors. One example is setting a maximum number of times a compulsive handwasher may wash his or her hands.
Family therapy. Parents play a vital role in any treatment process. A child’s school may also be included in care.
Selective serotonin reuptake inhibitors (SSRIs). These medicines help raise serotonin levels in the brain.
Antibiotics. Your child may need these medicines if his or her OCD is found to be linked to a streptococcal infection.

Teens with OCD may also have one or more types of eating disorders. These will also need treatment.

How can I help prevent OCD in my child?

Experts don’t know at this time how to prevent OCD in children and teens. But if you notice signs of OCD in your child, you can help by getting an evaluation as soon as possible. Early treatment can ease symptoms and enhance your child’s normal development. It can also improve his or her quality of life.

How can I help my child live with OCD?

OCD can be treated, often with a combination of one-on-one therapy and medicines. You play a key supportive role in your child’s treatment. Here are things you can do to help your child:

Keep all appointments with your child’s healthcare provider.
Talk with your child’s healthcare provider about other providers who will be included in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your child’s care team will depend on your child’s needs and how serious the OCD is.
Keep strong and open lines of communication with your child. Children with OCD can feel embarrassed about their disorder.
Tell others about your child’s disorder. Work with your child’s healthcare provider and school to create a treatment plan.
Reach out for support from local community services. Being in touch with other parents who have a child with OCD may be helpful.

Key points about OCD in children

OCD is a type of anxiety disorder. A child with OCD has obsessive thoughts that are not wanted. They are linked to fears, such as touching dirty objects. The child uses compulsive rituals such as handwashing to control the fears. These rituals may feel rational or irrational to the person doing them. The child may not understand why they do these rituals. They may feel embarrassed that the behaviors occur and can't be controlled.
The exact cause of OCD is unknown. Children with OCD don’t have enough of a chemical called serotonin in their brain.
Obsessive symptoms include repeated doubts and extreme preoccupation with dirt or germs.
Compulsive behaviors include hoarding objects and checking things often.
A mental health evaluation is needed to diagnose OCD.
Treatment includes therapy and medicine.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.
Before your visit, write down questions you want answered.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
Ask if your child’s condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if your child does not take the medicine or have the test or procedure.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Signs & Symptoms of Pediatric OCD

Obsessive compulsive disorder (OCD) is characterized by both obsessions and compulsions.

Obsessions are intrusive and unwanted thoughts, images, or urges that occur over and over again and feel outside of the child’s control. These obsessions are unpleasant for the child and typically cause a lot of worry, anxiety, and distress.

Common obsessions may include:

Worrying about germs, getting sick, or dying.
Extreme fears about bad things happening or doing something wrong.
Feeling that things have to be “just right.”
Disturbing and unwanted thoughts or images about hurting others.
Disturbing and unwanted thoughts or images of a sexual nature.

Compulsions (also referred to as rituals) are behaviors the child feels he or she “must do” with the intention of getting rid of the upsetting feelings caused by the obsessions. A child may also believe that engaging in these compulsions will somehow prevent bad things from happening.

Common compulsions may involve:

Excessive checking (re-checking that the door is locked, that the oven is off).
Excessive washing and/or cleaning.
Repeating actions until they are “just right” or starting things over again.
Ordering or arranging things.
Mental compulsions (excessive praying, mental reviewing).
Frequent confessing or apologizing.
Saying lucky words or numbers.
Excessive reassurance seeking (e.g., always asking, “Are you sure I’m going to be okay?”).

An OCD diagnosis is warranted when these obsessions and compulsions become so time-consuming that they impair day-to-day functioning (e.g., social, school, self care, etc.). Typically, these symptoms have a gradual onset, developing over the course of several weeks or months.

OCD can start at any time from preschool to adulthood. Although OCD can occur at any age, there are generally two age ranges when OCD tends to first appears:

Between the ages 8 and 12.
Between the late teen years and early adulthood.

In rare cases, symptoms may develop seemingly “overnight” with a rapid change in behavior and mood and sudden appearance of severe anxiety. If this is the presentation, then consider a sub-type of pediatric OCD caused by an infection (e.g., strep throat), which confuses the child’s immune system into attacking the brain instead of the infection. This then causes the child to begin having severe symptoms of OCD, often seemingly all at once, in contrast to the gradual onset seen in most cases of pediatric OCD. The sudden appearance of symptoms is very different from general pediatric OCD, where symptoms appear more gradually.

This type of OCD is called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) if it is a strep infection, or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) if it is any other infection.

Click here to learn more about PANDAS/PANS.

Treatment of childhood obsessive-compulsive disorder OCD in Israel

Obsessive-compulsive disorder (OCD) is also known as obsessive-compulsive disorder. This disorder affects 1% to 4% of children. About half of cases begin in childhood and continue into adulthood.

Anxiety is observed in children suffering from OCD, which manifests itself in a pronounced need to organize the world around them in a special way. They ask to retell what they have already been told many times, or to play the same game many times.

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R&D includes 2 components:

Obsessions or obsessions. The child constantly pronounces the same thought, returns to the same memories - both in the form of visual images and in the form of inner speech. The child may be constantly disturbed by the obsessive thought of pollution. He constantly wants to wash, avoid dirty places. He may require strict order in the house, symmetry in the arrangement of objects. If something is disturbed in his habits, this causes increased anxiety. The child may also be concerned about their own health and the health of their loved ones.
Compulsive actions or obsessive behavior is the second component of the syndrome. We are talking about repetitive behavioral rituals, which must be observed strictly in a strict order, otherwise, according to the patient, something bad may happen. Such rituals include constantly washing hands, touching certain things in a certain order with the hands, and much more. It should be noted that children, unlike adult patients, try to tell their parents about their rituals, which increases the chances of recovery. Unfortunately, parents do not always listen to children's experiences, and this contributes to the further development of the disorder.

When diagnosing obsessive-compulsive disorder, the Matspen Center conducts a comprehensive study of the patient's mental state to identify or exclude another concomitant disease. A complete physical examination of the patient is also carried out in order to determine contraindications to certain medications, as well as to establish possible physical prerequisites for the development of OCD.

The main cause of OCD in a child may be structural or functional changes in the functioning of the anterior lobe of the brain - the ventral-medial pre-frontal cortex. This part of the brain is responsible for repetitive actions, rituals in human behavior. The pathology associated with the development of addictions to repetitive actions is also localized there. This area is associated with areas responsible for emotions, anxiety, thoughts and desires. In this way, a brain functional network is created that supports OCD. This cause can be revealed during fMRI (functional magnetic resonance imaging).

why it happens and how to treat it

© Anastasia Ryzhkova

Psychiatrist Elisey Osin talks about obsessive-compulsive disorder.

Elisey Osin

Child psychiatrist

OCD (obsessive-compulsive disorder) in children is a serious illness for parents. Endless rituals - knock 5 times, swipe, ask the same question 25 times, etc. - can cause irritation that only increases guilt, fear and powerlessness.

The most acute and frequent questions of parents about OCD are answered by child psychiatrist Elisey Osin, an expert at the Vykhod Foundation.

- What is OKR? How to recognize it?

- OCD, obsessive-compulsive disorder is a disorder that consists of thoughts, memories, images (obsessions) obsessively invading a person's mental activity, which come again and again and cause anxiety or discomfort; and repetitive actions, rituals (compulsions) that a person needs to reduce the discomfort or anxiety associated with obsessive thoughts and experiences.

Obsessive thoughts in OCD create a lot of stress, anxiety, tension, and greatly interfere with daily life. And it's not just the experience of "whether I closed the doors or turned off the iron. " Obsessions can be very different: they can be very frightening, for example, a child may think that a loved one wants to kill him, or, conversely, he himself can kill a loved one, or that he has become contaminated internally or externally from contact with some objects ; and there are obsessions that are not frightening, but very disturbing, for example, when a child needs to count something or repeat a certain number of times.

Rituals for OCD have a protective function. I go to wash my hands or I go to my parents to make sure again and again that everything will be fine, I will not die, I will not get sick. If I wash my hands three times three times, if I turn the key, if I go up to my mother and my mother says exactly these words, just like that, everything will be fine. The essence of the ritual is not very important, the function is important: everything will be fine, I will not experience this discomfort, I will not cry, I will not get infected today, I will not become dirty, I will not . ..

- How to understand that this is not a childish fantasy, but OCD?

- Fantasies are usually pleasant for a child: he creates imaginary worlds, and this does not cause him stress. Children with OCD experience a lot of stress. And repetitive actions do not cause pleasure, they are designed to reduce anxiety.

- How to distinguish OCD from other conditions that are also accompanied by obsessions and fears? For example, from increased anxiety, psychological trauma?

- In post-traumatic disorders, obsessive experiences are associated with the situation of trauma, you can trace the moment of their occurrence.

Anxiety itself is a disorder. A person with increased anxiety lives poorly, he thinks all the time that something can happen. A child who is experiencing increased anxiety needs help. Anxiety interferes with development. If you constantly think about your own safety, you cannot function normally. It is necessary to understand what causes this increased anxiety and work with the causes of anxiety.

How do you differentiate “normal” anxiety from OCD? According to the result: they give actions aimed at relieving anxiety, the effect or not. If you checked the doors three times when leaving the house and calmed down, there are no difficulties - this is a normal interaction with the world, which is not always safe. If there is no calming, if you have to engage in complex rituals to cope with anxiety, if it interferes with daily life, it is possible that this is an obsessive-compulsive disorder.

— What can cause OCD in children?

- It is very rare to single out one reason. Most often, several factors in the development of OCD are identified.

Predisposition to develop OCD. There is no direct link between parent and child OCD. But if mom or dad has OCD, then the child has a significantly higher risk of developing OCD. Studies show that families of children with OCD are noticeably more likely to have various forms of anxiety disorders.

There are some characteristics of thinking associated with obsessive-compulsive disorder. People analyze the world in a certain way, and everyone has certain distortions; people with OCD have very specific distortions, very specific cognitive errors.

Apparently, certain parenting styles contribute to the development of cognitive distortions. It is possible that intense or very prolonged stress can contribute to the development of OCD.

Sometimes OCD and its symptoms can be caused by the presence of a streptococcal infection in the body.

— How exactly can OCD in a child be related to upbringing? Conditionally, are the parents to blame for yelling / criticizing - and now they brought the child to a nervous breakdown?

The cognitive distortions inherent in OCD can occur when a child is made to take responsibility not only for their own actions, but also for their own thoughts. Cognitive error, when a person feels responsible for their own thoughts, is one of the important factors in OCD.

Example. The child screams: “Mom, I hate you, I want you to feel bad, why did you forbid me to play the tablet?”. Mom says: “How can you think like that, you can’t think like that, when such thoughts come to your mind - you are bad! It is a great sin to think like that, you have no right to think like that.”

Notice the difference with "don't you dare talk about your mother like that." The ban on "speaking" is a ban on action, not a ban on thoughts, and it has the right to exist, because the child broadcasts the threat of violence - and this should be discussed with children.

The cognitive distortions inherent in OCD can be caused by evaluating certain thoughts as unacceptable or sinful. They try to force the child to take control over what he has no control over - over his own thoughts, and the child begins to experience great discomfort when forbidden thoughts come to him.

How should parents behave in the given situation? It is better to discuss with the child his and your feelings, not thoughts! Voice them and look for an acceptable way of expressing them.

- We have a normal family. We do not yell at the child and do not humiliate him, but he is still anxious, afraid of the dark and suffers from obsessive thoughts. Why is that?

“Because OCD doesn’t just come from upbringing—it’s also a biological disorder. In addition, it is not always necessary to offend a child or yell at him in order to trigger severe anxiety in him. It is enough to convey to him the idea that everything that we think necessarily returns to us. That the world reacts to our thoughts and changes depending on them. One of the causes of OCD is a sense of responsibility for something that is out of your control - for your own thoughts, as I said.

- Well, if the child's behavior is seriously similar to OCD, what exactly should parents do?

- First . Run diagnostics. See a specialist to determine if what is happening to the child is OCD or another disorder. This could be a psychotherapist working with mood disorders and anxiety, a psychologist working with cognitive behavioral therapy, or a psychiatrist. Whether it is necessary to conduct any instrumental examinations, whether it is necessary to take a blood test for the presence of a streptococcal infection in the body, the doctor will decide. The doctor will also determine the severity of the situation, as well as whether the child has depression. OCD and depression often go hand in hand. It is important to understand whether a child thinks, for example, about suicide, whether he also experiences depressed mood, melancholy in addition to obsessions, or his difficulties are limited to OCD symptoms.

Second. Determine the optimal treatment regimen. Treatment is prescribed depending on the degree of stress experienced by the child. In some situations, the only treatment will be to reassure the parents, give advice on organizing the day, discuss with the child what is happening to him, and teach simple relaxation techniques.

In complex cases, we go in three directions at the same time - we prescribe medications, begin psychotherapy, and conduct intensive family education in order to clarify the nature of the disorder.

If obsessive-compulsive disorder is complicated by something else—depression with suicidal behavior, highly violent behavior—the situation may sometimes require hospitalization, not because of the OCD itself, but because of the accompanying problems. Or more intensive pharmacological treatment is needed, not only with antidepressants, but also with mood stabilizers.

Third. Treatment, psychotherapy, work with parents.

— Doctors often prescribe pills for OCD. Can't do without them?

The symptoms of obsessive-compulsive disorder vary from person to person. Doctors look at how much stress the manifestations of OCD cause, how much they interfere. Sometimes the stress is mild, expressed only in anxiety, and this can be seen at the first meeting - by the way parents and the child talk about it. Then drug treatment may not be needed at all - psychotherapy is enough. But it happens that OCD affects a child very strongly: he is constantly in anxiety, constantly in rituals, cannot calm down, it is clearly hard for him. In such a situation, we usually try to use all the possibilities for help, including drug treatment. The right medications are a relatively quick, very effective, and fairly safe way to deal with some of the worst experiences a child has with OCD.

— Can you get rid of OCD with mild herbal sedatives?

There are no studies on the use of herbal medicines for OCD. In my opinion, getting rid of OCD with herbal sedatives is the same as getting rid of OCD with homeopathy, mud therapy, aromatherapy. If there is relief, it means that something else has worked, and not herbs. For example, parents began to pay more attention to the child, while giving soothing herbs, created a therapeutic environment. Or, in addition to herbs, they began to go to a psychotherapist.

- How to understand that the doctor to whom the child was brought is competent and will not prescribe antidepressants unnecessarily?

- The function necessary for a doctor is the ability to explain why he thought this way and not otherwise, why he prescribed this particular medicine and not another. If a doctor says he prescribes a drug simply because he has ten years of experience and six years of medical education and you don't, he doesn't really explain anything. Personally, I would avoid interactions with such a doctor.

If a doctor says: “I made such and such a diagnosis, because, according to modern criteria ...” and, for example, points to a diagnostic manual, this is normal, this is correct. A trusted doctor is willing to share at least a little of his thoughts. This, in fact, is not difficult to do within a fifteen-minute inspection.

It is desirable that the doctor's considerations be given out, at least briefly, in writing, so that after the meeting the parents can re-read them, think over everything, discuss it, turn to another doctor for a second opinion, raise the modern qualifications of diseases, read the literature and compare it with the fact what they were told.

- What is the best way for parents to respond to a child's behavior? It is difficult not to get annoyed when a child waves his arms strangely for the hundredth time / counts sips of water / asks the question “will our plane crash” and at the same time no consolation and reassurance work.

- First. Be sure to ask for help. OCD is a well-studied and well-understood disorder, and it can be successfully treated.

Second. Avoid extremes. First, do not participate in rituals (for example, do not repeatedly dissuade a person that he will die, or that his hands are not dirty), because this only encourages ritualized behavior: the child feels that he is not in control situation and needs adults to cope with anxiety and discomfort. Secondly, avoid devaluing what is happening to the child, for example, phrases like “what are you driving, it’s all nonsense”, “what did you come up with there”, “you are generally sick” or “you are normal, and everything is with you in order".

Third. The main message for a child with OCD should be: “I am with you, I see what is happening to you. I am on your side and I will help you. What's going on in your head really torments you, but it's only in your head. Together we will find a way to deal with this, we will find help.” This is a difficult message because it will mean slightly different things in each situation. For example, somewhere it’s just to hug a child, somewhere it’s to remind about the relaxation techniques that he has learned, somewhere it’s to practice these techniques with him. Sometimes good psychologists working with OCD involve the child's loved ones, as if taking them as partners in therapy, allowing them to go from the beginning of therapy to regaining control over themselves with the client (child).

- What parents of a child with OCD should not do in any case?

- First. Don't take OCD personally. For some people, obsessions can be directed at other people, for example, “Mom, do you love me?”, “Mom, will you give me to anyone?”, “Mom, am I bad?”

Second. Provocative or aggressive behavior is unacceptable: "If you say that again, I'll give you up!", "If you say that again, I'll really poison you!", "You got me!". This will only lead to an increase in the problems of the child.

Physical aggression, despite the apparent instantaneous effectiveness (some parents practice it, unfortunately), in the future can lead to auto-aggression. For example, parents hit a child who cannot cross the threshold, and he took a step. Parents created intense emotions for the child that overcame his anxiety, but did not remove his fear. And a person learns to cope with his anxieties and fears with the help of pain. At worst, this can lead to him hurting himself in order to cope with his anxiety.

Third. In no case should you refuse treatment.

OCD can sometimes be quiet and unobtrusive to others. For example, a teenager spends a little more time in the bathroom, the child repeats the same thing several times, he has strange habits, and relatives perceive this as eccentricity. Because of this, it seems that there is nothing to worry about, there is no need to treat. At the same time, a terrible struggle can take place inside a person for the absence of discomfort, very unpleasant or interfering obsessions come to his mind, which may not be clearly manifested outwardly, but for a child or teenager this is everyday hell. Or the child is too punctual, arrives on time, tries to do everything according to the rules, studies “excellently”, and in such a situation, parents begin to doubt the need for treatment. While the desire to do everything perfectly is one of the symptoms of obsessive-compulsive disorder.

Sometimes the basis of the refusal to treat a child is the parents' own internal anxiety. It can be expressed in the conviction that "chemistry" (pharmaceuticals) is harmful, and only what has grown in the garden or in the forest is useful. This is nothing more than their own attempt to control the processes of life and death, because of which parents refuse to help their children (do not give them the medicine they need).

Some parents refuse to take their children to therapy because going to therapy is admitting that there are problems in your family. And because of the fear or prejudice of parents, children do not receive the help they need.

- How to tell relatives and teachers about the child's condition?

- The family in a broad sense (grandparents, uncles, aunts) needs training. The family should be taken to counseling therapists or a psychiatrist, or given OCD literature to read. If there are questions left, they did not understand something, bring them again to a meeting with the doctor so that everyone has a clear and distinct picture of what is happening to the person.

The situation is more complicated for school teachers. Teachers have power over children, and much depends on the personality of the teacher and how he treats the child. If there is contact with the teacher, you need to talk to him in the same way as with relatives. That is, to tell what kind of diagnosis it is, that we are taking medication, that it will be easier, that, of course, it is not dangerous. The more openness in such a situation, the better.

Some teachers may not be very distant and do not want to read and learn anything, they may be afraid of a special child in the class. With such a person it is better to talk simply about increased anxiety, they say, he is very exciting with us, we go to a psychologist.

- How to help a child not be afraid that peers will find out about his condition, that he will be called "mental", teased?

“This is clearly the task of the teacher and the school administration. Children can endure fantastically difficult things if there is a clear teacher's position. I saw a child with a very serious disorder, he had vocalisms, he shouted out “Damn!”, “Damn!” many times during the lesson. The teacher was aware, he knew what it was like for a child to receive treatment, and he spoke to the class several times. The conversation was conventionally as follows: “Vasya has poor eyesight - he is sitting in front; The doctor told Masha that she needed to go to the toilet - she would go to the toilet without asking, when it was convenient for her; and Petya sometimes shouts out, he does it involuntarily, you don’t need to pay attention to it. If you tease Petya, you will make Petya worse, offend him, we don’t do that at home. ” The same goes for educators. Children are amazingly flexible creatures, and they behave the way they were taught.

It is very important for the child himself to understand that he is not alone in this situation.

If a child is bullied, then you need to behave as you would with any bullying, regardless of its cause. Bullying does not depend on the characteristics of the child, but on relationships in the classroom and at school, on the norms of interaction adopted there. This must be dealt with and worked on, regardless of the child's diagnosis and, in general, the presence of a diagnosis.