Many children will develop OCD early, starting between ages seven and 12. In fact, most adults with OCD say their symptoms started when they were children.
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OCD is more common in boys before the age of 12. After puberty, boys and girls are equally likely to develop OCD.
Over time, OCD symptoms can change. For example, your child might start out with excessive washing compulsions when he or she is young, but later develop excessive checking compulsions and stop washing in a compulsive manner.
Debbie is a 7-year-old girl whose mom has become concerned about her daughter's "odd" behaviors. Since she was five, Debbie has had peculiar dressing and eating habits. For example, she insists on wearing two pair of socks on each foot, and only wears pants made of nylon, and not cotton. She also refuses to wear clothes with elastic bands at the cuffs. Whenever her mother buys her new clothes, Debbie has a temper tantrum if the tags on the clothes aren't cut off right away. When going to bed, Debbie spends time fixing the bed covers, pillows, and teddy bears so that they are arranged in a very specific way. At dinner time, Debbie refuses to try any new foods, and only eating bland food items, such as white rice, bread, or pasta without sauce. If her mom puts a new item on her plate, such as broccoli, Debbie screams until it is removed.
Jamal is a 16-year-old boy whose parents have been concerned that he might be depressed and suffering from an eating disorder. Jamal was always a shy and friendly boy. In the last year, however, he has started avoiding his friends and family, he dropped out of soccer, and now spends most of his time alone in his room. In the last few months, he has started sleeping over 12 hours every day, and he eats much less. His parents noticed that he seems to avoid going into the kitchen, and he even asked his mom to take away all the sharp instruments (such as knives, razors, and tweezers), and lock them up so he wouldn't hurt himself or anyone else. Jamal's parents did as he asked because they were afraid that he was suicidal, but when they asked him about it, he denied that he was depressed or suicidal. After a while, he admitted that he kept having thoughts like "cut yourself" or "cut your friends and family", and that he sometimes had this strong and unwanted urge to act on the thoughts. Jamal said he was terrified by these thoughts. He would never want to hurt anyone, but he is worried that, because he has these thoughts, he might act on them. Jamal tries to push these thoughts out of his head, but it doesn't work. So, he avoids being around other people and around sharp objects, in an attempt to try to stop these upsetting thoughts from coming into his head.
Obsessions are unwanted and disturbing thoughts, images, or impulses that intrude into the mind and cause a great deal of anxiety.
There are many different types of obsessions, and children can have one or several different types.
Some examples of common obsessions are:
Fear of contamination. Fear of coming into contact with germs, getting sick, or getting others sick after touching "dirty" or "contaminated" items, sticky substances, or chemicals (e.g., household cleansers).
Fear of accidental harm to self or others. Fear of harming yourself or others through carelessness. For example, "what if I didn't clean off the counter properly and there are still germs on it, and my mom gets sick because of me!"
Fear of deliberately harming others. Some children and teens have unwanted thoughts about deliberately harming other people, or other inappropriate thoughts (e.g., swearing in church, stabbing a loved one in their sleep). These thoughts cause great anxiety because children with these obsessions would never act on these thoughts, and find them disgusting and repugnant.
Obsessions with symmetry and exactness. A need to have items ordered in a certain way (for example, according to color, size, or facing a certain direction). Children and teens with this type of obsession are either anxious because "it just doesn't feel right" or because of a superstitious belief that something bad will happen (e.g., "if my shoes are not arranged properly, my mom will die!"). Often, the content of obsessions sounds very odd or bizarre. For example, a child with OCD might say that he or she needs to arrange all the teddy bears from smallest to biggest or else something bad will happen to mom. Most children and teens are aware that these thoughts are strange; however, do not be surprised if your child doesn't think his or her thoughts are odd. Most younger children have no idea that their obsessions sound peculiar to others.
Compulsions are repetitive behaviors or mental acts that children feel a very strong urge to do, in order to reduce their anxiety.
Often, compulsions are performed in a ritualistic manner. That is, children and teens might have a particular way in which they complete their compulsion (for example, washing the right hand before the left), and if the ritual is not performed "correctly", they might redo the entire compulsion.
Some common compulsions include: Washing compulsions. For example, washing hands excessively, sometimes until they are raw and bleeding. There are many other types of washing behaviors, including:
Toilet rituals (e.g., excessive wiping).
Grooming/tooth brushing rituals (for example, brushing each tooth in a particular order).
Showering rituals (for example, washing each body part a certain number of times or in a particular order).
Cleaning compulsions (for example, rituals and rules for how to wash laundry, clean the bathroom, kitchen, etc.).
Checking compulsions. These types of compulsions can involve checking doors, locks, or appliances, to make sure everything is turned off or unplugged. Some children and teens will check to make sure that everyone is okay. For example, calling family members to "check" that they are safe.
Counting, tapping, touching, or rubbing rituals. Compulsions can involve counting, touching, or tapping objects in a particular way. Some children and teens have lucky and unlucky numbers involved in their rituals (for example, needing to touch a door four times before leaving a room).
Ordering/arranging compulsions. This involves arranging items in specific ways, such as bed clothes, stuffed animals, or books in the school locker or book bag. For example, a child might need to line up all the shoes in the closet so that they all face forward, and are matched by color.
Mental rituals. Not all children and teens with OCD will have compulsions that can be seen. Some perform rituals in their head, such as saying prayers or trying to replace a "bad" image or thought with a "good" image or thought. For example, a teen might have a bedtime prayer that he or she mentally repeats over and over again until it "feels right".
Need to tell or confess. Some children and teens fear they have done or thought something "bad", and therefore feel an overwhelming urge to confess all of their thoughts to family members. Children and teens with this type of compulsion will often also seek repeated reassurance that everything is okay ("Do you still love me, even though I had a bad thought?").
Avoidance: Children and teens with OCD often spend a lot of time and effort trying to avoid anything that might trigger their OCD. For example, children and teens with contamination fears might avoid touching door knobs or shaking hands with people. Sometimes their avoidance will be severe, and include avoidance of school or even leaving the home.
Reassurance seeking: A very common behavior among children and teens with OCD is asking for reassurance from family members, especially parents. Typically, they will ask for reassurance about whether they "correctly" completed a ritual (for example, "Is it clean? Are you sure?").
Getting family involved in rituals: Once of the most frustrating aspects for parents is the amount of rituals family members become involved in. That is, children or teens can become so distressed and anxious about their compulsions that they have their family members also follow certain. For example, asking parents to wash in a particular way (e.g., cleaning hands with bleach) or making family members call home repeatedly so they knows that mom and dad are safe.
It is normal, and developmentally appropriate for young children to have rituals and superstitions. For example, many children will eat their food in a certain order, or have superstitions about their clothes (putting on the left shoe before the right shoe).
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