Obsessive-Compulsive Disorder in Children: All You Need to Know
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There are a number of types of childhood anxiety disorders, including obsessive-compulsive disorder. 

Here, we get into what it means for children, the triggers, signs and symptoms as well as treatment available. Read on to find out more

What is Obsessive-Compulsive Disorder ?

Obsessive Compulsive Disorder is a condition that causes kids to have unwanted, and/or disturbing thoughts, images or urges. These obsessions cause a lot of anxiety and discomfort. In order to relieve the anxiety, the child then engages in repetitive behaviors or mental acts referred to as compulsions, which are also sometimes called rituals. 

What are Obsessions?

Obsessions refer to the unwanted or fearful thoughts that a child is unable to stop thinking about, even though they realize that these thoughts are irrational. 

Some obsessions include:

Extreme anxiety about coming into contact with dirt, and germs. The child keeps thinking about how they will get sick if they touch ‘contaminated’ items. They can also be distressed about others getting sick due to the ‘contaminated’ items. 

Some children have the need to have items ordered in a certain way because if things are not in symmetry or arranged exactly they need it to be, something bad will happen. 

For example, a child with these obsessions might say “If my toys are not arranged properly, my daddy will get sick and die”. The thought process often sounds odd to others, and older children with OCD might even realize that these thoughts do not make sense. Younger children most probably do not realize that their need for symmetry and exactness may come across as strange. 

Besides this, some children feel a need for perfection. They may need things to be perfect before being able to move on to the next task. For example, a child might not be able to leave for school before everything in her room is in perfect order. Some children might also need things to be 100% right. For example, the child might do the same assignment over and over again because she needs things to be perfect and is unable to tolerate even the slightest mistake.  

Children with OCD also have the extreme fear of accidental harm to themselves or to others. They might even think that it is their fault when the accident happens. For example, “If I dont make sure mom puts on her shoes properly, she might not be able to step on the car brakes and she will have a car accident!”

An older child with OCD may have an obsession with forbidden thoughts, such as being gay when they are not, or thinking about sexual acts even when it is upsetting to them. They are unable to control these thoughts and this can result in shame and guilt. 

What are Compulsions? 

Compulsions are repetitive behaviors that children engage in to lessen the anxiety of their obsessions. Compulsions can include:

  1. Washing and cleaning excessively. A child with OCD may have grooming rituals, showering rituals and cleaning rituals. For example, washing hands 10 times at night before going to bed. 
  2. Some children touch, tap or count things in a certain number of times or a certain way. Sometimes they need to count to a ‘lucky’ number. 
  3. A child’s compulsions can also drive them to make sure that they arrange things in a specific order. For example, all their books need to be arranged by size and color. They just need things to ‘feel right’. 
  4. Children with OCD may also have a checking compulsion. They continuously check to make sure that doors are locked or lights or off. They do so to make sure that things (and people) are safe. 
  5. Some compulsions are performed in the head. Mental rituals can include having to repeat a certain phrase a number of times before going out or going to bed. 

What triggers OCD in a child?

While the exact cause of OCD is unknown, we do know that biological and environmental factors do play a role. Kids who have a chemical imbalance in their brain and lack serotonin are more likely to feel anxious and more likely to suffer from OCD. 

Studies have also shown that exposure to stressful situations can trigger OCD. A child also ‘learns’ anxiety when watching how an anxious adult reacts to situations. Sometimes, both biological and environmental factors together trigger OCD. For example, a child who is biologically more prone to anxiety experiences a stressful traumatic event. 

Signs and Symptoms of OCD in Children

Signs and symptoms of OCD in children can be physical, emotional and behavioral. A child with OCD may also have certain thought patterns that resonate fear and anxiety. Signs and symptoms of OCD in children include:

Physical feelings:

  • Having headaches and migraines
  • Feeling dizzy
  • Stomach aches
  • Shortness of breath / shallow breathing
  • Increased heart rate
  • Increased muscle tension
  • Derealization – feeling detached from his or her own body

Emotional signs:

  • Always worried and fearful
  • Anxiety
  • Shame
  • Guilt 
  • Sadness
  • Depression

Behavioral signs:

  • Excessive washing and cleaning.
  • Making parents and family members wash their hands before preparing food.
  • Asking for cleaning supplies.
  • Avoiding touching ‘germy’ surfaces such as doorknobs.
  • Always checking to make sure something is done correctly.
  • Has to do things in a certain specific order.
  • Repeating certain phrases a certain number of times.


  • What if I get sick? 
  • What if I am sick and then my parents get sick because of me? 
  • I caused that accident
  • My future will be ruined if i do not get an A for this exam

What is it like for children with OCD? 

OCD can cause quite a disruption to everyday life for your child as well as your family. Common areas that are affected by OCD include the child’s school performance and grades. Your child might feel so much anxiety about school that many days are missed. 

Additionally, if your child needs everything to be perfect before being able to move on to the next task, she might not be able to concentrate or focus on the task at hand. 

Meal times can be hard for children with OCD. They worry if the food was prepared properly, and even make sure that you wash your hands before preparing food. You may find yourself and your child running late everyday because of his/her inability to leave the house unless everything is done in a certain manner and everything arranged in a certain way. 

A child who suffers from OCD might also have issues when going to bed. For example, she might have to say a certain prayer a certain number of times before she feels that it is ‘just right’ to go to bed. 

What is it like for toddlers with OCD?

The toddler stage sees a child growing with rapid development. Many children of this age sort objects by color, sizes and shapes. It helps them to make sense of the expanding world they are in and making the distinctions and similarities between objects is not only normal but very important. 

However, for toddlers with OCD, sorting and organizing becomes an obsession. This behavior starts to disrupt daily activities and the child may become upset if the items are not arranged in a certain way. A young child may not be able to tell you that they are anxious or fearful and may express their anxiety in other ways. They may cry and cling to a parent, have tantrums, refuse to go to daycare and have trouble sleeping. 

How is OCD diagnosed in a child? 

You will need to meet with a child psychiatrist or a child psychologist in order to diagnose OCD. The psychiatrist or psychologist will interview you and your child to find out more about what is going on. There might also be questionnaires and checklists for you to fill out. OCD is not diagnosed with lab tests. It is important that you get a right diagnosis as an accurate diagnosis will enable you to get the most effective treatment for your child. 

Treatment for children with OCD

Your medical professional will most probably suggest cognitive behavioral therapy (CBT) to treat your child’s OCD. This psychotherapy will not only help your child to understand her condition, but also to manage her fears and anxiety. It is based on the premise that our thoughts affect our emotions and our behaviors. 

Thus, CBT aims to correct the negative or irrational thoughts in order to overcome anxiety. Your child will also learn many coping skills and methods in CBT that will help her to overcome OCD. 

Your child might also be given medication such as selective serotonin reuptake inhibitors (SSRIs) to help balance brain chemicals. Sometimes, both therapy and medication will be given together as they work hand in hand. Therapy sessions might be more effective when your child is on medication because they are calmer. 

Does childhood OCD go away?

It is important to recognize that OCD is not a ‘phase’ that a child will grow out of. Many children will learn to manage OCD with the proper treatment. Some might never experience OCD symptoms again with good treatment. Others might have to deal with it their whole lives. In addition to this, childhood OCD might go away only to return in adulthood. 

How can you help your child with OCD? 

Raising a child with OCD is definitely not an easy task. As a parent, there are certain things that you can do to help your child get better. As with many issues, open and honest communication is key. Talk to your child about what is going on. Explain to your child what OCD is and if you are heading to the doctor, tell your child beforehand. 

Be supportive and listen to your child if she tries to express her fears and worries. Older children might feel embarrassed with their OCD and will need you to be their safe space in order to be able to share their fears and anxiety. 

You can also help your child be getting her the right psychiatrist or psychologist. Do not be afraid to get professional help. The right therapy will work wonders and help your child to manage the anxiety that they feel. 

Your child will need many therapy sessions in order to overcome OCD. Although it is a long process, your child will fare much better if you take part in your child’s therapy. Make sure that you and your child do not skip sessions even though it might be hard. When ‘homework’ is given, encourage your child to do it to the best of her ability. Your child will improve much faster when you play an active role. 

Lastly, get a support system. Seek out resources and other families that are in the same situation. Share your stories and do not be afraid or embarrassed to ask for help from others who have children who are dealing with OCD. 


OCD can be a debilitating anxiety disorder for a child. However, with a proper treatment plan, many children learn to overcome the anxiety and develop skills to manage OCD symptoms. If you find that your child is exhibiting OCD signs and symptoms, make an appointment with your doctor so that early intervention is possible. 

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