What is OCD?

Obsessive-compulsive disorder^[1] (OCD) is an anxiety disorder characterized by a cycle of intrusive thoughts, urges, or images (called obsessions) that drive an individual to perform repetitive behaviors or rituals (compulsions). You may experience focused or repetitive thoughts or behaviors. Most of the time, these don’t cause distress and disruption in your day-to-day life. However, for people with OCD, these thoughts are intrusive and persistent. If they don’t perform their routines or compulsions, they may feel highly distressed or think that something “bad” will happen.Many people with OCD understand that their obsessions are excessive or untrue (when they don’t, it is referred to as “poor insight”). Despite this realization, it can be very difficult to break habituated compulsions. Such behaviors can include constant hand-washing, repeatedly checking on things, or cleaning. The obsessions and compulsions characteristic of OCD often center around a theme, such as the fear of being contaminated by germs. They can cause a great deal of stress and significantly affect a person’s daily functioning, activities, and social interactions. Luckily, there are several options available for treating OCD. It may feel difficult to discuss your condition, but talking about your experiences with your healthcare provider is the best place to start to manage (and even overcome) OCD.

How common is OCD?

OCD is thought to affect roughly 1.2%^[2] of adults in the United States, with women (1.8% of cases^[3]) having a slightly higher likelihood of having the condition than men (0.5% of cases). While OCD can occur at any age from preschool to adulthood, it generally tends to appear^[4] between the ages of 8–12 and between the late teens years and early adulthood. It is estimated that at least 1 in 200 (around 500,000) children and teenagers in the U.S. have OCD.

OCD causes

It is not fully understood what causes obsessive-compulsive disorder. Several factors^[5] are thought to play a role in developing the condition, including:

• Genetics and family history: If you have a first-degree relative (such as a parent or sibling) with OCD, you’re at a greater risk for developing the condition yourself. This risk increases if the first-degree relative developed OCD as a child or teenager (as opposed to as an adult).
• Brain structure and functioning: Some imaging studies have shown differences in two parts of the brain (the frontal cortex and subcortical structures) in patients with OCD. While there may be a correlation between these abnormalities and the symptoms of OCD, ongoing research is being conducted to clarify this connection.
• Trauma and stress: Your risk for OCD may increase as a result of traumatic or stressful events.
• Infection: In some cases, children may develop OCD or its symptoms due to an infection. This is referred to as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS^[6]) when caused by strep, and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) when caused by any other type of infection.
• Other mental health conditions: OCD may be related to other disorders, including anxiety disorders, depression, tic disorders, or substance use.

OCD symptoms

The signs and symptoms^[7] of OCD usually begin gradually in the teen or young adult years. Obsessions and compulsions often vary in severity over the course of an individual’s life, generally worsening with increased stress. OCD may be mild to moderate or so severe and time-consuming that it’s disabling. Generally^[8], people with OCD:

• Spend at least 1 hour each day on obsessive thoughts or compulsive behaviors
• Can’t control these thoughts or behaviors (even when they’re recognized as excessive)
• Don’t feel pleasure when performing rituals or behaviors (but may feel relief from the anxiety caused by obsessive thoughts)
• Experience significant disruption or difficulty in daily life as a result of these thoughts or behaviors

Some people with OCD also experience tics. Tics are strong, often overwhelming urges to perform repetitive movements or actions. Muscle tics are sudden, brief, repetitive muscle movements, such as blinking your eyes or shrugging your shoulders. Some common vocal tics include sniffing or inhaling sharply, throat-clearing, and grunting. If you experience obsessions, compulsions, or tics, talk to your healthcare provider. They will be able to provide you with the right diagnosis and treatment.

Obsessions

The first component of OCD is obsessions. An obsession is a persistent, recurrent thought, impulse, or image that causes distressing feelings, such as anxiety, fear, or disgust. Some common obsessions include:

• Excessive fear of germs or contamination
• Intrusive taboo or “forbidden” thoughts involving sex, religion, or violence/harm
• Keeping compulsive habits or items symmetrical or in a particular order
• Aggressive or violent thoughts about oneself or others

People with OCD often realize that their intrusive thoughts, images, or urges are fabricated and excessive. However, just realizing that these obsessions are not based in reality isn’t enough to quell them. Managing obsessions usually requires psychotherapeutic treatment.

Compulsions

Compulsions are the second component of OCD. These are repetitive behaviors, habits, or mental acts that a person with OCD feels compelled to do in response to their obsessions. Generally, compulsions are performed with the aim of preventing or reducing the distress or fear an obsession may cause. Although compulsions can temporarily relieve the anxiety surrounding an intrusive thought or impulse, the obsession will return, and the cycle will begin again. In severe cases, a person’s day may be consumed by repeated rituals or habits, making it difficult to complete normal routines. Some common compulsions include:

• Cleaning: People with obsessions surrounding germs and contamination will often spend excessive amounts of time cleaning themselves or their surroundings.
• Checking: OCD often causes the urge to repeatedly check whether things have been done, such as turning off the stove or locking the front door. While it’s normal to double-check certain things, people with OCD can develop rituals involving repeating an action over and over to make sure something has been done. Some people may, for example, retrace a driving route to make sure they haven’t hit anyone.
• Repeating: Some people seek to dispel anxiety by saying a name or phrase or repeating a certain behavior multiple times. While they know that these repetitions are unnecessary, people with OCD often feel anxious or fear that something bad will happen if these behaviors aren’t done.
• Ordering and arranging items: Some obsessions may cause people to arrange objects—such as books or shoes—in a particular, sometimes symmetrical order.
• Mental compulsions: Some people silently pray or repeat phrases to themselves to reduce anxiety or prevent an impending event from occurring. This “event” may be more of an abstract concept than a specific anticipated event. For example, someone with OCD may think, “If I don’t think this phrase five times before the crossing light turns green, something bad will happen.”

OCD complications

The obsessions and compulsions resulting from OCD may lead to the following complications^[9]:

• Poor quality of life
• Disruption of work, school, or social activities
• Strained personal relationships
• Health issues, such as contact dermatitis caused by excessive hand-washing
• Suicidal thoughts or behaviors

OCD in children

It’s common—even encouraged—for children to develop daily routines and habits. Many children even develop their own routines around mealtime, bedtime, and other activities. However, if a child exhibits troubling compulsions or rituals that they can’t seem to control, they may have OCD. Obsessive-compulsive disorder often begins in childhood^[10]. As in adults, OCD in children causes severe anxiety, intrusive thoughts, and repetitive behaviors that can get in the way of normal functioning and daily life. Despite the difficulties it can cause, OCD is not something a child can simply “get over.” It’s often extremely difficult for a child to control the obsessions they experience and the compulsions they use to alleviate their anxiety. Some common obsessions in children with OCD may include:

• Worrying about germs, getting sick, or dying
• Feeling like things have to be “just right”
• Excessive fear about bad things happening or doing something wrong
• Disturbing and intrusive (unwanted) sexual or violent thoughts or images, sometimes about others

While adults generally realize that their obsessions are not based in reality, children may be more prone to believing that engaging in their compulsions will prevent anticipated bad things from happening. Common compulsions in children may include:

• Excessive, repetitive checking (whether the oven is off, the door is locked, or an object is in the right place)
• Excessive washing or cleaning
• Repeating actions until they’re “just right,” or starting things over again if they’re not
• Ordering or arranging things
• Saying lucky words or numbers
• Making sure to perform rituals or habits the “right” way, such as tapping their fingers a certain number of times
• Excessively seeking reassurance (such as asking, “Are you sure it’ll be okay?”)
• Mental compulsions (excessive praying, mental reviewing)
• Ritualistic habits (such as having to kneel down before sitting on the couch or clicking their tongue before eating)
• Motor or vocal tics, such as sniffling or eye twitching
• Frequent confessing or apologizing

As with adults, the signs and symptoms of OCD in children may vary from mild to severe. OCD is generally diagnosed in children when their obsessions and compulsions become so time-consuming that they negatively impact day-to-day life. Rarely, OCD may seemingly develop “overnight.” A child’s behavior and mood may change suddenly and inexplicably, and they may experience severe anxiety. This is a sub-type of pediatric OCD. When caused by a strep infection, this form of OCD^[11] is referred to as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus, or PANDAS. Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) refers to OCD in children caused by any other type of infection. Many children have OCD for a while before their caregivers, teachers, or healthcare providers notice it. If your child has OCD, you may notice that they have difficulties in different areas of life. OCD can often cause^[12] children to:

• Feel and act anxious, irritable, sad, or upset
• Have difficulty concentrating on schoolwork or enjoying normal activities
• Seem unsure of whether things are “okay”
• Have trouble making decisions or choices
• Take longer than usual to perform everyday tasks, such as bathing, dressing, or completing homework
• Insisting that parents or siblings say or do something in a particular way

As a parent or caregiver, there are a number of ways that you can help support your child with this condition.

• Talk to your child about their symptoms: Show support and care by listening intently if your child feels comfortable talking. To broach the subject, you may want to note that you’ve noticed your child likes having things a certain way and gets frustrated if they can’t make it so.
• Bring your child to a healthcare provider: If you don’t feel well-versed enough in the area, a healthcare provider is the best person to explain OCD to your child. They can help reassure your child that nothing is wrong with them and that there is an identifiable cause of what’s been going on.

If they believe your child has OCD, your provider will likely recommend making an appointment with a pediatric psychiatrist or psychologist for further treatment.

• Play an active role in your child’s treatment: Educating yourself on your child’s condition and how to support them is crucial to provide a strong foundation for recovery. Help keep your child engaged and encouraged by practicing techniques recommended by their provider.

It’s also important that you don’t miss any psychotherapy or psychiatry appointments and help your child take their medications as prescribed, if necessary.