Like adults, children occasionally experience intrusive thoughts (e.g., “What if my hands are not clean enough?”) and behave compulsively (e.g., wash their hands repeatedly). For some children, however, obsessions and compulsions become extreme and time-consuming. They cause considerable distress and dysfunction (e.g., at school, in relationships with friends). Many of these children meet the criteria for obsessive-compulsive disorder (OCD).
In this article, we first explore the risk factors and symptoms of OCD in young people and then discuss effective treatments for this condition.
Symptoms and risk factors of Obsessive-Compulsive Disorder
As described in the DSM-5, OCD has two components: obsessions and compulsions.
Obsessions are recurrent urges and thoughts experienced as intrusive and distressing. For example, a child might have intrusive thoughts about suddenly losing control and hurting her sibling. Or she may have obsessions about germs, fearing, for instance, she will contract a serious disease and die.
Compulsions are mental acts (like counting, or repeating a word or phrase) or behaviors (like hand washing, checking, or ordering) intended to reduce distress or prevent the obsession. Compulsions are repetitive, excessive, and irrational. To illustrate, a child who experiences intrusive thoughts about burglars breaking into the house might check the door locks dozens of times every night.
Risk factors for Obsessive-Compulsive Disorder (OCD) include the following:
- The person’s temperament: strong tendencies to experience negative emotions (e.g., becoming easily upset); withdrawn behavior in unfamiliar situations.
- Environmental factors: previous stressful or traumatic occurrences (e.g., physical abuse); certain infections.
- Genetics: The relatives of individuals who developed OCD in childhood or adolescence are 10 times more likely to have OCD themselves when compared to first-degree relatives of those without this condition.
One of the most effective treatments for Obsessive-Compulsive Disorder is cognitive-behavioral therapy (CBT).
CBT aims to modify unhelpful behaviors and distorted thoughts and beliefs in OCD, such as an inflated sense of responsibility and the overestimation of threat.
CBT for OCD often incorporates what is known as exposure and response prevention. During exposure therapy, patients are encouraged to gradually confront the thoughts and situations that cause distress and, more importantly, to do so without engaging in compulsions. The goal is to teach young individuals with Obsessive-Compulsive Disorder that intrusive thoughts are not dangerous and compulsions are unnecessary.
To illustrate, imagine a child fears that thinking his parents could get very ill or die will make these terrible things come true. To prevent these occurrences, the child believes he must repeat “good and healthy mom and dad” exactly 99 times, whenever thoughts of illness and death pop into his mind.
During an exposure session, the child is exposed to the obsessions (i.e. thoughts of illness and death) in a gradual manner. To manage his anxiety without resorting to compulsions, he will use various coping strategies and relaxation exercises he has learned in therapy. With practice, the child will learn his thoughts are just thoughts and not reality. And that he can manage his anxiety (i.e. compulsions are not necessary).
To control more extreme or distressing symptoms of OCD, or to help children with treatment-resistant OCD, it may be necessary to combine CBT with medications.
Commonly prescribed medications for OCD include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox). The tricyclic antidepressant clomipramine (Anafranil) is often recommended only if the SSRIs are not effective.
Research has found both medications and CBT are effective in reducing Obsessive-Compulsive Disorder symptoms in children, though CBT appears more effective than medications.