Obsessive-compulsive disorder is an anxiety disorder in which a person has an unreasonable thought, fear, or worry that he or she may try to manage by performing a ritual activity to reduce the anxiety. Frequently occurring disturbing thoughts or images are called obsessions, and the repeated rituals performed to try to prevent or dispel them are called compulsions. Problems arise as the behaviors interfere with daily life functioning, school or job performance and managing personal relationships.

During the normal growth and developmental process of children and adolescents, rituals and obsessive thoughts normally occur with a purpose and focus based on age. Preschool children often use rituals and routines around mealtimes, bath and bedtime to help them stabilize their expectations and understanding of their world.

School-aged children normally develop group rituals as they learn to play games, team sports and recite rhymes. Older children and teens begin to collect objects and develop hobbies.

An individual with OCD has obsessive thoughts that are unwanted and related to fears (such as a fear of touching dirty objects) and uses compulsive rituals to control the fears (such as excessive hand washing).

When OCD is present, obsessive thoughts cause distress and compulsive rituals can become so frequent or intense that they interfere with activities of daily living (ADLs) and normal developmental activities.

Causes of Obsessive-Compulsive Disorder

The cause of OCD is not known. Research indicates that OCD is a neurological brain disorder. Evidence suggests that people with OCD have a deficiency of a chemical in the brain called serotonin.

Twenty percent of children and adolescents with OCD also have another family member with OCD. Some evidence suggests a genetic component; however, OCD may also develop without a family history of OCD.

Incidence of Obsessive-Compulsive Disorder

While symptoms of OCD do occur in children, it is recognized as a common mental health disorder in adolescents. Most people are diagnosed by age 19. Current estimates suggest one to three percent of the U.S. adult population has this condition.

Signs and Symptoms

The following are the most common symptoms of obsessive-compulsive disorder. However, each child may experience symptoms differently. Symptoms may include:

• An extreme preoccupation with dirt, germs, or contamination
• Repeated doubts (for example, whether or not the door is locked)
• Obtrusive thoughts about violence, hurting, killing someone, or harming self
• Spending long periods of time touching things, counting, thinking about numbers and sequences
• Preoccupation with order, symmetry, or exactness
• Persistent thoughts of performing repugnant sexual acts or forbidden, taboo behaviors
• Troubled by thoughts that are against personal religious beliefs
• An extreme need to know or remember things that may be very trivial
• Excessive attention to detail
• Abnormalities with eating patterns
• Excessive worrying about something terrible happening
• Aggressive thoughts, impulses, or behaviors

Compulsive behaviors (the repetitive rituals used to reduce anxiety caused by the obsessions) can become excessive, disruptive, and time consuming, and may interfere with daily activities and relationships.

Examples of compulsive behaviors may include:

• Grooming rituals, including repeated hand washing, showering and teeth brushing
• Checking and rechecking repeatedly (to ensure that a door is locked)
• Following rigid rules of order (putting on clothes in the very same sequence every day, keeping belongings in the room in a very particular way and becoming upset if the order becomes disrupted)
• Hoarding objects
• Counting and recounting excessively
• Grouping or sequencing objects
• Repeating words spoken by self (palilalia) or others (echolalia); repeatedly asking the same questions
• Coprolalia (repeatedly speaking obscenities) or copropraxia (repeatedly making obscene gestures
• Repeating sounds, words, numbers, or music to oneself

The symptoms of OCD may resemble other medical conditions or psychiatric problems, including Tourette's disorder. Always consult your child's physician for a diagnosis.

Diagnosis Obsessive-Compulsive Disorder

Child psychiatrists, adolescent medicine physicians, psychologists or other qualified mental health professionals usually diagnose anxiety disorders in children or adolescents following a comprehensive psychiatric evaluation.

Parents who note signs of severe anxiety or obsessive or compulsive behaviors in their child or adolescent can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

For a diagnosis of OCD to be made, the obsessions and compulsions must be pervasive, severe, and disruptive enough that the individual's activities of daily living and function (including school performance) are adversely affected.

In most cases, the activities involved with the disorder (hand washing, checking the locks on the doors) consume more than one hour each day and cause psychological distress and impaired mental functioning.

In most cases, adults realize that their behaviors are unusual. However, often, younger individuals do not have this critical ability to judge this type of behavior as irrational and abnormal.

Treatment for Obsessive-Compulsive Disorder

Specific treatment for OCD will be determined by a physician based on:

• Age, overall health, and medical history
• Extent of symptoms
• Tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition

OCD can be effectively treated -- usually with a combination of individual therapy and medications. Treatment can be implemented once a comprehensive evaluation of the individual has taken place while also giving special consideration to family genetics. Individual therapy usually includes both cognitive and behavioral techniques. Cognitive therapy focuses on helping identify and understand their fears and learn new ways to resolve or reduce their fears more effectively.

Individual therapy usually includes both cognitive and behavioral techniques. Cognitive therapy focuses on helping identify and understand their fears and learn new ways to resolve or reduce their fears more effectively.

Behavior techniques establish contracts or guidelines to limit or change behaviors (such as establishing a maximum number of times a compulsive hand washer may wash his / her hands.)

Medications used most often to treat OCD are Anafranil, Luvox CR, Prozac, Paxil and Zoloft among others. Treatment recommendations may include family therapy and consultation with the school. Parents, guardians and family members play a vital supportive role in any treatment process.

Twenty to 40 percent of adolescents with OCD also experience one or more types of eating disorders, which also require treatment.

Preventive Action

Preventive measures to reduce the incidence of OCD in children are not known at this time. Further research needs to be conducted to better understand OCD. However, early detection and intervention can reduce the severity of symptoms, enhance normal growth and development and improve the quality of life experienced by individuals with anxiety disorders.