OCD in Children and Young People

What is OCD in children?

The word 'obsessive' gets used commonly. This can mean different things to different people. Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. In this condition, the young person has obsessions and/or compulsions that affect their everyday life, like going to school on time, finishing homework or being out with friends.

What are the symptoms of obsessive-compulsive disorder?

Some people have thoughts, ideas or pictures that come into their mind over and over again. They are difficult to get rid of and can feel silly or unpleasant. These are called obsessions. Some examples of obsessions include:

• I must count to twenty or something bad will happen.
• Worrying about germs and disease.
• Worrying about things being tidy.

Some people feel they have to do something repeatedly even if they don't want to or it doesn't make sense. These are called compulsions. Some examples of compulsions include:

• Repeatedly checking that the light is switched off.
• Washing hands again and again.
• Counting or repeating words in your head.

Often people try to stop themselves from doing these things, but feel frustrated or worried unless they can finish them. Problems with obsessions and compulsions can cause distress and worry, and can begin to affect young people at home with their families or at school with friends.

Many young people have mild obsessions and compulsions at some time - for example, having to organise their toys in a special way, or saying good night a certain number of times. This is normal and may be the result of worry due to stress or change.

How do I know this is obsessive-compulsive disorder?

If you are worried that a young person may have OCD, you need to think about the following questions:

• Do the compulsions upset the child?
• Do they interfere with the child's everyday life (eg, school, friends, etc)?

If the answer to these questions is 'yes', it may be that the young person has OCD. If this is the case, you should seek professional advice.

How common is it?

OCD can affect people of all ages irrespective of their gender, religion or class. It usually starts in childhood. It is thought that 1-2% of the population have OCD. This means that at least 130,000 young people have OCD.

What causes obsessive-compulsive disorder?

We do not know the cause of OCD for certain. Research suggests it may be due to an imbalance in a brain chemical called 'serotonin'. It may also run in families and in people with tics (jerky movements) in the family. Very occasionally, OCD can start after an illness. It can also occur after a difficult time in a person's life for example, after having an accident.

How is obsessive-compulsive disorder treated?

There are two treatments that are helpful for OCD: behaviour therapy and medication.
These can be given on their own or together. If possible, a young person should have access to both forms of treatment.

• Behaviour therapy - this starts with an assessment of the problem. This can include the young person and family keeping a diary of the obsessions and compulsions. The aim of the treatment is to teach young people how to be in control of the problem, by tackling it a little bit at a time. The young person designs the treatment programme with the therapist as it is important to be actively involved in planning.
• Exposure and response prevention (ERP) - the therapist helps the child to face the things that they fear and have been avoiding. They are taught a wide range of skills to manage the anxiety that OCD creates. Often parents or other family members get very involved in the OCD rituals. Families need to learn about OCD, and also about how to help their child combat it. This can involve parents working with the child and therapist to find ways of helping their child to resist the rituals and being able to say 'no'.
• Medication - can be helpful in controlling the OCD. Unfortunately, many people who improve on medication become unwell again when the medication is stopped. Some people who need medication may have to continue taking it for a long time.

Where can I get help?

OCD is a common problem, and your GP will be able to help and advise you as to what you need to do. If the young person needs more specialist assessment and treatment, the GP may suggest a referral to a Child and Adolescent Mental Health Service (CAMHS).

If the young person has been unwell for a long time, or their life has become severely affected by OCD, other professionals may need to help too - for example, teachers or educational social workers may be able to help the young person get back to ordinary life at school or college.

Recommended reading and references

• Heyman, I. (1997) Children with obsessive-compulsive disorder. BMJ, 315, 444.
• Rutter's Child and Adolescent Psychiatry, Fifth Edition (2008). Publisher: Wiley-Blackwell.
• National Institute for Health and Care Excellence: Clinical guideline 31: Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder.
• Great Britain. Office for National Statistics: Census 2001: Population report, United Kingdom, all ages.

Content used with permission from the Royal College of Psychiatrists website: Obsessive Compulsive Disorder in children and young people (March 2017, due for review March 2019). Copyright for this leaflet is with the Royal College of Psychiatrists.