Obsessive Compulsive Disorder

Obsessive Compulsive Disorcer (OCD) can include obsessions, compulsions, or both.  A common presentation is an obsession with dirt or germs linked with handwashing or other cleansing compulsions. Some children are afflicted by obsessions around thoughts that seem unacceptable, and they engage in complex rituals to undo or atone for these thoughts. By definition, OCD symptoms occur with daily functioning. OCD symptoms can take up so much time that the child is unable to participate in other activities and can disrupt the household as others get involved in accommodating the compulsive behaviors.

Obsessions: recurrent, persistent, intrusive thoughts, urges or images such as:

  • dirt, germs or other contamination
  • danger, threat, or intrusion
  • unacceptable thoughts (sexual, or harming onself or others)

Compulsions: repetitive behaviors or mental acts that an individual feels they must perform to neutralize an obsessioon or according to rigidly applied rules

  • washing hands, body, clothing, surfaces
  • checking, ordering, rituals
  • counting, praying, repeating words silently
  • confessing, atoning

The mean age of onset of OCD in children is 9-10 years. There may be another peak of onset in early adulthood.

OCD is highly comorbid with tic disorders, ADHD, and anxiety and mood disorders. OCD symptoms overlap with those of Autism Spectrum Disorder, creating a diagnostic challenge.

The long-term prognosis for childhood-onset OCD in many children is partial or complete remission of symptoms. Adverse prognostic factors include very early age of onset, significant psychiatric comorbidity, first-degree family history of OCD and poor initial response to treatment. 


Combination of a selective serotonin reuptake inhibitor (SSRI) and a form of Cognitive Behavioral Therapy (CBT) called Exposure-Response Prevention in which the patient is exposed to the object of the obsession (eg, an unclean surface) and practices not responding with the compulsive behavior (eg, handwashing).

Most children with OCD should be seen by a psychiatrist for initial medication management, and by a CBT therapist.  Children with OCD may need long term treatment with an SSRI once stabilized.