Obsessive-compulsive disorder (OCD)

Some kids like to wash their hands, but Sarah does it too much. She wants to stop, but her hands just don't feel clean enough and she can't make herself turn off the water. Sometimes she scrubs her hands until they are red and raw. After eating, she feels she has to wash again.

Because she spends so much time washing, Sarah has to rush to get to school on time. At school, she tries not to touch doorknobs or handrails, worrying that if she does she may catch a serious disease. Sometimes, Sarah gets behind in her classwork because she feels that she needs to keep checking it over and over.

During a quiz or test Sarah checks and rechecks every answer and erases anything that isn't perfectly straight or neat. Sometimes she erases so hard it tears the paper, but she can't help it. Sarah gets a bad feeling that if everything isn't exactly right, something terrible may happen. All this worrying, checking, and fixing takes so long that Sarah hardly ever finishes the test before time is up. So even though she knows the work, she often gets an incomplete mark or even fails.

Sarah tries so hard to hide her habits. She worries that she might be going crazy or that people would think she's weird if they knew what she was doing. Sarah knows that the time she spends washing and checking could be spent having fun with friends or doing her schoolwork, but she can't seem to stop herself. That's because Sarah has obsessive-compulsive disorder (OCD).

What Is OCD?

OCD is a type of anxiety (say: ang-zye-uh-tee) that happens when there is a problem with the way the brain deals with normal worrying and doubts. Kids with OCD worry a lot. Sometimes they feel afraid that bad things could possibly happen to them, sometimes they feel that something bad could happen to people they love, or sometimes they feel like they have to get things "just right" and have to check to make sure.

Like Sarah, some kids with OCD are afraid of getting dirty or catching germs. Others always worry that their parents will get sick or hurt. Some kids feel that they have to say things a certain number of times, ask questions over and over again, or keep things super-clean as a way to keep bad things from happening.

Some kids even worry about thinking bad thoughts. They sort of believe that thinking bad things could make them come true.

Some kids may also worry about things being out of "order" or not "just right" and they may worry about losing "useless" items or feel the need to collect them.

People with OCD worry so much that they can spend many hours, or even the whole day, worrying about things and trying to make sure the bad things they worry about don't happen.

Normal Worry or OCD?

Of course, it's normal to worry now and then. Everyone does. Kids may worry about getting lost or that something will happen to their parents. They may sometimes feel afraid that they will get sick or hurt. It's normal for kids to worry once in awhile about burglars, fires, or earthquakes. Sometimes, worrying can help kids learn how to be safe and careful. Normal worries come and go without causing too much of a problem.

But OCD is much more than normal worry. Instead, the worry is really intense and it can happen over and over again. With OCD, the brain replays the worry thoughts and if nothing is done, the worry feeling can get worse and worse.

These frequent worry thoughts are called obsessions (say: ob-sesh-unz), and the behaviors people do to try to make the worry thoughts go away are called compulsions (say: kum-pul-shunz).

What Are Obsessions?

A kid who has OCD might have obsessions about illness or injury or cleanliness. And these obsessive worries just don't quit. The brain keeps repeating them instead of moving on to something else. It can be a lot like that awful song you hear that gets stuck in your head. No matter how much you don't want to hear it, your brain just keeps playing it back. The difference is that the obsessive thoughts come with anxiety.

Having upsetting thoughts that you can't get rid of can feel terrible and scary. And having so many worry thoughts can make it hard to concentrate on anything else. OCD can take the fun out of almost anything.

With OCD, someone may have obsessions about:

• germs or dirt
• illness or injury (involving the person or someone else)
• coming across unlucky numbers or words
• things being even or straight
• things being perfect or just right in a certain way
• making mistakes or not being sure
• doing or thinking something bad

What Are Compulsions?

Compulsions are the behaviors, or actions, that someone with OCD does to try to shut down the worry thoughts. Another name for compulsions is rituals. By doing compulsions, people with OCD hope to keep bad things they worry about from happening. They believe that doing a certain ritual will make the bad feeling go away and, for a while, it often does. They feel scared that if they don't do the ritual something bad will happen. Some kids may have a difficult time explaining a reason for their rituals and they do them "just because." But in general, by doing a ritual, someone with OCD is trying to feel absolutely certain that something bad won't happen.

Of course, plenty of people who don't have OCD have rituals or actions that are important to them. Maybe you tap your pencil three times before starting a tough test or sing a certain song just before diving off the high dive. Perhaps you have a lucky number or even a lucky pair of socks. But OCD compulsions are much more than doing something just for luck.

Kids with OCD feel they have to do certain things over and over to feel protected from unlucky events or make the anxiety go away. Kids with OCD don't really want to be doing rituals. But when you have OCD, performing the rituals seems like that's the only way to feel safe from bad things happening.

And the more kids with OCD do these rituals, the more they feel like they have to do them. Kids with OCD can end up spending so much time on rituals that they have little time left for the things they really do want to do.

Here are some OCD compulsions:

• lots of hand washing or showering (doing this way more than usual or having a hard time stopping)
• counting (like having to count 25 white cars before going into school)
• touching (like touching every single fence post between home and the bus stop)
• checking things over and over (such as doors, locks, or stoves)
• doing things a certain number of times (like having to try on five dresses before leaving your room)
• arranging things in a very particular or neat way
• asking the same question over and over
• tying and retying shoes over and over until they feel just right
• re-reading, erasing, and re-writing

What Causes OCD?

Obsessive-compulsive disorder isn't contagious, so you can't catch it from someone like you can a cold. Second, kids with OCD have not done anything wrong or bad to get it. It's not their fault that they have it.

Nobody knows exactly how and why some people get OCD, though scientists are beginning to learn about it. Experts know that:

• OCD runs in families. Many kids with OCD have another person in their family who has OCD or another type of anxiety. Exactly how OCD is passed on in a family is not yet known, but scientists are trying to learn about genes that may get passed on that make people more sensitive to worry problems like OCD.
• OCD comes from a problem with the way the mind handles messages about fear and doubt. This problem probably has to do with the chemicals that carry messages to nerve cells in the brain. If the flow of these chemicals gets "blocked," or if there is not enough of them, messages about doubts and worry seem to get "stuck." This leaves a person with a feeling that something's not right and creates lots of worry thoughts.
• Some experts are studying the connection between OCD and the body's immune system response to a strep infection. In some cases, it seems that OCD and strep infections may be related. When OCD starts after a strep infection, the symptoms appear suddenly and very intensely. Most people who get strep infections, though, don't get OCD.

Who Gets OCD?

Kids with OCD are not alone. In the United States, about 1 million children and teens, both boys and girls, have OCD. That's about 1 in every 200 children and teens. In some studies including adults, OCD was reported as commonly as 1 in 50 people. You might know someone who has OCD and not even realize it.

What's Life Like for Someone With OCD?

Living with OCD can be very hard. Compulsions often take up lots of time and energy, making it hard to finish homework, do chores, or have any fun. Some kids even find it difficult to go to school or make friends. Sometimes kids feel ashamed. They know the behaviors seem silly to other people, so they often keep it to themselves. It can be really difficult to talk about OCD! But dealing with something all alone can make it even harder.

Sometimes, even parents and friends who know about a person's OCD have a hard time understanding that OCD is not just a bad habit. They might act impatient or make it seem like a person could just stop if he or she tried hard enough. But with OCD, the need to do rituals can feel too strong to ignore. Some kids say that OCD is like hearing a constant, nagging voice that tells them bad things could happen if they don't do certain things. Some kids say it seems like OCD takes over everything.

Treatment for OCD

Treatment can really help kids with OCD get better. OCD can be treated in two ways: with medicine and behavior therapy. Medicines that help brain chemicals work properly can help kids with OCD. How? These medicines can make the obsessions and compulsions feel less intense, and they also help tone down the worry and fear. By itself, medicine doesn't completely fix OCD, and many kids with OCD don't need medicine to get better. But for some kids, medicine sure does help.

With or without medicine, a special type of "talk therapy" is the most important part of treatment for kids with OCD. This type of therapy is called cognitive behavior therapy (also called cognitive-behavioral therapy). For most kids with OCD, cognitive behavior therapy helps them learn to deal with anxiety, to face fears, to resist compulsions, and to slowly but surely conquer OCD.

What's Behavior Therapy for OCD Like?

Lots of mental health specialists, psychiatrists, psychologists, and counselors (also called therapists) are trained to do the cognitive behavior therapy that works for OCD. The therapist might start by just getting to know the child and parents. The therapist might ask about favorite activities or TV shows, pets or hobbies, or particular sports.

The therapist will also ask some questions about problems with worry and rituals that the child has been having. Then the therapist will explain about OCD and how the cognitive behavior therapy works to help it get better. The therapist will help parents understand the child's OCD and what they can do at home to help it get better, too.

In cognitive behavior therapy for OCD, kids learn different ways to deal with their worries without doing a ritual. At first, it may seem hard to stop doing rituals, but the therapist can teach kids how to feel safe enough to try. It's definitely tough at first, but if they stick with it, kids begin to feel stronger and braver against OCD.

After learning about ways to get their worries under control, kids start to practice them. As with anything new (such as playing the piano or kicking a soccer goal), the more someone practices, the better he or she can do it. When kids practice what they learn in behavior therapy, they find out it actually works!

Kids with OCD usually go to therapy about once a week (or sometimes more often) for a while, then less often as they begin to get better. Getting better can take anywhere from a few months to a few years.

It's important to remember that with some help, kids with OCD can get better. Kids usually are really relieved when the symptoms of OCD get weaker and they begin to feel stronger. It feels good to be free of OCD!

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: November 2008
Originally reviewed by: David V. Sheslow, PhD