Obsessive Compulsive Disorder (OCD) involves unwanted and disturbing thoughts, images, or urges (obsessions) that intrude into a child/teen’s mind and cause a great deal of anxiety or discomfort, which the child/teen then tries to reduce by engaging in repetitive behaviors or mental acts (compulsions).
Often, compulsions are performed in a ritualistic, or very specific way, for example, counting to six each time an article of clothing is removed.
The following lists common obsessive themes and compulsive rituals:
Obsessions
Contamination Fear or distress about coming into contact with dirt, germs, sticky substances, or chemicals (e.g., household cleansers), or getting sick, or getting others sick after touching “dirty” or “contaminated” items
Accidental harm to self or others Fear of harming yourself or others through carelessness. For example, “what if I didn’t clean off the counter properly and there are still germs on it, and my mom gets sick because of me!”
Symmetry and exactness A need to have items ordered in a certain way (for example, according to color, size, or facing a certain direction). Children and teens with this type of obsession are either anxious because “it just doesn’t feel right” or because of a superstitious belief that something bad will happen (e.g., “if my shoes are not arranged properly, my mom will die!”). Often, the content of obsessions sounds very odd or makes no sense. For example, a child with OCD might say that he or she needs to arrange all the teddy bears from smallest to biggest or else something bad will happen to mom. Most children and teens are aware that these thoughts are strange; however, do not be surprised if your child doesn’t think his or her thoughts are odd. Most younger children have no idea that their obsessions sound peculiar to others.
A need for perfection Some kids and teens feel a strong need for things to be perfect or right. For example, your child might not be able to start her homework until her books are all ordered and perfectly arranged, or cannot turn in an assignment until she is certain its perfect. Other kids struggle to tolerate if something isn’t 100% right, focusing on doing the right thing all the time or thinking about every tiny mistake.
Forbidden thoughts Entering into adolescence is a time of sexual maturity and most teens think about sex and sexual identity during this time. However, for some teens they are plagued with unwanted thoughts and images about being gay when they know they are not, or thinking about engaging in sexual behavior that feels upsetting and even repulsive to them.
Compulsions
Washing or cleaning Washing hands excessively, sometimes until they are raw and bleeding. There are many other types of washing behaviors, including:
- Toilet rituals (e.g., excessive wiping)
- Grooming/tooth brushing rituals (e.g., brushing each tooth in a particular order)
- Showering rituals (e.g., washing each body part a certain number of times or in a particular order)
- Cleaning compulsions (e.g., rituals and rules for how to wash laundry, clean the bathroom, kitchen, etc.)
Checking These types of compulsions can involve checking doors, locks, or backpacks, to make sure everything is safe. Some children and teens check to make sure that everyone is okay. For example, calling family members to “check” that they are safe.
Counting, tapping, touching, or rubbing Compulsions can involve counting, touching, or tapping objects in a particular way. Some children and teens have lucky and unlucky numbers involved in their rituals (e.g., needing to touch a door four times before leaving a room).
Ordering/arranging This compulsion involves arranging items in specific ways, such as bed sheets, stuffed animals, or books in the school locker or book bag. For example, a child might need to line up all the shoes in the closet so that they all face forward, and are matched by color.
Mental rituals Not all children and teens with OCD will have compulsions that can be seen. Some perform rituals in their head, such as saying prayers or trying to replace a “bad” image or thought with a “good” image or thought. For example, a teen might have a bedtime prayer that he or she mentally repeats over and over again until it “feels right”.
