Obsessive compulsive disorder (OCD) in children and teenagers

Obsessions: what are they?

Obsessions are thoughts, images or urges that people don’t want but can’t stop thinking about. When people have these thoughts, they might also feel very anxious or fearful.

Some examples of obsessions include:

imagining loved ones getting hurt
worrying about dirt, germs or infection – for example, feeling scared about getting sick from touching dirty surfaces
feeling that something terrible will happen if things aren’t done a certain way – for example, if books aren’t in the right order.

Compulsions: what are they?

Compulsions are things people feel they must do over and over. Compulsions are often called rituals. Sometimes people might have compulsions to try to stop an obsessive thought. But sometimes they don’t know why they feel and behave this way.

Some examples of compulsions include:

washing hands repeatedly
hoarding – that is, not being able to throw anything away
counting or tapping repeatedly
checking things repeatedly, like locks or windows
pulling at hair or picking at skin.

Obsessions and compulsions: should you be worried?

Many children have obsessions or compulsions.

Obsessions and compulsions can be a part of child and adolescent development. For example, your child might go through a stage of wanting their bedtime ritual to be exactly the same every night. Or your child might worry about something bad happening to a family member.

Obsessions and compulsions that don’t get in the way of your child’s or family’s life aren’t usually anything to worry about.

When obsessions and compulsions become obsessive compulsive disorder (OCD)

Children and teenagers might have obsessive compulsive disorder (OCD) if they have unwanted thoughts or compulsive behaviour or both, and these don’t go away, are distressing and interfere with daily life.

Speak to a health professional if you notice your child has:

severe obsessions that make them feel upset, anxious or disgusted
obsessive thoughts or compulsive behaviour that interfere with life or stop them from enjoying life
obsessive thoughts and/or compulsive behaviour that lasts for more than 6 months.

OCD is uncommon in children and teenagers.

How OCD affects children and families

Obsessive thoughts and compulsive behaviour affect children’s ability to relax and enjoy life. So if your child has obsessive compulsive disorder (OCD), they might also have challenges like:

problems at school – for example, difficulty paying attention or doing homework
disrupted routines – for example, difficulty going to school or getting to sleep unless their rituals are done
physical problems from feeling stressed or lack of sleep
social problems – for example, avoiding social situations or spending more time on their obsessions and compulsions than with their friends
negative feelings – for example, worrying that they’re different from friends and family or that they aren’t in control of their behaviour
other mental health problems – for example, child anxiety, child depression, teenage anxiety or teenage depression.

Obsessive compulsive disorder is a mental health disorder that won’t go away on its own. And sometimes children who have OCD go on to have other mental health problems later in life. This is why it’s important to get professional treatment for your child with OCD.

Getting professional help for children with OCD

If you think your child has obsessive compulsive disorder (OCD), see your GP for a referral to a paediatrician, psychiatrist or psychologist. These professionals can diagnose OCD.

If your child is diagnosed with OCD, they’ll need treatment from a mental health professional. The mental health professional will probably try the following therapies with your child:

Cognitive behaviour therapy (CBT) – this will help your child learn to cope with challenges, replace negative thoughts with helpful thoughts, and do things that improve their mental health.
Exposure and response prevention (ERP) – this involves your child practising facing the things that make them anxious, until these things no longer cause them anxiety or trigger their compulsive behaviour.

The mental health professional will get you involved in your child’s therapy. They might also recommend involving school staff, especially if your child’s obsessive thoughts or compulsive behaviour happens at school.

Medicine combined with therapy is sometimes recommended to treat moderate to severe OCD. Treatment is most successful when therapy and medicines are used together.

Your child might be able to get Medicare rebates for up to 10 sessions with a mental health professional each calendar year. To get these rebates, your child will need a mental health treatment plan from a GP or a referral from a psychiatrist or paediatrician.

Helping children with OCD at home

Your child’s mental health professional will explain how you can support your child’s therapy. This might include specific exercises or activities for you to do at home.

In addition to any exercises that the mental health professional suggests, here are simple strategies you can try at home with your child:

Reassurance – children with obsessive compulsive disorder (OCD) can feel different, isolated and lonely. You can help your child feel less alone by being there to listen. You can also reassure them that anxiety is natural and that you’ll work with them to overcome their OCD.
Relaxation – your child could try breathing exercises or muscle relaxation exercises, meditation or mindfulness exercises.
Helpful self-talk – you could encourage your child to practise saying things like ‘I can stop doing this’ or ‘I will be OK if I don’t do this’.
Distraction – you could suggest your child does something else that they enjoy, like reading a book or playing basketball. Even short distractions from worries can be good.
A worry box – you could encourage your child to write down or draw their worries and then put them in the box. This might help your child to put aside their worries.
A calm place – this could be a space inside or outside where your child can do activities that distract them from worries.

When your child with OCD is learning to manage their anxiety, they’ll start small. For example, instead of turning the light on 4 times, they might turn it on only 3 times. Try to be patient with your child’s progress and praise them for being brave and trying. Avoid criticising or getting frustrated with your child if they’re still doing their rituals.

Causes of OCD

We don’t know what causes obsessive compulsive disorder (OCD), but several things probably contribute to it.

OCD can happen if parts of the brain don’t communicate well. It can also happen when there’s a family history of anxiety or when children have been through a stressful or traumatic event.

In some rare instances, children develop OCD symptoms after a streptococcal infection (a throat infection caused by bacteria). Or the infection makes OCD symptoms more severe.

Children with OCD often experience other challenging behaviour or mental health conditions, like depression or anxiety. These issues might also contribute to OCD.

If your child develops OCD, it isn’t your child’s fault and it isn’t your fault.

Looking after yourself helps you give your child what they need to grow and thrive. Staying active, eating healthy food and getting enough rest will help with your energy levels. Sharing support, advice and experiences with other parents can also be a big help. You could try joining an online or face-to-face support group to connect with other parents raising children diagnosed with OCD.