Obsessive-compulsive disorder (OCD) usually begins in adolescence or young adulthood and is seen in as many as 1 in 200 children and adolescents. People with OCD have recurrent intense obsessions and/or compulsions that are severely painful and interfere with day-to-day functioning. Obsessions are recurrent and persistent thoughts, impulses, or images that appear without warning, are unwanted, and cause extreme anxiety or distress. Frequently, the thoughts are irrational, without bearing to current happenings. They are not just worried about real-life problems or preoccupations. Compulsions are repetitive behaviors or rituals (like hand washing, keeping things in order, checking something repeatedly) or mental acts (counting, repeating words silently, avoiding). In OCD, the obsessions or compulsions must cause significant anxiety or distress or interfere with the child's routine, academic functioning, social activities, or relationships.
The obsessive thoughts may vary with the child's age and may change over time. A younger child with OCD may have persistent thoughts that harm will occur to himself or a family member, for example, an intruder entering an unlocked door or window. The child may compulsively check all the doors and windows of his home after his parents are asleep in an attempt to relieve anxiety. The child may then fear that he may have accidentally unlocked a door or window while last checking and locking and then must compulsively check repeatedly.
An older child or a teenager with OCD may fear that he will become ill with germs, unwanted sexual thoughts, fears of causing harm, the need for things to be symmetrical and just right, counting religious thoughts, fears of being a bad person or having sinned, need to pray continuously To cope with his/her feelings, a child may develop "rituals" (a behavior or activity that gets repeated). Sometimes, the obsession and compulsion are linked; "I fear this bad thing will happen if I stop checking or hand washing, so I can't stop even if it doesn't make any sense."
Research shows that OCD is a brain disorder and tends to run in families, although this doesn't mean the child will also have OCD if a parent has the disorder. A child may also develop OCD with no previous family history.
Children and adolescents often feel shame and embarrassment about their OCD. Many fear it means they're crazy and are hesitant to talk about their thoughts and behaviors. Good communication between parents and children can increase understanding of the problem and
help the parents appropriately support their child.
Families and caregivers are often affected by the youth’s OCD. The impact on the functioning of the person with OCD may change the plans or activities of family members. Caregivers may “give in” to youth suffering from OCD to try to support the child; this is a process known as “accommodation.” Most caregivers are not aware of the amount of accommodation they do.
Family support and education are also central to the success of treatment. Seeking help from a child and adolescent psychiatrist is essential both to understand better the complex issues created by OCD as well as to get treatment.
