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Obsessive-Compulsive Disorder

Obsessive-compulsive disorder is an anxiety disorder in which a person has an unreasonable thought, fear, or worry that he or she tries to manage by performing a ritual activity to reduce the anxiety. Frequently occurring disturbing thoughts or images are called obsessions, and the repeated rituals performed to try to prevent or dispel them are called compulsions.

During the normal growth and development of children and adolescents, rituals and obsessive thoughts normally occur with a purpose and focus based on age. For example:

  • Preschool children often use rituals and routines around mealtimes, bath, and bedtime to help them stabilize their expectations and understanding of their world.
  • School-aged children normally develop group rituals as they learn to play games, team sports and recite rhymes.
  • Older children and teens begin to collect objects and develop hobbies.

These rituals help children to socialize and learn to master anxiety.

A child or adolescent with OCD has obsessive thoughts that are unwanted and related to fears (such as a fear of touching dirty objects) and uses compulsive rituals to control the fears (such as excessive hand-washing). When OCD is present, obsessive thoughts and compulsive rituals can become so frequent or intense that they interfere with daily living and normal development.

Obsessive-compulsive disorder causes

The cause of OCD is not known. Research suggests that there may be a genetic component, though OCD can develop without a family history. Other studies point to a possible deficiency of serotonin in the brain in those who suffer from OCD.

While symptoms of OCD do occur in children, it is recognized as a relatively common mental health disorder in adolescents, with 1 in 200 children and adolescents having OCD.

Obsessive-compulsive disorder symptoms

Although OCD sufferers may experience symptoms differently, some common signs of a problem include:

  • Extreme preoccupation with dirt, germs or contamination

  • Repeated doubts (for example, whether or not the door is locked)

  • Obtrusive thoughts about violence, hurting, killing someone or harming self

  • Spending long periods of time touching things, counting, thinking about numbers and sequences

  • Preoccupation with order, symmetry or exactness

  • Persistent thoughts of performing repugnant sexual acts or forbidden, taboo behaviors

  • Troubled by thoughts that are against personal religious beliefs

  • An extreme need to know or remember things that may be very trivial

  • Excessive attention to detail

  • Excessive worrying about something terrible happening

  • Aggressive thoughts, impulses and/or behaviors

Compulsive behaviors, the repetitive rituals used to reduce anxiety caused by the obsessions, can become excessive, disruptive, and time-consuming. They may also interfere with daily activities and relationships.

Examples of compulsive behaviors may include:

  • Repeated hand-washing (often more than 100 times daily)

  • Checking and rechecking repeatedly (for example, to ensure that a door is locked)

  • Following rigid rules of order (for example, putting on clothes in the very same sequence every day, keeping belongings in the room in a very particular way and becoming upset if the order becomes disrupted)

  • Hoarding objects

  • Counting and recounting excessively

  • Grouping or sequencing objects

  • Repeating words spoken by self (palilalia) or others (echolalia); repeatedly asking the same questions

  • Coprolalia (repeatedly speaking obscenities) or copropraxia (repeatedly making obscene gestures)

  • Repeating sounds, words, numbers, and/or music to oneself

The symptoms of OCD may resemble other medical conditions or psychiatric problems, including Tourette's disorder. Always consult your adolescent's doctor for a diagnosis.

Diagnosis and treatment

A child psychiatrist or other qualified mental health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive psychiatric evaluation.

Parents who note signs of severe anxiety or obsessive or compulsive behaviors in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

In order for a diagnosis of OCD to be made, the obsessions and compulsions must be pervasive, severe, and disruptive enough that the child or adolescent's activities of daily living and function are adversely affected. In most cases, the activities involved with the disorder (for example, hand-washing, checking the locks on the doors) consume more than one hour each day and cause psychological distress and impaired mental functioning.

OCD can be effectively treated, usually with a combination of the following:

  • Medications
  • Behavior techniques
  • Cognitive therapy
  • Family therapy

Adolescents with OCD may also experience one or more types of eating disorders, which will also require treatment.

Prevention of obsessive-compulsive disorder

Preventive measures to reduce the incidence of OCD in adolescents are not known at this time.

Early detection and intervention are the best line of defense. They can reduce the severity of symptoms, enhance the adolescent's normal growth and development and improve the quality of life experienced by children or adolescents with anxiety disorders.

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