Obsessive-compulsive disorder (ocd) and related disorders in children and adolescents

[Dave Paprocki]

Obsessive-compulsive disorder is characterized by recurring, unwanted, intrusive doubts, ideas, images, or impulses (obsessions) and unrelenting urges to do actions (compulsions) to try to lessen the anxiety caused by the obsessions. The obsessions and compulsions cause great distress and interfere with school and relationships.

Obsessions often involve worry or fear of being harmed or of loved ones being harmed (for example, by illness, contamination, or death).
Compulsions are excessive, repetitive, purposeful behaviors that children feel they must do to manage their doubts (for example, by repeatedly checking to make sure a door is locked), to prevent something bad from happening, or to reduce the anxiety caused by their obsessions.
Behavioral therapy and drugs are often used in treatment.

(See also Overview of Anxiety Disorders in Children and Adolescents and Obsessive-Compulsive Disorder in adults.)
On average, obsessive-compulsive disorder (OCD) begins at about age 19 to 20 years, but about 25% of cases begin before age 14. The disorder often lessens after children reach adulthood.
Obsessive-compulsive disorder includes several related disorders:

Body dysmorphic disorder: Children become preoccupied with an imagined defect in appearance, such as the size of their nose or ears, or become excessively concerned with a slight abnormality, such as a wart.
Hoarding: Children have a strong need to save items regardless of their value and cannot tolerate parting with the items.
Trichotillomania (hair pulling)
Skin picking

Some children, particularly boys, also have a tic disorder.
Genes and environmental factors are thought to cause OCD. Studies to identify the genes are being done.
There is some evidence that infections may be involved in a few cases of OCD that begin suddenly (overnight). If streptococci are involved, the disorder is called pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS). If other infections (such as Mycoplasma pneumoniae infection) are involved, the disorder is called pediatric acute-onset neuropsychiatric syndrome (PANS). Researchers continue to study the connection between infections and OCD.