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Obsessive-compulsive disorder (OCD) is characterized by two major symptoms: obsessions and compulsions. Some patients experience both of these symptoms, whereas others experience just one.

Obsessions are recurrent and persistent thoughts or impulses that a person cannot control. These thoughts may occur once in a while or may be almost constant, crowding the mind and preventing a person from concentrating on other tasks. Typical obsessions in children include:

• Fear of dirt, germs or environmental toxins
• Worry about catastrophic events
• Excessive concern with order, symmetry and exactness
• Religious obsession
• Obsession with lucky and unlucky numbers
• Sexual or aggressive thoughts
• Fixation on intrusive thoughts or words
• Concern about, or disgust with, bodily wastes and secretions

Compulsions are repetitive behaviors that a person engages in and cannot control. A child engages in compulsions as a means of combating obsessive thoughts, even though this action may seem irrational to the child and others. For example, children who are obsessed with a fear of germs may wash their hands compulsively to the point that the skin becomes raw to combat this fear. In other cases, the compulsive act is not as clearly associated with the obsessive thought. Many children also develop rules to follow that help control anxiety in the midst of obsessive thoughts, such as touching objects a specific number of times or counting to a certain number. In some cases, performing the compulsion does indeed relieve the anxiety, but only temporarily.

Typical compulsions in children include:

• Excessive washing of hands, showering or bathing
• Excessive grooming and brushing of teeth
• Repeatedly going in and out of doors or standing up and sitting down in a chair
• Repeatedly checking doors, locks, stoves or homework
• Rituals to avoid contact with contaminants
• Ritual touching or a pattern of tapping
• Counting rituals
• Hoarding and collecting certain items
• Cleaning rituals

In many cases, a child’s obsessions and compulsions are related to food. For example, children may feel compelled to limit their food choices to a restricted range of foods, which may impact their nutrition.

Children with OCD are likely to feel frustrated by and ashamed of their behavior. This may impact their self-esteem. Children with OCD may also have other mental health disorders. Studies have found that the most common of these are tic disorders (e.g., Tourette syndrome), depression and behavioral disorders.  Other conditions frequently diagnosed in children with OCD include other anxiety disorders (including phobias), learning disorders (e.g., dyslexia), oppositional disorder, attention-deficit hyperactivity disorder, adjustment disorder, compulsive hair pulling (trichotillomania) and habit disorders, such as nail biting and skin picking.

Children who have OCD typically develop symptoms so gradually that parents or caregivers may be unaware of them. In addition, many children hide their symptoms for as long as possible. Children may successfully hide their symptoms for months or even years.

However, certain signs should alert parents to the possibility that something is wrong. In some cases, children may require parents to participate in their rituals. For example, children obsessed with germs may continually ask their parents if they touched something infested with germs. If the parent says “no,” the child feels satisfied until the ritual begins again later. When parents refuse to participate in this way, the child may become difficult or upset.

Other signs of OCD in children include:

• Raw skin from excess washing
  
  
• High rate of soap and towel usage
  
  
• Sudden decline in test grades
  
  
• Holes erased through paper or homework
  
  
• Requests of other family members to repeat words or to answer the same question
  
  
• Persistent fears of illness
  
  
• Excessive amount of time preparing for bed
  
  
• Continual fear of bad events that might happen
  
  
• Reluctance to leave the house at the same time as other family members