Obsessive-compulsive disorder (OCD) is a mental health condition that can affect children and teenagers as well as adults. It involves unwanted, intrusive thoughts, images or urges, together with repetitive behaviours or mental acts that a young person feels driven to carry out. These experiences can be distressing, time-consuming and disruptive to family life, education, friendships and sleep.
OCD is often misunderstood. It is not simply being tidy, organised or particular about routines. A young person may recognise that their fears or rituals do not make sense, yet still feel unable to resist them. Others may have limited insight, particularly when they are younger or highly anxious. With appropriate assessment and evidence-based treatment, OCD can improve significantly.
What are obsessions?
Obsessions are recurrent and intrusive thoughts, images, impulses or doubts. They are usually unwanted and cause anxiety, disgust, guilt or a strong sense that something is not right. The content of an obsession does not reflect a child’s wishes, personality or intentions.
Common themes can include:
- Fears about contamination, germs, illness or dirt.
- Worries that harm will come to themselves or someone else.
- Repeated doubts, such as whether a door is locked or an appliance is switched off.
- Fears of making a serious mistake or being responsible for a bad event.
- A need for symmetry, exactness or things to feel “just right”.
- Unwanted aggressive, sexual, religious or blasphemous thoughts.
- Concerns about accidentally causing harm or acting in a way they do not want to.
Children may not always describe these experiences as “obsessions”. They might say they cannot stop thinking about something, repeatedly ask for reassurance, become distressed when a routine changes, or appear stuck on a particular question.
What are compulsions?
Compulsions are repetitive behaviours or mental acts performed to reduce anxiety, prevent a feared outcome or obtain certainty. The relief is usually temporary, which can strengthen the cycle of obsession and compulsion.
Compulsions may include:
- Washing, cleaning, showering or changing clothes repeatedly.
- Checking locks, taps, homework, messages or bodily sensations.
- Repeating words, prayers, numbers or actions until they feel correct.
- Touching, counting, arranging or ordering objects in a particular way.
- Seeking repeated reassurance from parents, teachers or friends.
- Avoiding certain places, people, objects, activities or conversations.
- Carrying out mental reviewing, comparing, cancelling thoughts or silently repeating phrases.
Some compulsions are not obvious to other people. A young person may sit quietly while performing complex mental rituals, analysing whether they have caused harm or trying to replace an intrusive thought with a “safe” thought. Reassurance and avoidance can also become part of the OCD cycle, even when families are understandably trying to help.
How OCD can appear in children and teenagers
The presentation of OCD can vary with age and developmental level. Younger children may struggle to explain their fears and instead become tearful, irritable, slow to complete everyday tasks or reluctant to separate from parents. They may insist that family members follow particular rules or repeatedly ask the same questions.
Teenagers may hide symptoms because they feel embarrassed, guilty or afraid of being judged. They may spend long periods in the bathroom, delay leaving for school, repeatedly change clothes, avoid homework or become preoccupied with online searches about illness or safety. Academic performance can decline because rituals take time or concentration is affected by intrusive thoughts.
Families may initially notice accommodation rather than the underlying OCD. This occurs when parents or carers answer repeated questions, check things on the young person’s behalf, provide items in a particular way or alter family routines to prevent distress. Although accommodation can reduce immediate anxiety, it may unintentionally maintain OCD over time.
OCD or typical childhood behaviour?
Many children have preferences, routines, worries or repetitive play. These are not necessarily symptoms of OCD. Assessment considers whether thoughts and behaviours are intrusive, difficult to control, distressing, excessive or significantly interfering with daily life.
It is particularly important to seek advice when symptoms are taking substantial time, causing avoidance, affecting attendance or functioning at school, disrupting sleep, limiting eating or washing, creating conflict at home, or preventing normal social and family activities. A child does not need to be completely certain that they have OCD before asking for help.
What happens during an OCD assessment?
A thorough assessment explores the nature, frequency and impact of intrusive thoughts and compulsions. It also considers the young person’s developmental history, physical health, sleep, education, relationships and emotional wellbeing. We will aim to understand what happens before, during and after a ritual, including how family members may be involved.
Assessment may also consider related or overlapping conditions, such as generalised anxiety, depression, panic symptoms, specific phobias, eating difficulties, tic disorders, autism or ADHD. Repetitive behaviours associated with autism, for example, may have a different function from compulsions driven by fear or a need to neutralise an intrusive thought. Tics are also different from compulsions, although OCD and tic disorders can occur together.
A clinician will discuss the young person’s level of insight, distress and risk. Intrusive thoughts about harm, sex or religion are common OCD themes and do not, by themselves, mean that a young person intends to act on them. However, any concerns about self-harm, suicide, abuse, psychosis or immediate risk require prompt professional attention.
Evidence-based OCD treatment
For children and young people, the main psychological treatment for OCD is cognitive behavioural therapy (CBT) that includes exposure and response prevention (ERP). This involves carefully and gradually facing feared situations, thoughts or sensations while reducing the usual compulsive response. The work is planned collaboratively and paced according to the young person’s needs.
ERP is not about forcing a child to confront fears or removing all reassurance suddenly. It is a structured treatment that helps the young person learn that anxiety can reduce naturally and that feared outcomes do not need to be prevented through rituals. Parents and carers are usually included so they can respond consistently and support progress at home.
Depending on the severity of OCD, the young person’s age, previous treatment and clinical circumstances, medication may also be considered. Selective serotonin reuptake inhibitors (SSRIs) can be used within specialist care, particularly when OCD is moderate to severe or when psychological treatment alone has not been sufficient. Medication decisions should be individualised, discussed with the young person and family, and monitored carefully.
When should you seek an assessment?
Consider seeking a professional assessment if your child or teenager has persistent intrusive thoughts, repetitive rituals, marked reassurance-seeking or avoidance, especially when these interfere with daily life. Early support can help prevent symptoms becoming more entrenched and can guide the whole family in responding helpfully.
Speak to your GP, school health professional or a specialist child and adolescent mental health service. If there is immediate risk of harm, seek urgent help through NHS emergency services or call 999. OCD symptoms involving distressing thoughts should be discussed openly and without judgement.
OCD assessment and treatment at Healing Young Minds
Healing Young Minds provides specialist assessment and treatment for children and young people experiencing OCD and related difficulties. Our Consultant Child and Adolescent Psychiatry service follows NICE-guideline diagnostic pathways and takes account of development, family context, education and co-occurring conditions.
We offer a careful assessment and clear explanation of recommendations, followed by an appropriate treatment plan. To find out more or discuss whether an assessment may be suitable, please contact healingyoungminds.com.