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Obsessive-Compulsive Disorder (OCD) and Related Disorders in Children and Adolescents


Josephine Elia

, MD, Nemours/A.I. duPont Hospital for Children

Reviewed/Revised May 2023

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.

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:

Genes and environmental factors are thought to cause OCD. Studies show that gene networks of OCD are highly complex and are involved in many of the body's processes, including development of the brain and nervous system, the immune system, and the inflammatory system.

There is some evidence that infections may be involved in a few cases of OCD that begin suddenly (overnight). If the bacteria 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.


Typically, symptoms of OCD develop gradually, and most children can hide their symptoms at first.

Children are often obsessed with worries or fears of being harmed—for example, of contracting a deadly disease or of injuring themselves or others. They feel compelled to do something to balance or neutralize their worries and fears. For example, they may repeatedly do the following:

  • Check to make sure they turned off their alarm or locked a door

  • Wash their hands excessively, resulting in raw, chapped hands

  • Count various things (such as steps)

  • Sit down and get up from a chair

  • Constantly clean and arrange certain objects

  • Make many corrections in schoolwork

  • Chew food a certain number of times

  • Avoid touching certain things

  • Make frequent requests for reassurance, sometimes dozens or even hundreds of times per day

Some obsessions and compulsions have a logical connection. For example, children who are obsessed with not getting sick may wash their hands very frequently. However, some are totally unrelated. For example, children may count to 50 over and over to prevent a grandparent from having a heart attack. If they resist the compulsions or are prevented from carrying them out, they become extremely anxious and concerned.

Most children have some idea that their obsessions and compulsions are abnormal and are often embarrassed by them and try to hide them. However, some children strongly believe that their obsessions and compulsions are valid.

OCD resolves after a few years in about 5% of children and by early adulthood in about 40%. In other children, the disorder tends to be chronic, but with continuing treatment, most children can function normally. About 5% of children do not respond to treatment and remain greatly impaired.


  • A visit with a doctor or behavioral health specialist

  • Sometimes questionnaires about symptoms

Doctors base the diagnosis of OCD on symptoms. Several visits may be needed before children with OCD trust a doctor enough to tell the doctor their obsessions and compulsions.

For OCD to be diagnosed, the obsessions and compulsions must cause great distress and interfere with the child's ability to function.

If doctors suspect that an infection may be involved, they usually consult with a specialist in these disorders.


  • Cognitive-behavioral therapy

  • Sometimes medications

Cognitive-behavioral therapy, if available, may be all that is needed if children are highly motivated.

If needed, a combination of cognitive-behavioral therapy and a type of antidepressant called a selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors (SSRIs) Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine... read more (SSRI) is usually effective for OCD. This combination enables most children to function normally. If SSRIs are ineffective, doctors may prescribe clomipramine, another type of antidepressant. However, it can have serious side effects. Other options are available if these do not work.

If treatment is ineffective, children may need to be treated as inpatients in a facility where intensive behavioral therapy can be done and medications can be managed.

If streptococcal infection (PANDAS) or another infection (PANS) is involved, antibiotics are usually used. If needed, cognitive-behavioral therapy and the medications typically used to treat OCD are also used.

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