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OCD Symptoms in Children

Some recent movies and television shows have featured plots made interesting when it’s revealed that the main character suffers from OCD. The disorder is sometimes treated in a comical way, showing a character incessantly performing a compulsion such as rearranging objects or washing hands. While comedy performances like this may have raised general awareness of OCD, the result can also be an increase in ridicule of people who actually have OCD. Anyone who suffers from this debilitating illness knows that OCD is not fun and is no laughing matter.

Although there are many forms of OCD symptoms in children, there are some symptoms that are more commonly seen than others. The following information should give you a good idea of the general types of behavior that may signal OCD in children:

Obsessions	Compulsions
Fear of germs or contamination	Repeatedly washing hands, bathing, showering, using anti-bacterial wipes or hand-sanitizer Too-frequently changing clothes, washing clothing or surfaces; asking parents to wash clothing more than once to get it “really clean” Avoiding touching “dirty” surfaces such as doorknobs; avoiding touching others, not playing with siblings or wanting to be touched or kissed Avoiding contact play or sports - either because of fearing catching a disease or fear of contaminating another person or child Avoiding public places like malls or refusing to use public washrooms; avoiding certain areas of the home Seeking reassurance that they or others are not “sick” or “dirty”
Extreme dread of uncertainity; fear of harm or danger; fear of causing harm to others (such as a fire or accident)	“Checking” behavior such as to make sure doors and/or windows are locked, checking that parents are OK , making sure there are no monsters under the bed or in the closet “Counting” behavior such as counting, touching or saying words a certain number of times to “magically” keep harm from coming to another -- this could include silently counting or thinking words or prayers in a certain order Unreasonable avoidance of ordinary activities, places, animals or people A belief that a thought can cause an event to happen or not happen
Fear of losing something valuable or important	“Saving” behavior, such as saving useless items -- scraps of paper, candy wrappers, bottle caps, broken items; being unable to part with things that are not needed any more “Hoarding” behavior, such as holding onto items that they fear might be needed sometime in the future, such as their books, toys, food, school papers, clothing; wanting multiples of the same item
Fear of violating religious rules or that they have been "bad"	Being preoccupied with religious observances; praying, saying prayers a certain number of times; excessive praying to atone for being “bad”; repeatedly needing to confess perceived “sins” or bad behavior
Need for symmetry	Constantly “evening up” items or groups of items, such as books on a shelf or toys on the floor; aligning edges to be “right” or “even” Rearranging items to achieve a certain order, such as shoes on the closet floor, CDs on a shelf, clothing in a specific order or in certain color groups
Need for perfection	Overly seeking reassurance that what they’ve done is right or perfect Repeatedly revising the way they have written words to make them look “right” – erasing through the paper Extreme slowness with activities, chores or school work -- making sure it looks “right” or is done “right” or in a certain order or pattern Repeating actions over and over for no apparent reason

Other Confusing Behavior Could Be OCD

Children with OCD may have other symptoms, or their behavior may seem to fit in more than one of these common categories. And the focus of children’s fears is likely to shift from time to time so, just when you think they have “grown out” of one set of symptoms, new and different symptoms arise. Some confusing behaviors may include:

• Eating rituals - eating foods in a certain order, chewing a certain number of times, refusing certain foods (that they may have eaten in the past) because they are “afraid” to eat them, cutting food into a specific number of pieces, tapping the fork or spoon a certain number of times before eating, and not being able to eat if this is not allowed.
• Obsessions over physical appearance - extreme distress over weight and hair (color, style, curl or lack of it, etc.) are very common and could be confused with normal developmental concerns over appearance; however, extreme distress over how they look, or how clothing “feels” may indicate a more serious problem.
• Extreme sensitivity or concern with odors - especially body odors (their own or others). Feeling ill or becoming extremely upset or distressed when exposed to ordinary odors such as in a restaurant, school, gym or at home.
• Superstitious or magical thinking - an extreme conviction that certain numbers are very lucky or very unlucky; that certain acts must be done a certain number of times to keep evil away and certain numbers must be avoided to prevent harm to themselves or those they love.
• Intrusive sexual thoughts - children or teens may be bothered with thoughts of “bad” sexual activity, deviant thoughts that violate religious beliefs, or thoughts of violence connected to sex or religion. They may worry that they will act out these thoughts and harm another, or disrupt a religious service with blasphemous words or behavior. They may avoid social situations or church services for fear they will act inappropriately.
• Inability to make decisions - extreme concern over making a wrong choice and the extension of this behavior to not making decisions at all, or taking an excessive amount of time with homework because of the fear that the answers he or she is writing may not be “right”.
• Obsessive slowness - slowness in normal activities may be related to an inability to make a decision or in weighing (over and over again) alternatives to take the “right” action, get the answer “right” or make sure it looks “right” on the page. The action may be repeated many times to get it “just right” or perfect, including repeatedly walking up and down stairs or in and out of a room or door. Homework may be smudged from erasures and the paper rubbed through leaving holes from excessive erasing and rewriting.
• Extreme separation anxiety - usually seen in younger children; overriding fears of being left alone or that the parents or caregiver will never return.
• Extreme hiding of activities or being highly secretive; making their room or possessions “off limits” to siblings or parents.
• Temper tantrums when a normal routine is interrupted, or a seemingly routine activity is disrupted; inflexibility to the point of tantrums if even a small part of the bedtime ritual or other household routines are changed.

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