Obsessive-compulsive disorder (OCD) Symptoms & Causes

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What causes obsessive-compulsive disorder?

The cause of OCD is not known, but as is the case with many psychiatric conditions, thought to be multifactorial. Research indicates that OCD is a neurological brain disorder. Evidence suggests that people with OCD have a deficiency of a chemical in the brain called serotonin. OCD tends to run in families, suggesting a genetic component. However, OCD may also develop without a family history of OCD. Certain environmental triggers during pregnancy and/or stressful life experiences have also been associated with OCD. Recent studies suggest that streptococcal infections may trigger the onset or increase the severity of OCD.

Who is affected by obsessive-compulsive disorder?

While symptoms of OCD do occur in children, it is recognized as a relatively common mental health disorder in adolescents, with up to 2 percent to 3 percent of children and adolescents having OCD. The ratio of males affected by OCD is twice that of females. The mean age of onset for pediatric OCD can be between 9-11 years old for boys and 11-13 years in girls. Twenty percent of children and adolescents with OCD also have another family member with OCD.

What are the symptoms of obsessive-compulsive disorder?

There are two hallmark symptoms of OCD, obsessions and compulsions. Individuals with the disorder may experience either symptom or both.

Obsessions are defined as recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive (bothersome), unwanted, and that most individuals find distressing. The child attempts to ignore or suppress such obsessions with some other thought or action (i.e. performing a compulsion).

The following are the most common obsessions

  • an extreme preoccupation with dirt, germs, or contamination
  • repeated doubts (for example, whether or not the door is locked)
  • obtrusive thoughts about violence, hurting, killing someone, or harming self
  • preoccupation with order, symmetry, or exactness
  • persistent thoughts of performing repugnant sexual acts or forbidden, taboo behaviors
  • troubled by thoughts that are against personal religious beliefs
  • an extreme need to know or remember things that may be very trivial
  • excessive attention to detail
  • excessive worrying about something terrible happening
  • spending long periods of time thinking about numbers and sequences
Compulsions are defined by repetitive behaviors or mental acts that the individual feels the need to perform in response to an obsession or according to a rule that must be applied very strictly. The behaviors or mental acts are done in order to prevent, or reduce anxiety related to some dreaded event or obsession. However, the behaviors or mental acts are not connected in a realistic way with what they are aimed at preventing or neutralizing; or are clearly excessive and time-consuming. Note: Young children may not be able to understand, recognize, and identify the aims of their behaviors.

The following are common compulsive behaviors:

  • repeated and excessive hand-washing
  • checking and rechecking repeatedly (i.e., to ensure that a door is locked)
  • following rigid rules of order (i.e., putting on clothes in the very same sequence every day, keeping belongings in the room in a very particular way and becoming upset if the order becomes disrupted)
  • hoarding objects
  • counting and recounting excessively
  • grouping or sequencing objects
  • repeating words spoken by self (palilalia) or others (echolalia); repeatedly asking the same questions
  • coprolalia (repeatedly speaking obscenities) or copropraxia (repeatedly making obscene gestures)
  • repeating sounds, words, numbers, and/or music to oneself

Note: The symptoms of OCD may resemble other medical conditions or psychiatric problems, including Tourette's disorder. Always consult your child's physician for a diagnosis.

How can I tell if my child has OCD?

Many children can have routines that they do in the context of normal development as discussed above. Concern should arise if you note that the thoughts and/or routines that your child engages in become excessive (i.e. taking up large portions of their time) and cause distress; or if the rituals/routines negatively impact your child’s social/interpersonal relationships, academic performance, daily mood, and/or sleep. If any of these signs are present, it is best to seek the advice of a mental health specialist and have your child evaluated.

Is obsessive-compulsive disorder preventable?

Preventive measures to reduce the incidence of OCD in children are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the child's normal growth and development, and improve their quality of life.

What is the long-term outlook for a child with OCD?

A substantial percentage of pediatric OCD cases will become “subclinical” over time, meaning that the symptoms will remit and/or reduce in severity so that there is no impact on daily functioning. For individuals who continue to have symptoms into adulthood, ongoing psychotherapy and medication treatment are recommended to help alleviate the impact that OCD symptoms have on daily life.

A calm, supportive family environment in which parents and/or caregivers actively support the child's coping strategies also should improve outcome.

A substantial portion of individuals with OCD will have a co-occurring psychiatric illness which can complicate the effectiveness of treatment in the child or adolescent.

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