OCD affects at least 1% of young people. Obsessions or compulsions can negatively impact on the lives of young people within their family environment, school and with friends. Nearly all children have little worries or fears as a normal part of growing up, without ever having OCD. The time to consider OCD is when these worries take over an hour a day and are particularly distressing for the child.

OCD breaks down into two main parts as the name suggests. The obsession which is the thing the child fears might happen. They may fear for example something bad will happen to their family or pets. The second part being the compulsion which is the ritual they believe they have to carry out to prevent the bad thing from occurring. The child might feel the need to constantly say sorry to God or repeat numbers ritualistically. The stereotypical OCD sufferer will obsess about germs which means the compulsion is to repeatedly wash their hands. The reality of OCD is that the obsessions and compulsions can be both many and varied.

They will carry out these compulsive behaviours in order to lessen the anxiety linked with the obsessions or to stop their negative thoughts from coming true.

However, the relief they feel is temporary often fleeting so they will need to repeat it and so a patterns of OCD behaviours emerge.

The most common obsessions affecting young people with OCD include:

• Fear of contamination
• Fear of dirt and/or germs
• Symmetry, order and accuracy
• Religious obsessions
• Lucky and unlucky numbers (e.g. 666, 13)
• Sexual or aggressive thoughts
• Fear of illness
• Dying or death of a relative
• Self harming
• Suicidal thoughts
• Intrusive thoughts, sounds and/or words  

The most common compulsions affecting young people with OCD include:

• Rituals to avoid harming self or other people
• Repeating rituals, going in and out of doorways, getting up and sitting down, needing to move in a special way.
• Continually checking appliances to make sure they are turned off, checking that a door is shut locked.
• Hand washing, showering and teeth brushing
• Touching rituals, having the urge to touch objects or anything around them
• Hoarding and collecting things (e.g. free leaflets, magazines, bottle tops)
• Counting rituals (e.g. counting backwards or counting your fingers in a specific order)
• Cleaning rituals (e.g. tidying and cleaning the house)
• Ordering or arranging objects
• Avoidance rituals (e.g. won’t stand on cracks in the pavement, won’t swallow as germs are in the saliva, wont touch contaminated objects)
• Protective rituals (e.g. wearing of gloves so hands can’t become contaminated, use feet for turning on lights, or television)

Most of these symptoms above tend to diminish in childhood and change within a spectrum of three to five different obsessions and compulsions through growing up into adulthood if left untreated. (Please refer to the page Treatment for Children). For example, as a child or even an adult you may suffer from a fear of contamination or some other obsession and gradually over the years this may fade and you will start noticing you may have gained another obsession like symmetry or a fear of illness. It is also not unusual for children to have one particular obsession or fear and as soon as you think you’ve beaten that one another one reappears in its place.

OCD DOCTOR

The good news is that many specialists consider OCD to be one of the most treatable mental health conditions and the first step is a visit to your doctor or school nurse. It’s a great idea for parents to make a list of the Obsessions and Compulsions they have noticed their child doing as it can be a very difficult condition to explain, so be prepared. The doctor and/or school nurse should refer your child to the Children’s and Adolescent Mental Health Service (CAMHS) which is a terrific organisation full of specialists who can help and will have seen it all before a thousand times. Your area may benefit from other specialist services of which the GP will be aware. The Nice guidelines will explain your entitlements, you may wish to check out the NICE Guidelines here.