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Obsessive-compulsive disorder in children: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025

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Obsessive-compulsive disorder is characterized by obsessions, compulsions, or both. Obsessions and compulsions cause significant distress and interfere with academic and social functioning. Diagnosis is based on history. Treatment includes behavioral therapy and SSRIs.
In most cases, obsessive-compulsive disorder (OCD) has no obvious etiologic factor. However, some cases appear to be associated with infections caused by group A beta-hemolytic streptococci. This syndrome is called pediatric autoimmune neuropsychiatric disorder associated with streptococci (PANDAS). PANDAS should be suspected in all children with sudden onset of severe symptoms similar to childhood obsessive-compulsive disorder, as early antibiotic therapy may prevent or reduce long-term sequelae. There is active research in this area, and if PANDAS is suspected, specialist consultation is strongly recommended.
Symptoms of Obsessive Compulsive Disorder in Children
Typically, obsessive-compulsive disorder in children has a gradual, subtle onset. Most children initially hide their symptoms, and when examined, they are found to have been present for several years before diagnosis.
Obsessions are typically worries or fears of some adverse event, such as contracting a fatal disease, sinning and going to hell, or some form of injury to oneself or others. Compulsions are deliberate, thoughtful actions, usually done to neutralize or counteract obsessive fears, such as constant checking and rechecking; excessive washing, counting, tidying, straightening, and more. The connection between an obsession and a compulsion may have an element of logic, such as washing your hands to avoid getting an infection. In other cases, the connection may be illogical, such as counting to 50 to prevent your grandfather from having a heart attack.
Most children experience some anxiety that their obsessions and compulsions are abnormal. Many children are shy and secretive. Cuts and cracks on the hands may be signs that the child is compulsively washing them. Another common symptom is that the child spends an extremely long time in the bathroom. Homework may be done very slowly (due to an obsession with mistakes) or may be replete with corrections. Parents may notice that the child performs repetitive or strange actions, such as checking the door lock, chewing food a certain number of times, or avoiding touching certain things.
Such children frequently and tiresomely ask for reassurance, over-cautiousness, sometimes dozens or even hundreds of times a day. Some examples of reassurance and reassurance include questions such as, “Do you think I have a fever? Is there a tornado? Do you think the car will start? What if we’re late? What if the milk is sour? What if a burglar breaks in?”
Prognosis and treatment of obsessive-compulsive disorder in children
In about 5% of cases, the disorder improves after a few years and therapy can be discontinued. In the remaining cases, there is a tendency for the disorder to become chronic, but normal functioning can be maintained with continued treatment. About 5% of children are resistant to treatment and their lifestyle remains significantly impaired.
In the vast majority of cases not associated with streptococcal infection, treatment usually involves a combination of behavioral therapy and SSRIs. If appropriate centers are available and the child is highly motivated, behavioral therapy may be used alone.