Although movies and series sometimes present OCD in a funny or comical way, the truth is that it’s a difficulty that thousands of adults and children have to deal with every day.

Most of the information we know about this disorder comes from adults, although the problem usually appears, in almost half of the cases, during childhood. Why? Very few children who have an Obsessive Compulsive Disorder ask for help . They believe that they are like that, that they cannot do anything about it. Besides, they often hide the symptoms because they feel confused or ashamed.

Obsessive Compulsive Disorder in children

Children with OCD suffer from obsessions or compulsions that cause them enormous anxiety and discomfort, interfering with their development and their daily lives. Their behaviors are egodistonic, preventing the child from reaching their goals and objectives.

But let’s define those concepts. Obsessions are disturbing thoughts or images (generally violent) that the person, in this case the child, cannot ignore, and that generate in him/her fear and anxiety. They are repetitive and involuntary, interrupting again and again the mental activity of the child.

Compulsions are repetitive acts, mental or motor , that aim to relieve anxiety and discomfort caused by obsessions. Children self-generate this “solution” that provokes only a momentary relief, but in the long run what it does is reinforce the obsession, increasing its intensity and frequency.

In some cases, obsessions and compulsions are related, for example, feeling dirty and washing your hands constantly. Other times, it only seems to be related in the child’s mind, such as fearing that his family will be hurt if he doesn’t snap all his fingers.

Examples of obsessions and compulsions

Some frequent obsessions or compulsions in childhood are: praying a lot of times, to prevent something bad from happening; constantly asking relatives if something has happened, for fear of having hurt someone; or the feeling of dirt and the constant washing of the whole body . With regard to this last obsession, a case that can help us understand how OCD makes the child’s life difficult may be the following.

Case study on childhood OCD

Alfonso is an 11-year-old boy who comes to the clinic brought by his mother, because the latter perceives a drop in his academic performance this last year. His parents are separated and Alfonso lives with his mother. Alfonso’s mother says that he spends his afternoons loafing around (she can’t check, as he works and doesn’t get home until 8); she also says that he goes to bed very late watching YouTube videos. So far everything is normal.

The truth is that, after many sessions, it was discovered that Alfonso did not play “lazy” in the afternoons, nor did he watch Youtube videos. He did not take advantage of the study time because in reality Alfonso had the obsessive thought that every time he went to the bathroom to defecate, he was never completely clean, so he began a stereotyped series of compulsive cleaning rituals that lasted between 2 and a half and 3 hours. The videos he watched on the Tablet were nothing more than a search for information to find ways to go to the bathroom with which he would get as little stain as possible.

Can we imagine the physical and mental fatigue that it takes for an 11-year-old child to repeat a series of 3-hour-long behaviors every day, all surrounded by thoughts, which cause him strong anxiety and from which he cannot escape?

A more difficult disorder to detect

One of the differences between the obsessions of a child and those of an adult lies in the elaboration of the same. An adult knows how to explain them in detail, has built a story around them. For his part, the child can only express “because”, “I can’t stand it”, “it appears because”.

Parents may not know the full extent of their child’s symptoms , because many of them occur in the child’s mind and others are easily hidden or disguised. A mother or father may notice that the child avoids certain things, seems distracted, inattentive or irritable, repeatedly seeks approval or confesses to minor transgressions, or cannot tolerate uncertainty. But often it doesn’t come out clearly, and the child often makes an effort to hide it.

Why do the symptoms appear?

It is a neurobiological disease caused by an imbalance of certain substances in the brain, most notably serotonin. There are several variables that make a child more vulnerable to suffer from this difficulty, although we still do not have enough information to know the weight of each one in the genesis of the problem : genetic predisposition, a style of upbringing based on the constant demand for perfectionism, a stressful life event, such as the death of a family member… However, the data are currently inconclusive.

In children it usually appears around 7 and 12 years of age, although in cases where there is a family history of OCD, it can arise even at 3 years of age. On the other hand, in girls the problem usually originates in adolescence .

The normal child population can also have obsessive thoughts and doubts, the difference is that when a change occurs in the maturity stage, these thoughts are conceived as bizarre and most children discard them, while a very small segment gives them a relevant and central value in their lives.

I hope this article helps to understand a little better the characteristics of OCD in childhood, and to make visible this difficulty that thousands of children have to deal with on a daily basis.