Children who have OCD struggle with obsessions and/or compulsions. Obsessions are unwanted and intrusive thoughts, images or impulses. Obsessions make kids feel upset and anxious.  Compulsions are actions or rituals kids are driven to perform to get rid of anxiety.  To understand how OCD works, think about a mosquito bite. When you get bitten by a mosquito, it itches, so to make it feel better you scratch. While you scratch the bite, it feels great, but as soon as you stop scratching, the itching gets worse. That is how OCD plays out. When children with OCD feel anxious they will do something to fix it temporarily, however, that ritual makes it worse over time.

Kinds of obsessions and compulsions

Obsessions fall into a variety of categories, including:

• Contamination: Kids with this obsession are sometimes called “germophobes.” These are the kids who worry about other people sneezing and coughing, touching things that might be dirty, checking expiration dates on foods or getting sick. This is the most common obsession in children.
• Magical thinking: This is a kind of superstition, like “step on a crack, break your mother’s back.” For example, kids might worry that their thoughts can cause someone to get hurt or get sick. A child might think, “Unless my things are lined up in a certain way, mom will get in a car accident.”
• The “just right” feeling: Some kids feel they need to keep doing something until they get the “right feeling,” though they may not know why it feels right.  They might think: “I will line these things up until it just kind of feels right, and then I will stop.”
• Scrupulosity: This is when kids have obsessive worries about offending God or being disrespectful to their religion in some way.
• Aggressive obsessions: Kids may be plagued by a lot of different kinds of thoughts about bad things they could do. “What if I hurt someone? What if I stab someone? What if I kill someone?”

Compulsions can be things that kids actively do — like line up objects or wash hands — or things done mentally, like counting in their head. A compulsion could also be an avoidance of something, like a child who avoids touching knives, even flimsy plastic ones, because of a fear of hurting someone.  Compulsions are usually more visible so it is common for parents to be more aware of them than obsessions. Kinds of OCD compulsions include (but are not limited to):

• Cleaning compulsions: excessive or ritualized washing and cleaning
• Checking compulsions: checking locks and windows, checking to make sure a mistake was not made, checking to make sure things are safe
• Repeating rituals:  rereading, rewriting, and repeating actions like going in and out of a
• doorway
• Counting compulsions: counting certain objects, numbers, and words
• Arranging compulsions: ordering things so that they are symmetrical, even, or lined up in a specific pattern
• Saving compulsions: hoarding and difficulty throwing things away
• Superstitious behaviors: touching things to prevent something bad from happening or avoiding certain things
• Rituals involving other persons: asking a person the same question repeatedly, or asking a parent to perform a particular mealtime or bedtime ritual 

This publication was adapted from information from the Child Mind Institute

Reviewed by:  HB M.D., PL M.D.  | 01/2024