Obsessive compulsive disorder (OCD) is a type of anxiety disorder. It is characterized by obsessive thoughts or impulses that cause a great deal of anxiety or distress and compulsive, repetitive behaviors. The obsessions are often grounded in irrational or unfounded fears. Yet the anxiety they provoke leads to the development of ritualistic behaviors to cope with the symptoms. The compulsive behaviors can take a great deal of time, disrupting normal routines and interfering with social and family relationships.

The National Institute of Mental Health estimates OCD affects 2.2 million adults in the U.S. Some of the most common types of obsessions include: worry about dirt or germs, worry that bad things will happen if items aren't placed in a certain position or order and fear about losing or accidentally discarding objects that have little or no value. Common obsessions include: repeated hand-washing or cleaning, continually checking that doors are locked or the stove or iron is turned off and hoarding useless objects (like junk mail or newspapers).

OCD in Adolescents and Teens

OCD can occur at any age. Researchers estimate up to three percent of children and adolescents are affected by the disorder. In fact, many cases of adult OCD begin during childhood. Many children also have other mental health issues, like depression, anxiety and tic disorders.

Sometimes children and adolescents understand their obsessions and compulsions are unrealistic, but are embarrassed to admit to or talk about the problem. Andrew Gilbert, M.D., a Child Psychiatrist at the University of Pittsburgh Medical Center (UPMC) says parents should look for patterns of behavior that appear to be excessive or when symptoms are interfering with homework, school and relationships.

In some cases, however, the compulsive behaviors aren't always obvious. Sometimes a child is able to cope in one situation but not in another (for example, being comfortable at home but experiencing obsessions and anxiety at school). The Anxiety Disorders Association of America lists some signs that may indicate OCD in a child:

Rough, red hands

Holes in homework or test papers

Sudden increase in the amount of dirty laundry

Sudden changes in grades or school performance

Isolation from peers

Help is available. Gilbert says OCD in children is typically treated the same way as in adults: cognitive-behavioral therapy, exposure and response therapy and medications. In cognitive-behavioral therapy, a trained therapist helps patients become more aware of their obsessions and compulsions and find better ways to cope.

In exposure and response therapy, a patient is purposely exposed to a trigger (the obsession) and prevented from performing the response (the compulsion) for a certain amount of time. At first, the treatment can produce a great deal of anxiety for a child. So a therapist will often use cognitive-behavioral techniques to help the child cope. As the length of time to an allowed response is extended, the anxiety decreases.

The most common medications for children with OCD are the selective serotonin reuptake inhibitors (SSRIs), like Prozac®, Paxil® and Zoloft®. These medications must be used with caution because use may increase the risk of suicidal thoughts or actions.

Group Therapy

UPMC has one of the few centers in the country that offers a treatment program geared specifically for children and adolescents with OCD. In group sessions, each child works on his/her own particular symptoms. But the common bond of OCD enables the participants to support each other through the therapy.

One tool used in the group session is a "fear ladder." The ladder helps participants rank the severity of their symptoms. The goal is to have children gradually work their way "up the ladder" - or further away from the anxiety. Another tool is the "fear thermometer."

Children sit around a table. Then, each in turn is exposed to a personal obsession, which evokes the anxiety. However, a child is not allowed to immediately perform the compulsion. Initially, the child uses the ladder or thermometer to gauge the level of anxiety and talk about his/her fears. Eventually, the child gets used to the anxious feeling and the symptoms subside.

Gilbert says many children will continue to battle OCD as they grow into adults. Different triggers may arise that provoke anxiety and lead to the development of new compulsive behaviors. While some will eventually need further treatment, Gilbert is hopeful coping skills learned during childhood will reduce the frequency and severity of new obsessions and compulsions in adulthood.

For general information on obsessive compulsive disorder:

American Academy of Child and Adolescent Psychiatry

American Psychiatric Association

American Psychological Association

Anxiety Disorders Association of America

Mental Health America

National Alliance on Mental Illness (NAMI)

National Institute of Mental Health

Obsessive Compulsive Foundation