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Ask the Doctors: Obsessive-compulsive disorder often begins in childhood

OCD is marked by a stressful cycle of unwanted and disruptive thoughts, images or sensations and repetitive behaviors that become a compulsion.

A craving for symmetry is among the obsessive thoughts often associated with OCD.
A craving for symmetry is among the obsessive thoughts often associated with OCD.
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Dear Doctors: Can you please talk about OCD in kids? We’ve noticed that our youngest daughter, who is 6, is developing some rituals with numbers and bedtime and mealtimes. She gets pretty worked up if one of her brothers keeps her from finishing. Should we be worried?

Answer: Obsessive-compulsive disorder, commonly referred to as OCD, is an anxiety disorder that often begins in childhood and adolescence, though it can arise in adults.

OCD is marked by a stressful cycle of unwanted and disruptive thoughts, images or sensations and repetitive behaviors.

It’s normal for children to develop a few habits or rituals to help ease the steep learning curve of growing up. What sets OCD apart is the intensity and rigidity of the thoughts and rituals. Rather than helping a child cope, these behaviors interfere with daily life.

Obsessive thoughts often focus on a fear of germs, dirt and illness; persistent dread that something bad is about to happen, a fixation on minute details, a craving for symmetry and fears about safety.

Compulsive behaviors are often driven by rigid rules that might revolve around numbers and counting. They can include repetitive actions, such as checking and rechecking that a door is locked or constant hand-washing.

At first, the rituals might soothe a child. But these behaviors tend to take increasingly more time and energy and create a barrier between the child and the rest of the world.

The result is often an increase in worry and anxiety. This can become so severe that children with OCD can develop sleep disorders, become depressed, avoid spending time with others and have trouble leaving the house.

If you believe your daughter’s behaviors fit OCD, speak with your health care provider about having her evaluated. This involves a psychiatric assessment and questions about her behaviors for the adults in her life.

If an OCD diagnosis is reached, the child’s age, mental and physical health and severity of symptoms will determine treatment to help manage the condition. A therapist helps the child identify the fears or worries that drive the behavior and offers alternatives to reduce or resolve them. In some cases, medications are prescribed.

You can find useful information and contacts on the International OCD Foundation’s website: kids.iocdf.org.

Dr. Eve Glazier and Dr. Elizabeth Ko are intenists at UCLA Health.