Obsessive Compulsive Disorder (OCD) affects at least 1.2% of Americans over the age of 18. That’s 12 out of 1000 people who suffer from OCD.
However, this is likely a severe underestimation. For one, these statistics are nearly two decades old; but they’re the most recent reliable statistics on OCD prevalence.
Moreover, these figures do not account for pediatric and adolescent OCD.
While adults are more likely to be diagnosed with OCD, OCD can develop as early as childhood. Various studies estimate an OCD prevalence of 0.2%-4% in children and adolescents.
Unfortunately, OCD remains widely underdiagnosed in children because children can not seek help the same way adults can. Moreover, children are sometimes misdiagnosed because OCD symptoms in children can be slightly different or atypical than adults.
Therefore, it is important to know how to identify OCD symptoms in children so that your child can get the treatment they need.
Table of Contents
What is OCD?
OCD was formerly classified under the umbrella of anxiety disorders, and many still cite it as such. However, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the “gold standard” for diagnosing mental illnesses— classifies it as a stand-alone disorder.
OCD is characterized by two broad symptoms— obsessions and compulsions:
- Obsessions are constant intrusive and distressing thoughts, images, ideas, or urges. These obsessions are “intrusive” because the sufferer does not want to have them but doesn’t have any control over them.
- Compulsions are repetitive, borderline ritualistic behaviors to neutralize or temporarily soothe the obsessions. The sufferer can feel a lot of anxiety, fear, or discomfort if they do not perform these compulsions.
Obsessions and compulsions can manifest differently for different people with OCD. For example, one person might obsessively wash their hands, whereas another might experience unwanted taboo thoughts. This is why there are different subtypes of OCD, such as:
- Contamination and washing OCD
- Checking OCD
- Symmetry OCD
- Harm OCD
- Taboo thoughts OCD
- Relationship OCD
- Rumination OCD
- Perinatal OCD
There are countless more subtypes, and it is not uncommon to experience different subtypes of OCD simultaneously.
What Ages Suffer from OCD?
While there is certainly a relationship between the development and diagnosis of OCD and age, any age group can suffer from OCD.
OCD is most commonly diagnosed in adults between the ages of 18 and 29, with a prevalence of 1.5%. Furthermore, OCD is diagnosed in 1.4% of people between 30 and 44 years of age and 1.1% of people between 45-59%. OCD prevalence in people over the age of 60 is 0.5%.
On the other end of the spectrum, children as young as four years old have been diagnosed with OCD. However, the average age of childhood-onset OCD is ten years.
When OCD develops at an early age (before puberty), it is known as childhood-onset OCD. Conversely, adult-onset OCD develops at a later stage in life. Moreover, childhood-onset OCD affects boys more than girls, but that ratio flips after puberty hits.
That’s not the only difference between childhood-onset and adult-onset OCD, though.
Childhood Vs Adulthood OCD
For the most part, the phenomenology of OCD in children and adults is similar. However, children with OCD either remain undiagnosed until adulthood or get misdiagnosed with another condition. For instance, a 10-year-old was initially misdiagnosed with schizophrenia and took antipsychotics for two months until he was diagnosed and treated for OCD.
Why is this?
Recall how OCD manifests differently in different people. In other words, the content of obsessions and types of compulsions can change from person to person. As it turns out, these obsessions and compulsions can differ from age to age as well.
Think about it: due to differences in cognition and mental and social development, there are certain things adults may obsess over that children don’t (such as sexuality, self-harm, romantic relationships, or religion).
Other differences in obsessions and compulsions are as follows:
- Childhood-onset OCD develops more gradually and excruciatingly, which is why some clear OCD symptoms are dismissed in early childhood.
- Children with OCD more commonly have obsessions related to the death of their parents or guardians.
- As such, children’s compulsions and rituals revolve around their families and loved ones.
- Children experience hoarding OCD more frequently than adults.
- Childhood-onset OCD signals a greater risk of tic disorders and ADHD.
What Causes OCD in Children?
The exact cause of OCD remains unknown, although some theories have been proposed:
- Genetic factors come into play, as a person with OCD is four times more likely to have another family member with OCD than someone who doesn’t have OCD.
- Some researchers hypothesize that a person with OCD has an entirely different brain structure and activity.
- Chemical imbalances in the brain may perpetuate or worsen the symptoms of OCD.
- Environmental factors such as a volatile household environment can lead to OCD development.
- Some studies have also found a link between childhood trauma and OCD development.
Sudden Onset OCD in Children
Sometimes, children may develop acute OCD symptoms out of nowhere. This sudden-onset “OCD” occurs in about 5% of children, and it’s not actually OCD. Instead, it is a subtype of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).
PANDAS OCD is easily distinguishable from regular OCD vis-a-vis the following symptoms :
- The symptoms of OCD arise abruptly and are severe.
- There is a concurrent presence of additional ADHD symptoms, such as hyperactivity, inattention, fidgeting, etc.
- Sudden mood changes
- Development of insomnia
- Development of separation anxiety from parents/ caregivers.
Furthermore, PANDAS OCD is easily treatable with antibiotics, intravenous immunoglobulin, plasma exchange, NSAIDs, and corticosteroids.
How to Treat OCD in Children
There are two modes of treatment for OCD, and they are usually employed together: Cognitive Behavioral Therapy (CBT) and medication.
Exposure response prevention (ERP) therapy is the go-to form of CBT and treatment for OCD in general. It involves exposing the patient to certain situations that would trigger their OCD, but they can not act on their compulsions. ERP happens in a controlled environment under the guidance of a trained ERP therapist.
When the symptoms of childhood OCD are severe, medication is often prescribed in tandem with ongoing ERP therapy. These are usually classes of anti-depressants and anti-anxiety meds.
Conclusion
We often dismiss children’s antics and annoying behavior, chalking it up to childhood shenanigans. But sometimes, these antics and shenanigans can signal an underlying mental health issue.
Paying attention to the signs of OCD in your children can make a world of difference for successful treatment. Otherwise, the symptoms will likely worsen with age.
But with an early and correct diagnosis of childhood OCD, your child can start the road to recovery.
