OCD Subtypes Most Commonly Seen in Children and Teenagers
Obsessive Compulsive Disorder (OCD) can present in many different ways, from an extreme fear of getting sick, to intrusive thoughts about about someone being harmed, to time-consuming rituals that can be confusing to those who don’t have OCD.
In children and teenagers, OCD most often presents as anxiety or fear that is atypical for their developmental stage, rigidity around routines and activities, repetitive behaviors or rituals that alleviate their anxiety or discomfort, and irritability or panic when their rituals are disrupted.
OCD can be harder to recognize in young children because they don’t always have the words to describe what’s happening in their minds, or why they’re engaging in a certain behavior. There may be fewer concrete fears about something bad happening, and more of a general feeling of discomfort or distress when rules that their OCD has made up are not being followed.
Below are some of the most common themes, or “subtypes“, of OCD that present in children and adolescents.
Contamination OCD:
Frequent and excessive worry about germs or getting sick (including that someone they love might become sick), which leads to rigid rules around cleaning and/or avoidance of places or objects that might be contaminated with pathogens
Common examples:
“I heard someone in my class cough today, I’m worried their germs got on me and I’m going to get sick.“
“We can’t eat at that restaurant, they had a bad review 3 years ago of someone saying they got food poisoning there.“
Excessive cleaning of hands, clothes, objects, and surfaces (in severe cases, children may become adamant about using strong cleansers, like bleach)
Having rigid rules for family members about how household items are cleaned and stored, or how the family washes or their hands
Avoiding public spaces or enclosed areas where contracting an illness may be likely, or tolerating them with extreme difficulty
Asking parents or other adults for reassurance that they cleaned something correctly (including having a parent watch/supervise while they clean an item or wash their hands)
Checking OCD:
Frequent and excessive worry that an everyday task was not done properly - or at all - which might lead to something bad happening.
Common examples:
Asking a parent, “Are you sure you turned the stove off before we left? The house could burn down if you didn’t.“
“Someone could have snuck into the house while we were gone and is hiding in my closet or under my bed. I need to check before I go to sleep.“
Checking the stove, door, window, etc. multiple times before leaving the house or going to bed
Asking a parent to check for them or with them because they don’t trust their own eyes or memory
Counting OCD:
A strong belief that certain numbers are safe or lucky while others are not, which may lead to doing activities a specific number of times, or avoiding numbers that are unlucky or “bad.“ It can also present as a compulsive need to count nearby objects, even if there is no specific number they’re looking for.
Common examples:
“Three is a lucky number, four is an unlucky number. Therefore I can only eat three chips at a time.”
“I have to walk in and out of the door five times, otherwise something bad will happen.”
Needing to count steps or lines in a wall each time they are present
Symmetry OCD
A strong, intolerable feeling of discomfort when something in their environment is uneven, or when there is an uneven feeling in their body
Common examples:
“I can’t stand when my body feels uneven on one side“
“I have to write exactly in the lines on my paper“
Repeatedly tapping both sides of their body with their hand or against the wall until they feel “even“
Being very careful or deliberate with how they write, play, or complete a chore so that the end result is even or symmetrical
Just Right OCD
Needing to do a task or activity a specific way, according to rules that may or may not make sense to others. Sometimes the task must be done “perfectly,” while other times it must be done in a way that simply feels “just right“ and alleviates an uncomfortable or “incomplete“ feeling in their body.
Common examples:
“I have to get the writing on this report absolutely perfect“
“I’ve washed my hair three times but it just doesn’t feel right“
“I feel uncomfortable when my clothes don’t fit the right way on my body, but I can’t explain how they’re supposed to fit“
Repeatedly doing a task (such as washing their hair or body, practicing handwriting, or chewing food) over and over until it feels “just right“ according to their own standards
Harm OCD
Frequent worry that harm will come to themselves or a loved one, including that they might be the one to cause the harm.
Common examples:
“What if an intruder breaks into our home while we’re sleeping?“
“I’m scared I’m going to hurt the dog, even though I don’t want to.“
Getting flashes of disturbing images of people being shot, stabbed, run over, or otherwise harmed
Avoiding touching knives or other objects that can be used as weapons
Avoiding close contact with family members, friends, young children, or pets
Asking for reassurance that they wouldn’t do anything “bad“
If your child displays any of these behaviors, it might be time to get them assessed for obsessive compulsive disorder.
OCD is more common than parents realize. It takes an average of about 10 years to be properly diagnosed with OCD, as many medical and mental health professionals write off these symptoms as “just anxiety.”
Anxiety and OCD are treated differently, and it’s important that children and teenagers with OCD receive the right treatment. Exposure and Response Prevention (ERP) is the gold standard psychotherapy for OCD. Acceptance and Commitment Therapy (ACT) can be a helpful adjunct to improve treatment outcomes.
Finding a therapist who specializes in treating OCD with ERP can make all the difference in your child’s life.
Evoluer Counseling treats children and teens with OCD and anxiety disorders, offering weekly sessions in person in Sacramento, and virtually across California.
Click here to read more about our approach to OCD therapy for children and teenagers, which includes Exposure and Response Prevention (ERP), and Acceptance and Commitment Therapy (ACT).
Ready to schedule a free 20-minute consultation call?