What is the difference between OCD and occasional unusual thoughts or a preference for routine?
Most people experience unwelcome thoughts or images now and then. Similarly, many children and teens, as well as adults, prefer specific routines from time to time.
Children usually express a preference for rituals from about 18 months until around age two to three. These are called age-dependent behaviours and are completely normal. During this time, it is not unusual for children to want to eat the ingredients of their meals in a particular order or have their toys lined up in a certain way, for example.
What separates these preferences and age-dependent behaviours from OCD is a person's ability to dismiss their thoughts (i.e., recognize them as “just a thought”), be flexible with their behaviour, and maintain regular functioning. For instance, someone without OCD would not get upset if their thoughts were interrupted and would not feel compelled (forced) to perform or complete a ritual.
In contrast, people with OCD tend to be very rigid in these situations. If they are interrupted, they will insist on returning to the routine to complete it. Another difference is that completing a pattern, sequence or routine can become very time-consuming.
Impact of OCD on a child's daily life
The main features of OCD include the presence of obsessions and/or compulsions that:
- take up at least one hour of a child's day
- significantly interfere with or impair a child's life at home, at school, with peers and, if they are employed, at work
Impact on family life
If a child has OCD, common effects on the family include:
- disruption of family activities and routines
- parent frustration
- sibling discontent
- arguments
Impact on schooling
At school, a child or teen with OCD can:
- be distracted (because of their unwelcome thoughts)
- have difficulty getting tasks done (because of their prolonged rituals)
- experience medical problems (for example, if they refuse to use school washrooms all day)
- be indecisive
- be consistently late for school or class or refuse to attend
- be unable to use school library books or shared materials for fear of contamination
- experience falling grades
Impact on relationships with peers
OCD in a child can, understandably, be difficult for other children to understand. OCD can disrupt a range of activities between a child and their peers. In turn, this can lead to bullying or to a child being excluded or isolated in more subtle ways.
Long-term effects of OCD
If left untreated, OCD can lead to a range of longer-term social and psychological problems for a child. These include:
- depression and other mental health conditions
- eating disorders such as anorexia or avoidant/restrictive food intake disorder (ARFID), when OCD rituals include eating
- long-term under-achievement at school
- social isolation; difficulty in relationships
- inability to hold regular employment
- a general inability to reach their potential
Further information
For more information about OCD, please see the following pages:
OCD: Treatment with psychotherapy and medications
Resources
The following books and websites have some useful advice about OCD for parents and teens.
Books
Chansky, T. (2001). Freeing Your Child from Obsessive-Compulsive Disorder: a Powerful, Practical Program for Parents of Children and Adolescents. Harmony.
Derisley, J., et al (2008). Breaking Free from OCD: a CBT Guide for Young People and Their Families. London: Jessica Kingsley Publishers.
Dotson, A. (2014). Being Me with OCD: How I Learned to Obsess Less and Enjoy My Life. Free Spirit Publishing.
Jassi, A. (2013). Can I Tell You about OCD? A Guide for Friends, Family, and Professionals. London: Jessica Kingsley Publishers.
Websites
International OCD Foundation (2016). OCD in Kids.
TeenMentalHealth.org (2016). Obsessive Compulsive Disorder.
AnxietyBC (2016). Obsessive Compulsive Disorder.