Many children occasionally have thoughts that bother them, and they might feel like they have to do something about those thoughts, even if their actions don’t actually make sense. For example, they might worry about having bad luck if they don’t wear a favorite piece of clothing. For some children, the thoughts and the urges to perform certain actions persist, even if they try to ignore them or make them go away. Children may have an obsessive-compulsive disorder (OCD) when unwanted thoughts, and the behaviors they feel they must do because of the thoughts, happen frequently, take up a lot of time (more than an hour a day), interfere with their activities, or make them very upset. The thoughts are called obsessions. The behaviors are called compulsions.

It’s common to worry about things like germs or to double check that the stove is turned off. But for people with obsessive-compulsive disorder (OCD), these thoughts and behaviors are so severe that they interfere with daily life.

OCD is a mental health condition that causes repeated unwanted thoughts, called obsessions. This can trigger compulsions—the urge to do things over and over to deal with the troubling thoughts. You don’t need to have both to have OCD.

Many people with OCD have a fear of germs or contamination. This can lead to obsessive thoughts about things being “dirty.” Some people may feel a need for things to be symmetrical or in a perfect order. Worries about harm to yourself or others are also common. In some cases, these unwanted thoughts can be violent or disturbing.

“An obsession is an intrusive, distressing thought that usually kids or adults with OCD are able to recognize as a fear that doesn’t make a ton of sense,” explains Dr. Kate Fitzgerald, an OCD expert at the University of Michigan. “But these intrusive thoughts tend to cause them much anxiety.”

People with OCD may develop rituals meant to relieve their anxiety from the thoughts. This could involve behaviors like excessive handwashing or cleaning, arranging things in a certain order, or compulsive counting.

Many of us are a little “obsessive.” So when is there cause for concern? The biggest sign is if these thoughts or habits are making it hard to function in your day-to-day life, explains Fitzgerald.

This can mean problems with family, work, or school. Spending more than one hour a day on thoughts or behaviors can indicate a problem.

You may have heard someone say that they’re “OCD” about cleaning or organizing. But OCD is a debilitating disorder.

“Those terms are just kind of out there in the popular culture without recognizing that true OCD can paralyze people,” notes Fitzgerald. “There are people who can’t work, can’t go to school, can’t function because of the illness.”

People usually develop symptoms of OCD as a child or young adult. Most people are diagnosed by about age 19. But childhood onset of OCD often occurs as early as eight or nine years old.

Scientists aren’t sure what causes OCD. But genetics are likely to play a role. People with a parent or sibling with OCD are at a higher risk for developing the disorder themselves.

OCD is usually treated with antidepressant medication and psychotherapy. One of the most common forms of psychotherapy for OCD involves exposing people to their triggers. Therapists then help people overcome their compulsive thoughts or actions. This form of therapy is called exposure and response prevention.

Although psychotherapy helps many people with OCD, it isn’t effective for everyone. Fitzgerald and her team are trying to learn more about who responds to psychotherapy. Her studies suggest that people with certain patterns of brain activity are more likely to benefit. One day, brain scans or other testing might help match people with OCD to the best treatment.

Is it OCD?

Everyone double checks things sometimes. But a person with OCD generally:

• can’t control his or her thoughts or behaviors, even after recognizing that they’re excessive.
• spends at least one hour a day on these thoughts or behaviors.
• doesn’t get pleasure when performing the behaviors or rituals, although they may bring brief relief from anxiety.
• experiences significant problems in his or her daily life due to these thoughts or behaviors.

About 1 in 100 Americans has been diagnosed with OCD. Half of people with OCD have a severe form of it. People with OCD are at higher risk of other mental health conditions, especially depression and anxiety. Eating disorders are more common in women with OCD.

If your parent or sibling has OCD, you are more likely to have it too. Also, people who were abused during childhood are more likely to develop OCD. Some women with OCD report that their symptoms get worse during their menstrual cycle, during pregnancy, or after pregnancy when hormone levels change.

No one knows what causes OCD. Researchers think that genetics and environment play a role. Researchers are also studying how changes in the structure of the brain in people with OCD might lead to the condition.

Having OCD means having obsessions, compulsions, or both.

Examples of obsessive or compulsive behaviors include:

• Having unwanted thoughts, impulses, or images that occur over and over and which cause anxiety or distress.
• Having to think about or say something over and over (for example, counting, or repeating words over and over silently or out loud)
• Having to do something over and over (for example, handwashing, placing things in a specific order, or checking the same things over and over, like whether a door is locked)
• Having to do something over and over according to certain rules that must be followed exactly in order to make an obsession go away.

Children do these behaviors because they have the feeling that the behaviors will prevent bad things from happening or will make them feel better. However, the behavior is not typically connected to actual danger of something bad happening, or the behavior is extreme, such as washing hands multiple times per hour.

A common myth is that OCD means being really neat and orderly. Sometimes, OCD behaviors may involve cleaning, but many times someone with OCD is too focused on one thing that must be done over and over, rather than on being organized. Obsessions and compulsions can also change over time.

A mental health professional can diagnose OCD. She or he will talk to you about your symptoms, thoughts, and behaviors. The mental health professional will also ask about your family’s medical history.

OCD can sometimes be hard to diagnose, because its symptoms are like those of other mental health conditions, such as anxiety disorders. It is possible to have both OCD and other conditions. Not everyone who experiences obsessions or compulsions has OCD. To have OCD, the condition must cause significant mental or emotional distress and interfere with your ability to achieve everyday tasks at work, school, or home.

On average, most people with OCD are diagnosed by 19 years old. But girls are usually diagnosed later than boys.

The first step to treatment is to talk with a healthcare provider to arrange an evaluation. A comprehensive evaluation by a mental health professional will determine if the anxiety or distress involves memories of a traumatic event that actually happened, or if the fears are based on other thoughts or beliefs. The mental health professional should also determine whether someone with OCD has a current or past tic disorder. Anxiety or depression and disruptive behaviors may also occur with OCD.

Treatments can include behavior therapy and medication. Behavior therapy, specifically cognitive-behavioral therapy, helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. Behavior therapy for OCD can involve gradually exposing children to their fears in a safe setting; this helps them learn that bad things do not really occur when they don’t do the behavior, which eventually decreases their anxiety. Behavior therapy alone can be effective, but some children are treated with a combination of behavior therapy and medication. Families and schools can help children manage stress by being part of the therapy process and learning how to respond supportively without accidentally making obsessions or compulsions more likely to happen again.

It is not known exactly why some children develop OCD. There is likely to be a biological and neurological component, and some children with OCD also have Tourette syndrome or other tic disorders. There are some studies that suggest that health problems during pregnancy and birth may make OCD more likely, which is one of many important reasons to support the health of women during pregnancy.