OCD Subtypes in Children: Types of Obsessive-Compulsive Disorder and Effective Treatments

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by persistent, recurring unwanted thoughts (obsessions) and repetitive behaviors (compulsions). In children, these manifestations vary with age and can significantly impact their daily lives and development, particularly during the teenage years. For instance, children might believe wearing a specific clothing item prevents bad luck. When these persistent thoughts and urges continue, despite attempts to remediate them, it may indicate the need for more significant help from a licensed mental health provider. 

What Are the Various Types of OCD?

While OCD can manifest in many forms, most cases fit into one of four common categories. These four types of OCD can present in children including:

Checking

Checking involves repetitive actions like verifying locks, alarm systems, ovens, or light switches. It can also entail irrational concerns about having a medical condition or illness.

Contamination

Individuals with contamination OCD subtype have an intense fear of encountering germs or dirt or feel compelled to engage in excessive cleaning behaviors, which is sometimes referred to as "obsessive cleanliness disorder." Contamination OCD can also include feeling mentally or emotionally tainted.

Symmetry and Ordering

People with the symmetry and ordering subtype have a strong need for items to be arranged in specific, organized patterns.

Ruminations and Intrusive Thoughts 

Intrusive thoughts OCD includes obsessive, persistent thoughts, which may include disturbing or violent themes.

In addition to these four primary categories, there are many other themes that can become a focus of OCD obsessions and compulsions. There are also a range of other conditions and disorders that share some similarities to OCD. These are referred to as “OCD spectrum disorders” and are thought to exist on a spectrum because they exhibit features of obsessive thinking and compulsive behaviors, but may have their own distinct characteristics, such as body dysmorphic disorder and hoarding disorder:

How Can I Recognize Different Types of OCD in My Child?

Deeply rooted in anxiety, OCD can manifest at any stage of life—from preschool to adulthood—with a higher likelihood of onset during the pre-adolescent phase. 

Indications a child might have OCD

• Fear of dirt, germs, and contamination: An intense fear of dirt, germs, and contamination from people, which can manifest as children often avoiding touching surfaces.

• Concerns about household safety: Persistent doubts concerning household safety, such as whether doors are locked, windows are closed, or appliances are turned off.

• Worries about appearance, organization, and presentation: A preoccupation with appearance, organization, and presentation, such as fixating on the appearance of homework or the symmetrical arrangement of objects, clothing, or food.

• Worries about causing harm: Anxiety related to accidentally causing harm to a parent, sibling, or friend.

• Superstitions: Adherence to superstitions, believing that undesirable outcomes will occur if seemingly unrelated actions are not performed or are performed in specific ways, such as avoiding stepping on sidewalk cracks or engaging in particular rituals a certain number of times.

Compulsions can also develop in a child with OCD. These are recurrent behaviors or mental acts carried out to provide relief brought on by distressing obsessions. 

Common signs of compulsions

• Excessive cleanliness: An incessant compulsion for frequent and intensive washing, bathing, showering, or changing clothing.

• Rituals: Rituals entail the need to execute precise movements or touch body parts in specific ways, often in pursuit of symmetry.

• Rigidity: Rigidity concerns daily routines that may involve strict adherence to specific morning or bedtime rituals.

• Repetitive words or prayers: This compulsion involves the continuous repetition of phrases as a means to ward off perceived negative events.

• Reassurance-seeking: This compulsion encompasses the act of repetitively seeking comfort and validation from parents, teachers, or others as a means to alleviate anxiety.

• Avoidance of perceived threats: This compulsion relates to the avoidance of situations believed to entail the risk of adverse events.

In rare instances, pediatric OCD may have a sudden onset characterized by a rapid change in behavior, mood, and severe anxiety. This abrupt appearance of symptoms is distinct from the typical gradual onset and can be triggered by an infection, such as strep throat, which can confuse the child's immune system into attacking the brain rather than the infection itself. This immune response leads to the abrupt emergence of severe OCD symptoms. When associated with strep, it is known as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS), and for other infections, it is referred to as Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS).

Are There Specific Treatments Tailored to Different Types of OCD?

OCD is generally diagnosed when obsessions and compulsions significantly disrupt a child’s daily life, including social interactions, school performance, and their own self-care. Symptoms usually develop gradually over weeks or months and can onset at various stages of life, though the two primary age ranges for its initial appearance are between 8-12 years old, or during the late teens to early adulthood.

The two typical treatments for OCD are psychotherapy and medications, and often, the most effective treatments are a combination of the two. 

The most common therapeutic approaches for managing childhood OCD subtypes are cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP). A qualified, licensed mental health professional will typically employ these evidence-based therapies to address and alleviate OCD symptoms. Treatment typically involves gradual exposure to obsession triggers, allowing the child to practice anxiety management in a safe environment while avoiding compulsions. 

In more severe cases, a combination of CBT and selective serotonin reuptake inhibitors (SSRIs) may be used. SSRIs reduce anxiety and complement therapy. As children acquire coping skills through therapy, they may require less medication or gradually discontinue its use. Additionally, "booster sessions" for skill reinforcement are common for children with OCD in the years following treatment.

Are There Support Groups or Resources for Children with Various OCD Types?

Support groups and resources are available for families and children with various types of OCD. These aim to provide support, information, and coping strategies for children and their families dealing with OCD. Consulting with a licensed mental health professional can help identify the most suitable resources based on the child's specific needs and location. 

These resources may include:

Local support groups

Many local mental health organizations and community centers offer support groups specifically designed for children with OCD and their families. These groups provide a space for sharing experiences and coping strategies.

Online forums and communities

There are numerous online forums and communities where children and parents can connect with others who have experience with OCD. Websites like the International OCD Foundation (IOCDF) and various social media groups provide a platform for discussions and support.

Books and literature

There are books and educational materials tailored to children and parents to help them understand and cope with OCD. These resources often include explanations, coping strategies, and real-life stories.

Therapist recommendations

Mental health professionals who specialize in OCD can often recommend specific local or online resources and support groups for children and families dealing with OCD.

School-based resources

Some schools may have resources or counselors experienced in helping children with OCD. It's worth discussing the issue with the school's counseling department.

Treatment Centers

Some specialized treatment centers for OCD provide resources for children and their families, including educational materials and support.

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Obsessive-compulsive disorder is complex and can manifest in myriad ways at different stages of a child’s life. Early recognition of its symptoms is often crucial in providing the appropriate level of support and treatment. CBT and exposure and response prevention are typically effective approaches to managing OCD, with medications like SSRIs are many times used in more severe cases. Support groups and resources are available for children and families dealing with OCD, offering valuable assistance and guidance. 

It is important to seek help from mental health professionals to ensure a comprehensive and tailored approach to managing this condition. Handspring Health therapists have expertise in evidence-based treatments for OCD in children, adolescents, and young adults. If you need further support or assistance in helping a child who is experiencing OCD symptoms, don’t hesitate to reach out for a free consultation from a licensed Handspring Health therapist today. 

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