“This little piece of paper is going to control my whole life!” he proclaims as he tries to convince his mother to help him remove an insignificant remnant of a wrapper. A scrap that by no means hindered his attempt to get to the chocolate pudding. An unwanted, unshakeable thought but perhaps such logic doesn’t penetrate a 3-year old child. It doesn’t when he turns 5 or 8 or when more candles are added to his birthday cake in a symmetrical manner. Rafael feels compelled to correct the chaos of his surroundings because of his OCD.

Rafael was diagnosed with OCD and High Functioning Autism, also known as Aspergers, at three years old. Obsessive-compulsive disorder (OCD) is a type of anxiety disorder. Obsessions are recurring thoughts. Compulsions are recurrent behaviors.

A child with OCD has obsessive thoughts that are not wanted. They are linked to fears, such as touching dirty objects. He or she uses compulsive rituals to control the fears, such as excessive hand washing. 

As children grow, rituals and obsessive thoughts normally happen with a purpose and focus based on age. Preschool children often have rituals and routines around meals, bathing, and bedtime. These help stabilize their expectations and view of their world. School-aged children often create group rituals as they learn to play games, take part in team sports, and recite rhymes. Older children and teens start to collect objects and have hobbies. These rituals help children to socialize and learn to deal with anxiety.

When a child has OCD, obsessive thoughts and compulsive rituals can become very frequent and strong. They may interfere with daily living and normal development.

Tara: “Step on a crack, break your mother’s back! The first time I heard that stupid rhyme was when I was eleven years old and still in possession of my own thoughts…I heard it while I was brushing my teeth, Step on a crack, break your mother’s back! eating dinner, Step on a crack, break your mother’s back! doing my homework, Step on a crack, break your mother’s back! having a conversation, Step on a crack, break your mother’s back! and falling asleep.

So the last thing in the world I wanted was to think the same thought over and over and over again, especially a thought as uninteresting and a rhyme as stupid as Step on a crack, break your mother’s back. Not that it mattered what I wanted to do or think about. Because not long after I heard that moronic rhyme for the first time, I suddenly couldn’t take my eyes off the sidewalk long enough to cross streets safely.

Unexplainably, and in a state of confused foreboding, I was examining every square of pavement between my house and my school. And I was counting the cracks. Lots of them. At approximately 60 paved squares a block, there were roughly 480 opportunities to break my poor, sweet, understanding, gentle, funny mother’s back. Actually, there were exactly 495 opportunities to break her back. And the idea of life without her, or of her lying in traction for the rest of her life, scared me so much that my upper lip would sweat whenever I thought of it-which I did with alarming frequency.” 

Malcom: He repeated this pattern of words and numbers until he felt a small sense of relief that he would ace his next exam. But the fear would always rise up in his chest again, and he would find himself having to start writing them down just to reassure himself that he was as brilliant as he thought he was.

Unbeknownst to Malcolm, childhood bullying and a verbally abusive father had taken a toll on him. They had affected his levels of confidence about his intelligence. Part of his obsession with these words and numbers had a lot to do with the disparaging remarks he had heard as a bully victim. These early childhood experiences were inevitably part of the pattern of his compulsions.

Lily: “I always knew I was bad. By the age of 13, I had killed someone with a thought, spread untold disease, and spied on my friends without even leaving my house. Only by performing a series of secret routines could I correct my sins. But it was never enough. My wrongdoings cannot be undone. No matter how many times I flick the light switch”

Each child may have different symptoms. These are the most common symptoms:

  • An extreme obsession with dirt or germs
  • Repeated doubts, such as whether or not the door is locked
  • Interfering thoughts about violence, hurting or killing someone, or harming oneself
  • Long periods of time spent touching things, counting, and thinking about numbers and sequences
  • Preoccupation with order, symmetry, or exactness
  • Ongoing thoughts about doing offensive sexual acts or forbidden, taboo behaviors
  • Troubled by thoughts that are against personal religious beliefs
  • A great need to know or remember things that may be very minor
  • Too much attention to detail
  • Too much worrying about something bad occurring
  • Aggressive thoughts, urges, or behaviors

Compulsive behaviors are the repetitive rituals used to ease anxiety caused by obsessions. They can be excessive, disruptive, and time-consuming. They may interfere with daily activities and relationships. They may include:

  • Repeated hand washing (often 100 or more times a day)
  • Checking and rechecking many times, such as making sure that a door is locked
  • Following firm rules of order, such as putting on clothes in the very same order each day
  • Hoarding objects
  • Counting and recounting a lot
  • Grouping objects or putting things in a certain order
  • Repeating words spoken by oneself or others
  • Asking the same questions again and again
  • Repeatedly using four-letter words or making rude (obscene) gestures
  • Repeating sounds, words, numbers, or music to oneself

Causes of Obsessive-Compulsive Disorder

The exact causes of Obsessive-Compulsive Disorder are currently unknown. However, a variety of factors are believed to play a role.


There does appear to be a genetic component to this disorder, as twin and family studies have shown that those who have first-degree relatives are more at risk for developing the disorder.

Brain Structures

Brain studies have also revealed grey matter abnormalities in the brain potentially related to the disorder, including under-activation in areas of the brain related to stopping habitual behavior and areas of the brain that do not respond normally to serotonin (which helps facilitate communication between nerve cells).

PET scans have also revealed elevated activity in areas of the frontal lobes (involved in decision-making) and the basal ganglia in patients with OCD. The basal ganglia is involved in a variety of functions, including motor control, executive functioning, emotions and behavior.


Stressful life events such as trauma, adverse childhood events. Individuals with other disorders like autism spectrum disorder, anxiety disorders, depression or substance abuse may also be more prone to developing OCD.

Treatments for Obsessive-Compulsive Disorder

It’s important to note that rituals only provide temporary relief to the obsessive-compulsive person, not any sense of long-lasting peace. A professional diagnosis and treatment program is needed in order to alleviate symptoms of OCD in the long-term.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for OCD often includes a combination of the following:

  • Therapy with cognitive and behavioral methods. Cognitive methods help a child identify and understand his or her fears. They also teach a child new ways to better resolve or reduce those fears. Behavioral methods help the child and their family make pacts or rules to limit or change behaviors. One example is setting a maximum number of times a compulsive handwasher may wash his or her hands.
  • Family therapy. Parents play a vital role in any treatment process. A child’s school may also be included in care.
  • Selective serotonin reuptake inhibitors (SSRIs). These medicines help raise serotonin levels in the brain.
  • Antibiotics. Your child may need these medicines if his or her OCD is found to be linked to a streptococcal infection.
  • Teens with OCD may also have one or more types of eating disorders. These will also need treatme

Obsessive Compulsive Disorder is not a personality trait, nor a quirk that can be corrected in a child with a few strokes of the cane and severe expressions. This is a common, chronic, and long-lasting disorder in which a person has uncontrollable reoccurring thoughts (obsession) and behavior (compulsions) that s/he feels the urge to repeat over and over again. Be compassionate, allow them to indulge in that itch in their brain but have the empathy to stop it from consuming them completely. 

The very least you can do to someone is reassure and support them during times of anxiety. They could be a hand-washer, a checker, a compulsive disinfector, a ruminator, a tantrum thrower… but they’re also exhausted by the neurotransmitter imbalance in their heads.

Remind them that even though it’s there every second, it doesn’t define or dictate who they are or what they do. OCD doesn’t get that. 





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