Obsessive-compulsive disorder (OCD)
for parents and carers
This webpage explains what obsessive-compulsive disorder (OCD) is, who it affects and what can be done to help.
Some people have thoughts, ideas or pictures that come into their mind over and over again. They are difficult to get rid of and can feel silly or unpleasant. These are called obsessions. Some examples of obsessions include:
- “I must count to twenty or something bad will happen”
- worrying about germs and disease
- worrying about things being tidy.
Some people feel they have to do something repeatedly even if they don’t want to or it doesn’t make sense. These are called compulsions. Some examples of compulsions include:
- repeatedly checking that the light is switched off
- washing hands again and again
- counting or repeating words in your head.
Often people try to stop themselves from doing these things, but feel frustrated or worried unless they can finish them. Problems with obsessions and compulsions can cause distress and worry, and can begin to affect young people at home with their families or at school with friends
Many young people have mild obsessions and compulsions at some time, for example having to organise their toys in a special way, or saying good night a certain number of times. This is normal and may be the result of worry due to stress or change.
If you are worried that a young person may have OCD, you need to think about the following questions:
- do the compulsions upset the child?
- do they interfere with the child's everyday life (e.g. school, friends, etc.)?
If the answer to these questions is ‘yes’, it may be that the young person has OCD. If this is the case, you should seek professional advice.
There are many factors that affect whether OCD develops:
- Genes – OCD is a complex disorder. Studies have shown that there are different genetic risk factors involved in whether someone develops OCD. People who have a relative with OCD are more likely to develop OCD than people who don’t.
- Stress – Stressful life events bring it on in about one or two out of every three cases.
- Life changes – Times where someone suddenly has to take on more responsibility, like puberty, moving house or changing school.
- Brain changes – We don't know if it’s a cause, or the result of OCD - but if someone has the symptoms for more than a short time, researchers think that there may be changes in how a chemical called serotonin (also known as 5HT) works in the brain.
- Personality – If someone is a neat, meticulous, methodical person with high standards they may be more likely to develop OCD. These qualities are normally helpful, but can slip into OCD if they become too extreme.
- Ways of thinking – Nearly all of us have odd or distressing thoughts or pictures in our minds at times, like "what if I stepped out in front of that car?" Most of us quickly dismiss these ideas and get on with our lives. But, if someone has particularly high standards of morality and responsibility, they may feel that it's terrible to even have these thoughts. So, they are more likely to watch out for them coming back – which makes it more likely that they will.
There are two treatments that are helpful for OCD:
- Behaviour therapy
These can be given on their own or together. If possible, a young person should have access to both forms of treatment.
- Behaviour therapy starts with an assessment of the problem. This can include the young person and family keeping a diary of the obsessions and compulsions. The aim of the treatment is to teach young people how to be in control of the problem, by tackling it a little bit at a time. The young person designs the treatment programme with the therapist as it is important to be actively involved in planning
- Exposure and Response Prevention (ERP) is when the therapist helps the child to face the things that they fear and have been avoiding. They are taught a wide range of skills to manage the anxiety that OCD creates.Often parents or other family members get very involved in the OCD rituals. Families need to learn about OCD, and also about how to help their child combat it. This can involve parents working with the child and therapist to find ways of helping their child to resist the rituals and being able to say ‘no’.
- Medication can be helpful in controlling the OCD. Unfortunately, many people who improve on medication become unwell again when the medication is stopped. Some people who need medication may have to continue taking it for a long time.
OCD is a common problem, and your GP will be able to help and advise you as to what you need to do. If the young person needs more specialist assessment and treatment, the GP may suggest a referral to a Child and Adolescent Mental Health Service (CAMHS).
If the young person has been unwell for a long time, or their life has become severely affected by OCD, other professionals may need to help too - for example, teachers or educational social workers may be able to help the young person get back to ordinary life at school or college.
"It started without me really noticing it. I got anxious about someone in my family dying – so I began to tap three times, when I got worried, for good luck and that would calm me down. Then I had to do it before I could go to sleep at night –not once but 3 x 3.
When I watched the programme on TV about those germs in hospital it began to get worse. I couldn’t tell my Mum or Dad about it because it sounded so silly. I had to wash my hands all the time because I thought I would pass on an infection and someone would die. It was mainly at home, but then I began to worry that I would catch something at school.
I made my Mum wash my school uniform every day. She tried to say no, but I would get so worked up that she would give in. It came to a head when I couldn’t get to school on time because I was spending hours in the bathroom in the morning. I had to wash my hair three times as well as going through washing in a set order. If I was interrupted because someone needed the bathroom, I had to start again.
Mum got me some help. I didn’t want to be seen as some psycho person, but Dr Roberts was really nice and understood why I was so worked up about everything. That was when I was 14. Now I am 18. It was hard work doing the therapy. It is called CBT. You have to try and work out why you are so anxious and try and control it. Now I am at college and doing a course that I like. I still do some counting, but I can keep it under control."
International OCD Foundation - An international not-for-profit organisation made up of people with Obsessive Compulsive Disorder and related disorders, as well as their families, friends, professionals and others.
OCD Action - National charity for people with Obsessive-Compulsive Disorder and related disorders such as body dysmorphic disorder, compulsive skin picking and trichotillomania.
OCD-UK - A national charity working with and for people with Obsessive-Compulsive Disorder (OCD).
- Heyman, I. (1997) Children with obsessive-compulsive disorder. BMJ, 315, 444.
- Rutter’s Child and Adolescent Psychiatry, Fifth Edition (2008). Publisher: Wiley-Blackwell.
- National Institute for Health and Clinical Excellence: Clinical guideline 31: Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder.
- Great Britain. Office for National Statistics: Census 2001: Population report, United Kingdom, all ages..
Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).
With grateful thanks to Dr Kashmeera Naidoo, Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.
This resource reflects the best possible evidence at the time of writing.