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Obsessive-Compulsive Disorder - Symptoms, Causes, Prevalence, Treatment

adolescence ocd child washing common

Mental illness characterized by the recurrence of intrusive, anxiety-producing thoughts (obsessions) accompanied by repeated attempts to suppress these thoughts through the performance of certain irrational, often ritualistic, behaviors (compulsions).

Obsessive-compulsive disorder (OCD) is classified as a mental illness, and is characterized by the recurrence of intrusive, anxiety-producing thoughts (obsessions). The person with obsessive-compulsive disorder repeatedly and consistently tries to suppress these thoughts through the performance of certain irrational, often ritualistic, behaviors (compulsions).


Although there are marked similarities between cases, no two people experience this anxiety disorder in exactly the same way. In one common form of obsessive-compulsive disorder, an exaggerated fear of contamination (the obsession) leads to washing one's hands so much that they become raw (the compulsion). Other common manifestations of OCD involve sorting, checking, and counting compulsions. Checking compulsions seem to be more common among men, whereas washing is more common among women. Another type of OCD is trichotillomania, the compulsion to pull hair. The compulsive behavior is usually not related in any logical way to the obsessive fear, or else it is clearly excessive (as in the case of hand-washing).

Everyone engages in these types of behavior to a certain extent—counting steps as we walk up them, double-checking to make sure we've turned off the oven or locked the door—but in a person with OCD, such behaviors are so greatly exaggerated that they interfere with relationships and day-to-day functioning at school or work. A child with a counting compulsion, for example, might not be able to listen to what the teacher is saying because he or she is too busy counting the syllables of the teacher's words as they are spoken.

These are some of the signs that a child might be suffering from OCD:

  • Avoidance of scissors or other sharp objects. A child might be obsessed with fears of hurting herself or others.
  • Chronic lateness or the appearance of dawdling. A child could be performing checking rituals (e.g., repeatedly making sure all her school supplies are in her bookbag).
  • Daydreaming or preoccupation. A child might actually be counting or balancing things mentally.
  • Inordinate amounts of time spent in the bathroom. A child could be involved in a hand-washing ritual.
  • Late schoolwork. A child might be repeatedly checking her work.
  • Papers with holes erased in them. This might also indicate a checking ritual.
  • Secretive and defensive behavior. People with OCD will go to extreme lengths in order not to reveal or give up their compulsions.

Although people with OCD realize that their thought processes are irrational, they are unable to control their compulsions, and they become painfully embarrassed when a bizarre behavior is discovered. Usually certain behaviors called rituals are repeated in response to an obsession. Rituals only temporarily reduce discomfort or anxiety caused by an obsession, and thus they must be repeated frequently. However, the fear that something terrible will happen if a ritual is discontinued often locks OCD sufferers into a life ruled by what appears to be superstition.


Sigmund Freud attributed obsessive-compulsive disorder to traumatic toilet training and, although not supported by any empirical evidence, this theory was widely accepted for many years. Current research, however, indicates that OCD is neurobiological in origin, and researchers have found physical differences between the brains of OCD sufferers and those without the disorder. Specifically, neurons in the brains of OCD patients appear to be overly sensitive to serotonin, the chemical which transmits signals in the brain. A recent study at the National Institute of Mental Health suggests a link between childhood streptococcal infections and the onset of OCD. Other research indicates that a predisposition for OCD is probably inherited. It is possible that physical or mental stresses can precipitate the onset of OCD in people with a predisposition towards it. Puberty also appears to trigger the disorder in some people.


Once considered rare, OCD is now believed to affect between 5 and 6 million Americans (2-3% of the population), which makes it almost as common as asthma or diabetes mellitus. Among mental disorders, OCD is the fourth most prevalent (after phobias, substance abuse, and depression). In more than one-third of cases, onset of OCD occurs in childhood or adolescence. Although the disorder occurs equally among adults of both genders, among children it is three times more common in boys than girls.


Fewer than one in five OCD sufferers receive professional help; the typical OCD patient suffers for seven years before seeking treatment. Many times, OCD is diagnosed when a patient sees a professional for another problem, often depression. Major depression affects close to one-third of patients with obsessive-compulsive disorder.

In recent years, a new family of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) has revolutionized the treatment of obsessive-compulsive disorder. These drugs include clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft). They work by altering the level of serotonin available to transmit signals in the brain. Thanks to these medications, the over-whelming majority of OCD sufferers (75-90%) can be successfully treated.

In addition to medication, an extreme type of behavior therapy is sometimes used in patients with OCD. In exposure-response prevention therapy, a patient slowly gives up his or her compulsive behaviors with the help of a therapist. Someone with a hand-washing compulsion, for example, would have to touch something perceived as unclean and then refrain from washing his/her hands. The resulting extreme anxiety eventually diminishes when the patient realizes that nothing terrible is going to happen.

Further Reading

Rapoport, Judith L. The Boy Who Couldn't Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder. New York: E.P. Dutton, 1989.

Further Information

The Obsessive-Compulsive Foundation Inc. P.O. Box 70, Milford, CT 06460–0070, (203) 878–5669, (800) NEWS-4-OCD.

Obsessive Compulsive Anonymous (OCA). P.O. Box 215, New Hyde Park, NY 11040, (516) 741–4901.

The Obsessive Compulsive Information Center. Dean Foundation for Health, Research and Education, 8000 Excelsior Drive, Suite 302, Madison, WI 53717-1914, (608) 836–8070. http://www.fairlite.com/ocd.

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about 9 years ago

Wow, i thought i was the only one that counted the letters in sentences.its become so distracting that i've had to confide at work just how paralyzing it can be. i can relate to amandas story because my ritualistic counting began at the age of 11 when my parents divorced and my mothers affair with her now spouse whos a paranoid schizophrenic. there were many childhood traumas after that and i think it was from my brain shutting off the stress and focusing on a self soothing coping mechanism. i actually see the words in my head and i'll group them very quickly by the largest first, down to the smallest. personally, as time consuming and distracting as it is, i think its made me sharper and clever. i love it when it adds up to 10's, 20's, i love 4's adn 5's and anything that adds up to an even number. if the number is uneven like 17, i will add my own words. i love it and hate it all at the same time. when i was younger i remember having tics that would drive my mother mad and cause her to yell at me. i notice the same behaviour in my nine year old now and am probably the best person to understand the situation and make light of it for him. i wish i could find someone to talk to that does the same thing and who gets it.

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over 9 years ago

I count the letters in words and sentences, I've done it probably since i was 10 or 11, and I'm 16 now. I don't count everything I read or hear, but the majority of the time I do count them. Sometimes a certain phrase will stick out to me and I read it over and over again and count the letters. I like when the letters make an even number or a multiple of 5. I also like the number 9. Sometimes this makes reading difficult because I get stuck alot re-reading the same line many times. It also makes it hard to follow along when people are talking because I take sentences and focus on counting the letters. I thought I was the only person who did this up until a couple nights ago I looked it up online. It's very relieving to know I'm not the only one. Another thing I do unrelated to counting is scratching skin, either mine or somebody close to me, if I hear the sound of scrathing on fabric, particularly jeans or bed sheets. Just thinking about the sound makes me gag, and when I hear it I have to scratch skin to make the feeling go away. And if I am unable to scratch skin I feel the need to slide things under my nails, like the corner of a folder or something like that. Alot of my friends think its funny and they'll scratch their jeans or sheets just to bother me. I don't think they really understand how badly it bothers me. There are so many more things I could go on about that I do. At times it's very annoying and really gets to me, but I try to keep it to myself and do things descreetly.

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about 4 years ago

OCD is extremely complex where the etiology of the problems are is numerous as the symptoms manifested To me on one level the "ULTIMATE OF FEAR BASED ON INSECURITY" ONE BLINK OF AN EYE CAN CHANGE EVERYTHING TODAY.

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over 10 years ago

All day i count syllables and words in my head. I must look blank faced when people are talking to me as when they are talking i am counting their words and breaking them up into syllables.

I count steps and I have to finish with my left foot finishing at the bottom or top of the stairs.

Have tried many things to blot it out of my mind but to no evail. It first started about 12 or 13 years ago.

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almost 12 years ago

Counting seemed relatively benign to me. It was always my little secret. I didn't even realize counting steps wasn't normal until I was well into adulthood. Turns out my older brother counts his steps, too. It has its advantages, esp. when going down a flight of stairs with a full laundry basket. One knows when one has reached the end.

However, I have just come to learn that my 7 year old daughter counts. She just told me how many numbers long her nightly lullaby is. I am so sad for her because I just want her to enjoy life and.

My 12 year old boy pulls and pets his hair CONSTRANTLY and that has me very concerned. I don't want to be a nag and have tried suggesting other, less obvious things to touch (like the seam of his jeans).