Obsessive-Compulsive

Children with OCD experience either obsessive thoughts or compulsive behaviors.

Obsessions:   Children with obsessions have thoughts or images they can't seem to get out of their minds, or they have impulses to do something that they feel is inappropriate or that intrudes on their lives.  The thoughts, images, or impulses are not just excessive fears or worries about real-life problems.  Over time, the thoughts, images or impulses can build and become more frequent and cause marked anxiety and distress.  The child may try  to ignore or suppress these thoughts, images, or impulses, or neutralize them with some other thought or action, but s/he can't seem to stop them.

Compulsions: Children with compulsions exhibit repetitive behaviors (eg, hand-washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that they feel driven to perform in response to an obsession, or according to strict rules that must be followed.

The behaviors or mental acts are clearly excessive.  They are typically aimed at preventing or reducing distress, or some dreaded event or situation.   Also, even though the child may argue that s/he "just has to" engage in the compulsive behaviors or mental acts, these behaviors and acts are not connected in a realistic way with the outcomes they are designed to neutralize or prevent.

A. Either obsessions or compulsions:

1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress

2. The thoughts, impulses, or images are not simply excessive worries about real-life problems

3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action

4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion).

Compulsions as defined by (1) and (2):

1. Repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly

2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.

Specify if:

With Poor Insight: if, for most of the time during the current episode, the person does not recognize that the obsessions and compulsions are excessive or unreasonable