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How OCD Changes from Childhood and Adulthood

Anna Charlton
Glen Allen High School

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Introduction
What used to be thought of as a rare and untreatable disease is now widely researched
and known to impact one out of every forty Americans. Obsessive Compulsive Disorder is an
anxiety disorder that is characterized by obsessions, which are defined as intrusive, irrational
thoughts or impulses that repeatedly occur and compulsions, which are defined as repetitive
acts that temporarily relieve the stress brought on by an obsession (Obsessive Compulsive
Disorder, 2015). Additionally, in order to be diagnosed with OCD, the DSM-4 requires that the
obsessions and compulsions take up at least one hour of the persons day or significantly
interfere with the persons normal routine (Watkins & Brynes, 2003). Now that OCD has been
more widely studied it has been discovered that not only adults suffer from the disorder, but also
children as young as five years old. Therefore, in order to best help the wide variety of people
suffering from OCD it is essential to understand the similarities and differences between OCD in
childhood and adulthood.
Symptoms
Children and adults can experience very similar symptoms when dealing with OCD, yet
there can also be slight differences. People with OCD could experience obsessions relating to
germs, sex, or completing a task inadequately. Similarly, examples of compulsions include
washing and cleaning, repeating actions until they are just right, or apologizing excessively
(Wagner, 2009). These obsessions and compulsions can occur with both children and adults, but
some are more common for one age group than another. According to Kelly (2014), it is more
common for children to have obsessions and compulsions that involve their family members or
hoarding and it is less common for this age group to experience symptoms that deal with sexual

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thoughts and behaviors. On the other hand, more common adult obsessions and compulsions deal
with fears of contamination and of harming oneself or others.
According to Wagner (2009), the main difference between children and adults with OCD
is their ability to recognize that what they are doing is abnormal and destructive. Additionally,
according to Watkins and Brynes (2003), An adult generally is at least intermittently aware that
the obsessions or compulsions are unrealistic.However some children, particularly young
ones, may not have the cognitive capacity to understand the nature of the obsessions or
compulsions. Additionally, about 40% of adults and only 33% of children with OCD deny that
their compulsions are driven by obsessive thoughts (Kalra & Swedo, 2009). Therefore, as one
gets older and their brain matures, it is easier for that person to comprehend what is happening.
Furthermore, it has been proven in Kalra and Swedos study that children with poor insight into
their OCD also have a worse prognosis, which can also be carried over into adulthood.
Treatments
While a cure has not been discovered for OCD, there are a few different measures that
can be taken to help people deal with the disorder. The two most common forms of treatment are
cognitive-behavioral therapy and medication. However, doctors and counselors tend to go about
treatment in different ways when dealing with children versus adults. According to Wagner
(2009), CBT is the best treatment for children and should always be attempted before trying
medication. Within CBT there is exposure and response prevention therapy, which is effective
because it teaches people to expose themselves to an anxiety-evoking stimulus and then handle
the situation in a way that is different from what they have trained themselves to do through the
OCD (Watkins & Brynes, 2003). While this strategy is very commonly used for both children
and adults, some slight alterations are normally made. According to Watkins and Brynes (2003),

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young children can benefit by having a basic understanding of what is going on in their brain, so
some hands-on activities can be used to help demonstrate that. Additionally, they are advocates
for utilizing age-appropriate books, such as Brain Lock by Jeffrey Schwartz and Blink, Blink,
Clop, Clop, Why Do We Do Things We Cant Stop? by Maritz and Jablonsky. In these books the
OCD is depicted in an engaging and relatable way. For example, in Maritz and Jablonskys book
the OCD is named OC Flea and is an unattractive, silly but non-threatening creature
(Watkins & Brynes, 2003). An adult would not really benefit from reading this book, but to a
child it helps them visualize what they are dealing with, which can greatly help them in therapy
when trying to picture fighting the bad guy, or the OCD. Another important part of child CBT
is parental involvement, as it has been proved to be a strong predictor of treatment success
(Kelly, 2014). Overall, The main objectives of CBT are identifying the triggers of obsessions
and compulsions and designing personalized exposure and response prevention strategies that
can be practiced outside the therapy sessions (Kalra & Swedo, 2009).
Medication is often used in conjunction with CBT, but rarely by itself. Most people
dealing with OCD are prescribed an antidepressant called a selective serotonin reuptake
inhibitor. According to Wagner (2009), medication should only be used when the symptoms of
OCD are moderate to severe, and warns that symptoms can return with the discontinuation of
medication. Children and adults can be prescribed the same medications, but the doctor just must
take into account the size and metabolism of each patient.
Repercussions
In addition to symptoms there are also repercussions that come along with OCD.
Sometimes the rituals that children force themselves to go through cause them to be late for
school and other activities, which can also cause arguments within the family. Additionally, OCD

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can cause children to spend less time with their friends and family because they are so
preoccupied with completing their rituals. Specifically at school, OCD can affect attention and
focus and completion of tasks (Wagner 2009). Then, once students come home from school,
they complete extensive bedtime routines that can cause them to go to bed late and be tired the
next day, which can lead to feelings of sadness, anger, and explosiveness (Wagner 2009). Adults
can obviously experience these repercussions as well, but responsibilities like full-time jobs and
taking care of children are motivation for them to work through the symptoms and continue on
with their daily routines. One completely universal consequence of OCD is the fact that it can be
a long-term disorder if it is not treated. Without treatment, OCD symptoms can either steadily
increase in intensity, or they can wane and wax over time (Watkins & Brynes, 2003). Also, the
symptoms can change in their presentation. For example, someone can be dealing with
obsessions and compulsions that relate to germs and sickness, but later on can have obsessions
and compulsions that are associated with completing all tasks perfectly.
Associated Disorders
There are several disorders that can accompany OCD that have related symptoms. These
disorders include Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, Excoriation
Disorder, Attention Deficit Hyperactive Disorder, and depression. However, children and adults
tend to have different related conditions with their OCD. Childhood-onset OCD, which is
defined as OCD that develops prior to puberty, is more commonly accompanied by ADHD,
Tourettes Disorder, learning disorders, and Separation Anxiety Disorder (Kalra & Swedo, 2009).
On the other hand, adult-onset OCD is more commonly associated with depression and general
anxiety (Kalra & Swedo, 2009).

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Conclusion
While childhood-onset and adult-onset OCD have many similarities, there are some clear
differences between the two. There are trends that arise with childhood-onset and adult-onset
OCD, as children have a more juvenile mindset that influences their symptoms, treatments,
repercussions, and associated disorders. This research is important, as it will create a better
understanding for those dealing with Obsessive Compulsive Disorder themselves, as well as
those helping another person work through the disorder. Additionally, this research will allow
doctors and counselors to better tailor their treatments to the different age groups, which will
hopefully help people with OCD to lead a more pleasurable life.
Reference List
Kalra, S. K. & Swedo, S. E. (2009). Children with obsessive-compulsive disorder: are they just
little adults? The Journal of Clinical Investigation. Retrieved from
http://www.jci.org/articles/view/37563
Kelly, O. (2014). OCD in children: important differences between OCD in adults and children.
About Health. Retrieved from
http://ocd.about.com/od/typesofocd/a/Childhoodonset_OCD.htm
Obsessive compulsive disorder. (2015). National Alliance on Mental Illness. Retrieved from
https://www.nami.org/Learn-More/Mental-Health-Conditions/Obsessive-CompulsiveDisorder
Wagner, A.P. (2009). Obsessive compulsive disorder in children and teenagers. International

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OCD Foundation. Retrieved from http://iocdf.org/wp-content/uploads/2014/10/OCD-inChildren-and-Teenagers-Fact-Sheet.pdf
Watkins, C. E., & Brynes, G. (2003). Anxiety disorders in children and adults. Northern County
Psychiatric Associates. Retrieved from http://www.baltimorepsych.com/anxiety.htm