9 Child and adolescent psychiatry9.7 Disorders in childhood and adolescence
9.7.6 Obsessive-compulsive and related disorders in young people
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic to exams from January 2027.
What OCD is
Obsessive-compulsive disorder (OCD) involves obsessions, compulsions or both. It counts as a disorder when the symptoms take up time, cause distress or get in the way of daily life.
Young children may struggle to describe intrusive thoughts or to see that they are excessive. So assessment includes the rituals you can see and how the family responds to them.
Normal developmental rituals are common. Repetition alone does not separate them from OCD. Developmental rituals are flexible and cause little impairment.
Why it keeps going
A compulsion eases distress, but only briefly. That relief rewards the ritual, so it is repeated, and the underlying fear is never resolved.
Mental rituals include silent counting, reviewing or neutralising. If you see no checking, that does not rule out OCD.
Family accommodation means joining in rituals, giving repeated reassurance or changing routines to prevent distress. Tackle it gradually, without blaming carers.
Related disorders
Disorder | What sets it apart | What to do |
|---|---|---|
Body dysmorphic disorder | Preoccupation with a flaw in appearance that others see as slight or cannot see | Ask about checking, avoidance, missing school and suicidal thinking |
Trichotillomania | Repeated hair pulling causing hair loss, with attempts to stop | Consider awareness and habit-reversal work |
Excoriation disorder | Repeated skin picking causing lesions, with attempts to stop | Assess skin damage and use behavioural treatment |
Hoarding disorder | Ongoing difficulty throwing things away, with clutter and impairment | Consider the developmental context and whether another disorder explains it |
Telling OCD apart from similar problems
Tics are usually driven by a sensory urge. Compulsions more often follow a rule or aim to prevent a feared outcome. The two can coexist.
Autistic routines may give predictability or help with sensory regulation, but autism does not rule out OCD as well.
Body dysmorphic disorder differs from eating-disorder concerns about weight or fatness, though the two can occur together.
Assessment
Explore hidden symptoms, insight, family accommodation and school functioning. Screen for depression, tics and neurodevelopmental conditions, and assess risk.
Treatment
Cognitive behavioural therapy (CBT) with exposure and response prevention, adapted to the young person's development. Involve the family and agree practice between sessions.
If the response is poor, review the diagnosis, how treatment was delivered, comorbidity and practical barriers before escalating.
Selective serotonin reuptake inhibitors may be added after specialist review, depending on age, impairment and previous response. Monitor for activation and suicidal thoughts.
Body dysmorphic disorder is treated with disorder-focused CBT. Specialist assessment is better than pursuing cosmetic procedures as the answer to the preoccupation.
Course and relapse
Symptoms may fluctuate or stay hidden. Less distress does not always mean the rituals and avoidance have gone.
A relapse plan covers early warning signs, renewed family accommodation and access to further help. If difficulties continue into adulthood, plan the transition.