Every morning, Sarah takes a long bath and gets dressed before school just like other kids. However, after she's done, she washes her hands and arms for an hour before breakfast. She wants to stop, but her hands just don't seem to feel clean enough and she can't get herself to turn off the water. Sometimes she scrubs her hands so hard that they become red and raw. After she eats, she feels the need to wash again and clean her bedroom until it is spotless.

Usually Sarah rushes to get to school on time. Even if she makes it before the final bell, her days are miserable. Between every class, Sarah hurries to the restroom to wash. She avoids touching doorknobs or handrails, worrying that if she does, she may catch a serious disease. She falls behind in her class work because she needs to keep checking her work over and over. If she needs to wash during a quiz or test, she often gets an incomplete or even fails.

At night, Sarah can't go to bed until she has straightened her already clean room and bathed several times. There's little time for homework. Often she stays up late getting things in her room "just right" and is tired the next day.

Sarah hides her habits. She worries that if others knew what she was doing they'd think she's weird. Sarah knows that the time she spends washing and cleaning could be spent having fun with friends or doing her schoolwork, but she can't stop herself because she has obsessive-compulsive disorder (OCD).

What Is OCD?
Obsessive-compulsive disorder is an anxiety disorder, linked to a kind of "short-circuit" in the way the brain processes worry thoughts. People who have OCD worry a lot about little things. Some, like Sarah, are afraid of getting dirty or catching germs. Others always worry that their parents will get sick or hurt, or they worry about making everything around them perfect all the time. People with OCD worry so much, they can sometimes spend the whole day thinking about these things and trying to make sure bad things don't happen.

Obsessions (say: ahb-seh-shuns) are thoughts that push their way into your head and repeat themselves over and over. They're like the neighborhood bully who threatens you and makes your life horrible.

Obsessions lead to anxiety. These feelings of uneasiness and tension come from a fear that something bad might happen. To reduce their anxiety, people with OCD perform compulsions (say: kum-pul-shuns), which are specific actions repeated over and over. For example, someone obsessed about whether a door is unlocked may keep checking the lock. A person who feels dirty may wash 100 times a day.

Unfortunately, performing the compulsions only provides relief for a short time. And not performing them makes the person even more anxious and worried. People with OCD know that their fears and behaviors do not make sense, but they can't control having them. Sometimes the person does not even know why she is afraid.

Kids with OCD are not alone. In the United States, more than one million children have this disorder. That's about one in every 200 kids. It affects boys and girls equally. Obsessive-compulsive disorder isn't contagious, which means you can't catch it from someone like you can a cold.

What Are the Symptoms of OCD?
Everyone worries now and then. Kids may worry that something will happen to their parents, or they may feel afraid that they will get sick or injured. It's normal for kids to worry about burglars, fires, or earthquakes once in a while. Normal worries can help kids to learn how to be safe and careful. Usually these worries come and go without causing too much distress.

But kids with OCD worry so much it is almost constant. They can't shake worry thoughts, and the brain seems to replay them over and over as the worrying increases. This kind of intense worry thought that doesn't let go is called an obsession. With OCD, obsessions may include worries about:

• germs or dirt
• illness, harm, or injury
• coming across unlucky numbers or words
• things being even or straight
• things being perfect or "just right" in a certain way
• making mistakes or having doubts

Most people have rituals or actions they perform every once in a while, just for "luck." Maybe you tap your pencil three times before beginning a tough math test or sing a certain song just before diving off the starting block at an important swim meet. Perhaps you have a lucky number or even a lucky pair of socks.

But kids with OCD have to perform their rituals over and over to feel protected from unlucky events. When these rituals take over a person's life, they become compulsions. These compulsions may include:

• excessive hand washing or showering
• constant counting (like having to count 25 white cars before entering school)
• touching (like touching every fence post between home and the library)
• checking things over and over (such as doors, locks, or stoves)
• having to do things a certain number of times (like having to try on five dresses before leaving your room)
• arranging things in a very particular or orderly way
• collecting or saving useless things (like pieces of lint

What Causes OCD?
Nobody knows for sure what causes OCD. One thing is certain: kids with OCD have not done anything wrong or bad to get it. OCD and related disorders run in families. Exactly what is passed on in a family to make it more likely for someone to develop OCD is not yet known.

Scientists believe that OCD may be caused by a problem with the way the brain processes messages about fear and doubt. They think there may be problems in communication between the front part of the brain and other parts that use chemicals called neurotransmitters (say: nor-oh-trans-mit-erz) to send signals from nerve cell to nerve cell all over the brain. One kind of chemical messenger is called serotonin (say: ser-oh-toe-nin). Many people with OCD do not have enough serotonin in parts of their brain. Without it, the proper signals or messages may not be sent between nerve cells in the brain. In rare cases, OCD can be triggered by the body's response to a strep infection. When this happens, OCD symptoms appear suddenly and severely.

How Is OCD Diagnosed and Treated?
Many times a doctor will suspect something is wrong with a kid who has OCD. Sometimes a parent will realize a child's compulsions are making her unhappy. Teachers may notice a drop in a student's grades. If any of these people suspect a problem, it's time for the kid to see a mental health specialist like a psychologist (say: sigh-col-o-jest). This is a type of doctor who studies the mind and behavior. He or she will ask a kid, her parent, and perhaps her teachers a lot of questions to see if there are obsessions and compulsions that are more than just normal worries and habits.

If it's determined that a kid has OCD, she can be treated in two ways: medication and behavior therapy. Medicines that affect serotonin often lessen the severity of OCD symptoms and decrease anxiety. But medicine alone doesn't fix OCD. It can help to reduce the symptoms and may make it easier to work hard in therapy. In fact, not all kids with OCD need any kind of medicine. Whether medication is used, getting specialized therapy for OCD by a mental health professional is important. Behavior therapy (also called cognitive-behavioral therapy) is the most commonly recommended therapy for OCD in children. For most kids with OCD, behavior therapy by itself helps them learn to cope with anxiety, to shrink fears and face them, to resist compulsions, and to slowly but surely learn to conquer OCD.

Kids with OCD usually go to therapy about once or twice a week for a while, then less often as they get better. Getting better can take anywhere from a few months to a few years.

What's Life Like for Someone With OCD?
Living with OCD can be very difficult. Compulsions often take up a great deal of time and energy, making it hard to finish homework, do chores, or have any fun. Most kids with OCD know that what they are doing makes no sense, but they can't stop. They may try to hide their problem from family and friends. Some kids find it hard to go to school or make friends.

People may have a hard time understanding because they think it's just a matter of breaking  a bad habit. But the urges can be overpowering and uncontrollable. Some kids report that it feels like a constant, nagging voice inside their head telling them to do certain things, and no matter how much they want to stop those thoughts or behaviors, they can't. It takes over everything.

If you know someone who has OCD, don't tell her what she does is wrong. Instead, be a good friend and try not to judge her. She isn't stupid or crazy. If she isn't getting help, suggest she tell her parent or a teacher. Understand that OCD is like any other illness or disability. Left alone it usually becomes a bigger problem. But OCD is treatable. No one has to suffer from it if they get the help they need.

Reviewed by: D'Arcy Lyness, PhD
Date reviewed: January 2001

Source: KidsHealth www.KidsHealth.com is a project of The Nemours Foundation which is dedicated to improving the health and spirit of children. Today, as part of its continuing mission, the Foundation supports the operation of a number of renowned children's health facilities throughout the nation, including the Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the Nemours Children's Clinics throughout Florida.  Visit The Nemours Foundation to find out more about them and its health facilities for children http://www.nemours.org/no/