Whilst we can’t be sure what causes OCD in children, research has put forward several ideas, some of which remain quite controversial.
OCD can be a hugely debilitating illness, often impacting severely on the child’s quality of life. As the symptoms may seem to an outsider irrational or even bizarre, it’s only normal that we question why some children and teenagers have OCD whilst others don’t.
Research has shown that children who have a blood relative with OCD are 57% more likely to have OCD themselves, which suggests there is a strong genetic link. Studies with twins have shown that the genetic link can only be part of the reason though, as it is very rare for both twins to have OCD. It is also thought that if a parent or close relative has OCD, the child may ‘learn’ the OCD behaviour from them and therefore may be more likely to develop OCD by ‘transmission’.
Research has shown that children with OCD have differences in their brain to non-sufferers. One theory is that the part of the brain that is in charge of our primitive aspects of behaviour (flight or fight, anger and bodily functions) does not ‘switch off’ in the same way as someone without OCD. You could consider that in some ways the child remains on high alert, even when there is nothing to be fearful about.
Studies have also shown that there are differences in the serotonin levels in the brain. Serotonin is a really important chemical found in the brain and relevant to many different aspects of our mental health; one of its key roles is managing anxiety levels.
Serotonin acts as a transport system for the messages our brain needs to manage emotions or get things done. For children with OCD, it is thought that the serotonin gets ‘mopped up’ too quickly and therefore the message it was meant to deliver never gets through. This can mean the individual stays at high alert or remains anxious, even when there is no risk. Medications such as SSRI’s (selective serotonin reuptake inhibitors) can be used effectively in managing the symptoms of anxiety and OCD, but many Doctors are reluctant to prescribe them as there have been reports of the dangers they can pose to children and young people.
We all have intrusive thoughts at times, and for many of us these are fleeting or something we can easily diminish. For some however, these intrusive thoughts develop into the obsessions that characterise OCD.
Studies have looked at the characteristics of people with OCD and found that often children and adults with OCD have an ‘overinflated’ view of their personal responsibility. This means that they think that their actions or lack of, will have an impact on often unrelated external factors. So for instance, we might occasionally worry about loved ones having a car crash. Children with OCD may think about this endlessly and feel that they are somehow responsible for this happening. The compulsions come in as a way of ‘preventing’ the obsession from happening, for instance counting down from 100 every time they leave the house to prevent bad things from happening.
Whilst it is thought that stress alone cannot create OCD, it is widely agreed that stressful results can trigger it. A divorce, death, illness, house or school move or change in family circumstance can result in children developing OCD.
Another explanation for OCD in children is that infections such as Strep throat can trigger it in children who already have a genetic tendency. It is thought that the antibodies created by the child to fight the infection can affect the brain – the term for this is PANDAS – Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection. The symptoms of OCD normally start within a week or two of the infection.
Whilst there isn’t a definitive understanding of the causes of OCD, we do know that it is a complicated and powerful illness. Thankfully, treatment in the shape of talking therapies and, for some, medication, can help significantly. As the link between the obsessions and compulsions can be a viscous cycle, it is really important to seek help early.
Clinical Partners is the UK’s largest private mental health partnership, with over 200 clinicians who work with adults, children, families and business every day. If you are concerned about your child or loved one, you can call one of our qualified clinical advisors who will be able to advise you on the best treatment option for your situation. Please call 0203 326 9160 to speak to someone today.
 Toro,J., Cervera, M. et al. Obsessive compulsive disorder in childhood and adolescence: A Clinical study in J Child Psychol Psychiat vol 22, No. 6, pp 1025-1039 (1992)