Obsessive-Compulsive Disorder (OCD) and Related Body-Focused Repetitive Behaviours

INDEX
What is OCD?
Body-Focused Repetitive Behaviours (BFRBs)
Impulsivity vs. Compulsivity
How We Treat OCD and Related Behaviours
When to Seek Support
Frequently Asked Questions (FAQs)

Many children and teens experience habits or rituals at some point, wanting things “just right,” chewing on sleeves, picking at skin, or repeatedly checking something. For some young people, however, these behaviours become distressing, time-consuming, or interfere with daily life. When that happens, we begin to consider conditions such as Obsessive-Compulsive Disorder (OCD) and related body-focused repetitive behaviours like trichotillomania (hair pulling) or excoriation (skin picking).

What is OCD?

OCD involves two key components:

• Obsessions: Intrusive, unwanted thoughts, images, or urges that create significant anxiety or distress.
• Compulsions: Repetitive behaviours or mental rituals performed to reduce that distress or prevent something “bad” from happening.

Children with OCD often describe feeling trapped by their thoughts. Common obsessions in youth may include fears of contamination, illness, harm coming to loved ones, making mistakes, or needing things to feel symmetrical or “just right.” Compulsions might include excessive handwashing, checking, repeating, confessing, counting, or seeking reassurance.

Importantly, children typically do not want these thoughts. They often feel embarrassed or confused by them. Younger children may not have the language to explain what is happening and may instead become irritable, avoidant, or oppositional when rituals are interrupted.

Although OCD used to be classified as an anxiety disorder, it is now grouped in the DSM-5 under Obsessive-Compulsive and Related Disorders because research shows it has distinct neurological and behavioural patterns. That said, anxiety is very much part of the experience — compulsions temporarily reduce distress, which reinforces the cycle.

Without support, OCD can expand over time. Rituals can become more elaborate and begin to interfere with school, friendships, bedtime routines, and family functioning.

Body-Focused Repetitive Behaviours (BFRBs)

Conditions such as trichotillomania (hair-pulling disorder) and excoriation (skin-picking disorder, sometimes called dermotillomania) fall within the same diagnostic category but look different from classic OCD.

These behaviours involve recurrent pulling, picking, or scratching that result in noticeable hair loss or skin damage. Children may pull from the scalp, eyelashes, eyebrows, or other areas. Skin picking may target acne, scabs, or even healthy skin.

Unlike OCD compulsions, these behaviours are not always driven by a specific feared outcome. Instead, they are often:

• Triggered by boredom, stress, or sensory sensitivity
• Performed automatically (without full awareness)
• Used as a way to regulate emotions or tension
• Followed by relief and sometimes shame or frustration

Many children say, “I don’t even realize I’m doing it,” or “I try to stop, but my hands just go there.”

These behaviours are not about defiance or attention-seeking. They are self-regulation strategies that have become hard-wired habits.

Impulsivity vs. Compulsivity

Parents often wonder: Is this impulsive behaviour or compulsive behaviour?

• Impulsive behaviours are typically driven by seeking reward or stimulation and happen quickly without forethought.
• Compulsive behaviours are repetitive actions performed to reduce anxiety, discomfort, or tension.

In children, the line can blur. Many body-focused behaviours include both sensory reward and tension reduction. That is why careful assessment is important; treatment approaches differ slightly depending on what is maintaining the behaviour.

How We Treat OCD and Related Behaviours

The gold-standard treatment for OCD is Cognitive Behavioural Therapy (CBT) with a specific component called Exposure and Response Prevention (ERP). ERP helps children gradually face feared situations while learning to resist compulsions. Over time, the brain learns that anxiety decreases naturally without rituals.

For body-focused repetitive behaviours, we often use Habit Reversal Training (HRT) and related behavioural strategies. Treatment focuses on:

• Increasing awareness of triggers
• Identifying competing responses (e.g., squeezing a stress ball instead of pulling)
• Reducing environmental cues
• Building emotional regulation skills
• Addressing shame and self-criticism

We also work closely with parents. Reassurance, accommodating rituals, or repeatedly helping a child “fix” something may unintentionally strengthen the cycle. We help families shift from accommodation to supportive coaching.

When to Seek Support

It may be helpful to seek an assessment if:

• Behaviours take up more than an hour a day
• There is visible hair loss or skin damage
• Your child avoids activities because of fears or rituals
• Distress, shame, or frustration is increasing
• Family routines are significantly impacted

Early intervention leads to better outcomes. OCD and related behaviours are highly treatable, especially when children feel understood rather than judged.

Most importantly, children are not choosing these patterns. They are responding to internal discomfort in the best way they know how. With the right tools, they can learn new ways to manage anxiety, regulate emotions, and feel more in control.

 Frequently Asked Questions (FAQs)

1. How do I know if my child has OCD or just habits?

Many children develop temporary rituals or habits. Children’s OCD becomes a concern when intrusive thoughts cause significant distress and compulsive behaviours are time-consuming, interfere with daily life, or create avoidance. An assessment can clarify whether behaviours meet clinical criteria.

2. What is ERP therapy for children with OCD?

Exposure and Response Prevention (ERP) is a structured CBT approach where children gradually face feared situations while resisting compulsions. Over time, the brain learns that anxiety decreases naturally without rituals, weakening the OCD cycle.

3. Is hair-pulling or skin-picking part of OCD?

Hair pulling (trichotillomania) and skin picking (excoriation disorder) are related conditions but differ from classic OCD. These behaviours are often automatic and linked to tension relief or sensory regulation. Treatment typically involves Habit Reversal Training rather than ERP alone.

4. When should we seek OCD therapy?

Consider seeking OCD therapy if behaviours take up more than an hour daily, cause visible hair or skin damage, lead to avoidance, increase distress or shame, or disrupt family routines. Early support leads to better long-term outcomes.