As strange as OCD symptoms are, they don't hold a candle to the treatment. The cognitive behavioral treatment of OCD involves some of the most bizarre and outrageous interventions that you are ever likely to encounter in a therapy office. Most OCD clients are very surprised or even stunned when it is explained to them what they need to do in order to help make themselves better. They sometimes think the therapist is crazier than they feel.
And so something beyond telling is required. Explanations don't seem sufficient when you are being instructed to think and behave in a way that seems contradictory to your goals. It is often hard to "think outside the box," to think nonlinearly.
In the arts, whether we are referring to dance, music, sculpture, painting, writing, poetry, theater, or film making, there are countless examples of an emotion, a struggle, or an experience of some kind, which is communicated indirectly and expressed through the artistic medium. This artistic representation, when done effectively, allows the audience to better understand what is being communicated than if the idea being presented was done so by mere instruction. And so it is with describing the diagnosis and the treatment of OCD.
In terms of children and OCD, parents might not be sure when they should begin to worry. Children, especially younger children, tend to be superstitious, magical in their thinking, and compulsive and repetitive in their behaviors.
They may demand to be told the same bedtime stories night after night, insist that they line up their stuffed animals in a particular order, have a meltdown if the peas touch the mashed potatoes on their dinner plate, and play games such as "step on a crack break your mother's back." These are all healthy attempts to feel a little more in control of one's life when you are a little person living in a world completely dominated by grownups.
But when these rituals become non-functional and non-flexible, when they cause undo and chronic distress to the child as well as the family, then parents might need to consider professional intervention. No one instance or behavior alone may constitute the diagnosis, but if the child is completely unable to control his or her behavior, and is completely inflexible about altering it, and the behavior is excessive to the point of significantly interfering with functioning, whether at school, at home, or during a specific activity such as bathing, eating or getting ready for bed, then that is the time to seek professional help.
The good news is that help is available, and that we in the mental health field have gotten pretty good at helping most people with OCD to a significant degree. We don't have what one would call a cure (yet), but rather we teach children how to manage their OCD, and help parents help their kids to achieve the same goal. They may even get to the point where they seem to have no symptoms, even for a long time, but chances are that the OCD will re-emerge at a later time, especially when the child is stressed due to illness, lack of sleep, or a life change such as a move of residence or the death of a loved one, including a pet.