Obsessive-compulsive disorder (OCD) is characterized by obsessions and/or compulsions that are time-consuming (eg, take >1 hour per day) or cause clinically significant distress or impairment in school, social, family, or other important areas of functioning. The unique features of pediatric OCD include an insidious onset rather than precipitating events seen in adults. Children are less likely to recognize the irrational nature of these symptoms, and the impairment is often reported by parents, caregivers, or teachers.

Obsessions are defined as recurrent, persistent, unwanted, and intrusive thoughts, images, or urges associated with distress or anxiety, which cause the individual to attempt to decrease, avoid, ignore, or neutralize those experiences with another thought or action, such as performing a compulsion. For children, obsessions around harm to family members can lead to feeling that their relationships with family and friends are hazardous.

Compulsions are defined as repetitive behaviors or mental activities that a person...

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