Signs & Symptoms


Is your child insisting it has to be just so?

It is one thing to be a bit of a neat freak or to be a tad too organized. It is another when having things out of order causes extreme distress. Your child may obsess about cleanliness or germs. She may wash her hands or use sanitizer repetitively. He or she may have repetitive rituals that do not seem to serve a purpose. Your child may be constantly ‘checking’ for germs or potential dangers. The child may insist on his or her toys being sorted in a perfect order. If the little sister comes in and moves things around, the child may have a meltdown.

The child may say “But I have to,” as he insists on cleaning or organizing something over and over again. He may be scared to go certain places or to eat certain things based on these worries and concerns.

She may have to complete a ritual or routine before just being able to leave the house. You may often be late to places because of your child’s need to be ready or prepared in order to alleviate anxiety.

What do challenges with Compulsions look like?

  • Washing hands too much? To the point that skin is cracked or bleeding?
  • Experiencing extreme anxiety if things are not just so?
  • Often checking things, like whether his toys are lined up properly?
  • Always sitting in the same place at the dinner table?
  • Doing repetitive rituals that don’t serve a function?
  • Repeatedly ‘checking’ for germs; often saying, “I have to!”
  • Not letting it go when things aren’t perfect?
  • Leaving her locker a mess but organizing stuffed animals like a science?
  • Being unable to leave the house unless everything is in order?
  • Seeming to never be happy; always finding something that’s not quite right?

Why is Compulsions happening?

Nonfunctional routines or rituals used to relieve anxiety are referred to clinically as ‘compulsions.’ The underlying problem could be obsessive compulsive disorder (OCD)  or an obsessive-compulsive personality type. OCD is characterized by obsessions over something, such as germs, and corresponding compulsions are used to relieve the anxiety. 


Extreme anxiety and perseverative, obsessive thinking are often the result if compulsions are not carried out. For example, a child might feel extremely anxious if he is not allowed to wash his hands 5 times before leaving the house. This compulsive routine may be alleviating the obsessive worry that his hands are covered in germs. 


It is important to differentiate this symptom from a child’s rigidity or need to have things a certain way for the comfort of routine. If your child’s rigidity is related more to a specific interest and does not necessarily serve the purpose of relieving anxiety, this is generally referred to as a ‘repetitive behavior’ and not a compulsive ritual. 


The important thing to think about with compulsions is the level of difficulty the habit or ritual is having on your child. If your child’s hands are raw and inflamed from constantly washing them, or if you are always 20 minutes late for activities because your son had to turn off every light in the house 5x before leaving, the compulsions could be worthy of treatment. Compulsions are treated with Cognitive Behavioral Therapy and are quite amenable to interventions and therapy.

How can I manage Compulsions at home?

If your child has compulsive behavior that is impacting day-to-day functioning, it is important that you seek professional help. Consider a combination of psychotherapy and medication to treat these symptoms.

At home, support your child with warmth and patience. Do not punish compulsive behaviors.

Work with a professional to expose your child very gradually to feared stimuli like germs. Cognitive Behavioral Therapy is a modality with considerable research to support its effectiveness.

CBT can be paired with exposure response prevention treatments that are slowly introduced in a gradual manner, giving anxiety time to dissipate within the situation. For example, a child with OCD may work to gradually touch something with germs and not wash hands.

The child is going to be slowly and gradually presented with the obsession but be unable to complete the compulsive ritual or thinking pattern.

Then, CBT can address understanding obsessions and anxiety, recognizing worry and fears, and developing healthy and appropriate coping strategies. OCD treatment is generally individual therapy, but parents or family members may be involved to the practice exposure with response prevention.

How can Clear Child Psychology help with Compulsions?

If your child is struggling with this symptom to the point that it is getting in the way of his or her learning, relationships, or happiness, it’s time to seek professional help.

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