A Parent’s Guide to Anxiety and OCD in Children

If your child is experiencing intrusive thoughts, extreme fears, urges, or rituals, they may be displaying some of the common symptoms of obsessive-compulsive disorder, or OCD.¹ Between 1-3% of children and adolescents are diagnosed with OCD. But children with OCD also have a higher likelihood of having a dual diagnosis or comorbidity – about 70% of children and youth with OCD face other mental health conditions.²

One of the most common comorbidities in kids with OCD is an anxiety disorder.² A dual diagnosis of anxiety and OCD in children can make life complicated for both the parent and child. This comorbid diagnosis can cause significant distress, interfere with school and play activities, and affect how children interact with their family and friends.

But with education, love, support, and a helping hand from your healthcare provider, a lot can be done for your child’s anxiety and OCD.

Can You Have An Anxiety Disorder and OCD?

Around 76% of those with OCD also have a comorbid anxiety disorder.³ This can include separation anxiety, phobias, and generalized anxiety disorder (GAD), which are often characterized by excessive and uncontrollable worry about different events and activities. Some kids may have two or more anxiety disorders along with OCD.⁴

What Parents Need to Know About Anxiety and OCD in Children

The most common symptoms of anxiety and OCD in children include:

• Checking, such as making sure the environment is safe, or that the light is off⁵
• Excessive worries⁶
• Indecisiveness⁶
• An inflated responsibility, or a belief that they are responsible for preventing harm to themselves or others⁶

Co-occurring anxiety disorders and OCD in kids can make treatment more challenging due to overlapping symptoms, greater symptom severity, and increased instances of family conflict.

Mistaking Symptoms

Some symptoms of these two conditions may seem similar, and as a parent, it can be hard to distinguish these symptoms. For example, some of the worries in GAD can be confused with the obsessions in OCD. What differentiates them is that worries are usually more realistic in nature, while obsessions tend to be more irrational and not consistent with the individual’s self-perception.⁷

Symptom Severity

One study showed that comorbid OCD and anxiety disorders in youth is associated with greater OCD severity. The consequences may have a higher impact on children’s everyday activities and relationships.⁸

Potential Impact on the Family Dynamic

Parents of children who have comorbid OCD and anxiety disorders also report higher levels of family conflict. This dual-diagnosis can also lead to a decreased quality of life for the child and the whole family.⁸

Fortunately, there are a variety of treatment options that can mitigate the consequences of the dual-diagnosis.

Treating Anxiety and OCD in Children

Children with psychiatric comorbidity often benefit from several treatment options. These may include medication and therapy such as talk therapy or cognitive-behavioral therapy (CBT).⁹

A dual-diagnosis of anxiety and OCD in children and adolescents is also associated with a greater need for pharmacological treatment due to an increase in OCD severity.¹⁰

The most commonly used meds to treat anxiety and OCD in children are selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) and fluoxetine (Prozac).¹¹ SSRIs act by increasing the amount of serotonin available in the brain. SSRIs can help control obsessions and compulsions and are also used to treat anxiety.

Children with comorbid anxiety and OCD often need higher doses of SSRI,¹² which may increase the chances of having side effects.¹³

Polypharmacy

When treating comorbid psychiatric diseases, it may be necessary to use multiple medications;¹⁴ a practice called polypharmacy. Your child’s healthcare provider may pay close attention to potential drug-drug interactions to reduce the risk of adverse effects.¹⁰

How Can DNA Testing Help Children with Anxiety and OCD?

Not every person reacts the same way to medications. This is due, in part, to differences in each person’s genetic profile. Gene variants may influence how your child responds to treatment, and co-occurring anxiety and OCD may also affect how their body reacts to different medications.¹⁵

Pharmacogenetics (PGx) can help your family’s provider determine which medications and dosing may be most appropriate, based on your child’s genetic profile. By providing valuable insights into how your child’s body may respond to and metabolize medications, PGx testing is designed to minimize the risk of trial and error and side effects when prescribing medications.

For example, if your teenager has a genetic variant of a gene known as CYP2C19, certain SSRIs like escitalopram (Lexapro) may have a greater risk of inefficacy in treating anxiety disorders and OCD due to rapid metabolism, causing suboptimal levels of the drug. Because of this, your healthcare provider may recommend a different treatment option that goes through an alternative pathway.

With this information, your child’s healthcare provider can make more informed treatment decisions.

Genetic Testing for Anxiety and OCD Medications

Genomind’s pharmacogenetic test looks at 24 genes related to mental health treatment, including the CYPC219 gene. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:

• Which medications may be more or less likely to be effective
• Which medications may be more or less likely to have side effects
• How your child metabolizes medications for personalized dosing guidance

The Genomind PGx test can be done at a clinician’s office—or from the comfort of your home. It requires a prescription, and Genomind can help connect you with a verified Genomind provider near you. Get started by filling out this form.

In addition to genetic testing, your healthcare provider will want to determine when two drugs may not work well together. Genomind’s Precision Medicine Software, GenMed✔ Pro™, looks at both gene-drug and drug-drug interactions for 99% of the most commonly prescribed medications. This offers providers a more complete picture and helps avoid potentially harmful interactions. Designed to work with Genomind’s PGx test results, GenMed✔ Pro™ allows healthcare providers to evaluate safer prescribing options with speed and precision.

Managing Anxiety and OCD in Children

Dealing with a dual diagnosis of anxiety and OCD in children can be difficult, and treatment may be more complex. However, PGx testing for anxiety and OCD medication can help with this process, giving your child’s healthcare provider valuable information when making prescribing decisions.

If your child is diagnosed with an anxiety disorder and OCD, consider discussing PGx testing with their healthcare provider. Download our guide for How to Talk to your Provider about PGx Testing.

Sources

1. Common OCD symptoms: What is OCD? (2022)
2. Statistics about youth OCD: Obsessive-Compulsive Disorder in Children and Adolescents (2011)
3. Prevalence of OCD and anxiety disorders: Psychiatric Comorbidities and the Risk of Suicide in Obsessive-Compulsive and Body Dysmorphic Disorder (2020)
4. Multiple anxiety disorders and OCD: Quality of life in children with OCD with and without comorbidity (2014)
5. Checking: Impact of depressive and anxiety disorder comorbidity on the clinical expression of obsessive-compulsive disorder (2012)
6. Other common symptoms of OCD and anxiety in children: Worries and obsessions in individuals with obsessive–compulsive disorder with and without comorbid generalized anxiety disorder (1998)
7. Overlapping symptoms in anxiety and OCD in children: Obsessive–Compulsive Disorder Comorbidity: Clinical Assessment and Therapeutic Implications (2011)
8. Comorbidity associated with greater symptom severity and family conflict: Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder (2010)
9. Background on CBT: Understanding CBT for OCD (2022)
10. Need for pharmacological treatment: Clinical significance of psychiatric comorbidity in children and adolescents with obsessive-compulsive disorder: subtyping a complex disorder (2015)
11. SSRIs for treating OCD: Specialty knowledge and competency standards for pharmacotherapy for pediatric obsessive-compulsive disorder (2021)
12. Need for higher doses of SSRIs: Meta-Analysis of the Dose-Response Relationship of SSRI in Obsessive-Compulsive Disorder (2011)
13. Increased risk of side effects with higher doses of SSRIs: SSRI-Induced Activation Syndrome in Children and Adolescents—What Is Next? (2015)
14. Need for polypharmacy: Predictors of Polypharmacy and Off-Label Prescribing of Psychotropic Medications: A National Survey of Child and Adolescent Psychiatrists (2018)
15. Comorbidity’s effects on medication response: Effect of comorbidity on treatment of anxious children and adolescents: results from a large, combined sample (2013)