Does OCD start in childhood? Understanding where obsessions and compulsions come from

For those living with OCD, every day can feel like an exhausting, never-ending battle, with intrusive thoughts, obsessions and compulsions all creating a constant cycle of uncertainty. But could looking back to your childhood reveal how the cycle began – and help you move forward?

OCD – Obsessive-Compulsive Disorder – is characterised by an ongoing cycle of uncertainty: intrusive thoughts enter, obsessive beliefs create fear and specific compulsions provide temporary relief until the cycle begins again. While there are many possible reasons behind the development of OCD – and often, it’s a combination of several factors – experts believe certain patterns and attitudes towards uncertainty could begin in childhood.

Many people experience moments of anxiety around uncertainty – but what sets OCD apart is its persistency. ‘Have you ever left the house, only to turn back because you suddenly couldn’t remember whether you’d locked the front door? Replayed a conversation in your mind, searching for reassurance that you didn’t say the wrong thing? Or found yourself repeatedly checking something, despite already knowing the answer?’ asks Dr Jemma Anderson, a specialist educational and child psychologist and founder of educational psychology service, Perceptive.

‘For most people, these moments come and go,’ she continues. ‘The uncertainty feels uncomfortable, but eventually we move on. For others, however, the doubt doesn’t settle. It grows louder, more persistent and increasingly difficult to ignore. The more they try to find certainty, the more elusive certainty becomes. It’s understandable, then, that many people ask themselves: “Why does my mind do this? Could the answer lie, at least in part, in childhood?”.’

Does OCD begin in childhood?

‘As with anxiety and depression, there is rarely one single explanation for OCD,’ Dr Jemma explains. ‘Obsessions and compulsions arise through a complex interaction of genetics, brain development, temperament and life experiences. Childhood does not determine whether someone will experience obsessive-compulsive difficulties, but it can influence the ways we learn to respond to uncertainty, responsibility and perceived threat.’

If OCD is influenced by childhood experiences, a key factor could be how you dealt with uncertainty as a child. ‘One of the most important lessons children gradually learn is how to live with uncertainty,’ says Dr Jemma. ‘Children aren’t born knowing that unanswered questions can wait, that uncomfortable feelings will pass, or that not all worries signal danger. Through countless everyday interactions with trusted adults, they gradually discover that uncertainty can be tolerated.’

‘Of course,’ she adds, ‘children also bring their own unique temperament into the world. Some are naturally more sensitive to uncertainty than others, meaning two children may experience similar circumstances very differently. Our biology and our experiences continually interact, shaping how we make sense of the world around us.’

Mistaking certainty for safety

When fear around uncertainty becomes constant, OCD tendencies can develop. ‘For some people, uncertainty comes to feel especially difficult to tolerate,’ explains Dr Jemma. ‘This may reflect a combination of temperament, life experiences and environments in which they grew up. Whatever the reason, the mind naturally begins searching for ways to create a greater sense of safety. The difficulty arises when the mind mistakes certainty for safety.’

For people living with OCD, it might feel like finding complete certainty is the only way to feel safe and break the cycle – but in reality, uncertainty will always be a part of life. ‘Research consistently shows that intolerance of uncertainty is an important feature of obsessive-compulsive difficulties,’ Dr Jemma continues. ‘While most of us can accept that absolute certainty is impossible, someone struggling with obsessions may feel an overwhelming need to remove even the smallest possibility that something adverse could happen.’

When it comes to compulsions – the actions carried out to temporarily these ease feelings of fear – all rituals are ultimately seeking the same goal. ‘Checking, washing, mentally reviewing conversations, seeking reassurance or repeating actions may look different on the surface, but they often serve the same purpose: reducing doubt,’ Dr Jemma adds. ‘At their heart, they are all trying to answer one exhausting question: “Can I be completely certain that everything is going to be okay?”.’

And this is why OCD is such a vicious cycle – because true certainty can never be found. ‘Unfortunately, certainty is something none of us can ever fully achieve,’ explains Dr Jemma. ‘Although compulsions often bring temporary relief, the doubt soon returns, unintentionally teaching the brain that uncertainty itself is dangerous.’

The reality of living with OCD

OCD is a hugely misunderstood condition, with many people assuming it’s nothing more than keeping your desk tidy or washing your hands regularly. ‘One of the greatest misconceptions about obsessions and compulsions is that they are primarily about cleanliness or organisation,’ Dr Jemma explains. ‘In reality, intrusive thoughts often focus on the things we value most – our loved ones, our health, our relationships or our sense of being a good person. They are so distressing precisely because they conflict with our values.

It’s important to note that experiencing intrusive thoughts does not automatically mean you have OCD. ‘Intrusive thoughts are a universal human experience,’ Dr Jemma adds. ‘What distinguishes obsessive-compulsive difficulties is not the presence of these thoughts, but the meaning attached to them and the urgent need to feel certain that they pose no risk.’

This endless risk management can lead to intense feelings of shame and a fear of being misunderstood. ‘For many people,’ she continues, ‘OCD becomes an intensely lonely experience. Shame often keeps these thoughts hidden, leaving individuals fearful that others will misunderstand what they say about them. Yet these thoughts tell us very little about who someone is, and a great deal more about how frightened their mind has become of uncertainty.’

Looking back to move forward

‘Looking at obsessions and compulsions through a developmental lens is not about blaming childhood or searching for a single cause,’ Dr Jemma explains. ‘It is about recognising that the mind often develops remarkably creative ways of trying to keep us safe. Sometimes those protective strategies become so overworked that they begin to create the very distress they were trying to prevent.’

‘The encouraging news is that change is possible,’ she continues. ‘Evidence-based psychological therapies can help people build a different relationship with uncertainty, not by eliminating doubt, but by learning that uncertainty, although uncomfortable, can be tolerated.’

‘When we stop asking “Why can’t I just stop thinking like this?” and begin asking, “What is my mind trying to protect me from?”, we move away from self-criticism and towards curiosity,’ Dr Jemma concludes. ‘That compassionate shift is often where things can begin to change.’

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