To warrant a diagnosis of OCD, according to the Diagnostic and Statistical Manual of Mental Disorders - IV (DSM-IV) the obsessions and compulsions must be intrusive and severe enough to be excessively time consuming (more than 1 hour a day) and cause marked distress or significant impairment and interfere with normal routine. Although adults recognize that the obsessions or compulsions are unreasonable, children may not yet have the necessary cognitive skills or life experience to make this judgment

If the symptoms in children are severe, time-consuming and interfere with the child’s normal routine, they may cause problems with self-esteem and interfere with friendships and family functioning.