The content of the obsessions and compulsions varies among individuals with obsessive-compulsive disorder (OCD); however, there are five themes that are commonly experienced across both children and adults: contamination, symmetry/ordering, forbidden or taboo thoughts, harm, and hoarding. Notably, OCD becomes more gender balanced into adolescence and adulthood. Comorbid diagnoses are common among youth with OCD. Common comorbid disorders include anxiety disorders, tic disorders, attention deficit hyperactivity disorder (ADHD), and major depressive disorder. The etiology of OCD is multidetermined with behavioral, cognitive, genetic, and biological factors being implicated. This chapter describes three successful cognitive behavioral therapy (CBT) interventions: CBT with exposure and response prevention (ERP), family-based CBT with ERP, and cognitive therapy interventions that can be used in conjunction with ERP. Treatment guidelines for pediatric OCD suggest the most efficacious treatment is CBT with ERP, either alone or in combination with pharmaco-therapy for the most severe cases.