Fear of Throwing Up: A Parent’s Guide to Emetophobia in Children

Fear of throwing up, also called emetophobia, is a common and challenging problem for kids and teens.

Nobody likes throwing up. It’s only natural to want to avoid being sick. But what do you do if you’re the parent of a child who really, really, really does not want to throw up: not now, not ever? Unlike many other common childhood fears (ghosts, clowns, monsters under the bed), anxiety about vomiting can seem pretty logical—at least on the surface. But for some kids, anxiety about throwing up grows past what’s typical and starts to get in the way of daily life.

This extreme fear of vomiting is called emetophobia, and it’s one of the most common phobias experienced by young children. Frustratingly for parents, it can also be one of the trickiest to diagnose and treat!

If it feels like your life is being consumed by your child’s increasing worries about getting sick, there is good news. There are therapy techniques that are proven to help kids with emetophobia get back to living happier, less anxious lives. In this guide, we’ll cover the signs and symptoms of emetophobia that set it apart from a passing childhood phase. We’ll also discuss how it develops, what you can do to support your child, and how therapy can help.

How Do I Know if My Child Has Emetophobia?

Children with emetophobia have a fear of vomiting that goes above and beyond the discomfort a person would typically feel about throwing up. It’s common to be nervous about throwing up during an illness, but kids with emetophobia are preoccupied by their worries all the time, even when they’re healthy.

If your child has emetophobia, you may notice them going to great lengths to avoid places, activities, or things that they associate with throwing up. You might also observe your child repeatedly saying or doing things that they think will make it less likely that they’ll get sick.

Most people with emetophobia start developing their fear in early childhood: the average age of diagnosis is around 9 years old. While kids of any gender can have emetophobia, it’s more commonly diagnosed in girls than in boys.

All kids go through phases, and if a child’s worries are just a passing phase they will likely resolve on their own after a few days or weeks. Emetophobia is different. It grows and worsens over time. You may notice that your child’s list of avoidances gets longer and more generalized. For example, rather than staying off one specific rollercoaster where she once threw up, now she avoids all rollercoasters, as well as any vehicle she worries will be too bumpy.

Signs and Symptoms of Emetophobia in Children

Excessively avoiding people, places or activities that could cause illness is a common symptom of emetophobia in children.

Kids with emetophobia experience anxiety symptoms when they start thinking about the possibility of throwing up. To cope with their fear, they may avoid things that they believe could put them at risk of throwing up—even if it doesn’t logically make sense to do this. They might also repeatedly ask for reassurance or repeat behaviors that reduce their anxiety and make them feel more safe from the risk of throwing up. Here are some examples of anxiety, avoidance, and repeated behaviors to look out for:

Anxiety Symptoms:

• Overwhelming worries that are hard to control

• Panic symptoms, like sweaty palms, racing heartbeat, or shaking

• Dread before entering a situation that your child associates with throwing up

• Feeling sick to your stomach (anxiety can cause nausea, which sets off a vicious cycle!)

Avoidance Symptoms:

• Refusing to eat certain foods, either because your child once threw up after eating them or because your child fears they could cause nausea (too rich, too close to expiration date, etc.)

• Staying away from places where your child has previously thrown up or seen someone else throw up

• Avoiding activities that could cause nausea, like rollercoasters

• Keeping away from sick people, doctor’s offices, or hospitals due to a fear of catching germs

• Refusing to take medications that list stomach upset as a possible side effect

• Difficulty saying words like “vomit” or “threw up”

Repeated behaviors:

• Repeatedly asking for reassurance that they will not throw up

• Excessively washing hands

• Compulsively checking expiration dates on food or medications

• Repeatedly checking for bodily sensations like a gag reflex or stomach pain

• Staying close to a trash can or barf bag

• Eating slowly, cutting food into small pieces, or otherwise changing eating habits to avoid nausea

If you’re noticing several of these signs or symptoms of emetophobia in your child, check in with your pediatrician or a children’s therapist.

What Triggers Emetophobia?

Like most anxiety disorders, emetophobia is probably triggered by a combination of genetics and stress. There’s no one singular thing that causes emetophobia to occur, and it’s nobody’s fault: there’s nothing you could’ve done as a parent to prevent it.

Anxiety has a strong genetic component and tends to run in families. If your child has biological relatives who struggle with anxiety, there’s an increased chance your child will naturally have a heightened anxiety response, too. Even if nobody else in the family has emetophobia, simply having other anxiety disorders in the family tree can put a child at increased risk.

Even with a genetic predisposition for anxiety, there’s usually some kind of trigger or event that sets a child’s emetophobia into motion. Many children start showing symptoms after getting sick and throwing up. However, it’s also possible for emetophobia to be triggered by seeing someone else throw up, or even just having the sensation of choking or gagging.

These kinds of stressful events could have any child feeling worried or stressed for a little while. But kids who are already anxiety-prone may have a harder time brushing the event off and moving on. Instead, their experience with vomiting sticks with them and triggers recurring worries and attempts to avoid throwing up again.

While unlikely to cause emetophobia, parents may also notice that their child’s symptoms get worse after any stressful life change, like a move, the birth of a new sibling, or starting at a new school.

Do Children Grow Out of Emetophobia?

Symptoms can get much better with treatment, but it’s unlikely that a child will outgrow their emetophobia without help from an adult.

If you’re in the thick of it with emetophobia, you may be wondering if your child—and you—will have to cope with this debilitating fear of vomiting for life. The thought of a lifelong diagnosis can be a scary prospect: how can you enjoy a happy childhood when you’re struggling this much?

Generally speaking, kids won’t grow out of emetophobia on their own. One a child’s anxiety symptoms are this severe, they need help from parents and professionals to get back on track. In fact, research suggests that kids with emetophobia who don’t receive treatment tend to struggle with emetophobia into adulthood.

There also isn’t great data available (at least that I’ve found) about how many kids with emetophobia are 100% cured of their worries. This is probably because kids with a fear of vomiting often have other forms of anxiety they deal with, as well, like generalized anxiety or OCD.

I realize this all sounds a little hopeless. It isn’t! There’s good news: while emetophobia can be tricky to treat, especially without help, it can get better. Therapy can help kids and their parents gradually face the situations that trigger fears of vomiting, without needing reasssurance or special treatment.

Kids can become more confident in their ability to handle their anxiety on their own. When this happens, worries may not disappear entirely, but they become a passing annoyance instead of a debilitating fear.

How Can I Help My Child With Fear of Vomiting?

Kids with a fear of vomiting absolutely benefit from therapy with a professional. However, if you’re just starting out on this path and still searching for a therapist, there’s a lot you can do on your own to help your child. Parents play a huge role in their child’s recovery from emetophobia. Changing how you respond to anxiety can help your child cope better with their worries and prevent symptoms from snowballing.

The most important thing you can do to help your child with their fear of vomiting is to be mindful of how you are changing or adapting the way you do things to keep your child from experiencing fear. Nobody wants to see their child suffering, and it’s only natural to want to reassure a worried kid or take them away from an anxiety-provoking situation. However, when a child has an anxiety disorder like emetophobia, preventing a child from facing their fear head-on makes symptoms worse over time.

In therapy, we call this accommodation: families learn to change their ways over time to accommodate and “make room” for a child’s anxiety. While this might appear to help in the short term, over time you’ll find the anxiety takes up more and more space. Its list of demands grows: instead of one reassurance, your child may need many. Throwing out expired crackers once may lead to repeated requests to check expiration dates on everything in the fridge.

You may realize that you’re already doing a good deal to accommodate anxiety, and that’s okay. You don’t need to suddenly remove all the supports you’re offering your child. A therapist can help you gradually pull back on accommodation so your child feels empowered to face their fears, rather than overwhelmed by them.

Here’s some other quick tips to support your emetophobic child at home:

• Educate your child about their diagnosis: knowing that there’s a word to describe this problem and that many others have experienced it can help a child feel less alone.

• Practice daily relaxation skills with your child during calm moments. This can help them better manage overall stress, and will better equip them to use skills the next time they’re anxious.

• Listen to and validate your child’s fears, rather than rushing to reassure them that nothing’s wrong. Phrases like “I’d really scared, too, if I thought I was going to throw up in front of all my friends” can go a long way in helping your child feel heard.

• Once you’ve validated the feeling, ask your child questions to help them think logically about their fear. For example, how many times have they thrown up at school? Have they felt this anxiety before, and has it correctly predicted that they would throw up? Even if they did vomit, would it really be the end of the world?

• Keep an eye on how you’re accommodating anxiety, and be careful not to give in to any more of the anxiety’s demands. You can even try to gradually reduce your accommodating over time by setting gentle limits on how much support you provide your child: for example, offering only 3 reassurances per day.

Is Fear of Vomiting Related to OCD?

Excessive cleaning due to a fear of germs can be a symptom of both OCD and emetophobia in kids and teens.

There’s a lot of overlap between emetophobia (fear of vomiting) and OCD. For some kids, fear of vomiting may be a standalone phobia. For others, however, it can be part of a bigger picture that includes other symptoms of obsessive-compulsive disorder.

Children who have emetophobia without OCD may have a more straightforward fear of vomiting. While they’re likely to avoid situations that could prompt them to throw up, they’re less prone to associating things with throwing up in a superstitious or illogical way. As an example, a child without OCD might avoid hanging upside down or riding a tilt-a-whirl, but they probably wouldn’t think twice about wearing the same outfit they wore the last time they got sick.

On the other hand, kids who fear throwing up due to OCD are more likely to make these kinds of mental connections, and avoid anything that feels somehow linked to a time that they or someone else threw up. You may also notice more compulsive behavior from your child, such as repeatedly checking labels, frequent handwashing, or needing to keep a trash can or bucket nearby.

If you look at your child’s overall history, you may notice that their fear of vomiting is part of a larger trend: maybe they’ve had other intense, recurrent fears in the past that have also resulted in needing to repeatedly say or do things in a certain way. This is also a good sign that OCD could be a better, more helpful diagnosis for a child’s struggles.

Either way, OCD and emetophobia have a lot in common: they both involve recurring, uncontrollable worries as well as repeated behaviors to manage the anxiety. Because of this, the same therapy techniques that work well for OCD can help kids with emetophobia feel better, too.

How Do You Treat Emetophobia in Children?

Some common child therapy approaches, like play therapy and traditional talk therapy, may not work particularly well to help kids with emetophobia—at least not on their own. Kids with emetophobia need more than just a listening ear to help them express their feelings. They also need someone who can help them gradually face their fears, so that they can prove to themselves (and their anxiously wired brains) that things are rarely as bad as they seem.

Exposure and Response Prevention, also called ERP, is a special form of therapy that was designed to help kids with obsessive compulsive disorder tame their recurrent worries and break the cycle of compulsive behaviors that go with them. It’s a version of cognitive behavioral therapy (CBT), which teaches anxious people to use specific coping skills in the present, rather than spending a lot of time understanding the past.

In ERP therapy, you and your family might learn the following skills:

• An understanding of how anxiety works in the brain

• Relaxation techniques to physically calm down your body

• How to notice and “talk back” to anxiety when it gives you exaggerated or illogical worries

• How to support your anxious child without giving into their anxiety’s demands

• Strategies to gradually face fears, starting small and working your way up, without avoiding or trying to “fix” the anxiety

• How to prevent anxiety from spiraling out of control in the future

While treatment won’t solve your child’s emetophobia problems overnight, it can absolutely help in the short-to-medium term. Families who attend therapy regularly and follow up with at-home practice often notice significant improvement in a matter of weeks or months. Importantly, therapy also helps kids to maintain their progress over the long-term, making it less likely they’ll need to return to counseling in the future.

Therapy in Charlotte, NC for Kids with a Fear of Throwing Up

Treatment with ERP therapy can help Charlotte-area kids recover from emetophobia and live life without fear of vomiting. Photo courtesy of Skylar Ewing via Pexels.

If you’re in the Charlotte, North Carolina area and looking for therapy for emetophobia, I may be able to help. I’m a children’s therapist who specializes in helping tweens and teens navigate life with anxiety. As you’ve probably guessed by the length of this blog post, I spend a lot of time thinking about anxious kids and what we can do to make their lives easier.

I got trained in ERP and CBT therapy for anxiety and obsessive-compulsive disorder due in part to my own experiences with childhood OCD. These are the therapy approaches I wish I’d had access to growing up, and I hope they can help kids like yours feel better faster.

My child therapy office is located in Davidson, convenient to families in the Lake Norman area or North Charlotte. If you can’t manage the commute, I also see children for online therapy and find this format works really well for many middle and high schoolers. If you’re even further afield, I can work with families throughout the states of North Carolina, New York, and Florida. I also have an online coping skills course available for download wherever you live.

Ready to get started? Contact me here.

The Most Common Types of Childhood Anxiety: Forms, Prevalence, and Symptoms

Childhood anxiety is increasingly common, but often overlooked. Learn the 5 most prevalent types of anxiety in this post.

Anxiety isn’t exclusive to adults: children can experience it, too. Childhood anxiety, while often underestimated, is a very real and prevalent concern. Research suggests that 1 in 8 American kids suffers from some form of anxiety, and that 25% of kids will have symptoms at some point during their teen years. We also know that childhood anxiety is on the rise: some studies show that anxiety rates have doubled over the last few years, possibly due to a combination of pandemic stress, social media exposure, and world events.

As a therapist, what concerns me most is that many of these children—40%—are not getting treatment for their anxiety. And as a parent, I imagine you want to make sure you’re not missing any symptoms! It’s perfectly normal for kids to experience stress and worries in the course of day to day life, and it’s not always easy to tell when those more typical worries are evolving into something more.

In this guide, I’ll cover the 5 most common anxiety disorders experienced by children. You’ll learn the basics of each anxiety type, including its prevalence, common symptoms, and examples of how these symptoms might look in kids. We’ll wrap up by talking about how you can make sure your child gets effective help if they’re struggling with anxiety.

1. Specific Phobia: Most Common Overall (and Rarely Discussed)

How Common Is It? Hands down, this is the most common anxiety disorder that affects children and teens—and yet I rarely see content about it online! Around 7-9% of children have a diagnosable phobia, and the National Institute of Mental Health says that 19.1% of teens will have a phobia at some point in their lives!

What Are the Symptoms? Children with this disorder have an overwhelming fear of a particular thing or situation—hence the “specific” part of the name. Their fear is out of proportion to the trigger: often, the thing or scenario they’re afraid of is not actually dangerous at all. Children with phobias will go out of their way to avoid being around or even thinking about the thing that scares them.

Examples of Phobias in Kids: Animals, blood, needles, clowns, and bugs are all very common phobias in kids and teens. However, any object, animal, or situation can become the source of a phobia. Here are a few examples:

• Sofia and her mother are in a standoff about scheduling her annual physical. Sofia is terrified of needles and doesn’t want to get vaccines or a blood draw during her doctor visit. Last year she was only able to cope by holding her mother’s hand, but since then she’s avoided even talking about getting a shot.

• Even though he’s never been bitten by one, Jackson is terrified of dogs. He won’t visit the houses of friends who have dogs unless they are kept outside while he’s there. If he encounters a dog while walking in the neighborhood, he makes the family turn around and take a different route.

• Cecilia has asked to stay home from an upcoming family vacation because she dreads flying on airplanes. She often has panic attacks while on the plane, and needs a lot of support from both her parents in order to get through. The trip is still weeks away, but Cecilia is already getting anxious about the flight.

Good to Know: It’s common for kids to experience temporary fears after watching a scary movie, having a negative or traumatic experience, or even after participating in Halloween events. These fears tend to resolve on their own in days or weeks, whereas phobias stick around and may even worsen over time.

2. Generalized Anxiety Disorder (GAD): Prevalent in Tweens and Teens

A child or teenager who is overwhelmed by frequent and excessive worries may be suffering from Generalized Anxiety Disorder, which is prevalent in older kids. Photo by Leah Kelley via Pexels.

How Common Is It? Generalized Anxiety Disorder (also called GAD) is one of the most common forms of childhood anxiety, especially for older kids. Estimates vary, but approximately 2.9-4.6 percent of American kids would qualify for this diagnosis.

What Are the Symptoms? Kids with GAD experience overwhelming, frequent worries about a variety of subjects, like school, health, safety, and family. The worrying occurs most days and gets in the way of a child’s life, potentially making it harder to focus at school or go to bed at night. Kids with GAD often complain of bodily symptoms like muscle tension, headaches, and stomach aches, and may feel irritable, as well.

Examples of GAD in Kids: If your child or teen is dealing with Generalized Anxiety, these examples may feel familiar to you:

• Julian has a hard time unwinding at night because he can’t seem to turn off his worried mind: each night, he vents about a variety of subjects to his mom including school shootings, homework stress, and letting down his team in basketball. He knows he worries a lot, but he’s still not sleeping well.

• Maya often stops by the school nurse’s office complaining of headaches or tummy aches, but doctors haven’t found anything wrong. At home she often seems tense—physically and emotionally—and often snaps at her mom. Things are calm in Maya’s life, but she often asks “what if” questions about worst-case scenarios.

• Lulu has always been a worrier: the topics change, but the habit of worrying remains the same. Recently, though, things have taken a turn: Lulu is worrying so much that her attention drifts from her work at school. She’s having a hard time focusing, and her grades have dropped a bit.

Good to Know: Kids with GAD often have other mental health diagnoses, too. GAD is common in children with ADHD, depression, and other types of anxiety like Separation Anxiety.

3. Separation Anxiety Disorder: Common in Young Children

How Common Is It? Separation anxiety is the most common form of anxiety in young children. About 2-5% of kids under the age of 12 experience it. Older kids can have separation anxiety, too, but it’s not quite as common.

What Are the Symptoms? Kids with separation anxiety are fearful of being away from their parent or primary caregiver. They often worry that something bad will happen to themselves or their loved one while they are apart. It’s common for kids to miss their parents, but for children with this disorder, the fear is so intense that it can cause physical symptoms or prevent them from participating in age-appropriate activities.

Examples of Separation Anxiety Disorder in Kids: The main symptom of separation anxiety is pretty clear—kids are nervous to be away from Mom or Dad! Even so, this disorder can look quite different from kid to kid. Here are a few examples:

• 12-year-old Bella is the only one of her friends who has never been on a sleepover. She hates feeling left out, but the idea of being away from her mom overnight is just too frightening. Every time she considers going, she imagines having an emergency while she’s gone, without her mom there to help.

• Oliver started preschool this year but hasn’t attended very many times. He often tells his mom he has a stomach ache in the morning, and asks to stay home. His mom has noticed these tummy aches only appear on school mornings, and never on the weekend. Oliver has a harder time at drop off than most of his friends, and takes longer to recover from his upset.

• Jaci’s mom has worked from home for years, and just started going back to the office a few days a week. Jaci has an epic tantrum every time her mom has to leave the house. When asked, Jaci said she worries her mom will get into a car accident on the way to work and won’t come back.

Good to Know: Some separation anxiety is a normal —and even healthy—part of child development. To qualify for a diagnosis of Separation Anxiety Disorder, a child’s symptoms need to be long-lasting (more than a month) and be more intense than what is expected given a child’s age.

4. Social Anxiety Disorder: Not Just Shyness

Public speaking is a comon trigger for Social Anxiety Disorder, one of the most common forms of anxiety affecting children and teens. Photo by Rica Naypa via Pexels.

How Common Is It? Most estimates agree that between 3 and 6% of kids have Social Anxiety Disorder, making it one of the most common forms of childhood anxiety. It tends to affect teens more than younger children, and may be more common in girls than in boys.

What Are the Symptoms? Children with Social Anxiety Disorder aren’t really afraid of socializing: they have an intense fear of being embarrassed, humiliated, or judged by others. They may avoid activities where they could be observed or judged, refuse to participate in class, or worry excessively about offending other people. Physical symptoms include blushing, trembling, and an increased heart rate.

Examples of Social Anxiety in Kids: A kid can be friendly and outgoing and still experience severe social anxiety in certain situations. Here are some examples of social anxiety signs to look out for:

• Jeremiah arrives home from school starving every day because he refuses to eat in the cafeteria with his peers. The idea of people watching him eat makes him anxious. Although he enjoys sports, he’s started to hang back in gym class due to concerns that his classmates will be watching him there, too.

• Natalia’s biggest worry in life is that other people are judging her or talking about her behind her back. She describes feeling like she’s being watched when she’s riding the bus or walking in the halls at school. Her worries have gotten so bad that she dreads the ride to school in the morning and class changes during the day.

• Although he’s an excellent student, Hugo asks to stay home whenever he’s due to present a project in class. As soon as he gets to the front of the room his hands become sweaty, his body shakes, and he feels so lightheaded he worries he could faint.

Good to Know: A history of being bullied, trouble with social skills, and general shyness can all contribute to developing social anxiety. However, plenty of kids with Social Anxiety Disorder don’t have any of these risk factors.

5. Obsessive-Compulsive Disorder: Frequently Overlooked

How Common Is It? Less common than others on this list, OCD is estimated to affect around 1-3 percent of children. Technically, it’s also not quite an anxiety disorder: it gets its very own category in the DSM-5, the manual therapists use to diagnose mental health conditions. Due to its sneaky symptoms, however, OCD is commonly overlooked or mistaken for other forms of anxiety.

What Are the Symptoms? OCD involves the presence of unwanted and upsetting thoughts, called obsessions, as well as repetitive behaviors, called compulsions. Kids with OCD get stuck in a vicious cycle of obsessive thoughts or worries, which they try to manage through their compulsive behavior. Common obsessions include fears of contamination, harm, or moral wrongdoing, while compulsions may manifest as repetitive hand washing, checking, or counting.

Examples of OCD in Children: OCD in real life doesn’t always look the way it does in the media. Kids and teens with OCD are no more likely to be clean or organized than anybody else! To add to the confusion, some compulsive behaviors are invisible: mental rituals like counting, checking, and praying aren’t always noticeable to others. A child with OCD may experience difficulties like these examples:

• Nina is very concerned about locking the front door whenever her family leaves the house, for fear that a robber could break in while they are away. Nina meticulously locks the door and checks it several times before heading out. Within a few minutes, though, she doubts whether she really locked the door, and often returns home to double check.

• Sasha learned about germs and handwashing during Covid, and got very worried about possibly having germs on his hands during that time. Since then, his handwashing habits have gotten more frequent and more extreme. Sasha often leaves class to wash his hands, and his skin is chapped and dry from frequent washing.

• Gracie has repeated worries that she might have said or done something during the day to offend or upset her friends. In order to help herself feel better, she confesses anything she fears might have gone wrong to her mom. Gracie’s mom wants to be supportive, but the confessing is happening more and more often, even though Gracie knows she didn’t really do anything wrong.

Good to Know: Kids with OCD are often aware that the thoughts they’re having are “weird” or unusual. This causes a lot of distress, and sometimes prompts children to avoid sharing worries or try to disguise their compulsions.

Treatment for Children and Teens with Anxiety Disorders

Treatment is readily avialable for all of the most common forms of childhood anxiety—and it can really help kids get back to enjoying their lives without worry. Photo by Jonas Mohamadi via Pexels.

The statistics around childhood anxiety are intimidating: so many kids are suffering, and relatively few are getting help! Knowledge is power, however, and being able to identify when a child’s symptoms go above and beyond “normal” worries is a great first step toward supporting an anxious child. There are many treatment options available to help kids manage anxiety and get back to living a healthier, happier life.

Cognitive Behavioral Therapy is often considered the “gold standard” for childhood anxiety treatment because it has loads of research to back up its effectiveness. CBT therapy tends to be skills focused, with an emphasis on solving problems as they exist now rather than delving into the past to figure out their origins. Kids in CBT therapy can expect to learn coping skills to relax their bodies, deal with unhelpful worries, and face the fears they may be avoiding in day-to-day life.

Play therapy is another popular treatment option, especially for younger kids who may not feel comfortable sitting still and talking to a strange adult about their problems. Young children naturally use play to work through their feelings and understand the world around them. Play therapy allows children to tap into this innate ability, rather than putting all the emphasis on verbalizing thoughts and feelings. In play therapy, you can expect your child to use make-believe, art, and imaginative play to express themeslves and work through their feelings over time, with support from a counselor who knows how to interpret their activities from a psychological perspective.

I offer both play and CBT therapy in my Davidson, NC office, and also meet virtually with clients throughout North Carolina, Florida, and New York. If you’re looking to get your child started in anxiety therapy, you can reach out to me here.

What’s the Difference between an Intrusive Thought and a Normal One?

Many kids and teens wonder if they’re experiencing intrusive thoughts. Keep reading to learn more about them, and how they differ from more “normal” thoughts and ideas. Image by Liza Summer via Pexels.

As an elder milennial therapist, I’ve decided I don’t need TikTok in my life. I have plenty of apps and screens stealing my attention as it is! Instead, I behave like a responsible adult: I wait for all that TikTok content to make its way over to Instagram, where I consume it a few weeks (or months) late. This is how I discovered that, apparently, intrusive thoughts became kind of A Thing on TikTok for a while this summer.

Suddenly, my feed was awash with memes about “letting intrusive thoughts win.” Who would have guessed that this humble psychological symptom would ever enjoy such fame? Although the memes have slowed down, mentions of intrusive thoughts in my therapy office have not. So, I figured it was time to talk about intrusive thoughts: what they are, why they happen, and what makes them different from other, more “normal” thoughts.

Can You Really “Let the Intrusive Thoughts Win?”

Before we dig into intrusive thoughts, let’s talk about the meme. Maybe you’re an elder milennial, like me, who doesn’t have TikTok and somehow missed this entire phenomenon. Or, maybe you’ve found this article many years from now, when the intrusive thought’s 15 minutes of fame is nothing but a distant memory. Let’s take a journey back in time to this strange cultural moment in the summer of 2023…

According to the website Know Your Meme, catchphrases like “He/she let the intrusive thoughts win” and “Intrusive thoughts won” are “used to caption memes in which people, usually celebrities, exhibit behavior that breaks social norms. In memes, intrusive thoughts are typically confused with impulsive behavior.” Basically, these memes usually feature video of someone doing something kind of random or weird, usually to comedic effect. Said something awkward on live TV? You let the intrusive thought win. Hit a pane of glass with a hammer to see what would happen next? Intrusive thought won.

As an OCD therapist (and a person with OCD), am I offended by these memes? No. I am also a human being with a sense of humor. But they’re not a very accurate portrayal of intrusive thoughts. As Know Your Meme wisely points out, many of these memes show examples of impulsive behavior, as opposed to an intrusive thought.

It’s really common for a person to act on an impulse. It’s much less common for someone to act on an intrusive thought. In fact, that’s kind of an intrusive thought’s whole deal: people really, really don’t want to do what the thought is telling them to. And in almost every case, the person wins over their thought.

Intrusive vs. Impulsive: What’s the Difference?

An impulsive thought happens when we get the urge to do something without reflecting on cause and effect. We’ve all had these moments where we react in a knee-jerk way, without considering whether or not it’s actually a good idea. Most of us are more likely to act impulsively when we’re overwhelmed by emotion: think about the last time you blurted something unfortunate when you were angry.

Generally speaking, impulses are urges that, on some level, we want to act on, even if we know it might not be a great idea. Someone swipes a cookie off the plate because it’s too tempting to resist. A toddler runs off into traffic because they don’t have the self-control to hold themselves back. Curiosity gets the best of that Instagram guy, and he hits the car window with the hammer. Intrusive thoughts can be good, bad, or neutral, but usually they are fleeting. If you ignore them, they go away and never return.

Intrusive thoughts, on the other hand, are almost always negative. In fact, they’re often beyond negative: they’re dark, frightening, or embarrassing. They aren’t always realistic, either: they can be pretty illogical and bizare. Unlike an impulsive thought, intrusive thoughts sometimes repeat themselves. Even if you succeed in ignoring it or pushing it away once, it may pop up again when you least expect it.

Most importantly, intrusive thoughts are usually the total opposite of what a person wants to do in real life. A peaceful person may find themselves having violent thoughts, or a caring person may experience cruel thoughts about a loved one. People who suffer from intrusive thoughts are usually horrified by them. They may worry that they’ll somehow lose control and act on their unwanted thought, even though it’s the last thing they’d ever want to do.

Okay, So What Is an Intrusive Thought?

Intrusive thoughts are sudden, unwanted thoughts that are upsetting to experience, because they go against a person’s actual wants and desires. Photo by Andrew Neel via Pexels.

An intrusive thought is an unexpected, unwanted thought, image, or idea that makes the thinker feel uncomfortable. These thoughts pop into the brain on their own, and they’re not something a person is trying to think about. Because they’re outside of our conscious control, people often feel like these thoughts are “weird” in some way, almost like they have a mind of their own.

Intrusive thoughts often feel out of character, and may go against the thinker’s morals and values. They can sometimes be illogical or bizarre, leaving a person wondering why on earth they’d ever think such a thing. These thoughts are usually negative and cause upset for the person having them, although this can range from mild discomfort to extreme distress, disgust, or fear.

Intrusive thoughts often fall into one of the following “taboo” categories. These tend to be subjects we don’t feel comfortable thinking about, which makes the thoughts extra disturbing when they show up:

• Violence, aggression, and hurting others

• Sex, puberty, and sexuality

• Germs and illness

• Bad things happening to yourself or others

• Doubt about whether something was done correctly

• Doing something “wrong” or immoral

• Doing something that goes against your religion or angers God

Some intrusive thoughts are a one-time occurrence. Other thoughts repeat in the thinker’s mind, showing up over and over again. As you can probably imagine, this can cause a lot of stress.

Examples of Intrusive and “Normal” Thoughts

I’ll share some examples here of how an intrusive thought might look when compared to a similar, more typical thought. Please keep in mind that these are just examples and that intrusive thoughts come in many shapes and sizes! The quality of the thought—the fact that it pops up when you don’t want it to—is a big part of what makes it intrusive.

“Normal” thought: I should wash my hands before dinner.
Possible intrusive thought: Maybe touching that expired yogurt container got food poisoning germs on my hands, and now I’ll throw up.

“Normal” thought: What if I get a bad grade on tomorrow’s test?
Possible intrusive thought: What if I scream out a swear word in the middle of the test tomorrow?

“Normal” thought: I’m mad at my sister.
Possible intrusive thought: Having an image come to mind of pushing your sister down the stairs, for no reason, when you’re not angry.

“Normal” thought: Now that I’ve said my prayers, I can go to bed.
Possible intrusive thought: What I did something bad today that I don’t remember, and now God is mad at me?

“Normal” thought: My mom is picking me up from soccer practice tonight.
Possible intrusive thought: Unexpectedly picturing your parent’s car crashing.

Sometimes it can help to see an example in writing, especially if you think you may be suffering from intrusive thoughts yourself. If one or more of these thoughts felt familiar to you, you’re definitely not alone. Many people have intrusive thoughts—probably way more than you’d guess.

Does Having Intrusive Thoughts Mean You’re Crazy?

Intrusive thoughts can make you feel out of control, but they don’t mean you’re going crazy. They’re a really common experience! Photo by Liza Summer via Pexels.

You may have noticed in my example section above that I put the word “normal” in quotes. That’s because even though intrusive thoughts feel extremely abnormal, they’re actually incredbly common. A 1995 study found that 90% of people report having intrusive thoughts, which means it’s actually crazier not to have them. As uncomfortable as they are, intrusive thoughts are just part of the human experience.

I explain intrusive thoughts to kids in my therapy office like this: imagine your teacher is making you write 100 essays a day. From the time you wake up to the time you go to bed, you’re just writing essay after essay. With all that practice, you’d probably come up with a few pretty good ones. But a lot of them would be mediocre at best. And some of them would be absolute garbage. How could they not be? You’re writing 100 a day!

We have way more than100 thoughts a day. The average person has around 60,000 thoughts. With a number that high, some of them are bound to be less than awesome. Intrusive thoughts are the brain’s equivalent of a burp or a fart. They’re just a little poof of randomness that our brain hands to us asking “I dunno, is this anything?”

So if 90% of the population is having these thoughts, why isn’t everyone panicking? Why aren’t the intrusive thoughts winning? Here’s the deal: most people barely notice their intrusive thoughts. The thought pops up, the person thinks “Huh, weird.”, brushes it off, and moves on with their day. They know it’s not something they really want to do, so they don’t take it seriously. It’s only when people have trouble setting their intrusive thoughts aside that they start to cause problems.

Does Having Intrusive Thoughts Mean You Have OCD?

Having the occasional, fleeting intrusive thought doesn’t mean you have a mental health problem. Like I mentioned above, it’s just part of being human. However, intrusive thoughts can be part of several different conditions. In these cases, the intrusive thoughts tend to be frequent and overwhelming to the point that they start to interfere with a person’s daily life.

Intrusive thoughts are best known as a symptom of Obsessive Compulsive Disorder, or OCD. People with OCD have a much harder time disregarding their intrusive thoughts. They may start to question whether the thought could be true, or if having the thought in the first place means they’re a bad person.

The intrusive thoughts show up over and over, and they cause so much anxiety that the OCD sufferer is willing to do just about anything to make them go away. This can lead to a vicious cycle of repeated thoughts or worries—called obsesions—and repeated behaviors or rituals—called compulsions. Unfortunately, the more a person gives in to their compulsive behavior, the worse the obsessive worries tend to get.

Intrusive thoughts can show up as a part of other conditions, too, such as:

• PTSD

• Anxiety Disorders

• Depression

• Eating Disorders

If your child’s intrusive thoughts are happening often and causing a lot of distress, it’s worth speaking to a therapist to see if an underlying condition could be causing the problem.

Therapy Can Help Kids and Teens with Intrusive Thoughts

Therapists can help kids with intrusive thoughts learn to take them less seriously, so the thoughts don’t feel so overwhelming. Photo by Julia M Cameron via Pexels.

Intrusive thoughts are freaky. They are weird, they’re unpredictable, and they can be difficult to ignore. But they don’t have to take over your life! If you’ve taken anything away from this post, I hope it’s this: intrusive thoughts are all bark but no bite. They’re not as powerful as they feel, and they can’t compel you to do something you don’t want to do.

We have great therapy options to help kids with intrusive thoughts and OCD. Exposure and Response Prevention was designed specifically to help people cope with their OCD symptoms. It’s a specialized version of CBT, a popular, skills-based therapy approach that has helped people of all ages manage many forms of anxiety.

If you need help for a child or teenager with intrusive thoughts, take a look at the International OCD Foundation’s searchable database to find a therapist near you who has completed ERP training. You can even look for therapists who’ve gotten specialized education in how to practice ERP therapy with kids. You may want to consider broadening your search to include therapists throughout your state, if online therapy is an option for you.

If you live in North Carolina, New York, or Florida, I may be able to help. I’m a children’s therapist trained in pediatric ERP therapy—and I was also diagnosed with OCD as a kid. I’ve been on both sides of the OCD therapy equation, so I know exactly how hard it is for my kid clients to face their fears. I meet with kids in-person in my office in Davidson, North Carolina, and online with families throughout these three states where I’m licensed.

Looking to get started in therapy? Reach out to me here, or check out my About and FAQ pages to learn more about me and my work.

How Can I Help My Minor with OCD?

OCD symptoms often develop for minors during the tween or teen years, and most people are diagnosed before age 25.

If you’re looking for help for your minor child with OCD, you’re not alone. It’s common for OCD symptoms to first show up in childhood: two of the most common times to develop OCD are during the tween years or the late teen years. In general, most people with OCD start noticing symptoms before age 25.

Research suggests boys tend to devleop OCD at an earlier age than girls do. However, every kid is different. For example, I’m a children’s OCD therapist who was also diagnosed with OCD as a child, and my symptoms started at age 7.

Regardless of your child’s age, your support as a parent is really important. Kids—especially young ones—need their parents to be involved in the therapy process, and this is especially true when it comes to OCD therapy. The good news is that your support will have a huge, positive impact on your chid’s recovery from OCD. In this post, you’ll learn 5 simple ways you can help your minor child—and yourself—through OCD

Identifying OCD Symptoms in Minors

It’s not always easy to identify OCD symptoms in children. Kids are often aware that the worries OCD gives them are unusual, and will try to mask their symptoms as a result They may feel embarassed, ashamed, or afraid of the thoughts they’re having. They don’t want other people to know about these weird thoughts, so they cover them up instead.

Also, a child’s OCD symptoms might not fit the mold of what we expect OCD to look like. We might envision a very neat, orderly person who’s focused on avoiding germs or keeping things organized. In reality, OCD can look many different ways, and the signs are often very subtle. It’s entirely possible for a child with OCD to be messy, disorganized, or totally unworried about dirt or germs.

People with OCD have two things in common: obsessive thoughts and compulsive behavior. An obsession is an unwanted thought, worry, or mental image that pops up at unwanted times. It’s hard to get rid of, and causes a lot of anxiety or distress. In order to deal with these obsessions, OCD sufferers feel like they have to do something to alleviate their anxiety. This repeated behavior is called a compulsion.

Common obsessions for kids with OCD include:

• Worries related to getting sick, throwing up, or contracting germs

• Fear about somehow losing control and doing something bad, like hurting themselves or someone else (even though they don’t want to)

• Thoughts that if they don’t do something just right, something terrible could happen

• Worries about bad things happening to loved ones

• Doubts about whether or not they may have misbehaved or done something wrongj

• Worries about sexuality or being gay in children who aren’t otherwise questioning their identity

You may notice compulsive behaviors like these in your minor child with OCD:

• Checking and-rechecking that they’ve done something, like turned off a light switch

• Creating rituals that have to be done exactly the right way, such as a specific process for washing hands or a rigid bedtime routine

• Excessive cleaning, showering, or handwashing

• Repeatedly asking for reassurance about things, even after they’ve been given an answer

• Confessing bad thoughts or possible misbehavior to a parent

• Repeatedly touching or counting objects, or repeating actions to make them symmetrical (like tapping one leg and then the other)

The tricky thing about OCD is that compulsions never permanently get rid of an obsessive worry. This means that people get stuck in a cycle of doing their compulsive behavior over and over in order to feel some sense of relief.

Five Ways to Help Your Minor Child with OCD

As a parent, you can help your child understand their symptoms and work together as a team to combat OCD.

Now that we’ve reviewed the symptoms of OCD, let’s talk about how you can help your child to cope. OCD is a stressful diagnosis not just for the child who is suffering, but their entire family. Keep reading to learn ways to demystify OCD, reduce feelings of shame and loneliness, and start looking at OCD from a different perspective. These 5 steps will help you and your child look at OCD in a new light, so you can start working on healing together.

These techniques aren’t a replacement for therapy (more on that below), but they are tried-and-true approaches that I teach in my child therapy office. They’re also exactly the kinds of things that I think would have helped my family when I was a kid. If you’ve just noticed OCD symptoms in your minor child and you’re not sure what to do, start here.

#1: Help Your Child Understand OCD

I mentioned above that kids with OCD often know that their thoughts are unusual. That’s because OCD is ego dystonic: this means that the thoughts it causes go against a person’s temperament and values. They can feel weird, confusing, or “other,” almost like they’re not coming from you. Often, OCD preys on a child’s worst fears: peaceful kids may experience violent images, responsible children might worry about mistakes, and typically subdued kids can suddenly have thoughts about losing control and doing something inappropriate.

As you can imagine, this is really upsetting. Kids with OCD may worry they’re going crazy or that something is deeply wrong with them. They may also assume they’re the only one having these “weird” thoughts. This is especially true if their obsessions are about something embarrassing, shameful, or taboo.

You can help your child understand OCD so they feel less alone. Learning how OCD works can help kids realize that their symptoms aren’t so unusual after all, and that there is treatment that will help. Start by teaching a few important facts about OCD:

• Nothing a person does causes OCD. It’s mostly genetic, and not anybody’s fault.

• Just because you have a bad thought doesn’t mean you’ll act on it. In fact, people with OCD tend to have obsessive thoughts about things they’d never do in real life.

• OCD isn’t dangerous: it’s just a little glitch or “hiccup” that happens in the brain.

• You can fight back against OCD by not doing what it tells you to do: this is hard, but it teaches your OCD who is boss!

Reading books together is a great way to get these points across. It gives parents language they can use to explain OCD, and seeing that someone has gone through the trouble of writing a book can reassure kids that they really aren’t alone. What to Do When Your Brain Gets Stuck is a classic, and many people enjoy Up and Down the Worry Hill, too.

Your child might also appreciate taking a look at a list of celebrities who have OCD. About 1.2% of people are diagnosed with OCD. This means there are plenty of public figures who have been affected by it, including David Beckham, Daniel Radcliffe, and Camila Cabello.

#2: Be a United Team with Your Child Against OCD

Your child can separate herself from her symptoms by drawing a picture of what she imagines OCD looks like.

Battling OCD is not easy work. You have to do exactly the thing your brain is saying not to do in order to feel better! This can put parents at odds with their kids, because parents are the ones who have to hold bnoundaries and stick with the plan to overcome OCD. It’s important to remind your child (and yourself) that this fight is not you against them: it’s the two of you against OCD.

You can maintain a united front by imagining OCD as a little character or creature that is totally separate from your child. This is called “externalizing:" it’s a tool we use in therapy to help separate a problem from the person suffering from it. Externalizing OCD can help you feel like you’ve got a common enemy. It also reduces some of the shame and frustration kids feel when they experience thoughts and urges beyond their control.

Encourage your child to give their OCD a name: kids often choose something funny and nonthreatening, like “Bob” or “Dr. Annoying.” Your child might also enjoy drawing a picture of what they imagine their OCD would look like. Creating this kind of OCD character is a coping skill I use with almost all kids at the beginning of treatment (you can check out other OCD coping skills here).

Next time you notice your child saying or doing something related to their OCD, don’t blame them—blame Bob.

#3: Don’t Fall Into the Reassurance Trap

It’s only natural to want to comfort your child when they’re worried. As parents, we probably offer reassurance all day without thinking twice. Sometimes, a simple “it’s okay” or “everything will be alright” is all a child needs to hear in order to feel better.

Unfortunately, the usual rules don’t apply to OCD. Reassurance typically does more harm than good: even though it helps kids feel better in the short term, it fuels their anxiety in the long run. Reassurance-seeking is the most common OCD compulsion I see among kids in my therapy practice. Cutting back on reassurances can go a long way toward helping your child.

You might notice your child asking you the same question over and over, even after you’ve already explained that things will be fine. That’s because reassurance only quiets the OCD worries for a little bit. The OCD worries always come back, which means your child has to ask again to get relief. Over time, this pattern actually makes the symptoms worse.

One of the big goals of OCD treatment is to help parents gradually stop enabling their child’s OCD by giving into its demands. This means gradually scaling back on giving reassurance if you’ve been doing it a lot. If your child’s symptosm are mild, you may have good luck doing this on your own at home. If you’ve been stuck in this pattern for a while, a therapist can help you to gently break the cycle.

#4: Research Therapists who Treat Minors with OCD

Databases like the one provided by IOCDF can help you find therapists who specialize in treating OCD in minors.

While some minor children will recover from OCD without therapy, many will need extra help. Research has found that for about 1 in 5 kids, symptoms will resolve on their own, without treatment. For that remaining 4 out of 5, therapy will help kids get back on track and manage their symtpoms.

It might sound daunting at first to hear that most kids with OCD require therapy to recover. However, there are a couple of big silver linings here. The first bit of good news is that we have a form of therapy called ERP that’s been designed specifically for treating OCD, and it is highly effective. We also know that entering therapy early in life helps people with childhood-onset OCD make a much fuller recovery. That’s good news for your child!

Working with OCD is a specialty: not all therapists have extensive training in this area. The same is true for working with children. Finding a therapist who specializes in both OCD and working with minors might require a little extra legwork. The International OCD Foundation (IOCDF) has a searchable list of therapists who are trained in ERP, the “gold standard” treatment for OCD, including therapists who have been specifically trained to treat children. You can also run a search on Psychology Today to look for therapists in your area who offer ERP and see kids or teens.

Not all therapy therapy training programs don’t cover OCD or child therapy in tons of detail, so it can help to ask prospective therapists what their training and experience is with these two groups. Registered Play Therapists often have lots of training working with kids. ERP is the most common, best-researched therapy for OCD treatment. You can also ask more general questions, like the ones in this post, to get a sense for whether a therapist seems like the right fit for your family.

#5: Practice Self-Care So You Can Support Your Child

OCD is tough for kids, but it’s incredibly draining for their families, too. The bigger OCD symptoms grow, the more time and energy it takes to keep up with all the compulsive behaviors and rituals. Families—and parents especially—may feel like they’re bending over backwards or walking on eggshells to avoid triggering their child’s OCD. And even with all that effort, new worries pop up, seemingly out of nowhere.

It’s common for parents to feel exhausted, hopeless, or even resentful when they’ve been dealing with a child’s OCD for a long time. Kids often pick up on this tension, which adds extra stress to an already stressful situation. Gradually facing fears through OCD treatment is the most surefire way out of this vicious cycle, but it requires a lot of work, too. You’ll need a lot of patience and compassion to help your child through therapy.

Treating OCD is more of a marathon than a sprint. Resist the temptation to put yourself last on the to do list, and make sure you’re setting aside time to do whatever will help you continue to show up for your child. Date nights, exercise, time away from parenting, or watching something on TV that isn’t Bluey all count. You can also ask to speak to your child’s counselor in private or seek out your own therapist if you need to vent and get your own support.

OCD Therapy for Minors in North Carolina

You can help your child through OCD with the support of a therapist. I provide OCD treatment for kids and their families throughout North Carolina, New York, and Florida.

I hope you’ve found this article helpful, and that it gives you some options to try while you consider looking for a therapist. If you’re looking for OCD counseling for your child, I may be able to help! I’m physically located in Davidson, North Carolina, and can meet with local children in-person or online. I’m also available for virtual sessions with families in Florida and New York. You can learn more about my practice or email me to get started.

Looking for more information on how OCD affects minors? Check out some of my other posts:

Can a Child Have Mild OCD?
What Are the 4 Types of OCD?
How to Help a Child with Intrusive Thoughts
Does Childhood OCD Go Away?

Can a Child Have Mild OCD?

It’s bedtime, and your child’s goodnight routine is a little longer than usual. Over the past few weeks, it seems like things have gotten a little more elaborate, and the steps have to be done just right. Or, maybe you’ve noticed your child repeatdly asking if things are okay—even when they know the answer is yes.

You know kids can have quirky habits sometimes, and your child has always been prone to worrying. Is this just a passing phase, or could your child possibly have mild OCD? Is “mild OCD” even a thing?

When we see OCD portrayed on TV, it’s often easy to spot. Characters with OCD usually have easily noticeable symptoms, and they’re often pretty severe. In real life, OCD is much better at hiding: symptoms can be really subtle. What’s more, kids with OCD sometimes feel they need to hide their compulsive behavior. Children are often aware that not everybody has these “weird” thoughts and urges, and so they try not to advertise what’s going on.

The short answer is: yes, it’s very possible to have mild OCD. For the longer answer, keep reading! We’ll take a look at the different, sneaky ways that OCD can show up for kids.

First, Let’s Clarify What OCD Is

If your child’s problems are mild, it might be harder to distinguish whether or not OCD is really what you’re dealing with. Anxiety and OCD have a lot in common. And some personality traits and quirks can resemble OCD too, like perfectionism, superstitiousness, and orderliness.

People with OCD share 2 big symptoms in common:

• They have recurring unwanted thoughts, urges, or mental images. These are unwanted, tough to control, and cause the person anxiety or distress.

• The person tries to push away or “neutralize” these thoughts, usually with some kind of special thought or action.

That’s where we get the name “Obsessive Compulsive Disorder” from. The unwanted thought that shows up again and again is the obsession. The thing a person feels they have to do in order to make the uncomfortable thought go away is the compulsion. The trick is that, while compulsions make a person feel better in the short term, they actually make the thoughts and anxiety worse over time.

A child who holds herself to a high standard at school, prefers a clean room, or likes to carry a lucky charm on important days is unlikely to have OCD. However, a child whose worries seem to be stuck in a loop, or who repeatedly performs the same action might be showing OCD symptoms.

OCD Has a Range of Severities

Just like most other mental health problems, OCD can be mild, moderate, or severe. Some children might experience OCD as a minor inconvenience, while for others it can be completely debilitating. The media tends to show mental illness in its most severe forms because that’s what’s most dramatic and interesting. However, this isn’t the reality for all kids with OCD.

Many kids are able to fly under the radar for a while, without their symptoms being apparent to others. Even parents may not notice anything unusual, especially at first. By the time a child comes to treatment, they may have had OCD symptoms for quite a while.

Therapists look at a few areas to see if a child’s symptoms are mild, moderate, or severe:

• Frequency: A child whose worry shows up once a day may be on the midler end of the OCD spectrum. A child whose thought pops up many times throughout the day may have more severe OCD.

• Intensity: If a child can sometimes brush off the thought or it causes only mild anxiety, their symptoms are more mild. If a child can’t let go of a thought and it causes extreme stress, that’s severe.

• Duration: Kids with mild OCD symptoms may spend a few minutes a day doing something compulsively. Children struggling with severe OCD may spend hours.

• Functioning: Mild OCD may not really get in the way of things like school, friendships, or other everyday activities. On the other hand, severe OCD can affect relationships and keep kids from doing the things they want or need to do.

If you take your child to a therapist, they can use a special assessment to confirm an OCD diagnosis, and to see if your child’s symptoms fall into the mild, moderate, or severe range. This can be helpful to know because therapy recommendations will be different depending on where your child falls in that range.

You May Have Caught Your Child’s Symptoms Early

If you are noticing mild OCD symptoms in your child, it’s possible you’ve caught your child’s condition pretty early, while it’s still developing. As worrying as it can be to learn that a child is having these kinds of problems, discovering them early is great news.

Even though OCD is common, it can be hard to catch: one study found that it took the average OCD patient over 12 years to get a correct diagnosis! Younger people in the study had an easier time than older people when it came to getting diagnosed, but this is still a pretty long time to wait for the right help.

Research also tell us that kids who participate OCD therapy early often have better results than adults do. OCD symptoms tend to start in childhood or adolescence, so kids who are in therapy generally haven’t lived with their symptoms for as long as adults have. Quick treatment seems to make a difference: on average, they had more improvement in their symptoms than the adults in the study.

One final reason that it’s great to catch OCD symptoms early: mild OCD doesn’t always stay mild. When left untreated, kids may develop more complex and time-consuming rituals, and have more frequent and severe worries. As OCD grows, it can have more and more of an impact on a child’s quality of life. Kids who start therapy when their OCD is still mild can avoid a lot of this difficulty, and get their lives back on track sooner.

Sometimes, OCD Symptoms Are Invisible

There may be more to your child’s OCD than meets the eye. OCD involves obsessinos and compulsions that aren’t always easy to see. When we imagine a child performing OCD rituals, we might think of physical actions like handwashing or flipping light switches repeatedly. However, kids can have mental rituals as well, that don’t involve physically doing anything. Some examples are:

• Thinking a special word or thought in order to “undo” their worry.

• Praying compulsively

• Making mental lists

• Counting in their head

• Reviewing certain events over and over to double check them

Other times, compulsions involve saying something rather than doing something. These can also be a little more difficult to notice, at first. Pay attention for behaviors like:

• Asking for reassurance over and over

• Saying “I love you,” “I’m sorry”, or another phrase excessively

• Repeated confessions about things the child fears they have done wrong, such as having a bad thought, or possibly saying something unkind to someone

When parents begin to take stock of compulsions like these, what initially looked like mild OCD may look more complicated. There can be a lot happening beneath the surface, and these kinds of mental thoughts and rituals can be difficult for kids to talk about, or even put into words.

Do Kids with Mild OCD Still Need Therapy?

Even if your child’s symptoms seem mild, it’s a good idea to consult with a therapist to see if counseling could help. A therapist who specializes in OCD can complete a full assessment to see if any sneaky symptoms are going unnoticed. They can teach you and your child skills to deal with OCD worries without giving in to them all the time. Sometimes, it can be reassuring for a child just to hear from an adult who isn’t their parent that OCD worries are common, harmless, and not a sign of “going crazy.”

Occasionally, OCD symptoms may resolve on their own without therapy. Often, however, therapy is needed in order to overcome them. We know that mild symptoms tend to grow worse over time, and that younger kids do better in OCD therapy than adults. Because of all this, it’s worth talking to a counselor and considering therapy, even if your child’s symptoms aren’t getting in the way of life too much right now.

There are some great self-help resources out there for children with OCD. My favorite book for kids, What to Do When Your Brain Gets Stuck, is a great place to start. Up and Down The Worry Hill is another popular option. These books can give your family some helpful background information on OCD and how it works. You’ll also find tools you can use to take action right away.

How Can I Help My Child With Mild OCD?

There’s a lot you can do as a parent to help your child with OCD. In fact, parents are an important part of OCD therapy. A child’s symptoms tend to affect the whole family. Whether you’re waiting around for a child to complete a ritual or answering a question for the 100th time, parents ofen notice that they are changing the way they do things in order to keep the peace at home.

Unfortunately, OCD is never satisfied with what you give it. The more you give in to OCD, the bigger it grows. That’s why mild OCD often morphs over time into more moderate or severe illness.

OCD therapy helps both kids and parents to break this cycle. Using a form of therapy called Exposure and Response Prevention, a therapist can help your family learn new ways to stand up to OCD without giving in to compulsions and rituals. Kids can learn that they don’t have to listen to the thoughts and worries OCD gives them. Parents can learn how to support children without giving in to OCD’s demands.

If you’re noticing mild symptoms of OCD in your child, you can help right away by letting your child know that OCD thoughts are just random noise. The thoughts don’t mean anything, can’t hurt anyone, and everybody—even non-OCD sufferers—gets weird thoughts sometimes.

If you’re looking for help to deal with thoughts and worries right now, my free coping skills guide might help. You can download 5 Coping Skills for Anxious Tweens (That Aren’t Just Deep Breathing) right now, wherever you are.

If you’re hoping to begin therapy for OCD and you live in the states of North Carolina, New York, or FLorida, I may be able to help! I’m certified in Exposure and Response Prevention, the therapy that’s been proven most effective for OCD. As someone with a childhood OCD diagnosis, I remember how scary and overwhelming these symptoms can be. And I know that ERP therapy can really make a difference in the lives of children, whether their symptoms are mild or not.

You can learn more about ERP here, or contact me to inquire about starting therapy.

5 Common Types of Intrusive Thoughts Your Child Might Have

Intrusive thoughts are freaky. Like an uninvited guest, they pop up and bother us with ideas or images we wouldn’t want to think about on our own. They can be frightening for kids to experience, because it feels like you’re losing control of your own mind. But they’re also unsettling to hear about as a parent, especially if a child’s thoughts are about something taboo, like death or violence.

The truth is, many intrusive thoughts are about taboo subjects. The more upsetting or off-limits something is to think about, the more likely it is to push back into our consciousness as an intrusive thought. It’s sort of an “opposite day” situation, where the things we find the most unpleasant—things we’d never actually want to do—pop up as thoughts or mental pictures.

Just knowing that other people have these types of thoughts can be reassuring, and a first step toward learning to manage them better. So, in this post, we’re going to go over 5 types of intrusive thoughts children commonly experience.

Content Warning: We’ll discuss specific examples of intrusive thougths in this article, which are often about upsetting or shocking subjects.

What Exactly Are Intrusive Thoughts?

An intrusive thought is any kind of idea, urge, image, or impulse that comes to mind when you don’t want it to be there. They can be about anything, but tend to be about subjects that a person finds upsetting, gross, or wrong. They usually happen repeatedly, and they can cause a lot of distress.

Intrusive thoughts are “ego dystonic”, which is a therapy jargon way of saying that they go against a person’s beliefs or don’t sync up with their personality. They can feel foreign or weird. People who have intrusive thoughts are aware that the thoughts are unusual, but can’t stop them from happening.

Intrusive thoughts are a really common symptom of OCD, which often starts in childhood. They can also happen in kids with anxiety or a history of trauma. However, that doesn’t mean every kid who has an intrusive thought has OCD! Pretty much everybody experiences a thought like this at some point. However, less-anxious people are more able to shrug them off as a weird, random event that doesn’t really mean anything. People with anxiety and OCD are more likely to hold on to these thoughts and worry that they mean something is seriously wrong.

What Are Some Characteristics of Intrusive Thoughts?

Intrusive thoughts stand out from the usual noise our brains make all day. If you’re trying to figure out whether your child is dealing with intrusive thoughts, consider the following list. Intrusive thoughts are unique because they tend to be:

• Involuntary: a person doesn’t want to have the intrusive thought, but it happens anyway.

• Repetitive: these thoughts tend to come back again and again.

• Anxiety-triggering: the thoughts can be annoying at best, and scary at worst.

• Out of character: the subject matter is something a person wouldn’t usually think about.

• Inappropriate: often, intrusive thoughts have to do with taboo subjects like sex, death, illness, violence, or bad behavior.

• Unwanted: the person has no desire to act on the thought, which is part of why it’s so upsetting. However, kids with anxiety or OCD may worry that having the thought means that someday they’ll lose control and act on it anyway—that’s not how these thoughts work.

Once you know what to look for, it gets easier to spot intrusive thoughts when they happen.

What Sorts of Intrusive Thoughts Do Kids Have?

Kids tend to have intrusive thoughts about subjects that society thinks are wrong or impolite to talk about—actually, this is true of adults with intrusive thoughts, too! Themes related to religion, sex, death, illness, or immoral behavior are all common when it comes to intrusive thoughts. Children may imagine themselves doing something they don’t really want to do, or see a mental picture of something they don’t like.

Younger children are still in the process of understanding adult concepts like sex, death, and violence, and their intrusive thoughts can reflect this. Even though the subject matter is the same, a child’s intrusive thoughts may not be the same as an adult’s. You might notice that your child’s thoughts are not realistic or logical. This can help set intrusive thougths casued by anxiety or OCD apart from the flashbacks caused by trauma or PTSD.

Next, let’s take a deeper look at 5 of the most common types of intrusive thoughts kids experience.

Type 1: “What If” Thoughts

OCD loves to make people doubt themselves. These “what if” thoughts often happen as a part of OCD, but they’re also one of the more common types of intrusive thoughts in general. A “what if” thought prompts you to question something you thought you knew for certain.

“What if” thoughts can affect people’s perceptions of their relationships, tasks they’ve completed, or even their own identity. Even if you have a clear memory of yourself doing something, the thought injects the possibility that maybe you actually forgot—and something bad might happen as a result.

Some examples of “what if” thoughts children might have include:

• A usually responsible child worrying that they somehow forgot to lock the door, and their dog will run away.

• A teenager who is secure in their sexual identity wondering if they might unknowingly be gay.

• A child who is bothered by thoughts of someone possibly hiding in their bedroom, even after checking under the bed and in the closet.

The hard thing about “what if” thoughts is that reassurance or double-checking only helps for a little while. Eventually, the doubt creeps in again and the cycle starts over.

Type 2: Thoughts About Hurting Self or Others

It can be alarming to hear your child is having repeated thoughts about hurting themselves or somebody else. Just like all other intrusive thoughts, these harm-related thoughts are unwanted and go against the personality of the child. Often, children who have these kinds of intrusive thoughts are described as being particularly kind, empathetic, and gentle.

Of course, any time you hear a child talking about harm, you can’t automatically assume it’s an intrusive thought. You need to rule out other possibilities, like suicidal ideation, which always need to be taken seriously. An intrusive thought—rather than an actual urge—might look something like:

• A child who has images pop into mind of pushing a sibling down the stairs, even though they’d never do something like that in real life.

• A usually kind child has thoughts about stabbing people that are so frightening they avoid being around knives or sharp objects.

• A teenager complains of fleeting thoughts about jumping in front of a train or running into traffic that bother him, because he really doesn’t want to die.

In all these examples, the thoughts are causing a lot of distress. Kids with this kind of intrusive thought don’t want to be thinking about violence, and may take great lengths to avoid being in situations they worry could be unsafe.

Type 3: Thoughts About Doing Something Embarrassing, Unkind or Illegal

Similar to thoughts about harm, this variety of intrusive thought is based on a fear that a child might somehow “lose control” and do something that’s socially unacceptable. Many people experience a stray thought like this, and shrug it off knowing they’d never act on it.

When children have these thoughts, they may not be so easy to shrug off. These taboo behaviors flash into a child’s mind, which makes them worry that some part of them really wants to do that bad thing. They put a lot of meaning into the experience, which leads to more anxiety.

Examples of this type of intrusive thought include:

• A child having thoughts about saying something inappropriate in a public place, like yelling “fire” in a movie theater or “bomb” in an airport.

• A student having bothersome thoughts while at school of saying insulting things to a classmate.

• A child who worries that their thoughts about shoplifting mean that they actually want to steal something.

When a child is truly having an intrusive thought, it’s extremely unlikely that they’ll ever act on it. Thinking and doing are very different things! However, the fear of possibly losing control can be very powerful, and get in the way of a child’s day-to-day life.

Type 4: Sexual Intrusive Thoughts

Even though they are common, this category of intrusive thought can cause a lot of shame and distress for kids. It can be hard enough to talk about the birds and the bees under normal circumstances, and even harder when you’re having your day interrupted by thoughts or images of upsetting sexual situations.

Because they are so taboo, children experiencing these types of thoughts may choose to keep them a secret. Even if children are open about most worries, they may fear that hearing about sexual thoughts will change a parent or therapist’s opinion of them. It can be a relief for children to know they’re not alone with these thoughts and to hear about examples of common intrusive thoughts. Some common worries in this category are:

• Worries about losing control and groping or sexually abusing someone.

• Unwanted thoughts that include family members, animals, or children.

• Fears related to unintentionally getting pregnant or getting someone else pregnant, even when this may not be logical.

There’s nothing pleasurable about these kinds of thoughts. Instead, kids experience feelings of shock, disgust, shame, and fear. Just like kids who have thoughts about harm, children with sexual intrusive thoughts may worry that having the thought means some part of them must want to act on it, and may avoid certain people, places, or activities as a result.

In reality, kids suffering from these types of intrusive thoughts are not violent or bad people: they’re just normal kids experiencing a bothersome mental heath symptom. It isn’t a reflection on their personality or character.

Type 5: Thoughts About Illness, Contamination, or Germs

Most of us have been worried about getting sick at one time or another. Health anxiety is really common, especially in the wake of the recent pandemic. Kids who struggle with intrusive thoughts may worry about sickness, too. They may worry about catching a disease, picking up germs, or spreading illness to other people. But there are some differences between their intrusive thoughts and regular health anxiety.

The thoughts children have about illness, contamination, and germs may be illogical or extreme. They may worry about catching germs from things that aren’t usually considered dirty, or about getting sick with a disease they’re highly unlikely to get. They may also worry about touching, breathing, or eating something that has somehow been contaminated. Some common fears for children with this type of intrusive thought are:

• Repeated fears that their food, drink, or utensils have been poisoned or contaminated by a chemical or cleaning supply.

• Fears that common objects or surfaces may have had germs on them.

• Thoughts about getting sick and dying from a disease such as cancer or AIDS.

• Worries about unintentionally spreading germs or serious disease to loved ones.

Children with these thoughts may avoid touching items with their bare hands, only eat “safe” foods or use “safe” utensils, or repeatedly wash their hands in an effort to avoid transmitting disease. These behaviors go above and beyond the hygiene we’d expect to see in a Covid-conscious kid, and interfere with day-to-day life.

Get Help for Kids with Intrusive Thoughts

As upsetting as they may be, intrusive thoughts are normal and common. Kids dealing with these types of worries are not alone! Sometimes, just knowing this can help soothe children’s anxiety about intrusive thoughts. When children accept these thoughts for what they are—random brain hiccups—it’s easier to just let them pass by without trying to push them down. Over time, this can help the thoughts to happen less and less often.

Other kids will need more support in dealing with their thoughts. This is especially true if the thoughts are accompanied by an urgent need to do something again and again, like washing hands or asking a parent if everything is okay. Kids whose intrusive thoughts begin after a traumatic event should also get support to help them recover.

Exposure and Response Prevention is the most effective tool therapists have to help children with compulsive thoughts and behaviors get their lives back. TF-CBT can help kids and their parents learn skills to cope with trauma symptoms and move forward in life without feeling overwhelmed by flashbacks or memories.

I offer both these therapies in my child counseling practice. I’m based in the Charlotte, NC area, but also work with kids online throughout the states of North Carolina, New York, and Florida. If you’re interested in starting therapy for intrusive thoughts, contact me here.

If you’d like to learn more about intrusive thoughts, check out my other blog posts on the subject:

Intrusive Thoughts in Children, Explained
How to Help a Child with Intrusive Thoughts
Signs of OCD in Children: What Parents Can Look For

Do Coping Skills Work, or Are They Just a Band-Aid?

At first glance, you wouldn’t think coping skills were a controversial subject. What’s not to like about deep belly breathing or guided relaxation? We’ve all been talking about these kinds of skills for ages. Maybe that’s why we’re seeing a bit of a coping skills backlash these days. Coping skills have become such a popular concept that it’s tempting to think they’re the answer to every mental health problem.

It’s true. When they’re used incorrectly, coping skills can be a little like putting a band-aid on a major wound. But most of us still use band-aids, right? They give us quick help and make our lives more comfortable. We’re not going to outlaw band-aids just because they’re not the right choice in every situation.

The truth is, many parents and kid clients come into my therapy office asking for coping skills to deal with anxiety, stress, and even trauma. I think they’re right to ask! Coping skills may not be The Answer to Everything, but they do work. Let’s talk about what makes coping skills effective for kids.

No, Deep Breathing Isn’t Going to Magically Solve All Your Problems.

If a child is dealing with anxiety so severe that they have stopped attending school, they’re going to need more than coping skills to get back to living their normal life. Similarly, a child can learn all the coping skills on earth and it won’t be sufficient if parents are constantly fighting at home. Big, long-term, or complicated problems need more than just a few coping skills to resolve. They need to be looked at holistically.

Sometimes we put a little too much responsibility on kids to solve issues that are much bigger than themselves. For kids dealing with mild anxiety or a sensitive, deeply feeling temperament, coping skills may be all they need to course correct. For bigger issues, coping skills may just be the first step in a longer therapy process that involves parents or caregivers, too.

But When Coping Skills Work, They Can Change a Child’s Life.

Yeah, this is kind of a big statement, but I stand by it! I believe coping skills can change a child’s life. I wish I’d had access to more coping skills back when I was an anxious kid.

When we give children coping skills, we give them a sense of control over their own lives. We provide the emotional first aid they need to get through the day, which buys us some time to address the root cause of theri anxiety. And often, coping skills open the door to deeper learning. By changing their behavior, children make new discoveries about their feelings and relationships.

Anxious Kids Need Help Right Away

Imagine you’re a kid who has been dealing with debilitating anxiety for a long time. You can’t sleep at night, and you spend the whole bus ride to school feeling sick to your stomach. You haven’t gone on a sleepover in ages because it’s too scary to be away from home, and you’re pretty sure you won’t be going on any of the big field trips coming up, either.

Your parents have been begging you to try therapy, and you finally work up the courage to give it a try. You sit in a strange lady’s office, who tells you that she can absolutely help you with your anxiety…in 3 to 6 months.

How would that feel? 3 to 6 months is eternity for a kid. But that’s often how long it takes for a child to complete therapy, and during that time they’ll probably need to put in some hard work and try some things that scare them.

Coping skills give kids some “quick wins” that help them feel better right away. It may not cure their anxiety, but it can make it a whole lot easier to tolerate. Experiencing this fast relief—and discovering the control they have over their emotional responses—can help motivate children to go the distance in therapy.

Coping Skills Help Kids Stabilize, So They Can Do the Deep Work

Not only do coping skills motivate kids to go deeper in therapy, they’re often a necessary first step. Kids dealing with severe anxiety or trauma spend a lot of their time in fight-or-flight mode. When you’ve got all that adrenaline coursing through your body, you’re focused on survival, not learning.

It’s really hard to effect big, lasting change when a child is too worked up to learn. Effective coping skills soothe the nervous system, so kids can calm themselves more easily and spend less time in fight-or-flight.

If your child is participating in trauma therapy, learning to self-soothe is critical. As children tell deeper and more difficult parts of their story, they may find their symptoms get worse before they get better. Revisiting their coping skills helps kids care for themselves and prevent overwhelm.

Effective Coping Skills Help Kids Discover Their Own Power

Many kids (and adults) enter therapy feeling powerless in the face of their anxiety. It’s bigger than them, it’s frightening, and it’s seemingly impossible to control. Anxiety feels like something that happens to them, and since they’re powerless to change it, they might as well just give in to its demands.

Coping skills show children that they have agency when it comes to their feelings. Sure, painful emotions are going to happen sometimes, that’s just life. But we get to decide how to respond to anxious thoughts, and there are ways to calm anxiety so it doesn’t take over your whole day. Returning that sense of control to children can change their whole outlook on how they handle anxiety and challenging situations in life.

Coping Skills Work by Healing From the Outside In

Before I went to therapy school, I went to theater school. I took a bunch of acting classes. There are two big schools of thought in acting: “inside out” and “outside in.”

If you imagine a stereotypical, old school actor asking “what’s my motivation?” you’ve got a basic sense of what inside out acting is all about. In this approach, actors create an inner emotional life for their character that helps them decide what to do onstage: how to talk, how to move, how to behave.

Outside in actors do things in reverse order. They might figure out their character’s walk, first. Maybe they figure out an interesting voice to use. Going through the physical motions helps them understand how the character might be feeling, and why.

Neither approach is wrong! Both actors are going to get to the same place in the end.

I promise there’s a reason I’ve devoted several paragraphs to this. Therapy is the same way. Coping skills may seem shallow at first, compared to “deep” work like understanding the origins of anxiety or changing family dynamics. But they work from the outside in. They help kids get to that deep work.

I’ve had many a kid client figure out solid coping skills and return to therapy in a couple weeks with important new insights about their lives. They come into session and make a connection between their worries and a specific family situation, or share something they’d like to change about how they relate to their friends. Changing your behavior disrupts old patterns and gives you space to discover something new.

When Are Coping Skills a Bad Idea?

Before you think I’m some shill who has been paid off by Big Coping Skills or whatever, let’s talk about some of the drawbacks. There’s no one size fits all in therapy. Coping skills aren’t going to work for everyone or serve kids well in every situation. Here are some examples of times that coping skills will not be effective:

• When coping skills are used to avoid anxious situations forever, rather than gradually facing your fear

• When a child uses coping skills to push down or deny “bad” feelings in an attempt to “stay positive”

• When coping skills are used as a substitute for support from parents, caregivers, or other adults

• When a child doesn’t see anyone else modeling how to cope with feelings effectively

Coping skills aren’t a substitute for feeling your feelings. They don’t work very well in isolation, either: kids still need support from the adults in their lives to overcome worries and change family patterns that might accidentally contribute to anxiety. If they’re not used thoughtfully, coping skills can easily morph into an unhelpful form of toxic positivity.

Effective Coping Skills for Tweens

Coping skills work for kids of all ages. However, in my therapy practice I mostly work with tween-aged kids, roughly ages 8-13. Since these are the kids I see day in and day out, they’re the ones I feel most equipped to help when it comes to coping skills.

You couldn’t pay me enough to go back to middle school. The tween years can be really rough. Studies show that when kids tranistion to 6th grade, their grades dip and don’t fully rebound until they begin high school. Friend drama, relationship woes, academic pressure, and puberty all start during middle school, but most of the privileges and freedoms that come with growing up don’t arrive until later. Tweens get all of the angst, and not much of the fun.

The good news is tweens are at the perfect age for coping skills. Cognitively, they’re leaps and bounds ahead of where they were in elementary school. They’re ready for challenging stuff. But socially, they’re right at the beginning of the “big kid” years. There’s still so much in front of them. Learning coping skills in middle school sets kids up for success as they manage stress and drama in the years to come.

If you have a tween who would like to learn coping skills, you’ve come to the right place! My course, Worry-Free Tweens, was created just for them. It’s available online and on demand, so your child can complete the lessons at their own pace. Since we know coping skills work best when parents are involved, you’ll find plenty of information for yourself, too.

You can check out the course here.

5 Coping Skills for Kids with OCD

If your child is struggling with OCD symptoms, feel at a loss for how to help. Maybe you’ve tried using logic to help your child see how unlikely their worries are. Or, maybe you’ve been working really hard on relaxation and deep breathing techniques, but you aren’t seeing a lot of change. This is totally normal! The usual coping skills that help kids deal with anxiety and stress aren’t as helpful for OCD.

While many children with OCD benefit from counseling, there are still things you can try at home to help your child cope. You can help your child learn to understand what OCD is and how it works, and equip them with tools they can use to “fight back” against recurrent worries and rituals. Children with strong coping skills feel less alone, can manage their symptoms better, and they will likely progress through therapy more quickly, too. Let’s take a look at 5 coping skills you and your child can practice together.

Learn About How OCD Works

Obsessive-compulsive disorder, also known as OCD, is a mental health problem that is similar to anxiety, but with its own unique characteristics. It causes people to have unwanted worries or thoughts over and over again. To deal with these thoughts, people with OCD feel like they have to repeatedly do an action in order to relieve their anxiety or prevent something bad from happening. The repeated thoughts are called obsessions, and the repeated actions are called compulsions.

OCD often begins in childhood, and it can be confusing and frustrating for kids and parents alike. Kids really do not want to be thinking about the terrible things their OCD prompts them to think about. They may feel as though they’re going crazy, or worry that having bad thoughts means they are a bad person. Parents may be shocked by the seemingly out-of-the blue appearance of OCD worries. It can be tough to understand why a child is suddenly so afraid, especially when their worries do not seem logical or realistic.

The first step to coping with OCD is understanding what you’re dealing with. Books like Up and Down the Worry Hill and What to Do When Your Brain Gets Stuck teach kids that OCD is caused by a harmless “brain glitch” that keeps the brain from sorting out unhelpful thoughts. Books like these help children feel less alone, and can reduce feelings of shame and guilt that make it hard to get help. They also give kids helpful language to describe their experiences with OCD.

Cope by Focusing on Strengths, Not Worries

When your child comes to you with a problem, you naturally want to talk about it. We all want to be understanding, responsive parents, and heart-to-heart chats with our kids are part of the deal. This is a great approach for lots of childhood worries and struggles, but it doesn’t always work well for OCD.

The repeated worries that come with OCD aren’t logical. Kids with OCD often worry about events that are highly unlikely to happen, like a plane crashing into your home or contracting a rare disease. Sometimes, the worries don’t make much sense, such as being concerned that stepping on a sidewalk crack will cause something bad to happen.

Most kids know their fears aren’t realistic, but they still can’t stop thinking about them. Talking about the worries in detail and reassuring your child that nothing bad will happen is unlikely to make the worries stop. In fact, the more time we spend talking about and paying attention to OCD worries, the more likely they are to happen again.

You can help your child shift their focus away from the worry and towards something more productive: their own ability to cope. We can’t make anxiety go away, but we can help kids deal with their anxious feelings. Instead of asking lots of questions or giving lots of reassurance, praise your child for their effort to do hard things in spite of their worries. Remind them that they’re brave, strong, and capable of facing their fears…and that it will feel so amazing when they do.

Make an OCD “Worry Monster”

Parents may find themselves bending over backwards to try to soothe their child’s worries, or using tough love to try to muscle through activities that cause anxiety to flare. It’s exhausting, and can start to feel like a battle between parent and child. This leaves kids feeling frustrated or ashamed that they can’t just “get over” their symptoms.

Instead of fighting each other, parents and kids need to team up against the real enemy—OCD. We can help kids cope with their symptoms by externalizing OCD, meaning we imagine it as a force that isn’t a part of them and isn’t their fault. This helps to cut down on the shame kids feel, and can increase a child’s motivation to fight back.

A fun way to externalize OCD is by imagining it as an annoying pest, like a bug, creature, or monster. Ask your child to draw a picture that represents how they imagine their OCD. You might even give the creature a funny name. When you talk about your child’s struggles, blame them on this creature instead: “It sounds like Jim Bob is really giving you a hard time today.” It can inject some humor into a tough situation, and remind your child that they can choose whether or not to listen to what OCD is telling them to do.

Spot Unhelpful or Tricky Thoughts

Most of us go through life without questioning our own thoughts too much. We might misinterpret things at times, but it’s usually not a big deal. People with anxiety and OCD are much more prone to having overly negative, unhelpful thoughts. In particular, kids with OCD have a tough time dismissing thoughts that are upsetting or strange. Instead, these thoughts linger, and kids have to deal with the nagging, “what if?” feeling that comes with recurrent worries.

Kids with OCD can learn to notice when their thoughts are playing tricks on them. We call this skill metacognition, which means learning to think about your own thinking. Instead of just taking their thoughts at face value, kids can examine their worries like a detective. Over time, children can start to notice patterns in their own worries, which helps them not take the worries so seriously.

The book Tiger-Tiger, Is It True? is great for teaching this skill to younger children, and we cover it in depth in my online course for kids and tweens.

Practice “Talking Back” to OCD

So maybe your child has gotten very skilled at spotting their own unhelpful thoughts. What’s next? Kids with OCD have a couple options for coping with these unwanted worries: they can talk back to them, or simply ignore what OCD is telling them to do.

”Talking back” to a worry means finding something you can say to yourself instead that is more accurate or helpful. This could mean taking a huge worry and shrinking it down to a more realistic size, or reminding yourself that even when bad things happen, you can figure them out and move on. Talking back can also mean reminding yourself that you’re in charge of your thoughts, and don’t have to listen to the unhelpful ones. Here are a few examples of thoughts kids with OCD can use to “talk back:”

• “I don’t have any proof that this worry will happen.”

• “I’ve gone to school for 6 whole years, and I’ve never thrown up in class.”

• “Even if something bad does happen, I can handle it.”

• “This is just my OCD talking and I don’t have to listen.”

• “I’ve had this worry a million times and it’s never come true.”

Learning and practicing this coping skill empowers children to stop taking their worries and urges so seriously. Eventually, children may feel ready to ignore their OCD by not following through with compulsive behavior when anxiety arises. Facing scary situations and dealing with the anxiety without rituals or compulsions is the core of Exposure and Response Prevention, the most common and effective therapy treatment for OCD.

More Coping Skills for Kids with Anxiety and OCD

If you’re looking for more ways to help a child with anxiety or OCD, consider checking out my online coping skills course, Worry-Free Tweens. In the course, you’ll find child-friendly, in-depth lessons on how anxiety works, how to deal with it, and why anxiety can actually be a superpower.

You and your child will learn how to notice unhelpful thinking patterns and shift into a more realistic mindset when worries occur. Together, you can learn how and when to use coping skills most effectively. You’ll also find advice for parents on how to support and encourage an anxious child while avoiding the traps that can accidentally worsen anxiety over time.

If the course sounds like what you’re looking for, you can access Worry-Free Tweens here.

Counseling for Kids with OCD in Davidson, North Carolina

Coping skills are a great place to start when you suspect OCD. However, many kids will need the support of a mental health professional in order to overcome their symptoms. OCD often impacts the whole family: everyone has to change the way they do things in order to keep a child’s “worry monster” happy. Counseling can help both you and your child learn new ways to deal with repeated worries and urges, so you can get back to having fun together.

I’m licensed to help kids with anxiety and OCD in North Carolina, New York, and Florida. I offer face-to-face therapy in Davidson, NC, just outside of Charlotte. For families who live farther away, we meet for online therapy using a secure platform similar to Zoom. Both kinds of therapy can be effective (and sometimes even fun) for kids and tweens.

If you’re curious about therapy for OCD, check out my post on ERP. You can also check out my FAQ to learn more about what therapy with me is like. To ask other questions or inquire about setting up an appointment, send me an email. I am always happy to help.

What Are the 4 Types of OCD?

Pop culture is getting better about representing people with mental health conditions on TV, in movies, and in books. It’s allowed many people to get familiar with mental health conditions that aren’t always talked about, but affect millions of people. At this point, you’ve probably encountered a character that has OCD. In all likelihood, this character was super clean, hyper-organized, and maybe a little nitpicky or eccentric.

Although more representation for mental health issues is a good thing, for OCD it’s come with a small downside. Most portrayals of OCD only focus on one or two types of the disorder. As a result, most of us have an overly narrow idea of what OCD looks like. While it’s true that some people with OCD are very neat and tidy, many aren’t.

If you are wondering whether your child may have OCD, it helps to learn about all 4 types. This way, you’ll be prepared to spot all of the signs and symptoms of OCD, not just the ones we see on TV. Let’s take a closer look at each of the 4 main types and how it commonly manifests in kids.

OCD Type #1: Contamination and Cleaning

Many people associate OCD with germs and germaphobia. But this type of OCD is more than just practicing good hygiene or keeping a spotless home. People with contamination OCD worry about coming into contact with things that could get them dirty, sick, or even just feeling unclean. They may worry about their belongings becoming contaminated as well, or that they might spread their contamination to other people.

Sometimes, people with contamination OCD are concerned with germs or dirt. However, lots of other things can trigger it, too. Some kids with contamination OCD might be triggered by bodily fluids, certain strong smells, or even just by people or things that feel wrong to them.

Feeling contaminated causes anxiety to spike, so kids with this OCD type will do whatever they can to avoid the feeling or make it go away. This often means compulsively cleaning, avoiding “dirty” places and things, having difficulty sharing belongings, or completing rituals that help make something feel clean again.

What Contamination OCD Looks Like in Kids

I’ve met more children with contamination OCD in the wake of the Covid-19 pandemic. This makes sense: we’ve spent over a year talking about washing and avoiding germs, which I imagine makes it an easy subject for OCD to grab on to. Here are a few common ways contamination OCD may show up for kids:

• Repeatedly washing hands or taking multiple showers a day

• Not wanting to touch or use objects that have come in contact with something “dirty”

• Difficulty sharing toys or allowing others to use their things

• Overwhelming worries about getting sick or making others sick

• Cleaning belongings (like toys or school supplies) more often or thoroughly than is normal

• Bathroom difficulties due to worries about urine or feces contaminating clothing

OCD Type #2: Checking and Rechecking

Ever walked out of the house, only to stop and wonder if you locked the door on your way out? We all get that nagging “did I forget” feeling occasionally, but for people with this type of OCD it’s a daily occurrence. It’s harder for them to brush these thoughts aside, because they happen so frequently and feel so intense. To calm the feeling, they check or re-do things over and over, even if they know they just did them moments ago. Unfortunately, the “did I forget” feeling doesn’t stay away for long, which leads to a need to check again. As you can imagine, this can be really aggravating and take up a lot of time.

Compulsive checking activities may be physical actions, like flipping a light switch or turning a knob on the oven. They can also be mental actions, like double-checking that the fire alarm still has batteries or that a door is closed. Sometimes, repeated worries prompt kids to repeatedly ask parents for reassurance. This is another kind of checking that might be easy for parents to miss.

What Checking OCD Looks Like in Kids

Symptoms of compulsive checking range from super subtle to very overt. How easy they are to spot depends on what your child feels compelled to check. Here are a few examples of compulsive checking that you might notice in a child with this form of OCD:

• Repeatedly doing things like locking and unlocking doors, flipping light switches, or turning faucets on and off

• Asking the same question over and over, without a decrease in anxiety—for example, repeatedly asking a parent if they are sick

• Going back to check on things more often than seems normal

• Repeatedly asking parents for reassurance that something bad is not going to happen

• Asking parents if the child has forgotten something or if their memory is accurate

OCD Type 3: Perfection and Order

This is the type many people likely imagine when they think of OCD. Along with germaphobia, this is the other common OCD form that gets a lot of representation in pop culture. People with this OCD type may worry about symmetry, organization, or doing things just right. In fact, this type is also sometimes called “just right OCD.”

While this may sound like the hyper-organized, neat freak stereotype we often associate with OCD, the reality is it’s much more complex. Some people with this OCD type may be neat and tidy, or be concerned with appearances. However, this type also includes compulsive behavior like tapping things an even number of times, arranging items to appear symmetrical, or fixing and re-fixing something that nobody else would notice was “wrong.”

This OCD type also includes people who feel compelled to do things perfectly. This might lead to a lot of anxiety when working on school assignments or participating in sports or other activities. Some people with this type might fixate on a facial feature or part of their body and worry that it is not good enough.

What Perfectionistic OCD Looks Like in Kids

Although this type is more understood, it’s helpful for parents to remember that “perfection” and “order” doesn’t necessarily mean color-coded school binders and a clutter-free bedroom. A child’s focus can be on a very specific area that we don’t usually think about as something that needs to be organized or even, which can make these signs of OCD slightly tricky to spot. Here are some ways perfectionism and “just right” OCD might show up in children:

• Extreme difficulty completing homework assignments, especially open-ended ones, due to a fear of not being able to do them well enough

• Needing to feel that things are “even” on both sides of the body

• Doing things a set number of times, for example, saying the same thing three times in a row or stepping on the “right” number of leaves outside

• Fixating on a small detail related to clothes, hair, or makeup

• Having trouble texting friends due to fear about not saying the right thing

OCD Type 4: Mental Rituals & “Bad” Thoughts

This type of OCD is a little different than the others. Most forms of OCD involve acting out some kind of repeated or ritualized behavior. The behavior may be subtle, but it’s noticeable if you know what you’re looking for. Mental ritual OCD is sneakier. Rather than doing something repeatedly, people with this type of OCD think something repeatedly. This can make it much more difficult for parents to identify. In fact, until fairly recently, mental health professionals had a hart time identifying it too!

Mental ritual OCD is relatively new. You may also hear it described as “Pure O” OCD, which is short for “purely obsessional.” It’s called this because there aren’t any compulsions for those of us on the outside to see. However, that doesn’t mean they aren’t there.

People with “Pure O” or mental rituals are often bothered by thoughts that feel inappropriate: for example, thoughts about violence or sexual behavior. Some people may also be preoccupied with thoughts about religion or worries that they’ve done something wrong. They may worry that having these bad, taboo thoughts means that they are bad people.

To counteract the “bad” thought, a person may try to replace it with a “good” one or perform some mental action to make it better. This could include thinking a special thought, saying a number or word inside their head, praying, or reassuring themselves that they are okay.

What Mental Ritual OCD Looks Like in Kids

Mental rituals are extremely difficult to spot unless the person experiencing them says something about them. Some children with this form of OCD may also repeatedly ask for reassurance as a way to cope with upsetting thoughts or mental images. That can sometimes be a tipoff that other mental rituals could be happening, too. Here are some ways mental rituals might show up for “Pure O” kids:

• Compulsively saying prayers or confessing to things inside their head

• Repeatedly going over memories to see if they really happened

• Saying special words, numbers, or thinking of a special picture to make a bad thought go away

• Checking to see if a bad thought is still there

• Repeatedly reassuring oneself that something didn’t really happen, or that they would never do that thing in real life

Are There Any Other Types of OCD?

Yes and no! The 4 types of OCD I’ve outlined here are used by both therapists and people with OCD to describe different ways that OCD can look and feel. However, you won’t find them in the DSM-5, the big book of mental health problems that therapists use to help diagnose people. So even though they are common and helpful, they aren’t super duper official.

While many people divide OCD into 4 broad categories, others may identify as many as 6, 7, or 8 different types. It all depend on how specific you want to get with your labels. Here are some other OCD types you may hear others mention:

• Hoarding

• Ruminating

• Intrusive Thoughts

• Mental Contamination

• Moral OCD

• Doubt or Incompleteness

• Thoughts of harm or self-harm

I Think My Child Has OCD…What’s Next?

If you read through these 4 types of OCD and recognized your child in one (or more) of them, you may be wondering where to go from here. I’ve written a fair amount about OCD in children and OCD treatment on this blog if you’d like to learn more.

Learning anxiety coping skills is a good first step to help your child at home. There are several educational and self-help books for kids about OCD, too. What to Do When Your Brain Gets Stuck is my favorite.

Although books and coping skills can help, many children with OCD will need more support to overcome their symptoms. Research suggests OCD is not likely to go away on its own without professional help. Fortunately, children with OCD have options when it comes to therapy. Cognitive behavioral therapy can be really helpful, and there’s even a version of it designed especially for kids with OCD called Exposure and Response Prevention.

If you’re looking for a child therapist in North Carolina, New York, or Florida, I may be able to help. I meet with kids in person (in Davidson, NC) and online (everywhere else) to work through anxiety, stress, and trauma. You can email me here to ask question or set up an appointment.

How to Help a Child with Intrusive Thoughts

Dark, bad, scary, negative, weird…whatever words you or your child use to describe intrusive thoughts, the effects are the same. Intrusive thoughts are like unwanted guests in our minds, barging in without being invited to spoil the party. While any child can have intrusive thoughts, they’re more common in children with anxiety, OCD, or a history of trauma. Keep reading to learn what you can do at home to help your child with the normal, common, but still very stressful phenomenon of intrusive thoughts.

Why Does My Child Have These Negative Thoughts?

If you’re curious to learn more about intrusive thought and why they happen, check out last month’s blog post. I break down what intrusive thoughts are in detail, with real-life examples. I also talk about what mental health problems might make kids more prone to experiencing them.

If you don’t have time to read the whole post, the gist is that intrusive thoughts are normal, and not always a problem. Many people—if not most people—will have intrusive thoughts at some point in their lives. They’re just one of the many weird things our brains and bodies do in an effort to keep us safe. When most of us have these seemingly random thoughts, we can shrug them off and quickly forget about them.

However, some kids are not so lucky. It can be harder for kids to distinguish between a useful thought and a useless one. This makes it more difficult to brush the thoughts aside. Instead, children may end up focusing on the thought and worrying about it. This leads to more anxiety, which increases the likelihood that these bothersome thoughts will pop up again.

An occasional intrusive thought is no problem, but kids with anxiety or OCD may get them so often that it feels debilitating. Children also sometimes experience these thoughts after a trauma as a part of PTSD.

How Can I Help My Child With Intrusive Thoughts?

There’s a lot you can do as a parent to support a child struggling with intrusive thoughts. You hold a powerful role in your child’s life. Your child looks to you as a guide to decide how she should think and feel about things, so your responses carry a lot of weight. By responding calmly and compassionately, you can help your child self-soothe and take the power away from overly dark or negative thoughts.

We’ll go over each of these in more depth in a minute, but here are 3 ways you can help:

• Normalize intrusive thoughts for your child

• Teach the difference between thinking and doing

• Help your child name and accept intrusive thoughts

These steps can go a long way toward helping kids handle disturbing thoughts with less worry and stress. Next, let’s break down each one to see why it helps and how you can practice it at home.

Let Your Child Know Her “Bad Thoughts” Are Normal (and Not So Bad)

Intrusive thoughts can be disturbing, but they’re also really, really common. So common, in fact, that one study found that 94% of people experience them. They’re just a part of being human! As common as they are, we don’t tend to bring up intrusive thoughts during polite conversation. Because nobody ever talks about them, a child may assume she’s the only one who gets intrusive thoughts. The thoughts can become a big source of shame, especially because they might be about taboo subjects.

Things always feel scarier when we don’t understand them. Teaching children about intrusive thoughts takes away some of their power. When you tell children that many people have these bad thoughts and they aren’t alone, you alleviate their shame. Reducing fear and shame not only helps your child feel better; it can also reduce her intrusive thoughts over time.

Try explaining this to your child: “Our brains are always thinking, and always looking for ways to keep us safe.” Giving us these “bad thoughts” is sort of like the brain showing us a flashing danger sign. The only problem is, the brain isn’t always right! Sometimes, the more we try to ignore these bad thoughts, the more our brain pushes the thoughts back. These thoughts can be really weird, or scary, or even be about things we’d never want to do in real life. As weird as they seem, most people have them sometimes and they are totally normal.

Explain That Thinking Isn’t The Same as Doing

Have you ever knocked on wood to keep something bad from happening? Or worn your “lucky shirt” on game day to help your team win? If so, you’ve experienced magical thinking. Magical thinking is the belief that our private thoughts and behaviors influence what happens in the outside world.

Magical thinking is really common in children, especially younger kids. It’s usually most noticeable from the toddler years through about age 7. If you think back to your own childhood, you’ll probably discover magical thinking everywhere: cootie shots, lucky charms, and “step on a crack, break your mama’s back” are all examples of magical thinking that are fun for kids.

However, there can be a dark side to magical thinking, too. Children often believe that their thoughts can cause things to happen in the world around them. If a child worries their thoughts are responsible for something bad happening, this can cause terrible fear and guilt. It’s easy to imagine how a child who gets intrusive thoughts about violence or crime could begin to worry about accidentally hurting others.

Help your child understand that having bad thoughts does not make you a bad person. It’s our actions and choices—not our thoughts and feelings—that hep us to be “good people.” Next, reassure your child that thinking angry or scary thoughts about a person can’t hurt them or cause something bad to happen. Even if they feel bad to us, thoughts are not that powerful.

Shine Some Light on Dark Thoughts By Naming and Accepting Them

When I think about kids struggling with dark intrusive thoughts, a quote from famous psychiatrist Dan Siegel comes to mind: “Name it to tame it.” Dr. Siegel came up with this phrase, and it’s since been adopted by many therapists to describe a simple process that makes strong feelings more bearable.

“Name it to tame it” is exactly what it sounds like. Often, the simple act of labeling our thoughts and feelings as we have them can make them feel better. This is because naming something requires us to take a step back and go into observing mode, rather than being totally absorbed and overwhelmed by our feelings.

Naming intrusive thoughts as they happen can be a helpful reminder that we are not our thoughts. Thoughts come and go, but it’s up to us to decide how much attention they deserve. Calling out intrusive thoughts for what they are is also a helpful reminder that they are common and harmless: after all, they’ve happened to enough people that we’ve given them a name!

You can help your child practice saying one of these phrases (or something similar) the next time an intrusive thought strikes:

• “My brain is giving me one of those garbage thoughts again.”

• “I’m having an intrusive thought right now.”

• “This seems like one of those thoughts I don’t need to listen to.”

Once the thought has been named, don’t dwell! We can just let the thought pass by. The more a child resists having intrusive thoughts, the more likely they are to pop up again. It may sound counterintuitive, but accepting intrusive thoughts can actually reduce how often they happen. By naming the dark thought and moving on, your child is teaching herself that they’re nothing to be afraid of.

Need More Help? Begin Child Therapy for Intrusive Thoughts in North Carolina

Sometimes, a child’s intrusive thoughts grow to be so big and overwhelming that at-home strategies aren’t enough to tame them. Maybe your child’s thoughts are part of a larger problem with anxiety or OCD. Sometimes, intrusive thoughts show up after a child experiences something traumatic or highly stressful. If your child’s intrusive thoughts are very frequent or very overwhelming, therapy can help sort things out.

Cognitive-behavioral therapy teaches children that they have more power than they might think over their thoughts and actions. They can learn to spot intrusive thoughts when they happen, and dismiss them rather than worrying about what they mean. Play therapy can also help younger kids work through anxiety and other feelings that are sometimes difficult to put into words. If your child survived a trauma, TF-CBT is a special, kid-friendly form of therapy designed to help children work through their symptoms in a safe way.

I’m a play and CBT therapist who specializes in helping kids with anxiety and trauma. I can work with families in three states: North Carolina, New York, and Florida. Children who live near my Davidson, NC child therapy office are welcome to stop by in person. If that’s not possible, no worries! I really enjoy online therapy and have found it to be just as helpful for many kids.

Ready to learn more? Drop me a line here. I’m always happy to hear from you.

Intrusive Thoughts in Children, Explained

Every kid worries from time to time. It’s normal (and even healthy!) to wonder about fitting in before the first day of school, or to imagine the worst-case scenario before taking a big test. Usually, these worries are easy for kids to talk about, because they know other kids have felt the same way. They also tend to be time-limited: once the test or first day of school is over, the worries are over, too.

For some kids, worries aren’t so easy to talk about. A troubling thought or mental image might pop up out of nowhere, when a child isn’t expecting it. Their worries may be repetitive and feel very difficult to control. Often, these thoughts are really scary and upsetting. They can be dark, violent, or about a taboo subject. These kinds of worries are called intrusive thoughts.

Kids don’t want to be thinking these things, and know they would never act on the thoughts they’re having. So why do they keep happening? In this post, we’ll be talking about what exactly intrusive thoughts are, why they happen, and when to seek help.

What Are Intrusive Thoughts?

Take a second and imagine an intruder. What do you think of? Someone who busts down the door, unannounced, without being invited. What a scary scenario! It’s safe to assume that most of us would be pretty freaked out to discover an intruder in our home. We’d probably dread having it happen again, and try everything we could to make sure our house was secure in the future.

Intrusive thoughts are the brain equivalent of an unwanted guest. They show up to ruin the party. Intrusive thoughts tend to:

• Pop up out of the blue

• Come back repeatedly

• Feel unlike the thoughts a child usually has

• Be upsetting to the child

Intrusive thoughts are ego dystonic. This is therapy jargon that means a person doesn’t agree with the thoughts, and it may not even feel like the thoughts really belong to them. Intrusive thoughts include imagery that is violent, sexual, or feels “wrong” to a child. Other times, worries about worst-case scenarios might come up again and again. They aren’t things that kids would choose to think about, and they’re often the opposite of what a child would do or hope for.

Kids with intrusive thoughts may feel distressed, anxious, or ashamed. They may not understand why the thoughts are happening, but can guess that not everyone is bothered by their thinking in this way. Because the thoughts feel out of control, children may dread having more and try to avoid them.

At What Age Do Kids Get Intrusive Thoughts?

There is no set age at which intrusive thoughts start. However, they may be more common or noticeable in tweens and teens. Intrusive thoughts are sometimes a symptom of OCD, which can show up as early as age 7 or 8 and as late as the teens or early twenties.

In my child therapy office, it’s usually middle or high school kids who are able to put the weird experience of having unwanted thoughts into words. They are old enough to think about their own thinking and notice their thoughts as they pass by, so they know that something doesn’t feel right.

Although they may not talk about it as much, younger kids can be bothered by these thoughts, too. Because they don’t have the vocabulary to talk about what’s going on, you might see changes in their actions, instead. For example, they may ask for reassurance about the same subject again and again.

Why Do Children Have Intrusive Thoughts?

Now that we have spent the past several paragraphs talking about how difficult and upsetting intrusive thoughts can be, you’re probably wondering why kids get them in the first place. The answer may surprise you! Many people experience intrusive thoughts, and it doesn’t necessarily mean something is wrong. They may happen when a person is going through a lot of stress, or they may just happen randomly.

Having an intrusive thought every once in a while isn’t a sign of mental illness. They can be totally normal, like the brain version of a hiccup. A child with occasional intrusive thoughts can usually brush them off without taking them too seriously.

What Mental Health Problems Cause Intrusive Thoughts?

Children who are struggling with repeated, ongoing intrusive thoughts can’t brush them off so easily. In these cases, a child may be dealing with a mental health problem that needs attention. OCD and PTSD are two common mental health conditions that can cause children to have intrusive thoughts.

Kids with OCD deal with repeated thoughts, worries, or mental pictures that upset or scare them. Kids are bothered by these worries, and feel pushed to do something to make the worry go away or prevent something bad from happening. This creates a cycle of repeated worries and repeated behaviors, called obsessions and compulsions, that take up a lot of time and add even more stress.

Children who have survived extremely frightening or dangerous events may have lingering problems after the fact. While some kids will bounce back, others may be diagnosed with PTSD. Kids with PTSD will re-experience parts of their trauma in some way, often through intrusive thoughts or flashbacks. Flashbacks are vivid memories that pop up suddenly and intensely, almost as if a child is living through the event again.

What Are Some Examples of Intrusive Thoughts in Children?

Most of the intrusive thoughts children have fall into one of three broad categories: worries, flashbacks, and “inappropriate” thoughts. If you think your child may be having intrusive thoughts, keep reading to take a closer look at each category. I’ll share some examples of each intrusive thought type. It can be helpful for both kids and parents to discover that they’re not alone, and many kids (and adults) deal with these kinds of thoughts.

Worries: Children with anxiety or OCD may have repeated, unwanted worries that they cant seem to shake. These are often “what if” worries that focus on something bad that could happen in the future. Other times, these “what if” thoughts could be about something naughty a child worries they could have done. Some children with OCD may also get a nagging sense that if they don’t do something exactly right, they could cause something bad to happen. These thoughts may not always be logical, which can make them even more confusing and bothersome for kids. Here are some examples:

• “What if I throw up in public?”

• “What if I accidentally lied to the teacher?”

• “I have to step on all the sidewalk cracks or I won’t be safe.”

Flashbacks: These are most common in kids with PTSD. Flashbacks may feel like they come out of nowhere, or they can be triggered by something that reminds a child of their trauma in some way. They can include any of the 5 senses, and often activate a child’s fight-or-flight system as if the dangerous event was happening again. Examples of flashbacks include:

• Feeling as though you’re back in the place where a trauma happened

• Having an image of the trauma pop into mind

• Hearing or smelling something you associate with the trauma

“Inappropriate” Thoughts: I put inappropriate thoughts in quotes here because there’s a big difference between thinking something and acting on it. We all have weird thoughts from time to time about things we probably wouldn’t be proud to share. Sometimes, intrusive thoughts are about the exact subjects we try to push away or not think about in our day-to-day lives: things like sex, violence, and criminal behavior. These kinds of thoughts can cause a lot of shame, guilt, and distress for children, who worry these thoughts mean they are bad or naughty. They may have thoughts like:

• Imagining hurting someone else

• Picturing themselves stealing something

• Noticing other people’s bodies or imagining them naked

Are Intrusive Thoughts Normal?

The short answer: yes. Intrusive thoughts can be weird, annoying, or disturbing, but they are totally normal. In fact, most of us will probably have intrusive thoughts at some point in our lives. One recent study found that 94% of people have them, which is a surprisingly huge number.

That number is particularly surprising when you consider that most kids with intrusive thoughts feel like the odd one out. They may worry they’re the only ones who have ever had thoughts like this, and that it means they’re bad or weird. Most adults with intrusive thoughts don’t talk about them with other people, either because they quickly disregard them or because it would feel odd to mention in casual conversation. No wonder kids feel so alone.

So, intrusive thoughts are normal—but we know that they can still cause problems for kids. Those issues aren’t caused by the thoughts themselves. Problems arise when the thoughts are very frequent or intense, or when kids have a hard time dismissing them.

Children with OCD have a tougher time disregarding stray thoughts that the rest of us would shrug off. They may take these thoughts more seriously or begin to fixate on them, which causes the thought to pop up more often. Trauma-related thoughts and flashbacks may be so upsetting that they quickly overwhelm a child.

Help for Kids with Intrusive Thoughts in Charlotte, NC

If your child is complaining of an occasional intrusive thought, a little reassurance and education may be all she needs to feel better. It’s helpful for kids to hear that their thoughts are normal, and can’t hurt them or others. Armed with that knowledge, it may be easier for kids to let intrusive thoughts pass by without taking them too seriously. This reduces anxiety which, over time, can also reduce how often the thoughts happen.

On the other hand, you may be on this page because your child’s thoughts are causing larger problems. Maybe you recognized your child in the descriptions of OCD or trauma. If these thoughts have been happening for a long time, are disrupting your daily life, or are combined with other symptoms, therapy can help.

Cognitive behavioral therapy helps anxious kids learn how to catch themselves when their thoughts aren’t doing them any favors. Being able to put a name to your worries helps you to gently shift your mindset. In CBT kids learn that they have control over their thinking, and what thoughts they choose to listen to. A specialized form of CBT called Exposure and Response Prevention helps kids with OCD break the cycle of obsessive thinking and repetitive behavior.

Play therapy helps younger children work through their complicated feelings after trauma. Kids naturally make sense of the world around them through play, and this gentle, child-led approach lets kids handle scary topics in the way that feels safest to them. For kids who are ready to tell their story more directly, TF-CBT gives children a step-by-step path toward managing strong feelings, talking about their experiences, and coping with reminders of trauma.

If you are looking for therapy in North Carolina, New York, or Florida, I’d love to help. We can meet online or in-person in my counseling and play therapy offices just North of Charlotte, North Carolina. If you’ve got questions or would like to schedule an appointment, contact me here.

Does Childhood OCD Go Away?

If your child has OCD, you may worry at times about what the future holds. It seems like such an unfair burden for a young child to deal with. Maybe you’ve wondered whether your child’s OCD symptoms will eventually fade away, so she will be free to live life without constant worry. If you have, you aren’t alone.

“Does childhood OCD ever go away?” is one of the most common questions I hear from parents, especially at the beginning of therapy. And it’s totally understandable! OCD symptoms can be debilitating and time consuming. Handwashing, repeated checking, asking for reassurance, or long rituals are exhausting not just for the child, but for the whole family. Nobody wants a child be stuck with those symptoms forever!

I can’t predict what the outcome may be for your child, but I do know that therapy can lead to big, positive changes in the lives of kids with OCD. Today, I am digging into the research to see how common it is for childhood OCD symptoms to completely resolve. I’ll also take a look at what we can do to help all kids with OCD start feeling better.

How Common is Childhood OCD?

Childhood OCD is more common than you might think. While we may talk more about forms of anxiety and depression affecting kids, OCD also often starts early in life. Most studies estimate that 1-3% of kids have OCD, although their symptoms might fly under the radar for a long time. This is because because they can be hard to spot.

OCD most often starts when a person is a child or teen. Pretty much everyone with OCD starts getting symptoms before age 25. For childhood-onset OCD, the average age of onset is around 10 years old. It is common for boys to start noticing symptoms a little earlier, while girls might not develop OCD symptoms until later.

Some people may not get treatment for OCD until they reach the late teen or adult years, but their problems often began years earlier, during childhood.

You Can’t Outgrow Childhood OCD Without Help

Looking at the research, one thing that is really clear is that OCD is not likely to go away on its own. It’s not something that a child is likely to just outgrow or forget about. Kids with OCD need specialized therapy. The right counseling can help them learn how to deal with the intrusive thoughts that cause their anxiety and push them to repeat actions over and over.

OCD symptoms tend to ebb and flow over time: sometimes they’re better, sometimes they’re worse. Stress often plays a part in how bothersome OCD symptoms are. Some studies suggest that a small number of people might be able to “outgrow” their OCD without therapy: about 1 in 5. However, it can be a little tricky to tell if someone has really gotten rid of their OCD, or if they’re just in a low-stress time of life when it isn’t noticeable. It’s possible for symptoms to go away entirely when stress is low, only to return again during a more difficult time.

There’s also a risk that a child’s OCD could get worse without treatment. This can lead to small inconveniences, like chapped skin from too much handwashing, or major life impairments, like difficulty getting out of the house. Children with OCD are at an increased risk of also having other mental health problems, like anxiety and depression. Later in life, people with untreated mental health problems sometimes turn to unhealthy coping mechanisms like drugs and alcohol if they don’t have other good ways to deal with their symptoms.

The good news is that most people with OCD feel better after therapy. About 70% of people who get specialized treatment for OCD will improve, and usually they improve by a lot. The great news is that kids often get better results from OCD therapy than adults do. Catching symptoms early and getting help quickly leads to fewer symptoms later in life. Most kids will still have some leftover symptoms after therapy, but a small number of kids might see their OCD go away.

Sometimes, OCD Goes Away Completely (But Not Always)

Different experts have different opinions on whether or not it’s possible for OCD to completely go away. I don’t think I can argue with the experts! It’s not entirely clear whether people get cured of their OCD, or if they just go into remission from OCD. “Cured” means the symptoms are gone forever, while “remission” means the symptoms go away for a while, but may come back later.

Being the nerd that I am, I’ve looked over a handful of studies looking at the likelihood of OCD symptoms going away after therapy. It seems like it is possible for some people, and there are a few factors that increase a person’s odds. Kids whose symptoms start when they are young have better chances of remission than teens or adults. So do people whose symptoms are milder, and who are able to get therapy quickly. Finally, people who do not have other mental health problems alongside their OCD fare better than people who are also dealing with anxiety or other conditions.

Depending on the study you look at, you’ll see researchers estimating that anywhere from 32% to 70% of people go into remission after therapy, meaning that their symptoms are gone for a long time, or have gotten so mild that they aren’t getting in the way of things. However, this is different than being cured: there’s no guarantee that the symptoms might come back. The number of kids who are cured is much smaller and open to debate. Some experts guess that 20% of kids with childhood OCD are cured, while others think OCD never completely goes away.

You Can’t Always Cure OCD…And That’s OK!

As we just talked about in the last section, there’s a big difference between remission and cure. With good treatment, many kids with OCD will go for long stretches without problems. However, expecting your child to never have another OCD thought ever again for the rest of her life probably isn’t realistic. While some kids may fully outgrow their OCD, many won’t. Most experts consider OCD to be a chronic condition that, once you have it, sticks around for the long term.

That may be demoralizing to hear. The words “chronic illness” can sound very hopeless, especially if your child is struggling intensely right now. But just because OCD can be a lifetime diagnosis doesn’t mean it’s a life sentence. You may remember from earlier in this post that OCD affects 1-3% of people. That’s a pretty solid number! There are lots of kids and adults out there who are thriving, enjoying life, and just so happen to have OCD.

Help is Available for Childhood OCD in Charlotte, NC

OCD doesn’t have to run your child’s life. If you are tired of repeated worries and rituals taking up your family’s time, therapy can help. In counseling, kids can learn that OCD is just a way that some people’s brains think—and they have control over which thoughts they listen to and which they don’t. A skilled therapist can help a child gradually “talk back” to their worries and face their fears. Eventually, OCD stops being such an overwhelming urge and turns into background noise.

I’m a therapist based in Davidson, NC, just outside of Charlotte. I’m also someone who had childhood OCD! Everybody’s symptoms are different, but I remember what it felt like to be spending so much time every day dealing with worries I didn’t want to have. I love helping other kids manage their OCD fears so they can get back to enjoying childhood.

Cognitive Behavioral Therapy is a great option for OCD, and younger kids often benefit from play therapy, too. Is Davidson, NC a long commute for you? We can work together online if you live anywhere in North Carolina, New York, or Florida.

Want to learn more? Email me to ask a question or request an appointment.

Signs of Perfectionism in Children (And How Parents Can Help)

When you think of a child who is a perfectionist, what do you envision? Most of us probably think of the stereotypical straight-A student who is enrolled in 5 extracurriculars and still somehow finds time to volunteer on the weekends. Even though we all know perfectionism is a “problem”, it tends to be seen as a good problem to have—the kind of thing it’s okay to mention on job interviews when you’re asked to describe your weaknesses.

Although it’s not officially a diagnosis, perfectionism is often misunderstood when we talk about kids’ mental health. Just like we casually say “I’m so OCD” and mean we are super clean or organized, we tend to call anyone who is a high achiever a perfectionist. But perfectionism isn’t always something that pushes kids to succeed: it can also hold kids back, and put them at risk for anxiety and depression. Keep reading to learn about the common signs and symptoms of perfectionism in kids, and how you can help your child who has a perfectionistic streak.

Perfectionism Can Hold Kids Back

A lot of us—myself included, sometimes—think about perfectionism as something that drives children to succeed. After all, holding yourself to a high standard challenges you to work harder and not give up. True perfectionism doesn’t always work this way. Perfectionist kids are so terrified of failure that they may limit themselves to activities that come easily to them.

They might avoid new sports or extracurriculars where they would risk making mistakes. They may also stick to familiar school subjects and interests rather than stretching themselves in new, less certain directions. Over time, this can limit a child’s growth. Mistakes are a crucial part of learning, so avoiding them means a child is missing out on learning opportunities in the long run. These children also run the risk of missing out on opportunities for fun, too: maybe some of those unfamiliar activities they passed up would have been really fun, if only they’d given them a shot.

What Are the Symptoms of Perfectionism in Children?

Perfectionism is a personality trait, not a mental health diagnosis. This means there isn’t an official list of signs and symptoms we can use to determine if someone is a perfectionist. However, it can be good to know if your child tends to think in a perfectionistic way, because it can sometimes lead to bigger problems with anxiety over time. Some children with perfectionistic traits may also have diagnoses of social anxiety, generalized anxiety, or OCD.

If you’re wondering whether your child might be a perfectionist, here are some symptoms to look out for:

• Unrealistically high expectations for themselves or other people: more than just a high standard, these expectations are overly tough.

• Easily frustrated by mistakes on homework or during other activities, to the point that the child might abandon the whole project.

• Avoiding or putting off activities that the child fears may be difficult.

• Worries about failing that are out of proportion to the actual situation.

• Taking a long time to finish assignments or repeatedly re-starting them due to anxiety about not getting things exactly right.

• Self-consciousness, low self-esteem, or lots of negative self-talk about the child’s own achievements.

• Meltdowns when a child feels they have been criticized or not done well enough on their work.

Perfectionism goes beyond just a desire to succeed: the standards kids impose on themselves are unrealistic and exaggerated. Children may fear that their teachers will be extremely disappointed with them, or imagine their work is extremely sub-par, when in reality the situation is not so serious. Even small tasks can become a big deal when a child is struggling with perfectionism.

Can Perfectionism Cause Low Grades?

Not all perfectionistic kids are straight A students! While some perfectionistic kids are driven to excel in school, others have the opposite experience. Some children actually see their grades suffer as a result of perfectionism that’s gotten out of hand.

These children earn grades that are below their ability level because they are not handing in work they deem “not good enough.” Sadly, this often happens after hours of agonizing and working on an assignment—only to get no credit for it.

Even when a child with perfectionism is successful in school, it comes at an emotional cost. Although they may seem happy and accomplished on the outside, these children are often insecure and unhappy on the inside. It’s hard to feel satisfied with your achievements when it always feels like you could have done more.

How to Help a Child With Perfectionism

Parents can do a lot to support children who are prone to perfectionism. Many schools are starting to recognize the importance of developing a growth mindset, which encourages kids to focus on their effort instead of simply the end result. Fostering a growth mindset is one of the best things you can do to combat perfectionism. Here are a few things you can try at home to get started.

• Focus on the process, rather than the product. Instead of just praising your child’s amazing drawing or their high score on a test, let them know you are proud of the work it took to get to that point. You can compliment your child on all the research they did, how careful they were in drawing their picture, or how much time they put into learning a new skill. Even if the end result isn’t perfect, the effort is still worthy of praise.

• Make the connection between accidents and growth. Older kids might like to hear stories about some famous mistakes that led people to unexpected success. For example, penicillin was discovered accidentally when mold grew on a petri dish the scientist was trying to use for something else. Potato chips are the result of somebody cutting French fries way too thin. Penicillin saves lives, and who doesn’t love a potato chip?

• Read books that celebrate mistakes. Younger children might enjoy Beautiful Oops!, a pop-up book that shows how mistakes in art can be turned into something beautiful. I use this book a lot in my therapy practice. Although it’s intended for young readers, older children like it too. It can open up great conversations about creative problem solving.

• Be a good role model. Whether it’s because of genetics or just learned behavior, perfectionism can run in families. Kids study their parents closely to decide how they should deal with things, so even day-to-day setbacks can be a casual learning opportunity. Pay attention to how you talk about your own mistakes, especially if you tend to be hard on yourself, too. If you can reframe them as something that isn’t a big deal, your child may follow suit, too.

When Perfectionism Turns Into Anxiety, Child Therapy Can Help

Perhaps unsurprisingly, perfectionist kids are prone to developing anxiety and depression. Sometimes, perfectionism can be the first sign of a mental health disorder like OCD, which can involve repeating things, checking work, and recurring worries about mistakes. It can be really isolating to struggle with perfectionism, and children may feel like they’re the only people on earth dealing with these feelings.

If you’ve tried self-help coping skills and they aren’t enough to overcome your child’s worries, counseling can help your child approach school in a more balanced way. Approaches like cognitive behavioral therapy help notice when their thoughts are unrealistically focused on failure. Over time, kids can learn to think more flexibly and take mistakes in stride. Almost as importantly, therapy reassures kids that they’re not alone: plenty of kids (and adults) have felt this way, and overcome their worries.

If you’d like to learn more about counseling, you can check out my page on child therapy here. I am available to help kids in the states of North Carolina, New York, and Florida from my online and in-person therapy office in Davidson, North Carolina. If you’d like to talk more about therapy with me, you can drop me a line here.

Signs and Symptoms of Germaphobia in Children

After months of hearing about the dangers of catching COVID-19 and the need to sanitize everything, who among us hasn’t become a little germaphobic? Being extra wary of germs during a pandemic is a normal and healthy response. For children, however, fears about germs, catching illnesses, and needing things to stay clean might stick around long after our country reopens. Fear of germs is really common among kids with anxiety and OCD, and I suspect we’ll be seeing more kids than ever experiencing it after the pandemic. In this post, I’ll be sharing how to tell when your child’s fear of germs has become overwhelming, and how to spot common signs and symptoms of germaphobia in kids.

What’s Germaphobia, Exactly?

Simply put, germaphobia is a fear of germs: viruses, bacteria, parasites, you name it. An extreme fear of any of the creepy-crawlies that can make people sick is considered germaphobia. Although most people worry about spreading germs and catching diseases (especially right now), kids with germaphobia have fears that go above and beyond what is considered typical for most people.

Like other types of phobias, germaphobia is a response that is out of proportion to the actual threat. Even though germs can be dangerous, the lengths that germaphobic kids go to avoid contamination are extreme. In severe cases, the cleaning, avoiding, and rituals of germaphobia can start to feel like they’re taking over a child’s life.

As an example, a child with a healthy concern about germs might be diligent about washing their hands whenever they come in from outside, after they go to the bathroom, and before they eat. A child suffering from germaphobia may feel compelled to wash their hands constantly throughout the day, possibly to the point that their skin becomes chapped and dry. Most people might avoid eating meat at a restaurant that looks undercooked, but germaphobic kids might refuse to eat in restaurants at all, because they can’t control how the food is prepared.

What Makes An Intense Fear of Germs More Likely?

Phobias are more common among people who already have an anxiety disorder. Kids who are already prone to anxiety may be more likely to develop germaphobia symptoms than those who are not. In particular, many people with germaphobia are diagnosed with obsessive compulsive disorder, a form of anxiety that makes people feel like they have to perform certain actions over and over again to reduce anxiety or keep something bad from happening.

Obsessive worries about getting sick, throwing up, and contamination from germs are extremely common among kids and adults with OCD. Oftentimes, people with these types of obsessive worries feel compelled to wash their hands excessively, avoid places or objects they fear have been contaminated, or to overly clean their homes or belongings, sometimes in a ritualized way. Because these symptoms are so common in people with OCD, some experts believe that people who are truly phobic about germs can be diagnosed with OCD, as well.

Common Symptoms of Germaphobia In Children

Excessive hand washing, cleaning, and avoiding dirty places are all symptoms of germaphobia.

If you recognize your child’s behavior in one or more of the bullets below, it could mean that your child’s worries about germs and illness have gotten bigger than they need to be, and could be interfering with everyday life. Of course, mental health problems like germaphobia can’t be diagnosed over the internet, so you’ll need to follow up with your pediatrician or a children’s therapist. Here are some of the most common symptoms of germaphobia in children:

• Repeated, uncontrollable worries about getting sick or being exposed to germs

• Intense fear or terror about contamination

• Physical symptoms of anxiety, such as rapid heartbeat, stomach upset, and sweating when confronted with something that triggers the fear of germs

• Excessive cleaning or hand washing, that sometimes develops into a ritual that must be done the same way each time

• Avoiding people, places, or things that are “contaminated” with germs

Signs Your Child Has Germaphobia

Anxiety symptoms can be hard to spot: they’re felt very intensely by the child who’s experiencing them, but may not always be visible to parents or other people. Signs, on the other hand, are behaviors that are more apparent to outside observers. If you notice any of these possible signs of germaphobia in your child, it could indicate they are struggling with invisible fears about germs or disease:

• Avoiding places that your child perceives are “germy”, such as grocery stores, shopping malls, public transit, or airports

• Refusing to touch things that have been touched by other people, or requiring that things be cleaned or covered in plastic before touching

• Tantrums, crying, screaming, or clinging to a parent when in a public place that might contain germs

• Repeatedly asking for reassurance about not having germs or not getting sick

• Frequent handwashing, showering, or cleaning that seems to be more frequent than needed, especially if the cleaning has to be done in the same way each time

• Your child’s cleaning, avoiding, or worries are exaggerated and getting in the way of daily life

Cognitive Behavioral Therapy for Kids With Fears of Germs

Germaphobia can quickly become overwhelming, both for kids and families. Fortunately, therapy can help kids to feel more in control of their worries and develop a healthier level of concern about hygiene and germs. Cognitive behavioral therapy, a specialized form of therapy that helps kids to change unhelpful thoughts and behaviors, is often recommended for children with germaphobia or OCD.

Kids who participate in cognitive behavioral therapy learn to become more aware of when their worries are unrealistic, learn relaxation skills, and gradually face their fears of germs and contamination so that they can get back to their normal lifestyles. Because CBT is based on learning skills, it is a great fit for both in-person and online therapy.

If you’re located in New York or North Carolina and interested in counseling, I may be ale to help! I work with kids and tweens at my child therapy office in Davidson, North Carolina, as well as online in New York and Florida. You can send me an email to learn more. Not ready for therapy, but looking for more general help with worries? My online self-help course helps kids learn coping skills to manage anxiety at home.

Online CBT Therapy for Kids With Anxiety

Kids weren’t meant to sit inside all day, isolated from friends while overhearing scary things on the news. Our “new normal” in quarantine may be especially tough for kids, who are so reliant on their daily routines to help them feel safe in the world. If you have noticed a spike in your child’s anxiety symptoms since the coronavirus, you’re not alone. It’s an understandable response to a very strange, stressful time in our history. Fortunately, one of the most effective treatments we have to help anxious kids—cognitive behavioral therapy—translates easily into online work with a therapist. In this post I’ll be sharing the basics of how CBT can help kids with anxiety disorders, and how it works to get CBT therapy online.

What Is CBT, and How Is It Different Than Other Forms of Therapy?

What do you imagine when you think of therapy? Maybe that stereotypical image comes to mind of a patient lying on a couch, free associating about their childhood experiences while a therapist quietly nods. While some therapists still practice this more “old school” form of therapy (and it really works for some people!) therapy doesn’t always have this look and feel. CBT is a very popular approach to therapy that offers another way to deal with stress, anxiety, and mental health struggles.

CBT stands for Cognitive Behavioral Therapy, and it’s a style of therapy that focuses on helping people learn new ways to deal with problems in the present, rather than gaining insight into the past. While you might discuss past experiences with a CBT therapist, in general the goal is finding solutions in the here-and-now. To do this, clients in CBT therapy learn how to spot the negative thinking patterns and self-talk that can lead to exaggerated worries and depression.

In CBT therapy, your child might…

• Learn coping skills to manage stress more effectively

• Gradually practice facing her fears in order to overcome them

• Learn how to identify overly-negative thinking

• Practice replacing negative self-talk with more positive, realistic self-talk

• Learn social skills to express herself confidently and assertively

What Makes CBT So Popular for Kids with Anxiety?

One big reason CBT has become so popular for treating childhood anxiety is that it can help kids feel better faster. The coping skills children learn in CBT can be used right away to start managing anxiety, panic, and stress, so many children notice some improvement in their moods early on in treatment. CBT is often a shorter form of treatment, and in general, people in CBT need fewer sessions of therapy than people who aren’t. Kids who get CBT therapy for anxiety symptoms may be able to progress through therapy more quickly, and return to their lives with skills to handle future problems.

Another reason for CBT’s popularity is that there is a ton of research to show it’s effective. As a therapist, I like knowing that the skills I’m teaching kids to manage their anxiety have been studied over and over, and have been shown to be the most helpful tools for the job. I like feeling confident that the therapy techniques I’m using are the most likely to help a particular child, and have been shown to be safe.

How Does CBT for Children Work With Telehealth?

While some forms of therapy may look and feel a little different when conducted online, in my experience CBT sessions via telehealth feel pretty similar to my in-office sessions! Because CBT is more task-oriented and involves more learning and teaching, it’s a natural fit for online therapy. While I often incorporate games, art, and play into my child therapy sessions, CBT puts an emphasis on helping kids put their thoughts and feelings into words, too. I think the fact that it’s a more verbal form of therapy helps make online sessions flow smoothly.

If your child is enrolled in online CBT therapy, she might participate in activities like these:

• Role-play difficult situations with a therapist to figure out healthier ways to respond

• Learn relaxation skills in session, like deep breathing and mindfulness techniques

• Practice turning negative self-talk into more positive or realistic self-talk

• Set goals to practice at home during the week, such as practicing a relaxation skill or raising her hand more often in class

• Learn more about how anxiety works, which can help kids feel less alone with their feelings

Online CBT therapy might use books, worksheets, and other teaching aids to help children get the most benefit from learning new skills. I sometimes email simple worksheets to parents that kids can use to track negative thoughts during the week. I sometimes assign other “homework” assignments as well, such as practicing a new skill during the week or trying to reach out to friends more during quarantine. Usually, CBT homework requires no more than 5 minutes a day of work—I know kids are overloaded with school assignments right now, and I don’t want to add to that stress!

Online CBT Therapy for Kids in North Carolina, New York, and Florida

If your child is having a hard time dealing with anxiety during quarantine, CBT can help her manage this stressful situation and equip her with tools that she can use to deal with anxiety even after quarantine ends. As a first step, you may want to consider my online course, Worry-Free Tweens, which teaches CBT-inspired coping skills to anxious kids ages 8-12.

If you’re in North Carolina, New York, or Florida and looking for online therapy for your child, my (virtual) door is always open. I love using CBT to help kids and tweens overcome anxiety and worry. You can reach out to me here to learn more.

PANS and PANDAS: A Cause of Sudden OCD in Kids?

I have a confession: I have been a child counselor for a while now, and I had never heard of PANS or PANDAS until fairly recently. It wasn’t covered in my graduate school program, or in my postgrad training. As far I was concerned PANS and PANDAS were kitchen implements and cute fuzzy bears from China.

All of a sudden, this year I began receiving many calls from parents looking for help for their kids who had been diagnosed with one of these two conditions. In this post, I’ll share what I’ve learned about PANS and PANDAS as a possible cause of sudden-onset OCD symptoms in kids. I’ll also let you know how therapy can help.

What Are PANS and PANDAS?

PANS stands for Pediatric Acute-Onset Neuropsychiatric Syndrome. In a child with PANS, anxiety and OCD-type symptoms develop very suddenly and severely due to an infection that has affected the child’s neurological system. Many types of infections are linked to PANS, including some fairly common ones like mononucleosis and Lyme disease.

PANDAS, or Pediatric Autoimmune Neuropsychiatric Syndrome Associated with Streptococcus, is a form of PANS. In PANDAS patients, the child’s rapid-onset symptoms are believed to be caused by the Strep A bacteria. Some researchers believe that PANDAS and is an autoimmune condition, in which the child’s body is attacking the brain instead of the bacteria causing the infection.

PANDAS was first identified in 1998, making it a relatively new condition. Because it’s so new, doctors and therapists are still learning about the causes of PANDAS and how best to help affected children.

What Are the Symptoms of PANS and PANDAS?

The most important detail to remember about PANDAS and PANS is that the symptoms come on very quickly. Usually, OCD and anxiety disorder symptoms develop gradually, over the course of months or years. Parents of children with PANDAS and PANS often describe the symptoms as almost coming out of the blue, developing over a weekend or a few days. These symptoms can quickly become so severe that they start to interfere with the child’s day-to-day life.

According to the International OCD Foundation, symptoms of PANS and PANDAS can include:

• Symptoms of OCD, like ritualized behavior or repeated worries

• Anxiety symptoms, like sudden separation anxiety

• Tics and other unusual movements, or problems with coordinated movement like handwriting

• Changes in eating and bathroom habits

• A recent strep infection (or other infection, in the case of PANS)

How are PANDAS and PANS Diagnosed and Treated?

PANDAS and PANS are diagnosed by a medical doctor. If the doctor thinks a child’s symptoms sound like they could be PANDAS, they will order tests like a throat culture or blood test that can detect a recent strep infection. If these tests come back positive, a doctor may choose to prescribe antibiotics to treat the infection. If child’s symptoms are due to PANDAS, they should subside along with the strep. PANS is diagnosed in a similar fashion, with tests and medications prescribed according to the infection that is suspected to be causing problems. Sometimes, when a child’s symptoms aren’t responding well to other medicines, doctors will use a more in-depth treatment called intravenous immunoglobulin (IVIG).

Doctors also often recommend therapy for PANS and PANDAS patients to treat the symptoms of anxiety and OCD caused by the illness. Although PANS and PANDAS may have a different cause than other anxiety disorders, kids with these conditions can still get relief from their symptoms with counseling.

Controversies: Are PANS and PANDAS Real Illnesses?

Because PANDAS and PANS are so new, doctors and researchers still are not in total agreement about what causes them. Some doctors are very convinced that strep and other infectious illnesses are the cause of PANS and PANDAS, while others feel there isn’t enough evidence yet to be certain. Some doctors feel more comfortable than others prescribing antibiotics to treat PANS and PANDAS symptoms, especially if the testing shows that the infection wasn’t extremely recent.

I’m not a medical doctor so I can’t speak to what really causes PANDAS and PANS or the best way to medically treat it. I do know that many children have had these symptoms since doctors first identified PANDAS in 1998, so whatever the cause, the problems children are suffering from are real. I also know that counseling, especially cognitive behavioral therapy, can be really helpful for these children.

Can PANS and PANDAS be Cured?

PANS and PANDAS are believed to be curable. Usually, if the symptoms are being caused by an infection, they get a lot better when the infection is treated. Counseling can also support kids in recovering from PANS and PANDAS and help them resolve any remaining anxiety after their medical treatment is done.

CBT for Children with PANS and PANDAS

Therapy can be helpful for kids with PANDAS and PANS for a few reasons:

• Learning coping skills to deal with anxiety might help symptoms resolve more quickly.

• Sometimes, even after medical treatment a child still shows signs of separation anxiety or OCD-type worrying. For these kids, the anxiety might have become a habit. They may have avoided the things causing their anxiety for so long, that now it is difficult to get back into their normal routine.

• PANS and PANDAS can be really frightening for kids. Children sometimes describe feeling out of control of their bodies. Having some support to work through the experience of suddenly getting sick can also help children to feel better.
  

Cognitive behavioral therapy, or CBT, is often recommended for kids with PANDAS and PANS. This kind of therapy helps children to notice when they’re having unhelpful thoughts that lead to worrying, and learn how to face their fears rather than avoiding them. It’s more goal-oriented and structured than some other forms of child therapy, so kids can really focus on the triggers for their anxiety.

ERP for Kids with OCD Symptoms Due to PANS and PANDAS

For children who have sudden-onset OCD symptoms, a special kind of CBT called Exposure and Response Prevention, or ERP, is often the best fit. This kind of therapy helps children to gradually face the fears that set off OCD worries and behavior. Children learn how to handle triggering situations without resorting to rituals or repeated behavior to help calm them down. Over time, kids feel more in control of their thoughts and less bothered by worries.

Help for PANS and PANDAS in Davidson, North Carolina

I’m a counselor who practices in Davidson, North Carolina, where I specialize in using CBT to help children combat anxiety. If you’d like to hear more about how I might be able to help your child with PANS or PANDAS, reach out to me here.

Not located near Davidson? I can provide online therapy throughout North Carolina, New York, and Florida. I also have an online coping skills course for kids with anxiety called Worry-Free Tweens. Because it’s education-based and not therapy, it’s available everywhere.

You can also get more in-depth information by checking out the references below.

International OCD Foundation’s PANDAS Page
Parents.com’s feature on PANDAS
PANDAS Physicians Network on how CBT helps PANDAS

ERP Therapy for Children

How Exposure and Response Prevention Helps OCD

When I first meet a child with OCD, they often tell me they feel hopeless. Kids with OCD are usually aware something is wrong: the worries that bother them feel foreign, and they wish they could just make the thoughts go away. When a child isn’t able to control his thoughts on his own, it can be a powerless and scary feeling.

The compulsive behaviors and rituals that come along with OCD can quickly become all-consuming, taking kids away from fun activities they love and leaving them feeling frustrated and embarrassed. Even though OCD can feel hopeless, the truth is that there’s a therapy approach out there that is really effective for treating obsessions and compulsions. ERP therapy for children can help kids deal with the overwhelming worries of OCD, and the way that it works might surprise you.

What is ERP Therapy?

ERP stands for Exposure and Response Prevention. It is a form of therapy that has been specifically designed and studied to treat OCD symptoms in adults, teens, and children, and it is often considered a “gold standard” for OCD treatment. ERP is a form of cognitive behavioral therapy, meaning that it’s based on the belief that changing a person’s thinking patterns and actions can also affect their emotions. Although some kids with OCD might also benefit from medication, ERP therapy does not involve medication. You can find ERP being practiced in big mental health centers as well as in private practice by psychologists, counselors, social workers, and other mental health professionals.

The main goal of ERP is to help children gradually face the frightening or difficult situations that set off their OCD worries (called exposure) without having to do their OCD behavior or ritual (response prevention). This is done in a safe, controlled way, usually in the therapy office, to keep children from feeling too overwhelmed. Children are taught about how OCD thoughts work to make them less mysterious and scary, and are given tools to fight back when their OCD thoughts arise.

Can Young Children Have OCD?

OCD can start at any age. Although most people with OCD aren’t correctly diagnosed until adulthood, two thirds of adults with OCD say their symptoms began before the age of 18. OCD can be diagnosed in children as early as age 6, and the time frame between 6 and 15 years of age is a common time for children to develop symptoms.

Here are some possible signs of childhood OCD to look out for:

• Recurring fears, worries, or thoughts that the child doesn’t want to have, but can’t stop thinking about

• Fears about hygiene (like handwashing), morality (like telling the truth), illness (like vomiting), or violent or upsetting thoughts

• Needing to sort, count, or perform an action an excessive number of times, or in a certain sequence

• The repeated worries and tasks are getting in the way of your child’s day-to-day life

How Does ERP Therapy Work with Children?

ERP therapy for children is based on the same tools and ideas as ERP for adults, but adapted to be more kid-friendly. OCD can feel disorienting and even embarrassing to children, who are often aware something is wrong but feel powerless to stop it. The first step in ERP with kids is to help children understand what OCD is, how it works, and that they are not alone. Explaining OCD using metaphors, reading age-appropriate books about ODC, and art and play therapy techniques can all help demystify OCD and help children understand that they’re experiencing something common and manageable.

Once kids have a better understanding of OCD, we can start teaching children tools to stop the cycle of OCD worries, and get control over their compulsive behavior.

“Bossing Back” OCD Thoughts with ERP

ERP therapy for children is a cognitive-behavioral approach, meaning that it focuses on a child’s thoughts and behavior to help shift their mood. Usually, ERP starts by helping a child learn to manage the repeated worries and unwanted thoughts that arise over and over with OCD. Sometimes these are described as “intrusive thoughts” because the thoughts can be upsetting ones that a child would never choose to have, but they pop into the child’s brain anyway.

In ERP a child learns that, like a glitch or a hiccup, these intrusive thoughts can be bothersome, but they’re not dangerous or a sign that something is seriously wrong. Kids learn how these OCD thoughts are different and less realistic than everyday thoughts, and practice spotting them when they pop up. Once a child can identify her OCD thoughts, she can learn tools to be the boss of them, instead of getting bossed around by the unhelpful worries.

Children might learn ways to use logic to prove that worries aren’t accurate, which can help take some of their power away. Children can also learn how to talk back to their fears, coming up with more helpful and empowering statements to say to themselves when an OCD thought is bothering them. Rather than being bossed around by OCD worries, children learn how to “boss back” and challenge their thoughts to regain control over them.

Doing the Opposite

The behavior-based part of ERP therapy for children is the one that might surprise you. After children tackle the thoughts and worries of OCD, they are asked to do the exact thing their OCD tells them not to do. For example, a child with a fear of getting germs on their hands might be encouraged to play in the mud…without washing her hands right away. A kid who worries about throwing up might be asked to talk about vomiting and make barf jokes in therapy sessions.

This might seem counterintuitive: if a child is feeling really anxious about a certain activity, won’t doing it make him feel worse? When a person is anxious, it’s really tempting to avoid anything that triggers anxiety. Each time we do this, however, we are “feeding” the anxiety and making it stronger in the long run. Although our anxiety might go away when we avoid a scary thing, the next time we encounter the same situation it will come back even stronger.

Kids are never asked to face their fears all at once—this would be way too scary and overwhelming! Instead, a therapist helps a child to work up to the scariest situations, bit by bit, usually over the course of many weeks. This is done in a safe setting like a therapy office, where the therapist can control the situation and make sure the child is not feeling too overwhelmed. Each time the child faces a part of their fear, they re-train the brain that this situation is not something worth getting so anxious over. Children are also encouraged not to practice their OCD behavior during this time, even if it feels like it would help them to reduce their anxiety. By ignoring the urge to complete a compulsive behavior, we can diminish its strength over time, and eventually children may not feel the need to do it at all.

More Resources on ERP Therapy for Children

If you suspect a child in your life has OCD, and wonder if ERP therapy for children could be helpful, there are a few next steps you can take. My blog post on child OCD symptoms can help you learn more about how OCD can manifest in kids, or you can check out my homepage on childhood anxiety to get advice about how to help kids soothe anxiety at home. You can also visit the International OCD Foundation’s website, which has excellent resources for families and can help you find a therapist who specializes in OCD in your area.

If you’re in the Lake Norman or Charlotte, NC areas, I’m always happy to talk about local resources and how I might be able to help support your child with OCD. You can reach out to me here.

Signs of OCD in Children: What Parents Can Look For

Obsessive-compulsive disorder, or OCD, is a common form of anxiety that affects up to 3% of kids in the U.S. Parents can play a big role in spotting early signs and symptoms of OCD in children, especially since the problems kids experience can be subtle at first. In this post, I’ll debunk some of the common myths and misconceptions about OCD, highlight some common symptoms to look for, and share how to get the best help for your child if you’re concerned about OCD.

Obsessive-Compulsive Disorder: Stereotypes vs. Reality

“I like to make sure all my papers and pencils are organized…I’m a little OCD.”
“I’m super OCD about my house being clean.”
“I have such OCD about getting my books back to the library on time.”

Have you ever heard anyone talk like this? Over the last decade or so, “OCD” has become a household word. Often used as a slang term to describe someone who is very organized or strict about something, the way we use “OCD” in casual conversations is not a very accurate description of what life is like for people who have this disorder. More people are aware of OCD than ever before, which is great! On the other hand, the stereotype of an “OCD” person as always being extremely neat and tidy might make it harder for parents to spot true signs of OCD in children. Not all kids (or adults) with OCD are particularly clean or organized!

Obsessive-compulsive disorder, or OCD, is a form of anxiety that affects both children and adults, but often begins in childhood. The American Psychiatric Association defines OCD as “an anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions).”

Common OCD Symptoms in Children

OCD has two main symptoms: obsessions and compulsions. Obsessions are repeated, bothersome thoughts that are different from the worries most of us experience occasionally. They pop up again and again, even when the person does not want to be thinking about them. Often, the thoughts are very unrealistic, frightening, or illogical. People who suffer from OCD may know that their worries are not logical, but continue to be bothered by them.

To stop their obsession from bothering them, people with OCD feel compelled to do something to relieve anxiety or to prevent something bad from happening. This might be a common behavior that has been taken to an extreme and repeated too much, like handwashing or asking for reassurance. Sometimes, the behavior may not be tied logically to their worry. For example, kids with OCD may need to a certain number of items perform tasks in a certain order.

Kids with OCD sometimes describe an “itch” or “not right” feeling that they have until their compulsion is completed. While performing a compulsive behavior helps the person to feel better for a little while, the OCD thought always recurs again, leading the person to have to perform the compulsion over and over.

Everybody has worries or feels the need to do something to prevent bad luck from time to time, but for children and adults with OCD, these repetitive behaviors take up a ton of time—even many hours a day. The obsessions and compulsions of OCD get in the way of a person’s day-to-day life. If your child’s repetitive behavior or worries are beginning to interfere with their daily activities, it’s a sign that OCD symptoms may be to blame.

What Are the Most Common Signs of OCD in Children?

Often, children feel very confused or even ashamed of OCD symptoms. They may not be able to verbalize exactly what they’re going through to their parents, but they can probably tell something is not right. A child with OCD may bring up repeated worries, even after being reassured about it multiple times, or appear repeatedly anxious in situations that may not seem entirely logical. Some common fears and obsessions for children with OCD are:

• Fear of dirt, germs, or items becoming “contaminated”

• Worries related to religion or morality, such a truthful child being afraid of possibly lying

•  A need for things to be symmetrical, in a certain order, or done a certain number of times

• Worries about getting sick, others getting sick, or throwing up

• Thoughts about violent or upsetting things happening that feel intrusive (unwanted by the child)

In addition to these worries, children with OCD usually feel the need to repeat a certain behavior over and over again. These repeated actions, called compulsions, are also commons sign of OCD in children:

• Repeatedly checking things, such as light switches, the oven, or reviewing homework

• Rituals that must be performed exactly the same way each time, such as an elaborate bedtime routine

• Hand-washing, showering, or brushing teeth more often than necessary

• Counting or arranging items in a specific way

• Repeatedly asking for reassurance from parents or friends

What’s the Best Treatment for OCD Symptoms in Kids?

OCD can impact many areas of a child’s life, including their ability to focus on schoolwork, their sleep and eating habits, and their ability to fit in with friends. Treatment for OCD supports a child in all these domains, as well as helping the child to break the cycle of obsessions and compulsions. Research suggests that Exposure and Response Prevention, also known as ERP, is the most effective form of therapy for OCD.

ERP helps children to notice when their worries become obsessive, and empowers them with specific strategies to reduce their need to follow through with compulsive behavior. Over time, the urge to complete the compulsion gets weaker and weaker, and children are better able to identify and ignore any “OCD worries”.

Get Help for OCD and Childhood Anxiety in Charlotte, North Carolina

If you’re interested in learning more about how therapy could help your child with the signs and symptoms of OCD, feel free to reach out to me here. I’m available to help kids in North Carolina, New York, and Florida using online therapy. Not in one of those states, or not ready for therapy? Learning coping skills such as relaxation techniques and how to spot unhelpful thinking patterns can benefit kids with any form of anxiety. My educational course, Worry-Free Tweens, is not a replacement for therapy but may be a helpful first step for you and your child to learn skills together.

You can also find more helpful information at the sources below:
Nationwide Children’s Guide to OCD
The CDC’s Children’s Mental Health OCD Information Page