Do you know that OCD, or Obsessive-Compulsive Disorder, is more common in children? OCD often shows up in ways that can be confusing or even easy to miss. If a child suffers from OCD, their brain gets stuck in a loop.
As a result, their behaviors and thoughts are repeated several times over and go outside their control. These behaviors are driven mainly by the need to prevent a bad thing from happening, which gets reinforced every time they repeat the behavior.
Understanding OCD in Children
OCD is one of the most treatment-resistant mental health disorders in children and teens. It’s because OCD involves brain habituation and strong behavioral patterns that make the cycle of obsessions and compulsions hard to break.
OCD shows up in many different ways. I once worked with a parent whose kid had a bedtime ritual of checking under the bed and the closet repeatedly, and another midschooler who often sought reassurance by asking the same question over and over. These compulsive behaviors may seem like quirks, but they’re actually coping strategies for an overactive, dysregulated nervous system.
OCD is not just a phase or personality trait; it’s an actual mental health condition that affects how the brain processes anxiety. The OCD brain gets stuck in a loop – compulsions provide short-term relief for fears, but reinforce the obsessive thoughts over time.
Recognizing these patterns can help you support your child and start them on a calm and clear path to recovery.
What are OCD intrusive thoughts?
Intrusive thoughts or obsessions are uncontrollable thoughts, impulses, fears, and images that OCD kids can’t ignore, even when they aren’t real. These OCD thoughts can disrupt daily life, interfere with focus and relationships, and become completely debilitating.
Parents may think of intrusive thoughts as random thoughts that have no connection to anything that their children are doing. But in truth, these obsessive thoughts may come out of nowhere, can be about anything, and aren't typically rooted in anything real.
I know how tough OCD is on your kid and your family. Intrusive thoughts become as much of a barrier to healing as the OCD itself. Learning about how OCD affects the brain is a great first step to helping break the shame cycle.
Can you have intrusive thoughts without OCD?
Seif and Winston (2019) estimate that about 6 million people in the U.S. struggle with intrusive thoughts. These can happen with OCD, but also with anxiety, stress, or even hormone changes in teens and adults. In PTSD, they may be tied to trauma, like a car crash or violent event.
Intrusive thoughts aren’t always harmful—if someone can ignore them. But if they start changing how a person thinks or acts (which often happens with OCD kids), it’s time to get professional help.
What are OCD compulsions?
Compulsions are compulsive rituals that children and young adults with OCD feel they must keep repeating to make their anxiety disappear.
They feel better for a moment after doing the compulsions, but it just keeps the cycle going. The thoughts don’t make sense, and the rituals don’t solve the real problem.
What are the 4 Types of OCD?
OCD can look different from child to child, which makes it hard to recognize and diagnose. If your child shows signs of OCD, it’s important to get help from a mental health professional.
You can also check with The International OCD Foundation for helpful resources and a “find help” tool to connect you with trained OCD therapists and get the right treatment.
1. Contamination OCD:
Children and teens experiencing contamination OCD often demonstrate compulsive behavior aimed at decontaminating themselves in response to their fears of contamination like excessive hand-washing or long showers that can cause physical pain.
During the COVID-19 pandemic, symptoms worsened for many, with a study by Jalal et al. (2020) showing increased obsessions and compulsions during lockdown.
I recently worked with a teen boy whose OCD made him believe his parents spit in his food, leading to extreme food restriction and significant weight loss. Using PEMF, exposure and response therapy, and nutritional support through supplements, we calmed his brain and helped his parents stop accommodating the OCD.
Common Obsessions
- Fear of contamination and contaminating others
- Fear of getting in contact with anything thought of as unclean
- Fear of germs
- Fear of being around sick people
- Fear of getting poisoned
Common Compulsions
- Excessive hand washing
- Repeated disinfection
- Frequent clothing changes
- Rigid cleaning and scrubbing
- Avoiding dirty areas or persons
2. Orderliness or Symmetry OCD:
A study by Jacobsen and Smith (2017) found that symmetry OCD is one of the most common types in young people, involving a need for perfect order or sameness. These urges can feel uncontrollable, often triggering anxiety and fears that something bad will happen unless rituals are performed.
Common Obsessions
Overly concerned that something will happen if something is not in the proper order
Feels anxious when things are asymmetrical
Has an imperative need to achieve balance
Common Compulsions
Lining up things
Compulsive counting
Positioning items in perfect order
Ordering or arranging items by size or color
Repetitive behaviors related to visual checks
Rewriting things
Straightening up things
Counting
3. Checking OCD:
This may be mistaken for perfectionism, as the individual feels compelled to avoid mistakes and according to Van den Hout and Kindt (2003), this can lead to memory distrust. This over-conscientiousness feeds the OCD, making them more irrational and prone to the very errors they fear.
I once worked with a young woman who had to check septic and sewer caps because she feared she would fall in them. She knew it was completely irrational yet she could not leave her house because of her checking behaviors.
Common Obsessions
- Fear of starting a fire
- Fear of hitting people while driving
- Fear of inducing harm due to carelessness
- Fear of sending messages or emails with wrong content or inappropriate materials
- Fear of losing things
- Fear of leaving home unlocked
Common Compulsions
- Repeatedly checking that all home appliances are off
- Constantly ensuring that all window and door locks are working
- Always inspect things closely
- Never-ending seeking of reassurance about their concerns
- Engage in mental rituals to go over things that they did and didn't do
- Repeatedly saying certain words or phrases
4. Harm OCD:
Those with this OCD subtype have unwanted intrusive thoughts about being aggressive or doing a violent act and have certain compulsions to get rid of those violent thoughts.
Children with Harm OCD often need reassurance that they won’t act on their intrusive thoughts, yet they’re frequently misdiagnosed as suicidal due to a misunderstanding of their fears. Harm OCD treatment typically involves therapy and sometimes medication, but many kids are hospitalized because their OCD is not properly recognized.
Common Obsessions
- Getting violent mental thoughts and images and then worrying that they will act on them
- Thinks about inadvertently causing harm and never realizing it
- Terrified of hurting themselves or others on impulse
- Constant worrying about losing control and becoming a vicious person
Harm OCD: Common Compulsions
- Locking away sharp and pointed objects
- Reviewing one’s every action to check if they caused harm
- Avoiding violent movies, TV shows, or news
- Excessive research of crimes online
- Compulsive praying and belief in spiritual items
- Always asking if they are capable of hurting themselves or others
What are the Common Types of OCD Intrusive Thoughts?
1. Violent Intrusive Thoughts:
Some kids with OCD have scary thoughts, like hurting themselves or others, even though they would never actually want to.
To feel better, they might do certain actions or mental rituals to try to “cancel out” the thought or stop something bad from happening.
2. Religious Intrusive Thoughts:
Some children with OCD have upsetting religious thoughts, like being scared they’ve sinned or done something wrong in the eyes of their faith. This is called scrupulosity. To feel better, they might pray over and over even if they don’t want to—these thoughts are often driven by anxiety, not real beliefs.
McIngvale et al. (2017) found that children with these kinds of thoughts often have more severe OCD symptoms and more trouble in daily life. Siev et al. (2011) also found that they’re less likely to get help, since the behaviors can look like normal religious habits.
3. Sexual Intrusive Thoughts:
Some kids with OCD have upsetting sexual thoughts, like fears about their sexual orientation or worries about being touched.
It’s important to rule out any history of abuse, but if the thoughts are part of OCD, ERP therapy is the recommended treatment.
4. Magical Thinking Intrusive Thoughts:
These thoughts often start small but grow over time. Kids may believe certain actions—like touching something a certain way—can prevent something bad from happening. They might even think something bad happened because they didn’t do things “just right.”
Natural Solutions and Treatments for OCD Symptoms and OCD Intrusive Thoughts in Kids and Teens
Helping a child manage OCD and intrusive thoughts isn’t easy—it takes time, patience, and consistent support. But with the right tools, kids can learn how to calm their minds and take charge of those scary thoughts.
If you think your child may have OCD, it’s important to respond in a way that helps—not hurts. For example, avoid reacting to their thoughts like they’re dangerous or wrong. Berman (2018) found that when parents treat these thoughts as threats, kids are more likely to feel anxious and fall into patterns that make OCD worse.
1. Exposure and Response Prevention Therapy (ERP):
It is one of the best and effective OCD treatment options which exposes OCD patients to trigger their feelings of discomfort until they can regain control and eventually ignore them entirely.
ERP therapy, led by trained therapists, may initially increase anxiety but helps address OCD, with parents learning to manage emotions and support their child. Other treatments like neurofeedback, deep brain stimulation, and cognitive behavioral therapy can also improve OCD symptoms.
2. Psychoeducation:
This plays a crucial role in OCD treatment to effectively overcome the behavioral habituation that affects the entire family. A comprehensive understanding is important to help parents grasp how OCD impacts a child’s brain and behaviors, ensuring a more effective therapy process.
3. Natural Solutions:
Using mind-altering drugs may not be the most effective treatment for kids and research-backed natural treatments are often more effective for addressing OCD symptoms. That’s why I’ve been advocating for natural solutions to support children’s health and well-being.
If you're seeking natural ways to support your child, I’ve created a therapist-tested Natural OCD Thought Tamer Parent Kit that is packed with helpful tips, recommended supplements for OCD, calm brain tools, and other strategies to help you manage OCD at home.
Regular use of natural solutions can improve your child's OCD symptoms, but it's essential to first get an accurate diagnosis from a qualified mental health professional, such as a clinical psychologist. With the right treatment plan in place, you’re setting your child up for success and lasting improvements!
Parent Action Steps
Citations
Berman, N. C. (2018). “Should I Be Scared?” Examining Parents’ Interpretations of Children’s Unwanted Intrusive Thoughts. OCD in Kids. Retrieved from https://kids.iocdf.org/from-the-experts/should-i-be-scared/
McIngvale, E., Rufino, K., Ehlers, M., & Hart, J. (2017). An In-Depth Look at the Scrupulosity Dimension of Obsessive-Compulsive Disorder. Journal of Spirituality in Mental Health, 19(4), 295–305. https://doi.org/10.1080/19349637.2017.1288075
Seif, M., & Winston, S. (2019). Unwanted Intrusive Thoughts. Adaa.org. Retrieved from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/unwanted-intrusive-thoughts
Siev, J., Baer, L., & Minichiello, W. E. (2011). Obsessive-compulsive disorder with predominantly scrupulous symptoms: clinical and religious characteristics. Journal of Clinical Psychology, 67(12), 1188–1196. https://doi.org/10.1002/jclp.20843
Dr. Roseann is a mental health expert in Neurodivergence who is frequently in the media:
- Business Insider How to practice ‘autonomy-supported parenting' to boost your family's wellbeing
- Healthline Get Stuff Done: A Realistic Guide to Working From Home with Kids
- Love Shack Live How To Navigate The Parenting Journey As A Couple
Always remember… “Calm Brain, Happy Family™”
Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.
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