How Children Experience OCD And What Helps

If you’ve ever wondered whether your child’s “quirks” are more than just preference, this conversation brings clarity and relief. Kim Lee, a child and adolescent psychotherapist, breaks down what obsessive compulsive disorder looks like in real life for kids and teens: intrusive thoughts that feel sticky, rituals that promise relief, and the exhausting loop that follows. We unpack the most common themes—contamination fears, harm obsessions, checking and reassurance seeking, symmetry and “just right” needs, magical thinking, and purely mental rituals—and show how they all connect to the same anxiety cycle.

We also get honest about the family side. Reassurance seems kind, but when it becomes repetitive it quietly feeds the OCD cycle. Kim offers practical language to reduce shame and build agency, like naming the “OCD voice” to separate the child from the problem. You’ll hear how to respond with calm curiosity, validate feelings without debating the obsession, and support tiny, doable steps that strengthen tolerance for uncertainty. For adolescents who hide symptoms, we share signs to watch for—withdrawal, irritability, or secrecy—and ways to open safer conversations.

Finally, we walk through help that works. Exposure and response prevention (ERP) is the gold standard, and a thorough assessment can tailor the plan to your child’s patterns. Psychotherapy adds depth by exploring the meaning beneath symptoms and teaching flexible ways to relate to thoughts and feelings. With the right support, kids learn that thoughts are not commands, anxiety can rise and fall, and rituals can be resisted. Many go on to live full, flexible, joyful lives. If this resonates, follow the show, share it with someone who needs it, and leave a review to help more families find practical, evidence-based guidance.

Chapters

• 0:00 What OCD Really Is
• 2:12 Obsessions And Compulsions Explained
• 3:35 Common Childhood OCD Themes
• 5:15 The Inner Experience And Shame
• 6:38 Parent Responses That Help Or Hinder
• 7:53 Naming The OCD Voice

Transcript

SPEAKER_00: 0:00

Hello and welcome to the Children's Consultancy Podcast. I'm Kim Lee, child and adolescent psychotherapist, and today I want to talk with you about obsessive compulsive disorder or OCD as it's known in children and young people. OCD is often misunderstood, and people sometimes think of it as simply being tidy, organized, or perfectionist. But for children and adolescents, OCD can be incredibly frightening, confusing, and deeply distressing. I think the same is true for parents who see that their child is suffering in this way. Now, my aim in this episode is to help you understand what OCD really is, the different ways it can show, and how you might begin to recognize what your child or young person is experiencing. It isn't so much that this is something that you can resolve yourself, although sometimes it is, but by understanding what it is, it can help you in your approach to your child and consider what options might be helpful. Now, this is an anxiety-related condition, and it has two main parts. These are obsessions and compulsions. Now, obsessions are often intrusive thoughts, images, or urges that pop into the mind and feel unwanted, disturbing, or frightening. And children often describe them as thoughts that get stuck or that they can't switch them off. And compulsions follow because they are the behaviors or mental acts a child feels that they must do to reduce the anxiety caused by the obsession. These might be visible behaviors like washing hands repeatedly, or they may be invisible mental rituals like silently counting or repeating phrases in their minds. The key thing to understand is that OCD is not about choice. Children don't enjoy these rituals and they often feel embarrassed or scared to tell you about them. And the compulsions are attempts to feel safe. And there are common types of OCD in children and young people. And it can take many forms, but understanding the theme can help you make sense of what your child is going through. So sometimes we see things like contamination and germ fears. And some children are terrified of germs or becoming ill, dirt, toxins. They may wash their hands excessively, avoid touching objects, or insist on very specific cleaning routines. They also may fear that they will make someone else ill. Now, harm OCD or intrusive harm thoughts is a different category. Children may have intrusive thoughts about hurting someone, shouting something inappropriate, or acting in a dangerous way. These thoughts are extremely distressing and are not desires or intentions. The child often feels ashamed and may avoid situations or seek reassurance constantly. Checking and reassurance seeking behaviors are very common. Sometimes children repeatedly check doors, lights, or parts of their body. They may ask you the same questions over and over for reassurance. You know, are you sure I won't die? Are you sure I didn't hurt some? Are you sure the house won't say burn down? And so on. And this reassurance becomes part of the compulsion cycle. The other thing that I I sometimes see is something called symmetry and ordering and getting things just right, OCD. Some children need things to feel just right. They may line up toys, rewrite schoolwork, or repeat movements until it feels correct. And this isn't about neatness. It is about an internal sense of discomfort that only resolves when things feel balanced. Another category is what we call magical thinking and superstitious rituals. Children may believe that certain thoughts or actions prevent bad things from happening. For example, they might feel that they must tap something a certain number of times or think a specific phrase to keep family members safe. Now, in purely obsessional OCD, which are mental rituals, some children have internal rituals which include things like silently repeating words or counting or analyzing thoughts. And this is harder to spot because the distress is internal, but it can be just as consuming. For children, OCD can feel like a very loud, frightening voice in their minds. They often know that the thoughts don't make sense, but they feel unable to stop them. The anxiety can be hugely intense, and the compulsions become the only way they feel temporary relief. Many children feel shame or fear that they are bad for having these thoughts. Adolescents in particular may hide symptoms leading to significant internal distress, withdrawal, or irritability. But it's important to remember intrusive thoughts are common in all humans. OCD happens when these thoughts become powerful and sticky, and the child feels compelled to neutralize them with rituals. And what parents can do is really the main question here, isn't it? If you think your child may be experiencing OCD, try and listen with curiosity and calm. Avoid dismissing or panicking about their thoughts, and also avoid excessive reassurance. Because although reassurance might feel helpful in the moment, it can intentionally feed the OCD cycle. And what I mean by that is that essentially, although our intention is to help the child feel better, clearly it doesn't work because you have to keep doing it. And that then tells the child that they are unable to tolerate or graduate through the difficulty they're experiencing. It's an entirely understandable parental response, but it doesn't work. The other thing is it's okay to name the OCD. You can external it externalize it as the OCD OCD voice. So in a sense, you're saying to the child, yes, I know what this is. This is your OCD voice, which alerts the child to the fact that it is a part of them, it is not all of them, and it is something that can be seen and it can be understood. Do seek professional support. Generally speaking, OCD tends to grow into itself rather than being something that the child grows out of. There is a treatment known as ERP or exposure and response prevention, and it is something which will help children to manage their experiences differently. But I think from my experience, a combination approach may be required, and that should be preceded by thorough clinical assessment. Psychotherapeutic work can not only help children understand the emotional meaning of their symptoms, namely what it is that's underneath that's causing the behaviour, but it can also help children to view, experience, and manage the obsession and the compulsion differently. Now, it is a very treatable condition with the right support, and children and young people can often learn to manage these intrusive thoughts and reduce compulsive behaviors. Many go on to live full, flexible, and joyful lives. I hope this is helpful, but what I would say is in the first instance, try and recognize that this is a part of the child and that there are reasons that they don't understand which lie beneath the symptoms. Thank you for listening.