When “anxiety” in kids is actually OCD (and why it gets missed so often)
I’m a therapist who works primarily with kids and teens, and one pattern I see constantly is children being treated for “general anxiety” when they’re actually dealing with OCD.
A lot of pediatric OCD doesn’t look like the stereotypes people expect. It’s not always obvious handwashing or checking. Sometimes it shows up as:
- excessive reassurance-seeking
- confession rituals (“I need to tell you something bad I thought”)
- bedtime fears that never resolve with comfort
- repeated questions that seem irrational but feel urgent to the child
- avoidance that looks like “behavior problems”
- intrusive thoughts that cause shame or panic
- mental rituals parents can’t even see happening
One of the hardest parts for families is that traditional anxiety strategies can accidentally reinforce OCD. Reassurance, avoidance, and accommodation often bring short-term relief but strengthen the cycle long-term.
That’s why accurate assessment matters so much. Anxiety and OCD overlap, but treatment approaches can differ in important ways — especially when ERP (Exposure and Response Prevention) is appropriate.
I specialize in helping families sort through:
- Is this anxiety, OCD, or both?
- What behaviors are compulsions vs. coping?
- When is reassurance helping vs. maintaining the cycle?
- How do we support kids without feeding fear?
ERP with children can also look much more collaborative, playful, and developmentally appropriate than many parents expect.
Curious whether other clinicians, parents, or educators here have noticed how often OCD gets missed in kids — especially when symptoms present as perfectionism, emotional dysregulation, or constant worrying.
