Author name: Amanda Mulfinger

How OCD Shows Up in Children and Teens Obsessive-compulsive disorder (OCD) manifests differently depending on the age of the patient. Studies published by the International OCD Foundation on obsessive-compulsive disorder show that 1 out of 40 adults develops OCD at some point in their life. Among those affected, children are the most difficult to diagnose. This is due to the confusing nature of OCD. It’s important to understand the symptoms of early OCD to prevent it from permanently affecting children. This prevents the mental health issue from escalating or being misdiagnosed as OCD. Amanda Mulfinger, PhD, LP Updated: July 3, 2025 Get Started (952) 831-2000 Table of Contents   Table of Contents Key takeaways: Pediatric OCD is a serious mental health issue, not just odd behavior. OCD symptoms change with age, from physical rituals in kids to mental ones in teens. Look for distress, secrecy, and daily disruption as signs anxiety is escalating. Diagnosis involves clinical interviews; OCD often co-occurs with other conditions. CBT and ERP are key treatments, heavily supported by family and school involvement. What Is Pediatric OCD? Pediatric OCD is a mental health issue characterized by repetitive behaviors and unwanted thoughts. It is a compulsion that repetitively interferes with the daily life of a child, as they have to accommodate their life around the compulsion. Defining OCD in Younger Populations OCD manifests differently in the younger population because children may not understand their compulsion. The developmental difference leads to fear and confusion, riddled with internal compulsions. Children struggle with simpler rituals, such as lining up their toys or repeatedly touching things. On the other hand, teenagers frequently engage in mental rituals such as repeating words in their mind or counting silently. Most parents mistake this for distraction or daydreaming. According to studies by Carolin S. Klein at the University Hospital of Psychiatry and Psychotherapy in Tübingen, Germany, OCD affects an average of 1% of children and 4% of teenagers. The condition appears around the ages of 8 to 11, which makes it more difficult to diagnose. Since symptoms vary, parents and teachers alike don’t see the early signs of OCD. Children with this condition also face anxiety, shame, or guilt because they can’t properly explain why they feel the need to perform these rituals. When Anxiety Becomes Something More Worries and mild anxiety can turn into something more when they start disrupting the child’s daily life. Common red flags that the anxiety has escalated include the following: Emotional Distress: The child feels a lot of guilt, fear, and shame that doesn’t go away even after reassurance-seeking. Secrecy: The child tries to hide their compulsion out of fear that people will think they’re strange. Disruption: The rituals are starting to take a significant amount of time and interfere with sleep, meals, or school. School Avoidance: Children refuse to go to school because they are overwhelmed by their obsessions and rituals. Seek professional help if the patterns repeat too much and the behavior interferes with daily functioning. Early intervention keeps the symptoms from getting any worse. Symptoms of OCD in Children vs Teens Symptoms of OCD are more externalized during childhood years and internalized during adolescence. Intrusive thoughts are their base, but they manifest differently depending on the child’s awareness levels. Comprehensive mental health treatment from home 90% of Charlie Health clients and their families would recommend Charlie Health Get Started (952) 831-2000 We’re proud to partner with the following major insurance providers: Common Obsessions in Youth Common obsessions in youth center around harm fear, contamination, religious thoughts, and perfectionism. These intrusive thoughts disturb their ability to relax and enjoy their day. Children fear that their thoughts will result in negative real-world outcomes. Teens ruminate on them and try to find ways to undo them. Common obsessions manifest as follows:  Contamination Fear: The fear of getting sick after they touch something dirty. Harm OCD: Not wanting to harm someone they care about, such as the fear of harming pets. Scrupulosity: Moral or religious obsessions that include praying repeatedly or continuously seeking forgiveness. Perfectionism: The need to do things just right. As an example, a child might fear they’ll poison their pet cat if they don’t wash their hands three times. Teens could also think silently for hours, mentally replaying something they may have done wrong. Common Compulsions and Rituals Common compulsions include ritualized behaviors such as handwashing or tapping to cope with their obsessions. This helps reduce anxiety and can be both internal (mental) and external (physical). Children frequently express the following compulsions: Repeatedly washing or sanitizing their hands Tapping objects an exact number of times Repeatedly checking schoolwork, doors, and locks out of fear of making mistakes Seeking reassurance by asking repetitive questions Children wash their hands and are more physical in their compulsions. Teens count and experience other symptoms alongside the common ones. This includes: Counting in their heads until they get to the perfect number Silently repeating special prayers or words Creating mental scenarios to undo bad thoughts Consistently reviewing past actions to check for mistakes Avoidance is a key symptom, as kids refuse to touch specific items. They can also avoid certain colors or numbers for no apparent reason. Without intervention, these can solidify. What Makes It OCD and Not a Phase OCD is different from your average “quirky behavior” because the pattern persists and affects their daily routine. When it’s just a temporary habit, they want to do it. However, when it’s OCD, they have to do it. Some signs that suggest the symptoms escalated into OCD include the following: The ritual gets in the way of their daily activities, such as doing their homework, going to school, or spending time with friends. Stopping the ritual (intentional or not) leads to increased anxiety and even a breakdown. The child feels distressed when they can’t perform the activity just right. The frequency and duration are much longer than typical routines and can take hours. Lack of control over the behavior, even if they know

OCD vs. Anxiety: What’s the Difference? OCD and anxiety both involve fear and worry, but they differ in their core symptoms. One involves intrusive thoughts and compulsive behavior, whereas the other is characterized by excessive worry. Patients should learn how to differentiate the symptoms so they can receive the appropriate treatment. Amanda Mulfinger, PhD, LP Updated: July 3, 2025 Get Started (952) 831-2000 Table of Contents   Table of Contents Key takeaways: OCD is defined by unwanted thoughts and compulsive rituals; anxiety is pervasive worry without those specific neutralizing actions. OCD obsessions are often irrational and ego-dystonic, while GAD worries feel realistic and ego-syntonic. OCD patients act out rituals for relief, whereas GAD sufferers primarily avoid triggers and seek constant reassurance. Insight levels differ: OCD patients often know their thoughts are irrational, but GAD patients believe their worries are justified. Both can co-occur, necessitating specialized diagnosis and integrated treatment like CBT and ERP. What Is OCD? Understanding Obsessive-Compulsive Disorder OCD is a mental health condition that involves repetitive behavior (compulsion) and intrusive thoughts (obsessions). These interfere with a person’s daily lifestyle, causing distress unless they perform the ritual. How OCD Manifests Mentally and Behaviorally OCD causes intrusive thoughts that drive compulsive behavior. These thoughts have an ego-dystonic nature, which means the thoughts feel alien and unwanted. The thoughts intrude into the person’s awareness, and the individual repeats their “compulsions” to obtain relief. Common behaviors that repeat with OCD include the following: Thoughts about accidentally hurting someone, contaminating, or doing something wrong Frequently washing, checking, or arranging objects in a specific way Mentally repeating words or prayers to counteract bad thoughts Avoiding places, people, or situations that can trigger an OCD episode Repeated reassurance-seeking to ease uncertainty Studies by Hannah Brock in 2024 on obsessive-compulsive behavior suggest that OCD affects 1% to 3% of the population. Among those, studies by Dan J. Stein in 2025 on 26,136 individuals at the University of Cape Town suggest that 47.0% are mild cases, 22.9% are moderate, and 2.7% are severe. Common Subtypes and Symptoms The most common subtypes of OCD include contamination, checking behavior, harm OCD, and symmetry obsession. These subtypes are associated with the following symptoms: Contamination OCD: Patients fear illnesses, germs, and environmental toxins. They cope with excessive washing, cleaning, or avoiding contact. Harm OCD: Patients fear deliberately harming themselves or others. Individuals with these compulsions manage their fear by performing mental checks, avoidance, and seeking reassurance. Checking Behavior: Rituals develop where the person repeatedly checks locks and appliances to prevent a disaster. This can interfere with one’s daily life. Ordering and Symmetry OCD: Constantly arranging, aligning objects, or counting until it feels “just right.” Repeating the patterns leads to reinforcement. Patients feel like they have to perform the ritual, even if they know there’s no logical reason. What Is Generalized Anxiety Disorder (GAD)? General Anxiety Disorder (GAD) is a mental health condition that causes constant worry, fear, and a sensation of being overwhelmed. Recent statistics by the Anxiety & Depression Association of America on anxiety disorders show that the condition affects 19.1% of the population. Comprehensive mental health treatment from home 90% of Charlie Health clients and their families would recommend Charlie Health Get Started (952) 831-2000 We’re proud to partner with the following major insurance providers: The Nature of Chronic Worry and Overthinking General Anxiety Disorder (GAD) describes ongoing worry about real-life scenarios such as health, finances, responsibility, or work performance. This differentiates the condition from panic disorders and phobias, as they are not irrational fears. The worries feel justified on the surface, which makes them ego-syntonic. However, people overthink this to the point where the worry gets blown out of proportion. The anxiety builds, and the excessive worry becomes overwhelming. GAD has the following anticipatory anxiety features: Mentally rehearsing negative outcomes Feeling on edge most days Difficulty in tolerating uncertainty Always preparing for worst-case scenarios Trouble focusing because of the worries The stress compounds when these symptoms appear. This significantly interferes with your work, health, and relationships. Symptoms and Triggers of GAD Symptoms such as restlessness, fatigue, and difficulty concentrating are suggestive of GAD. That said, the somatic symptoms overlap with other conditions, such as depression or OCD. Patients present the following symptoms when anxiety affects their psyche: Restlessness Muscle tension and aches Trouble sleeping Fatigue Nervousness or feeling twitchy Frequent headaches and stomach problems Difficulty concentrating Irritability GAD is frequently triggered by chronic illness, stressful life experiences, and even substance use. Studies by Ji Ann Cho at the Yonsei University College of Medicine suggest that one cup of coffee increases anxiety by a 1.19 ratio. These triggers sustain worry loops and significantly affect your lifestyle. How OCD and Anxiety Disorders Differ OCD and anxiety differ in their thought content, structure, and behavior. A patient with OCD uses compulsions to reduce anxiety levels. However, anxiety “stews” without any elaborate coping rituals. Thought Content and Structure OCD is characterized by irrational, intrusive thoughts that most may see as strange. These thoughts frequently seem disturbing and alien, rarely making sense. They are ego-dystonic, making the patient feel shame or fear. In OCD, patients question if their thoughts mean something about who they are. If the thoughts recur, they question whether or not they are dangerous. However, in GAD, patients worry that they have overlooked something important. The prospect makes them worried enough that they create multiple scenarios in their head. Behaviors: Rituals vs Avoidance OCD patients believe rituals reduce fears and even neutralize them. These neutralizing acts become repetitive and deliberate to prevent an outcome that they fear. For example, someone with OCD will wash their hands for 10 minutes in fear of contamination. On the other hand, GAD leans into avoidance behavior. Patients don’t confront and act on it like those with OCD do. Instead, they avoid the situation that causes their stress. Someone with GAD may repeatedly seek reassurance and proof that something will go fine or avoid engaging altogether. When both behaviors repeat, it reinforces the idea

What Is ERP Therapy for OCD and How Does It Work? ERP therapy is a type of treatment that exposes you to thought triggers associated with obsessive-compulsive disorder (OCD). Studies at the Northwestern University Feinberg School of Medicine by Clara Law show that ERP therapy improved OCD symptoms by up to 50-60%. Patients should understand ERP therapy and how it differs from other forms of treatment because it helps manage their expectations. This article will offer more insight into this form of therapy and why it shows great potential for you as well. Amanda Mulfinger, PhD, LP Updated: July 4, 2025 Get Started (952) 831-2000 Table of Contents   Table of Contents Key takeaways: ERP is the core, action-based treatment for OCD, directly exposing you to triggers while preventing compulsive rituals. Unlike talk therapy, ERP actively rewires the brain, teaching it that feared outcomes won’t occur even without performing rituals. Sessions involve a “fear ladder” of exposures, practicing response prevention, and crucial homework for real-life application. ERP’s effectiveness lies in inhibitory learning, building new neural pathways that reduce anxiety and compulsive urges over time. Expect discomfort initially, but consistent ERP, often adapted with other treatments, leads to significant and lasting symptom relief. What Is ERP? The Core Treatment for OCD ERP is a type of therapy where patients receive controlled exposure to the intrusive thoughts that trigger an OCD episode. It differs from talk therapy because it relies on actions rather than just mere discussions. ERP is used alongside other forms of treatment to offer long-term results. Defining ERP in Simple Terms ERP stands for Exposure and Response Prevention. During this type of therapy, clients learn to resist their urges and compulsions by gradually getting trigger exposure. The brain becomes accustomed to the anxiety until the latter eventually fades. The procedure addresses both the obsession and the compulsions because the individuals face the triggers for intrusive thoughts head-on. Still, therapy prevents the clients from engaging in their usual rituals. This breaks the anxiety cycle as the thoughts fade. ERP treats OCD differently from talk therapy and CBT because it doesn’t just make you talk about your triggers. It puts them right in front of you in a controlled fashion. The initial discomfort fades as the behavior pattern shifts in a different direction. Why ERP Is Different from Talk Therapy ERP is different from talk therapy because it actively prevents the ritual from starting when exposed to the trigger. Talk therapy and CBT talk you through what you should do or think once exposed to the triggers. However, there’s no saying how you will react when exposed to the trigger outside of the office. This form of therapy is action-based because it actively interrupts the OCD cycle. Once that happens, the therapists support you with structured exercise that directly changes your behavior. The compulsion fades after repeated interrupted exposure because the brain learns the ritual is not necessary. The process is similar to phobias, where studies by Katherina K. Hauner at Northwestern University show that 95% of patients significantly recover after a year of therapy. How ERP Sessions Actually Work ERP sessions work by noting down your triggers and gradually exposing you to them within a controlled environment. Treatment starts with small triggers and goes up as the days or months pass. Step 1 – Assessment and Psychoeducation The first step is an assessment of your condition. The therapist notes a patient’s symptoms and guides them in the following ways: They conduct a comprehensive assessment of the symptoms. Here, clients share their experience and questions. Patients set goals about what they want to obtain from the treatment (e.g., decreasing the rituals). The therapist uses psychoeducation to explain how OCD works. This empowers patients and helps them prepare for the triggers. The therapist explains what each session will involve and what to expect during the procedure. Once the intake is complete, sessions begin with their gradual exposure. Step 2 – Creating the Exposure Hierarchy OCD situations are ranked based on their difficulty. This is referred to as the “fear ladder,” where you are first exposed to the least distressing element. Clients rank them before exposures begin and gradually work through them during each session. Most therapists use the Subjective Units of Distress Scale (SUDS) hierarchy for symptom ranking. Here, scenarios receive ranks from 0 to 100, with the highest number suggesting extreme anxiety. Therapists design this exposure hierarchy in collaboration with their clients. This ensures that their goals are achievable and that therapy is relevant. For example, someone with contamination OCD might rank a bus handrail as 40, but a public restroom is a solid 80. Knowing this lets the therapist decide where the exposures begin. Step 3 – Response Prevention in Action After the exposure, individuals learn to resist the ritual. The goal is to neutralize the behavioral response that reinforces the OCD cycle. Instead of acting on their urge, the clients try to resist and remain in that anxiety-riddled situation. Common rituals include: Excessive hand washing Repeat checking Counting Tapping in patterns Seeking reassurance Discomfort is normal, especially in the early stages of therapy, when the anxiety peaks. The compulsions fade once the brain realizes that the catastrophic consequences won’t happen. Therapists are there to coach and encourage you during these moments. This makes it easier to go through emotional discomfort. Step 4 – Homework and Real-Life Application Individual therapy continues at home, where clients practice what they learn in therapy. The patterns change when you reinforce new learnings and rewire the brain. Studies by Samuel E. Cooper at the University of Texas at Austin show that up to 60% patients with OCD who go to therapy sessions relapse. This frequently happens because the patients limit their exercises in the therapist’s office. Progress builds when you apply the right exercises based on your OCD. Here are a few exercise examples to use: Checking OCD: Leave for work without checking the lock or go out and don’t check the stove.