How OCD Is Different From Other Types of Anxiety
As a therapist who works with children and teens struggling with anxiety and OCD, one of the most important conversations I have with families is about understanding what makes OCD different from other types of anxiety.
OCD is often misunderstood. Parents might come to me thinking their child is “just anxious” or “likes things a certain way.” But when we dig deeper, what we often find is a pattern of distressing, intrusive thoughts and rigid, repetitive behaviors that aren’t about preferences. Instead, they’re about fear, guilt, or a deep sense of responsibility.
What Makes OCD Different from Other Anxiety Disorders?
Most anxiety involves a fear of real-world situations: public speaking, separation, tests, or making mistakes. With many forms of anxiety the thoughts may be excessive, but are usually based in common life experiences. In Obsessive-Compulsive Disorder (OCD), the worries are often irrational, unwanted, and intrusive. Children with OCD experience disturbing thoughts (obsessions) that feel deeply uncomfortable or even terrifying. These might include fears of:
Harming someone accidentally or on purpose
Germs and contamination
Things not being “just right”
To relieve the distress, kids engage in compulsions, which are rituals or behaviors that might look like:
Excessive handwashing or cleaning
Repeating phrases or prayers silently
Reassurance-seeking (“Are you sure I didn’t do something wrong?”)
Avoiding certain people, numbers, or places
From the outside, these compulsions might seem like habits or quirks. But in therapy, it becomes clear that they’re part of a powerful cycle that keeps the child feeling stuck and afraid.
OCD Can Be Especially Hard to Spot in Kids
Children don’t always have the words to describe what they’re feeling. I’ve worked with kids who couldn’t articulate their fears but showed them through behavior: taking hours to get ready for bed, refusing to touch certain objects, needing constant reassurance from parents or teachers. Many are overwhelmed by guilt, even though they haven’t done anything wrong.
Parents often report thinking, “I didn’t realize that was OCD,” or, “I thought they were just being dramatic or difficult.” OCD can wear many disguises, so education is an important part of treatment.
How Exposure and Response Prevention (ERP) Helps
When I begin working with a child or teen with OCD, one of the first things I share with families is that while OCD can be intense and confusing, we have effective tools to help.
Exposure and Response Prevention (ERP) is the gold standard for OCD treatment. It is a specialized form of therapy that helps children face their fears gradually, without engaging in compulsions. It involves two key steps:
Exposure: We slowly and safely introduce the child to the thoughts, images, or situations that trigger their anxiety.
Response Prevention: We support them in not doing the compulsion they usually use to feel better.
For example:
A child afraid of contamination might touch a “germy” object and practice sitting with the discomfort without washing.
A teen who feels responsible for bad thoughts might write those thoughts down and resist the urge to mentally undo them.
A child who checks doors or appliances might intentionally leave something unchecked.
ERP is not about throwing kids into situations they’re not ready for. It's about building skills, step by step, with compassion and support. We move at a pace that feels challenging but doable. Each time we practice an exposure it helps to rewire the brain to see that feared situations are not as dangerous as they seem.
A Note to Parents
If your child is struggling with scary thoughts or rituals that interfere with their daily life, know that OCD is highly treatable with the right approach. But it’s important to work with a therapist who understands the nuances of OCD, especially in children. Check out the International OCD Foundation for more information!