Some time ago, the most adorable and articulate 8-year-old boy walked into my office and proceeded to tell me, “ So you see, I am having these crazy thoughts. Every time I see a knife, I worry that I might, you know, do something to hurt myself. But, that’s crazy, because I have a really happy life!!!” As a result of these fears, this young man had started to avoid being around any type of sharp object and was compulsively seeking reassurance from his parents.
More recently, I met with parents who were concerned about their 12–year-old daughter’s constant confessing and reassuring seeking about sexual thoughts/images she was having (e.g., having sex with Dad, having sex with boys at school, even having sex with their family pets!!!). As a result, their daughter would no longer be alone with her Dad or their cat or dog and was starting to avoid being around boys at school all together.
Although these types of worries can be quite unsettling for both children and parents (and even pediatricians and many mental health professionals who are consulted), they are relatively common and easily recognizable OCD symptoms for experienced OCD therapists. Also, if treated appropriately, they generally diminish fairly quickly. Unfortunately, these types of symptoms are very often treated as generalized anxiety rather than as obsessive-compulsive and generally worsen as a result.
Before we talk about what appropriate treatment entails, let’s first talk about what doesn’t work. So, most parents (who have had any experience with these types of symptoms) have figured out that providing reassurance to their children does not work. In fact, it generally makes the symptoms worse over time. What kids have generally figured out is that strategies such as trying to will these unwanted thoughts or images away as well as seeking reassurance from others do not work. These attempts, in fact, also tend to make things worse over time.
In order to explain why these seemingly intuitive strategies don’t work, we need to understand conceptually how OCD works. So, as we know OCD is comprised of an obsessive component as well as a compulsive component. Obsessions are thoughts, images, or even just feelings that cause anxiety and are hard to get rid of. Compulsions are anything that one does either physically or mentally to get rid of the obsession and the anxiety associated with it. Compulsions do work (which is why people engage in them), but only temporarily until the doubt returns, leading to more compulsive behavior and increased fears over time. Bottom line is, compulsions don’t work long term. Because reassurance seeking and mental reviewing are both compulsive in nature, they don’t reduce anxiety long term…but, instead, actually feed the OCD. This generally leads to a whole lot of frustration particularly for parents who cannot understand why their rational responses just lead to more and more questions from their children. As a result, parents end up inadvertently helping the OCD, and when this backfires, often end up angry and frustrated with their children so that they are unable to offer support when needed the most.
Another strategy, mentioned above, that also backfires is trying to will the thoughts or obsessions away. Kids with these types of obsessions desperately try to block the thoughts out or run away from them to no avail. Why? Well, what happens if I tell you whatever you do, don’t think of ‘pink elephants’? Can’t do it, right? Nobody can (well, except for a very smart 11-year-old who told me he was thinking of ‘purple rhinoceroses’).
So, what does work? A treatment known as Exposure and Response Prevention (ERP) is the most appropriate choice for these symptoms. However, due to the sensitive nature of these symptoms, even experienced OCD therapists can struggle with how to appropriately engage kids in this form of treatment. However, the reality is these symptoms are just like any other OCD symptom and need to be treated in the same way.
Exposure means actively exposing yourself to the things that provoke your anxiety. Well, for the kids discussed earlier this meant gradually allowing themselves to be in the situations that provoked their worries (being around and using sharp objects, being around Dad and the family pets, etc.). This also meant doing some level of exposure to the thoughts themselves, by either just letting them be there (instead of trying to get rid of them) or by actively bringing them on through the use of a silly story or other creative means (e.g., making silly pictures of the child’s “gravestone” and hanging them all over). Humor and creativity are key when working with kids with these types of symptoms. Believe it or not, you can actually have fun with this treatment. My sessions are generally filled with tons of giggling!!!
In terms of Response Prevention (which is the voluntary blocking of any compulsive behavior), this means eliminating reassurance seeking, confessing, or any mental reviewing. Kids are encouraged to resist confessing/seeking reassurance, and parents are taught how to respond effectively (generally with some type of exposure) when kids slip up and confess or ask a question.
So you see, an OCD symptom is an OCD symptom is an OCD symptom and should be given equal treatment with ERP regardless of its nature. So, do not fret or fear if your child is experiencing harming and sexual obsessions…just get them into treatment and prepare to laugh!!!
Can you direct me in the right direction to find help for my 11yr old grandson in the Spring ,Texas area.
Thanks.
We recommend the best resource is the website for the International OCD foundation. You can access their website by typing https://iocdf.org/ in your computer browser. We hope it is helpful for you.
I need help with my 8 year old daughter I’m Houston tx
We are happy to help. Please contact our office directly at 508-457-3160.
I have these issues with my 9 year old son. The harming and sexual thoughts are hunting him. He feels so bad . He asks me for help, and I crying inside and out. He is the happiest boy ever. So good in his heart. Please help.
Did you get help? Just curious going through same thing with my good hearted 12 year old boy too.
Hi Kerri,
We are happy to help. Feel free to contact our office at 508-457-3160.
Hello! Any help in Michigan for an 11 year old and girl?
I’m desperate in need of help for my 12 yrs old daughter in Boston Ma
Please feel free to call our office for more information at 508-457-3160. We are happy to help.
So glad I found this, my 10 year old daughter is so freaked out, plus I’ve been doing all “the wrong” things to try and help her!
So glad it has helped. Let us know if there is anything else we can do to facilitate treatment.
Looking for help for my eight year old son Frisco, TX. Anyone referrals you know that might take blue cross blue shield PPO
The IOCDF.org website has a great referral resource that should help you find a qualified provider in your area.
I need help with my 9 year old daughter, coatesville Pennsylvania
We are happy to help in any way we can. Please call our office at 508-457-3160.
I am in Richmond CA I need help with my 11 year old daughter she has inappropriate sexual thoughts all day every day and she has been confessing to me everyday of things she has done inappropriately I am trying to be supportive but I don’t think I’m helping she has medi Cal can you please help me
Please help me, I’m trying to find a doctor in Ohio that is able to help my 11 year old daughter. I need to know what to look for and or what to ask for when calling offices. Thank you!!
My 7 year old has extreme anxiety and just recently has been bombarding me with all these “bad” and “nasty” thoughts she has about kissing, sex and killing. She is so upset and cries constantly. I am so scared and confused on how to help her. She struggles daily with this and it’s getting worse. She begs for help to get the thoughts out of her head. I want to help her.
Is there Any type of support group for parents? Reading these comments was heart wrenching but also soo comforting to know my sweet boy isn’t the only one going through this. We talked to counselors and his pediatrician but no one seems to take it seriously so we haven’t known what to do.
Hello my daughter is obsessing over sexual thoughts and parts and is physically making herself sick over to the point where she is not eating and not wanting to go to school because she’s afraid of being around other children. I think she saw something on youtube and now She feels like she’s weird because she can’t stop the thoughts and the depression if getting worse for both of us. I live in irvine ca. What should I do?
What should parent do when they 12yr old son is very aggressive with his sexuality and is is experiencing it with boys and trying to have sex inpuublic placeses and also is very aggressive towards his cousins,and his younger brother he’s doing things he,shouldn’t be doing and he got terminated out of school yesterday because he,got caught trying to have oral zex with a boy his age in the bathroom so he got terminated out his this just happen on 08/11/23 I’m a single grand parent me,and my 32yr old daughter is seeking help for him he doesn’t care who he does it with he just put himself outthwr,please help us we live in the,State of GA what do you recommend
He also suffers from Artysm