A mom writes to ask how to help her 10-year-old daughter, who is worrying a lot about “bad thoughts.”

Sometimes these thoughts are bad because they are mean: A family friend is “fat” or “wrinkly.” Sometimes they are sexual: She imagines a classmate naked. Or violent: She thinks she wants to kill her mother. They have one thing in common: she feels a need to confess all these thoughts to her mom, who wonders what’s going on.

It’s a scenario we hear a lot: A child is suddenly desperate to confess disturbing thoughts. A 9-year-old noticed his teacher’s cleavage, and feels guilty about it. As his dad writes: “The more he tries to control the thoughts, the more they come.” He worries out loud that there might be something wrong with him, and asks for reassurance that he’s okay. Over and over.

Kids can get very upset about these thoughts, though of course not all of them feel compelled to share them with their parents. But when they do, the constant confession and requests for reassurance can be stressful for parents, too.

Why do kids worry about “bad thoughts” and feel the need to confess them? And what can you do as a parent to help them?

Related: Sexual Obsessions and OCD

What does this thought say about me?

Jerry Bubrick, a clinical psychologist at the Child Mind Institute, reminds us that we all have random thoughts that we think, as these kids do, are bad. We may think, Wow, that was unkind, or weird, or inappropriate! And then we dismiss them. We don’t express them, or act on them, and we quickly forget about them.

In contrast, Dr. Bubrick says, kids can get upset when these ordinarily fleeting thoughts get “stuck” and they are unable to dismiss them and move on. Instead of recognizing bad thoughts as meaningless, the kids hold themselves responsible for them.

“These kids are placing value on themselves based on the thoughts they’re having,” Dr. Bubrick explains. So they think, There must be something wrong with me in having that thought.  Or, I must be a horrible person if I’m having that thought.”

Dr. Bubrick calls it “over-responsibility of thought”—kids literally holding themselves responsible for their thoughts, instead of letting them go.  “And that’s why kids feel compelled to confess. They’re asking parents for reassurance, for a parent to say, ‘Yeah, that’s okay. Don’t worry about it,’ ” he adds. “That calms that fear: Okay, I’m not a bad person.”

Why do some thoughts get stuck?

Thoughts are often driven by emotional states, Dr. Bubrick notes. For example, “when I’m happy I’m more likely to have happy thoughts, and when I’m scared I’m more likely to have scary thoughts. When I’m hungry I’m more likely to have thoughts about food.” When we get frustrated or angry, we can all relate to imagining bad things happening to the person who’s standing in our way.

But most of us don’t become alarmed or self-critical based on our thoughts alone—what matters are the actions we take. Becoming fixated on “stuck” thoughts can be a symptom of anxiety, whether it’s just an anxious personality or a full-blown anxiety disorder.

What kids consider “bad” depends on the culture and what they’ve been taught. In religious families, for instance, kids worry about “bad thoughts” they think might offend God. Sexual thoughts are not infrequently disturbing to boys, especially before puberty makes talk of sexuality common among their teenage peers. Worries about wanting to murder people are surprisingly common in young children. Rachel Busman, a clinical psychologist at the Child Mind Institute, treated one 10-year-old girl who felt she needed to sit on her hands because she had thoughts about strangling someone.

Kids who feel compelled to confess and ask for reassurance are usually less than 12, Dr. Bubrick notes. “Older kids tend not to tell parents what they’re thinking, I would imagine, because the thoughts are darker or scarier. They’re more sexualized, or they’re more violent.”

How can we help kids handle ‘bad thoughts’?

The goal is simple: to help kids recognize that their thoughts are just thoughts.

“Just because you have a thought—whether it’s a good or a bad thought—doesn’t make it true,” Dr. Bubrick explains. “A bad thought doesn’t make you a bad person—It just means you’re having that thought. ”

That’s the message clinicians use when they treat kids with anxiety disorders using cognitive behavioral therapy. Kids are taught to identify their obsessive thoughts as separate from themselves—as a “bully in the brain,” as Dr. Bubrick puts it. “When thoughts get stuck in our mind, they kind of bully us into thinking they’re more important than they are,” adds Dr. Busman.

“Seeking reassurance is a way to relieve the distress or anxiety,” she says. “And it works, for the moment.” But the only way to stop the cycle of getting stuck on intrusive thoughts and asking for reassurance is to learn to tolerate the distress without confessing, and see that the anxiety will fade.

If bad thoughts really become a problem for a child—if they continue, if they cause great anguish or interfere with the child’s functioning, it may be a sign of an underlying anxiety disorder that deserves professional help.

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