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Video: OCD and Internal Compulsions

The most hidden of internal compulsions and rituals are as real as physical ones

In the video above, Jerry Bubrick, PhD, a clinical psychologist at the Child Mind Institute, discusses the “hidden” mental compulsions some children with obsessive-compulsive disorder must contend with. Most kids with OCD are pretty good at hiding their rituals, even if they are elaborate physical tasks. When the rituals are internal, like counting, parents and caregivers need to be even more attentive to notice the symptoms and get children the help they need.


It’s possible for a lot of parents to wonder if their child has OCD but not necessarily see the symptoms physically or see the ritualistic behaviors. And so, a lot of times parents will ask, “Is it possible that my child has OCD even though I can’t see anything that they’re doing?” The answer is absolutely. There are many different types of compulsions. There are the physical compulsions that we can see, but there are also what we call mental rituals or mental compulsions where kids are doing things in their head. They’re counting to themselves, they’re making lists, they’re saying things over and over and over. They may be reviewing conversations over and over and over until they hear it “right,” until they hear a certain word. Parents are often very good at knowing that something is wrong with their child, but not necessarily knowing exactly what the child is thinking or feeling.

The treatment for OCD is the same whether we have physical compulsions or mental compulsions, and for you the parent, we would be able to give you specific skills and strategies as well to help your child when they’re struggling with those mental compulsions.

Children do a very good job of hiding their OCD. So, even when there are physical compulsions that other people may see, children do a good job of hiding those. They can also do a good job of hiding the mental rituals as well. So, it becomes very important for family members, parents, everyone involved in the child’s life to know how to help the child when they’re struggling with those symptoms.