Ask An Expert / OCD: Obsessive-Compulsive Disorders

My 9-year-old son is constantly confessing thoughts, or things he has done, that he thinks are bad. How can we help him?

Behavioral therapy gives kids tools to disarm obsessive thoughts that are interfering with their lives.

Jill M. Emanuele, PhD
Jill Emanuele, PhD

Senior Director, Mood Disorders Center

Child Mind Institute

My 9-year-old son has been coming to me recently with endless confessions of thoughts he has had, or things he has done, that he thinks are bad. He breaks down in tears over things like, "Last week I gave someone a rude finger and I didn't like it." Or "I thought about Y naked." Or "I saw my teacher's cleavage and I feel bad about it. The more he tries to control the thoughts, the more they come, he says. This all started when he looked at hot girls on the internet—now he feels an overwhelming guilt about it. We've tried to explain that curiosity is normal and reassure him that he is not a bad person and that he can continue to talk openly with us, which he does. During the day he seems to be fine as he is busy at school but he continues to get upset at night because of the shame. How can we help this boy?

Your son seems to be in some distress over the kind of thoughts that everyone has from time to time — thoughts that we’ve done something wrong and we’re embarrassed by or ashamed — but he is preoccupied with the thoughts to the point that they’re really getting in his way on a daily basis.

When a child reports being preoccupied with intrusive thoughts such as these, and the child feels he can’t control them, we have to consider that he could be having what we call “obsessions.” To figure out how to help him, we would want to know, among other things, what’s triggering the thoughts, how he is trying to control them, and how much time he’s preoccupied with the thoughts.

The fact that he seems to be fine at school and gets upset at night could mean that he manages to control these unwanted thoughts during the day, when it would be embarrassing to admit them or he’s distracted by other things, and then lets go at night, when he’s more comfortable, around his family. We also have to consider that there’s something reinforcing about sharing them with you, some kind of attention he gets from you in confessing these thoughts, although in general, it is good that he feels comfortable speaking openly with you about his difficulties.

The first step in addressing this problem would be to have him evaluated to get a clearer picture of what he’s struggling with. And if he needs help, cognitive behavioral therapy can be very successful at giving kids the ability to master intrusive thoughts, such as the ones you are describing.