Ask An Expert / OCD: Obsessive-Compulsive Disorders

My daughter worries constantly about thoughts, and things she has done, that she thinks are “bad.” What can I do to help?

How to tell if intrusive thoughts are signs of a problem

Rachel Busman, PsyD
Rachel Busman, PsyD

Senior Clinical Psychologist, Anxiety Disorders Center; Director, Selective Mutism Service

Child Mind Institute

My 9-year-old daughter has been coming to me recently with endless confessions of thoughts she has had, or things she has done that she thinks are "bad." I have tried explaining to her that it is normal to have thoughts that you don't like, but she keeps worrying. She breaks down in tears about these confessions, things like "in first grade I said I didn't like X." Or "I thought about Y naked." I have tried having her write down her thoughts in a journal, but it is not helping. Is this normal? What can I do to help her stop worrying about these things?

This is a great question because many kids have worrying, nagging thoughts. One of the questions we ask to distinguish if these are just passing thoughts or something more serious is how frequent and distressing they are. It sounds like your daughter is having a lot of these thoughts and that they’re very upsetting to her, so it’s good that you’re starting to ask questions. It also sounds like your daughter isn’t getting any better even after you talked to her, which suggests that your daughter’s worries are outside the typical range.

Without seeing your daughter I can’t say for sure, but it sounds like she might have obsessive-compulsive disorder. OCD is an anxiety disorder that involves unwanted and persistent thoughts, images, and impulses (called obsessions) and repeated, ritualized actions (compulsions) that help alleviate the anxiety caused by obsessions. Examples of obsessions that kids have include thinking about doing something “bad,” ruminating about past transgressions, or having intrusive sexual thoughts. This might sound scary, but the good news is that we know a lot about OCD and there are excellent treatments for it. So your goal right now is to get an evaluation for your daughter to see if she really does have OCD.

If she does, the best treatment for obsessive-compulsive disorder is cognitive behavior therapy (CBT), specifically a technique called exposure and response prevention (ERP). This treatment works by carefully exposing your daughter to the things or ideas that make her anxious in small doses so that over time she becomes more habituated to them.


Your daughter’s treatment plan should also involve her family. The symptoms you are describing are tough on parents because it’s our instinct to try and make a child feel better when they ask for our reassurance, but if your daughter does have OCD, regardless of the reassurance you’re giving, her intrusive thoughts will keep coming back. And unfortunately parents of kids with OCD can inadvertently start a cycle where kids ask for more and more reassurance, even though it isn’t really helping. So your child’s doctor should make sure to involve you in treatment so that you know how to deal with her requests for reassurance and other symptoms.

I also recommend a book called What to Do When Your Brain Gets Stuck, by Dawn Huebner. It’s a child-friendly explanation of what OCD is and how it is treated. Of course, it is no substitution for getting actual treatment, but you and your daughter might find it helpful.