Checking locks, washing hands, organizing objects — these kinds of behaviors are what a lot of people imagine when they think of OCD. Many children with OCD do repeat rituals like these, called compulsions, to tame distressing anxiety. But for some, the compulsions happen only in their minds. They may be counting, replaying memories or repeating words in their heads. This kind of OCD is sometimes called “pure O,” which is misleading. Kids who experience it do have compulsive rituals — they just aren’t visible.

This week on childmind.org we look at how to recognize and treat this easy-to-miss form of OCD. Kids with mental compulsions may appear distracted or withdrawn, but that’s because they’re preoccupied with rituals no one can see. We also have information on some common (and frequently misunderstood) obsessions among kids with OCD, including religious worries, sexual thoughts, and fears of suicide.