You’ve probably heard someone say ‘I’m so OCD about that’ — about their organized pantry or color-coded calendar. Most people don’t think twice about it. But for families living with real OCD, that throwaway line stings. OCD is one of the top 10 most debilitating mental health conditions in the world, according to the World Health Organization. In children, it often goes unrecognized for years.
In a recent episode of Kids These Days, Dr. Courtney sat down with Danielle McDowell, a licensed clinical social worker and OCD specialist based in Denver. Together they cut through the myths and gave parents a more honest picture of what OCD actually looks like — and what to do if you’re seeing it in your child.
OCD Is Not About Being Neat
One of the most persistent myths about OCD is that it’s about cleanliness, organization, or perfectionism. While those things can appear in some presentations, they represent only a tiny slice of the disorder. At its core, OCD involves two things: intrusive thoughts and compulsions.
Intrusive thoughts are thoughts, images, urges, or feelings that feel deeply distressing and out of sync with a person’s values. Compulsions are the behaviors — physical or mental — someone uses to reduce the anxiety those thoughts create. Harm OCD, scrupulosity, and sexuality OCD are just a few of the many themes. Many of the most common presentations have nothing to do with handwashing or tidiness, which is exactly why they go undetected for so long.
The Signs Parents Often Miss
Much of OCD is invisible — and that’s what makes it so hard to catch in kids. Physical compulsions like excessive handwashing or tapping are easier to spot. Mental compulsions, though, happen entirely inside a child’s head. Repeating a phrase internally, reviewing past events, mentally counting — no one can see any of it happening.
Children with OCD are also frequently ashamed of their thoughts, particularly when those thoughts involve what Danielle calls ‘taboo themes’ — fears about harm, sexuality, or intrusive fears about loved ones. Kids worry something is wrong with their brain. So they hide it and suffer in silence.
Some subtler signs to watch for: a child who seeks reassurance constantly, asking the same question over and over even when it’s already been answered; avoidance of activities or places they used to enjoy, with no clear explanation; getting stuck in routines around bedtime or transitions; and relentless ‘what if’ questions that never seem to resolve. That last one is one of Danielle’s biggest red flags. Reassurance never satisfies OCD — you can answer the same question ten times and the anxiety still comes back.
What Parents Do That Accidentally Makes It Worse
Here’s the part that tends to land hardest. The most loving, instinctive responses to a child’s distress can sometimes feed the very cycle parents are trying to stop.
In the OCD world, these responses are called ‘accommodations.’ Picking a child up from school to avoid triggering anxiety, answering the reassurance questions, completing rituals alongside a child, buying extra soap — all of these temporarily relieve distress. But each accommodation reinforces the OCD cycle by sending a message to the brain that the feared thing was genuinely dangerous.
Danielle speaks from personal experience here — her own daughter has OCD. She had to confront the ways her own responses were keeping the cycle strong. Pulling back from accommodations is hard, and requires doing it carefully and gradually. For many families, it also means parents doing their own work to tolerate watching their child be uncomfortable — which is genuinely one of the hardest things a parent can do.
Why Most OCD Treatment Doesn't Actually Work
Here’s a statistic that stops most parents cold: approximately 95% of people in treatment for OCD receive the wrong type of treatment. The average time between first symptoms and an accurate diagnosis is between 10 and 17 years.
Traditional talk therapy, coping skills, and breathing exercises can actually make OCD worse by functioning as compulsions themselves. Processing emotions in a session can bring relief in the moment. Without addressing the underlying OCD cycle, though, the symptoms return. Even reassurance from a therapist is still reassurance.
The evidence-based treatment for OCD is Exposure and Response Prevention therapy, or ERP. Therapists work with clients to build a ‘fear ladder’ of anxiety-provoking situations and work through them gradually — not to eliminate anxiety, but to build the capacity to sit with it without doing a compulsion. The goal is to teach the brain that intrusive thoughts are not dangerous. Decades of research show that ERP — especially combined with medication when appropriate — is the most effective treatment available. Finding a therapist who specializes specifically in OCD and ERP is one of the most important steps a parent can take.
What You Can Do Right Now
If something in this article is resonating with you — if you’re recognizing your child’s behavior in what you’ve just read — the most important thing to know is that OCD is treatable. Kids can and do get better. The path forward starts with finding the right support.
• Danielle McDowell, LCSW: link to her practice website
• International OCD Foundation (IOCDF)
• IBH OCD/Anxiety resources