Fear of Throwing Up: A Parent’s Guide to Emetophobia in Children

Fear of throwing up, also called emetophobia, is a common and challenging problem for kids and teens.

Nobody likes throwing up. It’s only natural to want to avoid being sick. But what do you do if you’re the parent of a child who really, really, really does not want to throw up: not now, not ever? Unlike many other common childhood fears (ghosts, clowns, monsters under the bed), anxiety about vomiting can seem pretty logical—at least on the surface. But for some kids, anxiety about throwing up grows past what’s typical and starts to get in the way of daily life.

This extreme fear of vomiting is called emetophobia, and it’s one of the most common phobias experienced by young children. Frustratingly for parents, it can also be one of the trickiest to diagnose and treat!

If it feels like your life is being consumed by your child’s increasing worries about getting sick, there is good news. There are therapy techniques that are proven to help kids with emetophobia get back to living happier, less anxious lives. In this guide, we’ll cover the signs and symptoms of emetophobia that set it apart from a passing childhood phase. We’ll also discuss how it develops, what you can do to support your child, and how therapy can help.

How Do I Know if My Child Has Emetophobia?

Children with emetophobia have a fear of vomiting that goes above and beyond the discomfort a person would typically feel about throwing up. It’s common to be nervous about throwing up during an illness, but kids with emetophobia are preoccupied by their worries all the time, even when they’re healthy.

If your child has emetophobia, you may notice them going to great lengths to avoid places, activities, or things that they associate with throwing up. You might also observe your child repeatedly saying or doing things that they think will make it less likely that they’ll get sick.

Most people with emetophobia start developing their fear in early childhood: the average age of diagnosis is around 9 years old. While kids of any gender can have emetophobia, it’s more commonly diagnosed in girls than in boys.

All kids go through phases, and if a child’s worries are just a passing phase they will likely resolve on their own after a few days or weeks. Emetophobia is different. It grows and worsens over time. You may notice that your child’s list of avoidances gets longer and more generalized. For example, rather than staying off one specific rollercoaster where she once threw up, now she avoids all rollercoasters, as well as any vehicle she worries will be too bumpy.

Signs and Symptoms of Emetophobia in Children

Excessively avoiding people, places or activities that could cause illness is a common symptom of emetophobia in children.

Kids with emetophobia experience anxiety symptoms when they start thinking about the possibility of throwing up. To cope with their fear, they may avoid things that they believe could put them at risk of throwing up—even if it doesn’t logically make sense to do this. They might also repeatedly ask for reassurance or repeat behaviors that reduce their anxiety and make them feel more safe from the risk of throwing up. Here are some examples of anxiety, avoidance, and repeated behaviors to look out for:

Anxiety Symptoms:

• Overwhelming worries that are hard to control

• Panic symptoms, like sweaty palms, racing heartbeat, or shaking

• Dread before entering a situation that your child associates with throwing up

• Feeling sick to your stomach (anxiety can cause nausea, which sets off a vicious cycle!)

Avoidance Symptoms:

• Refusing to eat certain foods, either because your child once threw up after eating them or because your child fears they could cause nausea (too rich, too close to expiration date, etc.)

• Staying away from places where your child has previously thrown up or seen someone else throw up

• Avoiding activities that could cause nausea, like rollercoasters

• Keeping away from sick people, doctor’s offices, or hospitals due to a fear of catching germs

• Refusing to take medications that list stomach upset as a possible side effect

• Difficulty saying words like “vomit” or “threw up”

Repeated behaviors:

• Repeatedly asking for reassurance that they will not throw up

• Excessively washing hands

• Compulsively checking expiration dates on food or medications

• Repeatedly checking for bodily sensations like a gag reflex or stomach pain

• Staying close to a trash can or barf bag

• Eating slowly, cutting food into small pieces, or otherwise changing eating habits to avoid nausea

If you’re noticing several of these signs or symptoms of emetophobia in your child, check in with your pediatrician or a children’s therapist.

What Triggers Emetophobia?

Like most anxiety disorders, emetophobia is probably triggered by a combination of genetics and stress. There’s no one singular thing that causes emetophobia to occur, and it’s nobody’s fault: there’s nothing you could’ve done as a parent to prevent it.

Anxiety has a strong genetic component and tends to run in families. If your child has biological relatives who struggle with anxiety, there’s an increased chance your child will naturally have a heightened anxiety response, too. Even if nobody else in the family has emetophobia, simply having other anxiety disorders in the family tree can put a child at increased risk.

Even with a genetic predisposition for anxiety, there’s usually some kind of trigger or event that sets a child’s emetophobia into motion. Many children start showing symptoms after getting sick and throwing up. However, it’s also possible for emetophobia to be triggered by seeing someone else throw up, or even just having the sensation of choking or gagging.

These kinds of stressful events could have any child feeling worried or stressed for a little while. But kids who are already anxiety-prone may have a harder time brushing the event off and moving on. Instead, their experience with vomiting sticks with them and triggers recurring worries and attempts to avoid throwing up again.

While unlikely to cause emetophobia, parents may also notice that their child’s symptoms get worse after any stressful life change, like a move, the birth of a new sibling, or starting at a new school.

Do Children Grow Out of Emetophobia?

Symptoms can get much better with treatment, but it’s unlikely that a child will outgrow their emetophobia without help from an adult.

If you’re in the thick of it with emetophobia, you may be wondering if your child—and you—will have to cope with this debilitating fear of vomiting for life. The thought of a lifelong diagnosis can be a scary prospect: how can you enjoy a happy childhood when you’re struggling this much?

Generally speaking, kids won’t grow out of emetophobia on their own. One a child’s anxiety symptoms are this severe, they need help from parents and professionals to get back on track. In fact, research suggests that kids with emetophobia who don’t receive treatment tend to struggle with emetophobia into adulthood.

There also isn’t great data available (at least that I’ve found) about how many kids with emetophobia are 100% cured of their worries. This is probably because kids with a fear of vomiting often have other forms of anxiety they deal with, as well, like generalized anxiety or OCD.

I realize this all sounds a little hopeless. It isn’t! There’s good news: while emetophobia can be tricky to treat, especially without help, it can get better. Therapy can help kids and their parents gradually face the situations that trigger fears of vomiting, without needing reasssurance or special treatment.

Kids can become more confident in their ability to handle their anxiety on their own. When this happens, worries may not disappear entirely, but they become a passing annoyance instead of a debilitating fear.

How Can I Help My Child With Fear of Vomiting?

Kids with a fear of vomiting absolutely benefit from therapy with a professional. However, if you’re just starting out on this path and still searching for a therapist, there’s a lot you can do on your own to help your child. Parents play a huge role in their child’s recovery from emetophobia. Changing how you respond to anxiety can help your child cope better with their worries and prevent symptoms from snowballing.

The most important thing you can do to help your child with their fear of vomiting is to be mindful of how you are changing or adapting the way you do things to keep your child from experiencing fear. Nobody wants to see their child suffering, and it’s only natural to want to reassure a worried kid or take them away from an anxiety-provoking situation. However, when a child has an anxiety disorder like emetophobia, preventing a child from facing their fear head-on makes symptoms worse over time.

In therapy, we call this accommodation: families learn to change their ways over time to accommodate and “make room” for a child’s anxiety. While this might appear to help in the short term, over time you’ll find the anxiety takes up more and more space. Its list of demands grows: instead of one reassurance, your child may need many. Throwing out expired crackers once may lead to repeated requests to check expiration dates on everything in the fridge.

You may realize that you’re already doing a good deal to accommodate anxiety, and that’s okay. You don’t need to suddenly remove all the supports you’re offering your child. A therapist can help you gradually pull back on accommodation so your child feels empowered to face their fears, rather than overwhelmed by them.

Here’s some other quick tips to support your emetophobic child at home:

• Educate your child about their diagnosis: knowing that there’s a word to describe this problem and that many others have experienced it can help a child feel less alone.

• Practice daily relaxation skills with your child during calm moments. This can help them better manage overall stress, and will better equip them to use skills the next time they’re anxious.

• Listen to and validate your child’s fears, rather than rushing to reassure them that nothing’s wrong. Phrases like “I’d really scared, too, if I thought I was going to throw up in front of all my friends” can go a long way in helping your child feel heard.

• Once you’ve validated the feeling, ask your child questions to help them think logically about their fear. For example, how many times have they thrown up at school? Have they felt this anxiety before, and has it correctly predicted that they would throw up? Even if they did vomit, would it really be the end of the world?

• Keep an eye on how you’re accommodating anxiety, and be careful not to give in to any more of the anxiety’s demands. You can even try to gradually reduce your accommodating over time by setting gentle limits on how much support you provide your child: for example, offering only 3 reassurances per day.

Is Fear of Vomiting Related to OCD?

Excessive cleaning due to a fear of germs can be a symptom of both OCD and emetophobia in kids and teens.

There’s a lot of overlap between emetophobia (fear of vomiting) and OCD. For some kids, fear of vomiting may be a standalone phobia. For others, however, it can be part of a bigger picture that includes other symptoms of obsessive-compulsive disorder.

Children who have emetophobia without OCD may have a more straightforward fear of vomiting. While they’re likely to avoid situations that could prompt them to throw up, they’re less prone to associating things with throwing up in a superstitious or illogical way. As an example, a child without OCD might avoid hanging upside down or riding a tilt-a-whirl, but they probably wouldn’t think twice about wearing the same outfit they wore the last time they got sick.

On the other hand, kids who fear throwing up due to OCD are more likely to make these kinds of mental connections, and avoid anything that feels somehow linked to a time that they or someone else threw up. You may also notice more compulsive behavior from your child, such as repeatedly checking labels, frequent handwashing, or needing to keep a trash can or bucket nearby.

If you look at your child’s overall history, you may notice that their fear of vomiting is part of a larger trend: maybe they’ve had other intense, recurrent fears in the past that have also resulted in needing to repeatedly say or do things in a certain way. This is also a good sign that OCD could be a better, more helpful diagnosis for a child’s struggles.

Either way, OCD and emetophobia have a lot in common: they both involve recurring, uncontrollable worries as well as repeated behaviors to manage the anxiety. Because of this, the same therapy techniques that work well for OCD can help kids with emetophobia feel better, too.

How Do You Treat Emetophobia in Children?

Some common child therapy approaches, like play therapy and traditional talk therapy, may not work particularly well to help kids with emetophobia—at least not on their own. Kids with emetophobia need more than just a listening ear to help them express their feelings. They also need someone who can help them gradually face their fears, so that they can prove to themselves (and their anxiously wired brains) that things are rarely as bad as they seem.

Exposure and Response Prevention, also called ERP, is a special form of therapy that was designed to help kids with obsessive compulsive disorder tame their recurrent worries and break the cycle of compulsive behaviors that go with them. It’s a version of cognitive behavioral therapy (CBT), which teaches anxious people to use specific coping skills in the present, rather than spending a lot of time understanding the past.

In ERP therapy, you and your family might learn the following skills:

• An understanding of how anxiety works in the brain

• Relaxation techniques to physically calm down your body

• How to notice and “talk back” to anxiety when it gives you exaggerated or illogical worries

• How to support your anxious child without giving into their anxiety’s demands

• Strategies to gradually face fears, starting small and working your way up, without avoiding or trying to “fix” the anxiety

• How to prevent anxiety from spiraling out of control in the future

While treatment won’t solve your child’s emetophobia problems overnight, it can absolutely help in the short-to-medium term. Families who attend therapy regularly and follow up with at-home practice often notice significant improvement in a matter of weeks or months. Importantly, therapy also helps kids to maintain their progress over the long-term, making it less likely they’ll need to return to counseling in the future.

Therapy in Charlotte, NC for Kids with a Fear of Throwing Up

Treatment with ERP therapy can help Charlotte-area kids recover from emetophobia and live life without fear of vomiting. Photo courtesy of Skylar Ewing via Pexels.

If you’re in the Charlotte, North Carolina area and looking for therapy for emetophobia, I may be able to help. I’m a children’s therapist who specializes in helping tweens and teens navigate life with anxiety. As you’ve probably guessed by the length of this blog post, I spend a lot of time thinking about anxious kids and what we can do to make their lives easier.

I got trained in ERP and CBT therapy for anxiety and obsessive-compulsive disorder due in part to my own experiences with childhood OCD. These are the therapy approaches I wish I’d had access to growing up, and I hope they can help kids like yours feel better faster.

My child therapy office is located in Davidson, convenient to families in the Lake Norman area or North Charlotte. If you can’t manage the commute, I also see children for online therapy and find this format works really well for many middle and high schoolers. If you’re even further afield, I can work with families throughout the states of North Carolina, New York, and Florida. I also have an online coping skills course available for download wherever you live.

Ready to get started? Contact me here.

What’s the Difference between an Intrusive Thought and a Normal One?

Many kids and teens wonder if they’re experiencing intrusive thoughts. Keep reading to learn more about them, and how they differ from more “normal” thoughts and ideas. Image by Liza Summer via Pexels.

As an elder milennial therapist, I’ve decided I don’t need TikTok in my life. I have plenty of apps and screens stealing my attention as it is! Instead, I behave like a responsible adult: I wait for all that TikTok content to make its way over to Instagram, where I consume it a few weeks (or months) late. This is how I discovered that, apparently, intrusive thoughts became kind of A Thing on TikTok for a while this summer.

Suddenly, my feed was awash with memes about “letting intrusive thoughts win.” Who would have guessed that this humble psychological symptom would ever enjoy such fame? Although the memes have slowed down, mentions of intrusive thoughts in my therapy office have not. So, I figured it was time to talk about intrusive thoughts: what they are, why they happen, and what makes them different from other, more “normal” thoughts.

Can You Really “Let the Intrusive Thoughts Win?”

Before we dig into intrusive thoughts, let’s talk about the meme. Maybe you’re an elder milennial, like me, who doesn’t have TikTok and somehow missed this entire phenomenon. Or, maybe you’ve found this article many years from now, when the intrusive thought’s 15 minutes of fame is nothing but a distant memory. Let’s take a journey back in time to this strange cultural moment in the summer of 2023…

According to the website Know Your Meme, catchphrases like “He/she let the intrusive thoughts win” and “Intrusive thoughts won” are “used to caption memes in which people, usually celebrities, exhibit behavior that breaks social norms. In memes, intrusive thoughts are typically confused with impulsive behavior.” Basically, these memes usually feature video of someone doing something kind of random or weird, usually to comedic effect. Said something awkward on live TV? You let the intrusive thought win. Hit a pane of glass with a hammer to see what would happen next? Intrusive thought won.

As an OCD therapist (and a person with OCD), am I offended by these memes? No. I am also a human being with a sense of humor. But they’re not a very accurate portrayal of intrusive thoughts. As Know Your Meme wisely points out, many of these memes show examples of impulsive behavior, as opposed to an intrusive thought.

It’s really common for a person to act on an impulse. It’s much less common for someone to act on an intrusive thought. In fact, that’s kind of an intrusive thought’s whole deal: people really, really don’t want to do what the thought is telling them to. And in almost every case, the person wins over their thought.

Intrusive vs. Impulsive: What’s the Difference?

An impulsive thought happens when we get the urge to do something without reflecting on cause and effect. We’ve all had these moments where we react in a knee-jerk way, without considering whether or not it’s actually a good idea. Most of us are more likely to act impulsively when we’re overwhelmed by emotion: think about the last time you blurted something unfortunate when you were angry.

Generally speaking, impulses are urges that, on some level, we want to act on, even if we know it might not be a great idea. Someone swipes a cookie off the plate because it’s too tempting to resist. A toddler runs off into traffic because they don’t have the self-control to hold themselves back. Curiosity gets the best of that Instagram guy, and he hits the car window with the hammer. Intrusive thoughts can be good, bad, or neutral, but usually they are fleeting. If you ignore them, they go away and never return.

Intrusive thoughts, on the other hand, are almost always negative. In fact, they’re often beyond negative: they’re dark, frightening, or embarrassing. They aren’t always realistic, either: they can be pretty illogical and bizare. Unlike an impulsive thought, intrusive thoughts sometimes repeat themselves. Even if you succeed in ignoring it or pushing it away once, it may pop up again when you least expect it.

Most importantly, intrusive thoughts are usually the total opposite of what a person wants to do in real life. A peaceful person may find themselves having violent thoughts, or a caring person may experience cruel thoughts about a loved one. People who suffer from intrusive thoughts are usually horrified by them. They may worry that they’ll somehow lose control and act on their unwanted thought, even though it’s the last thing they’d ever want to do.

Okay, So What Is an Intrusive Thought?

Intrusive thoughts are sudden, unwanted thoughts that are upsetting to experience, because they go against a person’s actual wants and desires. Photo by Andrew Neel via Pexels.

An intrusive thought is an unexpected, unwanted thought, image, or idea that makes the thinker feel uncomfortable. These thoughts pop into the brain on their own, and they’re not something a person is trying to think about. Because they’re outside of our conscious control, people often feel like these thoughts are “weird” in some way, almost like they have a mind of their own.

Intrusive thoughts often feel out of character, and may go against the thinker’s morals and values. They can sometimes be illogical or bizarre, leaving a person wondering why on earth they’d ever think such a thing. These thoughts are usually negative and cause upset for the person having them, although this can range from mild discomfort to extreme distress, disgust, or fear.

Intrusive thoughts often fall into one of the following “taboo” categories. These tend to be subjects we don’t feel comfortable thinking about, which makes the thoughts extra disturbing when they show up:

• Violence, aggression, and hurting others

• Sex, puberty, and sexuality

• Germs and illness

• Bad things happening to yourself or others

• Doubt about whether something was done correctly

• Doing something “wrong” or immoral

• Doing something that goes against your religion or angers God

Some intrusive thoughts are a one-time occurrence. Other thoughts repeat in the thinker’s mind, showing up over and over again. As you can probably imagine, this can cause a lot of stress.

Examples of Intrusive and “Normal” Thoughts

I’ll share some examples here of how an intrusive thought might look when compared to a similar, more typical thought. Please keep in mind that these are just examples and that intrusive thoughts come in many shapes and sizes! The quality of the thought—the fact that it pops up when you don’t want it to—is a big part of what makes it intrusive.

“Normal” thought: I should wash my hands before dinner.
Possible intrusive thought: Maybe touching that expired yogurt container got food poisoning germs on my hands, and now I’ll throw up.

“Normal” thought: What if I get a bad grade on tomorrow’s test?
Possible intrusive thought: What if I scream out a swear word in the middle of the test tomorrow?

“Normal” thought: I’m mad at my sister.
Possible intrusive thought: Having an image come to mind of pushing your sister down the stairs, for no reason, when you’re not angry.

“Normal” thought: Now that I’ve said my prayers, I can go to bed.
Possible intrusive thought: What I did something bad today that I don’t remember, and now God is mad at me?

“Normal” thought: My mom is picking me up from soccer practice tonight.
Possible intrusive thought: Unexpectedly picturing your parent’s car crashing.

Sometimes it can help to see an example in writing, especially if you think you may be suffering from intrusive thoughts yourself. If one or more of these thoughts felt familiar to you, you’re definitely not alone. Many people have intrusive thoughts—probably way more than you’d guess.

Does Having Intrusive Thoughts Mean You’re Crazy?

Intrusive thoughts can make you feel out of control, but they don’t mean you’re going crazy. They’re a really common experience! Photo by Liza Summer via Pexels.

You may have noticed in my example section above that I put the word “normal” in quotes. That’s because even though intrusive thoughts feel extremely abnormal, they’re actually incredbly common. A 1995 study found that 90% of people report having intrusive thoughts, which means it’s actually crazier not to have them. As uncomfortable as they are, intrusive thoughts are just part of the human experience.

I explain intrusive thoughts to kids in my therapy office like this: imagine your teacher is making you write 100 essays a day. From the time you wake up to the time you go to bed, you’re just writing essay after essay. With all that practice, you’d probably come up with a few pretty good ones. But a lot of them would be mediocre at best. And some of them would be absolute garbage. How could they not be? You’re writing 100 a day!

We have way more than100 thoughts a day. The average person has around 60,000 thoughts. With a number that high, some of them are bound to be less than awesome. Intrusive thoughts are the brain’s equivalent of a burp or a fart. They’re just a little poof of randomness that our brain hands to us asking “I dunno, is this anything?”

So if 90% of the population is having these thoughts, why isn’t everyone panicking? Why aren’t the intrusive thoughts winning? Here’s the deal: most people barely notice their intrusive thoughts. The thought pops up, the person thinks “Huh, weird.”, brushes it off, and moves on with their day. They know it’s not something they really want to do, so they don’t take it seriously. It’s only when people have trouble setting their intrusive thoughts aside that they start to cause problems.

Does Having Intrusive Thoughts Mean You Have OCD?

Having the occasional, fleeting intrusive thought doesn’t mean you have a mental health problem. Like I mentioned above, it’s just part of being human. However, intrusive thoughts can be part of several different conditions. In these cases, the intrusive thoughts tend to be frequent and overwhelming to the point that they start to interfere with a person’s daily life.

Intrusive thoughts are best known as a symptom of Obsessive Compulsive Disorder, or OCD. People with OCD have a much harder time disregarding their intrusive thoughts. They may start to question whether the thought could be true, or if having the thought in the first place means they’re a bad person.

The intrusive thoughts show up over and over, and they cause so much anxiety that the OCD sufferer is willing to do just about anything to make them go away. This can lead to a vicious cycle of repeated thoughts or worries—called obsesions—and repeated behaviors or rituals—called compulsions. Unfortunately, the more a person gives in to their compulsive behavior, the worse the obsessive worries tend to get.

Intrusive thoughts can show up as a part of other conditions, too, such as:

• PTSD

• Anxiety Disorders

• Depression

• Eating Disorders

If your child’s intrusive thoughts are happening often and causing a lot of distress, it’s worth speaking to a therapist to see if an underlying condition could be causing the problem.

Therapy Can Help Kids and Teens with Intrusive Thoughts

Therapists can help kids with intrusive thoughts learn to take them less seriously, so the thoughts don’t feel so overwhelming. Photo by Julia M Cameron via Pexels.

Intrusive thoughts are freaky. They are weird, they’re unpredictable, and they can be difficult to ignore. But they don’t have to take over your life! If you’ve taken anything away from this post, I hope it’s this: intrusive thoughts are all bark but no bite. They’re not as powerful as they feel, and they can’t compel you to do something you don’t want to do.

We have great therapy options to help kids with intrusive thoughts and OCD. Exposure and Response Prevention was designed specifically to help people cope with their OCD symptoms. It’s a specialized version of CBT, a popular, skills-based therapy approach that has helped people of all ages manage many forms of anxiety.

If you need help for a child or teenager with intrusive thoughts, take a look at the International OCD Foundation’s searchable database to find a therapist near you who has completed ERP training. You can even look for therapists who’ve gotten specialized education in how to practice ERP therapy with kids. You may want to consider broadening your search to include therapists throughout your state, if online therapy is an option for you.

If you live in North Carolina, New York, or Florida, I may be able to help. I’m a children’s therapist trained in pediatric ERP therapy—and I was also diagnosed with OCD as a kid. I’ve been on both sides of the OCD therapy equation, so I know exactly how hard it is for my kid clients to face their fears. I meet with kids in-person in my office in Davidson, North Carolina, and online with families throughout these three states where I’m licensed.

Looking to get started in therapy? Reach out to me here, or check out my About and FAQ pages to learn more about me and my work.

How Can I Help My Minor with OCD?

OCD symptoms often develop for minors during the tween or teen years, and most people are diagnosed before age 25.

If you’re looking for help for your minor child with OCD, you’re not alone. It’s common for OCD symptoms to first show up in childhood: two of the most common times to develop OCD are during the tween years or the late teen years. In general, most people with OCD start noticing symptoms before age 25.

Research suggests boys tend to devleop OCD at an earlier age than girls do. However, every kid is different. For example, I’m a children’s OCD therapist who was also diagnosed with OCD as a child, and my symptoms started at age 7.

Regardless of your child’s age, your support as a parent is really important. Kids—especially young ones—need their parents to be involved in the therapy process, and this is especially true when it comes to OCD therapy. The good news is that your support will have a huge, positive impact on your chid’s recovery from OCD. In this post, you’ll learn 5 simple ways you can help your minor child—and yourself—through OCD

Identifying OCD Symptoms in Minors

It’s not always easy to identify OCD symptoms in children. Kids are often aware that the worries OCD gives them are unusual, and will try to mask their symptoms as a result They may feel embarassed, ashamed, or afraid of the thoughts they’re having. They don’t want other people to know about these weird thoughts, so they cover them up instead.

Also, a child’s OCD symptoms might not fit the mold of what we expect OCD to look like. We might envision a very neat, orderly person who’s focused on avoiding germs or keeping things organized. In reality, OCD can look many different ways, and the signs are often very subtle. It’s entirely possible for a child with OCD to be messy, disorganized, or totally unworried about dirt or germs.

People with OCD have two things in common: obsessive thoughts and compulsive behavior. An obsession is an unwanted thought, worry, or mental image that pops up at unwanted times. It’s hard to get rid of, and causes a lot of anxiety or distress. In order to deal with these obsessions, OCD sufferers feel like they have to do something to alleviate their anxiety. This repeated behavior is called a compulsion.

Common obsessions for kids with OCD include:

• Worries related to getting sick, throwing up, or contracting germs

• Fear about somehow losing control and doing something bad, like hurting themselves or someone else (even though they don’t want to)

• Thoughts that if they don’t do something just right, something terrible could happen

• Worries about bad things happening to loved ones

• Doubts about whether or not they may have misbehaved or done something wrongj

• Worries about sexuality or being gay in children who aren’t otherwise questioning their identity

You may notice compulsive behaviors like these in your minor child with OCD:

• Checking and-rechecking that they’ve done something, like turned off a light switch

• Creating rituals that have to be done exactly the right way, such as a specific process for washing hands or a rigid bedtime routine

• Excessive cleaning, showering, or handwashing

• Repeatedly asking for reassurance about things, even after they’ve been given an answer

• Confessing bad thoughts or possible misbehavior to a parent

• Repeatedly touching or counting objects, or repeating actions to make them symmetrical (like tapping one leg and then the other)

The tricky thing about OCD is that compulsions never permanently get rid of an obsessive worry. This means that people get stuck in a cycle of doing their compulsive behavior over and over in order to feel some sense of relief.

Five Ways to Help Your Minor Child with OCD

As a parent, you can help your child understand their symptoms and work together as a team to combat OCD.

Now that we’ve reviewed the symptoms of OCD, let’s talk about how you can help your child to cope. OCD is a stressful diagnosis not just for the child who is suffering, but their entire family. Keep reading to learn ways to demystify OCD, reduce feelings of shame and loneliness, and start looking at OCD from a different perspective. These 5 steps will help you and your child look at OCD in a new light, so you can start working on healing together.

These techniques aren’t a replacement for therapy (more on that below), but they are tried-and-true approaches that I teach in my child therapy office. They’re also exactly the kinds of things that I think would have helped my family when I was a kid. If you’ve just noticed OCD symptoms in your minor child and you’re not sure what to do, start here.

#1: Help Your Child Understand OCD

I mentioned above that kids with OCD often know that their thoughts are unusual. That’s because OCD is ego dystonic: this means that the thoughts it causes go against a person’s temperament and values. They can feel weird, confusing, or “other,” almost like they’re not coming from you. Often, OCD preys on a child’s worst fears: peaceful kids may experience violent images, responsible children might worry about mistakes, and typically subdued kids can suddenly have thoughts about losing control and doing something inappropriate.

As you can imagine, this is really upsetting. Kids with OCD may worry they’re going crazy or that something is deeply wrong with them. They may also assume they’re the only one having these “weird” thoughts. This is especially true if their obsessions are about something embarrassing, shameful, or taboo.

You can help your child understand OCD so they feel less alone. Learning how OCD works can help kids realize that their symptoms aren’t so unusual after all, and that there is treatment that will help. Start by teaching a few important facts about OCD:

• Nothing a person does causes OCD. It’s mostly genetic, and not anybody’s fault.

• Just because you have a bad thought doesn’t mean you’ll act on it. In fact, people with OCD tend to have obsessive thoughts about things they’d never do in real life.

• OCD isn’t dangerous: it’s just a little glitch or “hiccup” that happens in the brain.

• You can fight back against OCD by not doing what it tells you to do: this is hard, but it teaches your OCD who is boss!

Reading books together is a great way to get these points across. It gives parents language they can use to explain OCD, and seeing that someone has gone through the trouble of writing a book can reassure kids that they really aren’t alone. What to Do When Your Brain Gets Stuck is a classic, and many people enjoy Up and Down the Worry Hill, too.

Your child might also appreciate taking a look at a list of celebrities who have OCD. About 1.2% of people are diagnosed with OCD. This means there are plenty of public figures who have been affected by it, including David Beckham, Daniel Radcliffe, and Camila Cabello.

#2: Be a United Team with Your Child Against OCD

Your child can separate herself from her symptoms by drawing a picture of what she imagines OCD looks like.

Battling OCD is not easy work. You have to do exactly the thing your brain is saying not to do in order to feel better! This can put parents at odds with their kids, because parents are the ones who have to hold bnoundaries and stick with the plan to overcome OCD. It’s important to remind your child (and yourself) that this fight is not you against them: it’s the two of you against OCD.

You can maintain a united front by imagining OCD as a little character or creature that is totally separate from your child. This is called “externalizing:" it’s a tool we use in therapy to help separate a problem from the person suffering from it. Externalizing OCD can help you feel like you’ve got a common enemy. It also reduces some of the shame and frustration kids feel when they experience thoughts and urges beyond their control.

Encourage your child to give their OCD a name: kids often choose something funny and nonthreatening, like “Bob” or “Dr. Annoying.” Your child might also enjoy drawing a picture of what they imagine their OCD would look like. Creating this kind of OCD character is a coping skill I use with almost all kids at the beginning of treatment (you can check out other OCD coping skills here).

Next time you notice your child saying or doing something related to their OCD, don’t blame them—blame Bob.

#3: Don’t Fall Into the Reassurance Trap

It’s only natural to want to comfort your child when they’re worried. As parents, we probably offer reassurance all day without thinking twice. Sometimes, a simple “it’s okay” or “everything will be alright” is all a child needs to hear in order to feel better.

Unfortunately, the usual rules don’t apply to OCD. Reassurance typically does more harm than good: even though it helps kids feel better in the short term, it fuels their anxiety in the long run. Reassurance-seeking is the most common OCD compulsion I see among kids in my therapy practice. Cutting back on reassurances can go a long way toward helping your child.

You might notice your child asking you the same question over and over, even after you’ve already explained that things will be fine. That’s because reassurance only quiets the OCD worries for a little bit. The OCD worries always come back, which means your child has to ask again to get relief. Over time, this pattern actually makes the symptoms worse.

One of the big goals of OCD treatment is to help parents gradually stop enabling their child’s OCD by giving into its demands. This means gradually scaling back on giving reassurance if you’ve been doing it a lot. If your child’s symptosm are mild, you may have good luck doing this on your own at home. If you’ve been stuck in this pattern for a while, a therapist can help you to gently break the cycle.

#4: Research Therapists who Treat Minors with OCD

Databases like the one provided by IOCDF can help you find therapists who specialize in treating OCD in minors.

While some minor children will recover from OCD without therapy, many will need extra help. Research has found that for about 1 in 5 kids, symptoms will resolve on their own, without treatment. For that remaining 4 out of 5, therapy will help kids get back on track and manage their symtpoms.

It might sound daunting at first to hear that most kids with OCD require therapy to recover. However, there are a couple of big silver linings here. The first bit of good news is that we have a form of therapy called ERP that’s been designed specifically for treating OCD, and it is highly effective. We also know that entering therapy early in life helps people with childhood-onset OCD make a much fuller recovery. That’s good news for your child!

Working with OCD is a specialty: not all therapists have extensive training in this area. The same is true for working with children. Finding a therapist who specializes in both OCD and working with minors might require a little extra legwork. The International OCD Foundation (IOCDF) has a searchable list of therapists who are trained in ERP, the “gold standard” treatment for OCD, including therapists who have been specifically trained to treat children. You can also run a search on Psychology Today to look for therapists in your area who offer ERP and see kids or teens.

Not all therapy therapy training programs don’t cover OCD or child therapy in tons of detail, so it can help to ask prospective therapists what their training and experience is with these two groups. Registered Play Therapists often have lots of training working with kids. ERP is the most common, best-researched therapy for OCD treatment. You can also ask more general questions, like the ones in this post, to get a sense for whether a therapist seems like the right fit for your family.

#5: Practice Self-Care So You Can Support Your Child

OCD is tough for kids, but it’s incredibly draining for their families, too. The bigger OCD symptoms grow, the more time and energy it takes to keep up with all the compulsive behaviors and rituals. Families—and parents especially—may feel like they’re bending over backwards or walking on eggshells to avoid triggering their child’s OCD. And even with all that effort, new worries pop up, seemingly out of nowhere.

It’s common for parents to feel exhausted, hopeless, or even resentful when they’ve been dealing with a child’s OCD for a long time. Kids often pick up on this tension, which adds extra stress to an already stressful situation. Gradually facing fears through OCD treatment is the most surefire way out of this vicious cycle, but it requires a lot of work, too. You’ll need a lot of patience and compassion to help your child through therapy.

Treating OCD is more of a marathon than a sprint. Resist the temptation to put yourself last on the to do list, and make sure you’re setting aside time to do whatever will help you continue to show up for your child. Date nights, exercise, time away from parenting, or watching something on TV that isn’t Bluey all count. You can also ask to speak to your child’s counselor in private or seek out your own therapist if you need to vent and get your own support.

OCD Therapy for Minors in North Carolina

You can help your child through OCD with the support of a therapist. I provide OCD treatment for kids and their families throughout North Carolina, New York, and Florida.

I hope you’ve found this article helpful, and that it gives you some options to try while you consider looking for a therapist. If you’re looking for OCD counseling for your child, I may be able to help! I’m physically located in Davidson, North Carolina, and can meet with local children in-person or online. I’m also available for virtual sessions with families in Florida and New York. You can learn more about my practice or email me to get started.

Looking for more information on how OCD affects minors? Check out some of my other posts:

Can a Child Have Mild OCD?
What Are the 4 Types of OCD?
How to Help a Child with Intrusive Thoughts
Does Childhood OCD Go Away?