What are Anxiety and OCD?
Anxiety in Kids
Everyone experiences anxiety at some point in their life, from the very young to the very old. Your child may get nervous during thunderstorms, or be afraid of the dark. In the school setting, your child may get nervous before a test or presentation, or when saying goodbye to you in the morning. It is normal and common for youth to get anxious in situations like these. When your child’s anxiety starts to creep into their everyday life outside of specific situations, that is when it might be considered that they have an anxiety disorder.
Anxiety as it relates to mental health is defined as chronic and/or generalized worry, fear, or nervousness that a child expresses a lot of the time. In other words, the anxiety your child feels is not driven by specific situations — they feel anxious most of the time, regardless of what is happening in their life. In these cases, anxiety noticeably impacts their behavior at home and in social situations. In school, anxiety has an effect on a child’s ability to participate in class, their learning, and/or their ability to perform assigned tasks.
For BIPOC youth, experiences of racism and discrimination, social determinants of health, current and historical stressors, and the resulting internalized stress may contribute to increased anxiety and mental health concerns. Further, youth living within a racially oppressive context may feel as if they are constantly in a state of hypervigilance, contributing to increased anxious arousal or generalized worry, fear, or nervousness.
Types of Anxiety Experienced by Youth
There are many types of anxiety and anxiety-related disorders that school-age youth can experience, including:
The common factor in each of these conditions is the severity of their chronic anxiety, though it will look different depending on their exact diagnosis.
OCD in Kids
One of the more common, but not often talked about mental health conditions in school-age youth is obsessive compulsive disorder (OCD). OCD causes severe anxiety in those affected. OCD involves both obsessions and compulsions that take a lot of time and get in the way of important activities, such as school and extracurricular activities, developing friendships, and self-care.
- Obsessions are intrusive and unwanted thoughts, images, or urges that occur over and over again and feel outside of the child’s control. These obsessions are unpleasant for the child and typically cause a lot of worry, anxiety, and distress.
- Compulsions (also referred to as rituals) are behaviors the child feels they “must do” with the intention of getting rid of the upsetting feelings caused by the obsessions. A child may also believe that engaging in these compulsions will somehow prevent bad things from happening.
In general, OCD is diagnosed when these obsessions and compulsions become so time-consuming that they negatively interfere with the child’s daily life. Typically, the obsessions and compulsions become gradually more severe over time until they get to this point.
Among racial and ethnic minorities, OCD symptoms may be influenced by negative stereotypes, racism, or one’s racial identity. For example, fear of validating false racial stereotypes may contribute to OCD-related anxieties. For more information about how experiences of racism may influence and/or exacerbate symptoms of OCD for racial and ethnic minorities, please view this video by Monica Williams, PhD, ABPP, Jenny Yip, PsyD, ABPP, and Valerie Andrews.
It is important to remember that anxiety/OCD are not a result of something that you, your child, or others did wrong. These are real mental health conditions, and they have real treatments that work. Your child’s life does not have to be limited by anxiety/OCD!
Is it Anxiety/OCD or is it Typical Behavior?
It is common for youth to have worries/fears, and to have certain routines/rituals for certain times. What makes anxiety and OCD different from these common fears and behaviors are the frequency and intensity at which they occur, and whether or not they get in the way of the child’s daily life. The following chart can help distinguish between fears and behaviors that are developmentally and culturally appropriate, and those that might constitute anxiety and/or OCD.
| Typical Fears/Routines | Anxiety/OCD |
|---|---|
| The content is usually commonplace (e.g. fear of thunderstorms, wanting to eat the same breakfast every day, etc.) | May seem bizarre or unusual, out of sync with what is happening. May be extreme or disproportionate responses to the situation. |
| Age-appropriate (e.g. wanting to be tucked in at night). | The student may have fears that are not typical to their age group (e.g. sexual/violent intrusive thoughts). |
| Do not consume an inordinate amount of time nor interfere with daily functioning. | Experience of fears and/or performance of rituals is excessive, time consuming, and has a negative impact on the student’s functioning. |
| Associated with enjoyment or satisfaction; the student wants to do them, or likes doing them. | Students find their behaviors distressing and/or overwhelming. |
| Responsive to logic or reason. | Reason or common sense do not stop or help the student’s fears or behaviors. Students often cannot be comforted or reassured. NOTE: Younger students may not realize that their fears are bizarre or unusual (i.e. they may lack insight). |
| Are able to be stopped or interrupted at will. | The student feels they cannot control their fears or stop doing their behavior(s). Interrupting the behavior will cause the student a lot of distress. |
Adapted from “Students with OCD: A Handbook for School Personnel” by Gail B. Adams, EdD
Anxiety disorders and OCD are not something a child can simply “snap out of.” The anxiety they feel that is disproportionate to the situation is often not easy for them to control, nor are the obsessions they suffer from and the compulsions they use to try to get rid of their bad feelings.
Signs/Symptoms of Anxiety and OCD
Anxiety Signs and Symptoms
Anxiety may make a child appear to be cautious, nervous, shy, or fearful. Anxious youth may express their fears by crying or throwing tantrums, and may be very difficult to calm down. Some children may seek constant approval or reassurance from others.
Youth may describe feeling physical symptoms, like headaches, stomachaches, racing heartbeat, or difficulty breathing. You may notice that they are sweating, or that they are trembling/shaking. In some cases, children may experience full blown panic episodes or panic attacks.
OCD Signs and Symptoms
When it comes to OCD, some noticeable compulsions include:
- Lining up, checking, ordering, or arranging items repeatedly.
- Wanting to complete assignments “perfectly,” checking, and re-doing it.
- Sloppiness or carelessness in completing assignments, which is not typical for the child.
- Erasing repeatedly until the paper has holes in it, the ink is smudged, and the writing or drawing is illegible.
- Reading letters, words, or sentences repeatedly, repeating syllables until they sound right.
- Incomplete assignments or homework, although the child is capable of doing them
- Frustration or anger when things are disorganized, interrupted, or routines change unexpectedly.
- Asking the same questions repeatedly, even after an answer has been provided or the child knows the answer
- Frequent trips to the bathroom either to use the toilet, wash hands, and/or shower.
- Refusing to touch other peoples’ things, or getting upset if own personal items are touched by others.
- Sudden avoidance of familiar things or reluctance to try new things.
- Odd behaviors, such as walking in specific patterns through doorways, counting tiles or syllables, touching or tapping in symmetry, or sitting and standing repeatedly
- Opening doors, lockers, desks, or books with elbows or with tissue in hand, holding hands in the air to avoid physical contact, refusal to shake hands, share pencils, or other supplies.
- Excessive reassurance seeking (e.g., always asking “Are you sure I’m going to be okay?”).
Common obsessions that fuel the noticeable compulsions may include:
- Worrying about germs, getting sick, or dying.
- Extreme fears about bad things happening or doing something wrong.
- Feeling that things have to be “just right.”
- Disturbing and unwanted thoughts or images about hurting others.*
- Disturbing and unwanted thoughts or images of a sexual nature.*
* PLEASE NOTE: Children who have sexual and/or violent intrusive thoughts find them to be very upsetting and distressing. The experience of these thoughts does NOT mean these youth have any desire or intention to act on them. It can be scary for a caregiver to hear about these thoughts, but it is very important to note that these children are not at risk and should not be confused with youth who may have a history of or intent to perform antisocial, aggressive, or otherwise violent behavior.
What is Racial Trauma?
While all youth are susceptible to anxiety or OCD symptoms in the school setting, youth from racial minority groups are also vulnerable to symptoms of racial trauma. Therefore, it's essential to understand the signs and symptoms of racial trauma to differentiate between normal vs. abnormal behavior, particularly when considering anxiety or OCD among BIPOC youth.
Racial Trauma in BIPOC Youth
Traumatic events that occur due to experiencing racism or discrimination can profoundly impact mental and physical well-being. Racial trauma, or race-based traumatic stress, refers to the mental and emotional impact of one’s experiences of racism and discrimination. Signs of racial trauma appear in students ranging from infancy-adulthood.
When it comes to racial trauma in your child, you may notice some of the following signs/symptoms:
- Racial trauma may contribute to them reporting increased physical symptoms, like headaches, stomach aches, tension in the chest, or a racing heartbeat.
- They may report increased negative emotions, such as depression or anxiety, within the context of discrimination.
- Exposure to chronically stressful race-related conditions may make some youth feel detached or numb.
- Racial trauma may elicit feelings of helplessness, hopelessness, and worry for youth about their skin tone and ethnic-racial identity.
- Some youth may become preoccupied with their safety or the safety of peers/family members.
- Your child may experience decreased academic motivation or have difficulty concentrating in the classroom.
- Incomplete assignments or homework, although they are capable of doing them.
- Some youth may seek reassurance or validation from others.
Now What?
If you’re a parent/guardian and you have read all of this information on anxiety/OCD you’re probably wondering, “Now What?”
If you suspect that your child (or young adult) has anxiety/OCD, it is important to seek a proper diagnosis. This usually involves setting up an appointment with a mental health professional that is familiar with anxiety/OCD. The provider will often start with an assessment or a psychological evaluation based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). For more information on the process of receiving a diagnosis for anxiety/OCD click here
Overall, being informed about anxiety/OCD is helpful to all parents/guardians. It allows you to better serve your child/young adult if they ever were to actually be diagnosed. It also allows you to educate friends, other loved ones, and those in your community.
How To Find a Good Therapist is a helpful article for parents/guardians, students, and school personnel that are looking for providers.
