371 | OCD Behaviors in Children: What We're Really Treating in CCPT

Episode summary

In this episode, I address a topic I've been getting more and more questions about: children who present with obsessive or compulsive behaviors that mirror OCD. I explain why I feel OCD is often not an appropriate childhood diagnosis and why these behaviors are best understood as manifestations of unmanageable anxiety combined with perfectionism and an intense need for control. When parents come in focused on eliminating specific behaviors, I walk through why that approach misses the heart of the issue and risks placing an agenda on the child that undermines the therapeutic process.

I outline how child-centered play therapy is uniquely suited to this presentation by addressing the underlying anxiety rather than the behaviors themselves. I discuss what these children often look like in the playroom, including rigid, imperative-driven thinking, and how elevating reflective responding—especially feelings—and gently contrasting wants versus reality helps children loosen their grip on control over time. The goal is never to "fix" the rituals, but to relieve the child of the burden of believing they must keep the world from falling apart. When anxiety decreases and emotional vocabulary grows, the behaviors no longer need to exist.