Understanding What You’re Seeing

Fears are a completely normal and healthy part of growing up. Most infants develop a fear of strangers, and many toddlers go through a phase of being afraid of the dark. Anxiety is a normal and temporary human emotion that helps protect us from danger.

When Is It More Than a Phase?

For some children, however, this internal alarm system becomes overly sensitive and starts to interfere with their life. Anxiety and OCD can look different in every child, especially when considering a child’s age, sensory sensitivities, or the specific situation. Because anxiety often hides behind tantrums, avoidance, and behavioral issues, it can be tricky to identify.  

So, how do you know if your child’s anxiety is a problem?

The simplest way is to consider its impact on their day-to-day life. Anxiety becomes an issue when it causes significant distress or stops your child from doing things they need or want to do, like making friends, participating in activities, or keeping up with schoolwork. As a general rule: “If your child’s anxiety is adversely affecting their life, then they will benefit from learning about how to overcome it.”

Below, you’ll find descriptions of the subtle and not-so-subtle signs of the worries and behaviors we commonly treat. If any of these sound familiar, we can help your family find relief.

When Anxiety Looks Like Misbehavior

Anxiety triggers a powerful physical “fight-flight-freeze” response in the body, which can feel very real and uncomfortable for a child. Because children often lack the vocabulary to explain feelings of fear or overwhelm, they express this internal distress through their actions. When a child’s brain hits the “panic button”—whether due to a school task, social challenge, or separation—this physical response naturally leads to certain behaviors. The most common reaction is avoidance, where a child tries to escape or stay away from the person, place, or situation that triggers their fear. However, in some children, this survival instinct demands an immediate escape, resulting in behavior that looks like misbehavior. This can include intense crying, yelling, explosive anger, hitting, or defiance. Recognizing these outbursts and meltdowns as signs of underlying anxiety—not just willful misbehavior—is the first step toward finding effective support.

Obsessive Compulsive Disorder (OCD)

If you’ve noticed your child repeating certain actions or getting stuck on particular thoughts over and over, you may be observing obsessive-compulsive disorder (OCD). OCD maintains its grip through a predictable cycle that tricks the brain into thinking repetitive behaviors are necessary to stay safe or feel “just right.” Your child may be struggling with OCD if you notice them repeatedly doing things that take up too much time, or if they constantly seek reassurance from you or others.

What it can look like:

• Constant questioning and seeking reassurance (e.g., asking “Are you sure I won’t get sick?” or “Are you sure the door is locked?” many times, even after getting an answer)
• Repetitive checking (like re-checking homework, locks, electronic devices)
• Frequent worry about specific themes like dirt, germs, or keeping things in perfect order
• Performing actions repeatedly in a ritualistic or excessive way that goes far beyond what is necessary (e.g., washing hands frequently, organizing belongings) or until it feels “just right”
• Repeating tasks like writing and erasing, standing up and sitting down, or touching things a certain number of times
• Refusing to touch things considered “dirty,” such as community crayons
• Having distressing, unwanted “taboo thoughts” that involve scary, confusing themes. Many children and teens find the topics difficult to talk about, such as intense worries about their morality, being a bad person, or fears of harming others or themselves. This can lead to avoidance of certain places or people (like avoiding church, being alone with younger children, using scissors) or engaging in excessive behaviors like hiding or throwing out potentially dangerous objects they come across.
• Getting very upset if they cannot perform their ritual

Generalized Anxiety Disorder (GAD)

If you feel like you’re constantly answering “what if” questions and can’t seem to calm your child’s racing mind, you may be seeing signs of generalized anxiety. Children with this have a tendency to worry about many different areas of life and are often described as “worrywarts.”

What it can look like:

• Worrying about many different things like their health, schoolwork, sports performance, or family safety
• Being particularly concerned about new or novel situations, or small things that might happen in the future
• Repeatedly asking questions to seek reassurance from parents
• Worrying excessively after seeing news programs or scary movies
• Spending hours making sure schoolwork is absolutely correct
• Frequent physical complaints like persistent stomachaches or headaches without a medical cause
• Significant problems relaxing, falling asleep, or staying asleep because their mind won’t turn off

Separation Anxiety Disorder

This can be one of the most heartbreaking forms of anxiety for parents, as every morning school drop-off or evening out can feel like a battle. It’s driven by a deep fear of being away from a main caregiver, often a parent. This goes far beyond typical “clinging” or sadness at goodbyes.

What it can look like:

• Extreme distress during drop-off at school, daycare, or activities, often involving dramatic crying, panic, or physical complaints
• Refusal to sleep alone or needing to sleep in the same room as a parent, long past the expected age
• Following a parent from room to room to avoid being out of their sight and being reluctant to go to other parts of the house alone (like the bathroom or basement)
• Refusing to have sleepovers at friends’ or relatives’ houses
• Avoiding or refusing to go to school
• Expressing fear that something terrible might happen to the parent or to themselves while they are apart (like a car accident, getting lost, kidnapping)
• Complaining of stomachaches or other physical problems when separation is near

Social Anxiety Disorder

Does your child seem excessively shy, clinging to you in social situations, and avoiding activities that other kids enjoy? This could be a sign of social anxiety. Social anxiety is a fear and worry in social situations where a child has to interact with other people or be the focus of attention. Your child may be struggling if fear of judgment makes it difficult to participate in social settings or public speaking.

What it can look like:

• Appearing excessively shy
• Avoiding situations like meeting new people, talking on the telephone, or joining teams
• Refusing to speak in front of the class or answer questions
• Intense fear of eating in front of others
• Having very few friends and often playing alone
• Becoming quiet if anyone they don’t know well comes over
• Hiding or clinging to a parent when strangers are present (especially in younger children)

Selective Mutism

This is an anxiety-fueled inability to speak that is limited to specific settings, even though the child can speak perfectly well at home.

What it can look like:

• The child or teen speaks normally at home with family members
• They consistently do not speak in specific social situations (like at school, in public places, with peers)
• They may appear to “freeze” or have a blank expression when expected to talk
• They may use nonverbal gestures (pointing, nodding) to communicate in those specific settings, but they cannot use their voice

Specific Phobias

It can be baffling when your child’s world shrinks because of an intense fear of something you see as harmless. This is often a specific phobia, which is an intense fear of a particular situation or object that the child will try very hard to avoid. Common phobias include fears of dogs, spiders, snakes, storms, being up high, flying, being in small spaces, seeing blood, getting a shot, vomiting, and choking.

What it can look like:

• An intense panic reaction (crying, screaming, running, hiding, freezing) when they encounter the item or situation
• Total avoidance of the feared object or situation (like refusing to go outside if they see a certain insect, refusing to go near bridges or in elevators)
• Physical complaints like dizziness, nausea, or a racing heart specifically when facing the phobia

Panic Disorder

This involves experiencing terrifying panic attacks that seem to come “out of the blue,” leading to a change in behavior to avoid future attacks.

What it can look like:

• Sudden, unexpected periods of intense fear that include frightening physical symptoms, such as feeling like they can’t breathe, their heart is pounding, they might pass out, or they are “going crazy”
• Worrying constantly about when the next attack will happen
• Avoiding places or activities (like crowded stores, playing sports, driving) because they fear it will trigger another panic attack

Body Dysmorphic Disorder (BDD)

BDD is a preoccupation with perceived flaws in one’s appearance that are often minor or not even noticeable to others. This is well beyond typical teenage concerns about how they look.

What it can look like:

• Spending hours every day checking their appearance in mirrors, reflective surfaces, or phone cameras
• Excessive efforts to camouflage or conceal the perceived flaw (like using heavy makeup, wearing certain clothing or hats)
• Constantly comparing their appearance to peers, models, or celebrities
• Frequently seeking reassurance about their looks from others, or repeatedly asking others if the “flaw” is noticeable
• Avoiding going to social events or arriving very late due to taking a long time getting ready
• Avoiding participating in sports that could reveal their “flaw” (like swimming)
• Refusing to have their photo taken or constantly deleting pictures of themselves to prevent others from seeing the perceived flaw

Hoarding Disorder

This is not just messiness; it is a strong inability to get rid of items due to distress, regardless of the item’s value.

What it can look like:

• The accumulation of vast amounts of items (like broken toys, clothes, school papers, craft supplies, wrappers, or free trinkets) in their room or personal space
• Significant distress or refusal to let go of specific collections or items, even if they are broken or no longer used
• Refusing to allow friends or family into their room due to shame or intense fear that the clutter will be seen, touched, or that items will be thrown away
• Rooms or play areas become unusable because they are so full of possessions (like the bed is covered so they sleep on the floor, the desk can’t be used for homework)
• Intense arguments or emotional outbursts when a parent tries to organize, clean, or discard any of their possessions

Body-Focused Repetitive Disorders (BFRBs)

These are repetitive self-grooming behaviors that result in damage to the body, often done in response to a physical urge.

What it can look like:

• Repeatedly pulling out hair (trichotillomania) from the scalp, eyelashes, or eyebrows, leading to bald spots
• Repeatedly picking or scratching skin (excoriation) that causes visible sores, scabs, or tissue damage
• Describing a hard-to-resist urge or tension before they perform the behavior, though some aren’t fully aware when they are picking or pulling
• Picking or pulling may occur when bored or during times of heightened stress
• Wearing hats or long sleeves even in warm weather or avoiding participating in sports (like swimming) so no one will see hair loss or skin damage

Illness Anxiety Disorder

This is an excessive fear of having or getting a serious illness, even when doctors confirm they are healthy.

What it can look like:

• Constantly asking parents or caregivers for reassurance that they are not sick
• Endless research online about symptoms and diseases
• Excessive checking or monitoring of their own body (e.g., taking temperature, checking heart rate, examining skin for spots)
• Frequently seeking medical appointments for every new physical sensation or minor symptom
• Avoiding reading news articles or watching TV shows about medical topics or illness for fear that they will contract or develop the disease

Tic Disorders

Tics are sudden, quick, and repetitive movements or sounds that are typically hard to control.

What it can look like:

• Making fast, repetitive movements (motor tics) like eye blinking, head jerking, shoulder shrugging, nose twitching, or grimacing
• Making repetitive sounds (vocal tics) like throat clearing, sniffing, grunting, or repeating certain words
• Describing an uncomfortable physical urge or tension that they must release by doing the tic
• Tics may occur more frequently in situations that increase stress

If any of these sound familiar, we can help your family find relief. Contact Rise Center for OCD and Anxiety or schedule a phone consultation with Dr. Lilly today.