Radically different
When a child confesses a frightening thought that seemed to come out of nowhere — “What if I hurt someone with this knife?” “What if mom dies in a car accident?” “What if germs get into this paper cut and I die of an infection?” — you can both find it confusing and disturbing. But in most cases these intrusive thoughts are not evidence of a problem.
Intrusive thoughts are unwanted ideas, images, or urges that pop into the mind seemingly out of nowhere. They might feel embarrassing, violent, sexual, or just plain strange — and they feel completely out of character, which is exactly why they’re so upsetting. “An intrusive thought is a lot like your brain sending junk mail,” says Theresa Welles, PhD, a clinical psychologist and director of the Bubrick Center for Pediatric OCD at the Child Mind Institute. “Just because it shows up doesn’t mean it’s important or true or something you even want.”
It also doesn’t necessarily mean that a child has OCD or another mental health disorder. Though intrusive thoughts are associated with OCD — in which unwanted thoughts (called obsessions) drive children to perform rituals (called compulsions) to alleviate them — for many children they are just fleeting thoughts. It’s only when kids become unable to let them go that they are concerning. Another way to think about it, says Dr. Welles, is that “the brain’s job is to generate thoughts, the same way an apple tree’s job is to produce apples. Not every apple is perfect — some are misshapen or wormy. And not every thought is meaningful or worth paying attention to. Having a thought is not the same as wanting it or intending to act on it.”
“Everyone who has a brain has them,” says Caitlyn Downie, LCSW, director of trauma and resilience at the Child Mind Institute. “It’s part of the human existence.” A child might suddenly imagine something terrible happening to a parent, or a teenager might have a violent or sexual thought that feels shocking or shameful. Most of the time, these pass quickly — unpleasant, but easy enough to brush aside.
That’s the key distinction: not the thought itself, but what happens after it. The concern isn’t that the thought appeared — it’s how the child responds, how often it returns, and whether it starts getting in the way of daily life.
For some children — particularly those who are anxious, perfectionistic, or who have OCD — intrusive thoughts become “sticky.” Instead of passing through, the thought snags. The child starts paying attention to it, trying to figure it out or make it go away, which only makes it feel more powerful. “Young people lack the experience to recognize that thoughts aren’t the same as intentions, desires, or actions,” Dr. Welles says. “The thoughts feel alarming. So the child pays more attention, and the more attention they give it, the more often it returns.” That loop of fear and self-doubt is what parents and clinicians need to be alert to.
Many children are too ashamed or frightened to describe what’s actually going on, so parents may never hear about the thought itself. Instead, changes in behavior are often the first clue. Look for signs like:
It’s worth seeking professional support when intrusive thoughts are frequent and intense, hard to shake, causing real distress, or getting in the way of school, friendships, or daily routines.
When an intrusive thought appears, it can set off the body’s alarm system — the same ancient survival mechanism that helped people run from danger or fight it off. In anxiety and OCD, that alarm bell rings when there’s no real emergency. The child has a thought, the body reacts with panic, and the child assumes the thought must be important because it feels big and important.
Children may also fall into what clinicians call thought-action fusion. “That’s the mistaken belief that having a thought makes it more likely to happen,” explains Dr. Welles, “or that it reveals something terrible about who they are.” A child who thinks, “What if I hurt my baby brother?” may become convinced the thought means they secretly want to — but intrusive thoughts are often the precise opposite of what a child would ever want. Paradoxically, Dr. Welles says, “for most people with anxiety disorders and OCD, these thoughts are the actual opposite of what they would ever do.”
The first thing to do is stay calm — harder than it sounds if the thought is violent, sexual, or taboo. Children look to their parents to gauge whether something is truly dangerous, so if you look horrified, your child takes that as confirmation the thought is something to fear.
When a child shares an intrusive thought, Downie suggests responding with warmth and curiosity: “Say something like, ‘I appreciate you telling me — it sounds like that was really scary.’ It also helps to normalize it: ‘A lot of people have thoughts they don’t particularly like.’” Some other responses that can help:
The goal is to help your child feel less alone and less ashamed, without treating the thought like a five-alarm emergency. And do your best to avoid reassurance. Reassuring the child about the contents of a specific thought (for example, responding to a child who asks, “Are you sure I’m a good person?” with “Yes, you’re a good person”) can actually make things worse, especially in kids with OCD. They feel very temporary relief but then the thought creeps back and they need more reassurance. It becomes a cycle. Instead try: “I know this feels awful. And I know you can handle it.”
It also helps to redirect the child to something concrete: getting dressed, eating breakfast, watching a show, texting a friend. With younger kids, you might guide them in doing slow breaths or suggest they move to another room so they distract themselves from the thought. With teens, you might mean teach them to resist the urge to Google their fears or thoughts, confess, or ask the same question over and over again. “The idea,” Downie says, “is to validate the feeling without validating the fear. You’re saying: ‘I hear you, this is hard, and you can get through it.’”
Intrusive thoughts aren’t a diagnosis on their own — they’re a symptom that can show up across a range of conditions, or in children who have no diagnosis at all. Disorders they may be associated with include:
Treatment depends on what’s driving the thoughts and how much they’re disrupting the child’s life:
One of the hardest things about intrusive thoughts is that they can make children afraid of their own minds — convinced that every thought needs to be examined or explained away before they can relax. But no one gets to have only pleasant, well-behaved thoughts.
What children can learn is that a thought can be upsetting without being meaningful, loud without being true, and it can pass through without becoming a verdict on who they are. As parents, the most powerful thing you can offer is a calm, steady presence — taking it seriously without treating it as a catastrophe. When your child sees you aren’t panicked, they get to borrow some of that calm for themselves.
Intrusive thoughts are unwanted ideas, images, or urges that pop into your mind unexpectedly. They often feel upsetting or out of character, but they’re essentially “junk mail” from the brain — not meaningful or important.
Yes, everyone can have them. Most children (and adults) experience intrusive thoughts at times, and in many cases they pass quickly without causing problems.
They’re a normal byproduct of how the brain works, but they can become more frequent or “sticky” in kids who are anxious, perfectionistic, or dealing with conditions like OCD or trauma. Paying extra attention to the thought can also make it return more often.
No. Having an intrusive thought doesn’t mean you want to act on it or that it reflects who you are. In fact, these thoughts are often the opposite of what someone would ever want or do.
The post What Are Intrusive Thoughts? appeared first on Child Mind Institute.
When people use the word dissociation, it can sound alarming. You may have seen it on social media, heard your child mention it, or noticed your child seeming “checked out” and wondered if that’s what’s happening. Dissociation can be confusing because it exists on a spectrum — from everyday experiences like daydreaming to more serious symptoms that may signal that a child is overwhelmed or struggling. The good news is that dissociation is often a temporary coping mechanism, and when it does become a problem, there are effective ways to help.
In simple terms, dissociation is a kind of mental disconnection. “When I think of dissociation, I think of there being some sort of disconnect between an individual and their sense of self, or a period of time that you later can’t recall, or feeling like you’re disconnected from your body,” says Lauren Allerhand, PsyD, a clinical psychologist at the Child Mind Institute and co-director of its DBT program.
Some kids describe dissociation as feeling spaced out, numb, or disconnected from their body or surroundings. Others say they feel like they’re watching themselves from outside their body, or that the world around them doesn’t feel real. “There’s some period of time where your normal sense of flow is disrupted,” Dr. Allerhand explains.
In its mildest form, dissociation is a commonplace occurrence. Kids might daydream in class, zone out during something boring like a long car trip, or feel detached when they are overwhelmed in some way. These experiences are usually not a cause for concern. “Our brains do a really good job of protecting ourselves,” Dr. Allerhand says. “Sometimes our brains develop strategies to protect us that are healthy, and other times they develop strategies that might work in short bursts but become less helpful if they happen too much.”
When dissociation happens often, or interferes with daily life, it may signal that a child is struggling with something more serious than ordinary, intermittent stress. “If it’s happening all the time, it’s less effective as a coping mechanism” because of the toll it can take when there is memory loss, confusion, and feeling disconnected to the self, she explains.
Children and teens may describe dissociation differently. Some say they feel:
“Kids might say they feel like a robot. Everything feels fake around them,” Dr. Allerhand says. “Younger children may not have the words to describe what they’re experiencing. Instead, parents might notice their child seems unusually quiet, unresponsive, or ‘not themselves.’”
Dissociation is often linked to stress or overwhelming emotions — kids may dissociate when they feel unable to cope with what’s happening around them. “This could be a response to any sort of highly intense emotion or experience,” Dr. Allerhand says, such as:
“It’s another way of coping with stress or trauma,” says Tanvi Bahuguna, PsyD, a clinical psychologist at the Child Mind Institute who specializes in trauma and mood disorders. “There’s this psychological process that helps them disconnect from overwhelming pain.” Some kids dissociate during panic attacks or periods of intense anxiety. Children who have experienced significant adversity may be more likely to dissociate. These experiences can include:
Still, experts are quick to note that dissociation doesn’t automatically mean a child has experienced trauma or has a serious disorder. “There are lots of exits on this highway before we’re at a dissociative disorder,” Dr. Allerhand says, adding that a full-blown dissociative disorder is very rare in children.
It can be hard to recognize when a child is experiencing more serious dissociation because it doesn’t always look different from daydreaming or inattention. One key difference is distress. “Spacing out or not paying attention is not often experienced as distressing,” Dr. Allerhand says. Moderate or serious dissociation “is often somewhat distressing.” Kids who are daydreaming are still connected to themselves and their surroundings; kids who are experiencing more serious dissociation may feel cut off from their body, emotions, or reality altogether.
If you think your child may be dissociating, the most important thing you can do is not panic or try to get your child to “snap out of it.” “The number one thing a parent can do is stay as calm as possible,” Dr. Bahuguna says. Speak gently, use short sentences, and reassure your child that they’re safe. Saying your child’s name and reminding them you’re there can help them reconnect.
Grounding techniques can also bring kids back into the present moment. One common method is called the 5-4-3-2-1 technique: Ask the child to name five things they can see, four things they can feel, three things they can hear, two things they can smell, one thing they can taste or imagine tasting. Other grounding strategies include:
If you find your child often dissociates, Dr. Allerhand recommends helping them make a plan for it. During a calm moment, talk with your child about what they find helpful. “I noticed that this is happening. How can I help you when this is happening?” she suggests asking. Having a plan in advance makes it easier to respond in the moment — and in the meantime, stay nearby and make sure your child is safe until the episode passes.
If dissociation is frequent, distressing, or associated with changes in your child’s functioning, seeking professional support is appropriate. “If something dissociative happens, and there’s a really big change in your child’s functioning, then I would be concerned,” Dr. Allerhand says.
Signs it may be time to reach out include:
A good place to start would be talking to your pediatrician, who may refer you to a mental health professional. “If your child is displaying behaviors that seem out of the ordinary, you should trust your instincts,” Dr. Allerhand says.
To determine whether a child is dissociating, a mental health professional gathers information from multiple sources, including parents, the child, and sometimes teachers, asking about the child’s behaviors, history, and any recent stressors or changes in behavior.
“The first thing would be a structured diagnostic interview with a qualified clinician,” Dr. Allerhand explains. “Parents bring the history and describe the behavior, and then the clinician meets with the child.” Clinicians also consider whether dissociation might be a symptom of another condition, such as post-traumatic stress disorder, borderline personality disorder, anxiety (especially panic disorder), and depression.
“It’s really gathering history, meeting the child, observing the child, and figuring out what this cluster of behaviors leads to,” she says. It’s more frequent to find that dissociation is a result of another disorder than an actual dissociative disorder.
Treatment depends on what’s driving the dissociation. If trauma is involved, therapy may focus on helping the child process difficult experiences and build coping skills. Evidence-based approaches include trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR).
If anxiety or emotional overwhelm is the primary cause, treatment may focus on emotion regulation, grounding techniques, and identifying triggers and early warning signs. Therapy, such as dialectical behavior therapy (DBT), typically involves both children and parents, helping families recognize patterns and respond in supportive ways.
For more severe or persistent dissociation, treatment may happen in phases — beginning with safety and stabilization, then skill-building, and eventually, when appropriate, processing difficult experiences. “The goal is helping the child learn to cope with their experience and stay in their body,” Dr. Allerhand says.
In children and teens, dissociation is usually a symptom of another condition. But in cases of very serious early trauma, abuse, or neglect, it can progress into a full-blown disorder. There are a number of dissociative disorders, including:
These disorders sometimes attract media attention, but they are extremely rare in children. What’s important for parents to know is that if you see dissociative behavior in a child, it’s most likely a normal coping mechanism for a child experiencing some stress or intense emotion. If it persists, is causing distress, or is interfering with a child’s life, it’s time to consult a pediatrician or mental health professional. Identifying what might be causing the behavior is the first step to getting appropriate treatment.
Dissociation is a mental disconnection from your thoughts, feelings, body, or surroundings. Kids may feel spaced out, numb, or like they’re watching themselves from the outside, as if the world doesn’t feel real.
Common signs include feeling detached from the body, emotionally numb, or like you’re in a dream. Some kids seem unusually quiet or “not themselves,” while others have trouble recalling what happened during that time.
Dissociation is often a response to stress, anxiety, or overwhelming emotions. It can also be linked to trauma, major life changes (such as the sudden loss of a family member), or intense feelings the child doesn’t yet know how to manage.
Grounding techniques can help bring you back to the present moment, like naming what you see, hear, and feel, or focusing on breathing. Having a plan for what you will do the next time can make it easier to manage when it happens.
The post Dissociation: Signs and Causes in Children appeared first on Child Mind Institute.