The Overlooked Answer: When School Anxiety is Really OCD

School is back in session, and anxiety can be overwhelming! Many students face challenges returning to the classroom after a summer of fun, but some students are experiencing overwhelming anxiety keeping them from being able to enter their classroom or stay at school for a full day. In these cases, what appears to be school anxiety may actually be an expression of Obsessive Compulsive Disorder, or OCD. 

The Overlapping Terrain: School Anxiety and OCD

Both school anxiety and OCD cause intense feelings of distress, but they are caused by different internal experiences. School anxiety normally comes from appropriate worries about academic performance, social interactions, and fitting in with others. OCD is persistent, intrusive thoughts (known as obsessions) that make us feel incredibly fearful (known as fear) triggering behaviors (known as compulsions) that are focused on reducing the fear caused by the obsession. Because the presentation sounds so similar, OCD can be overlooked when fears are seen surrounding school.

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Recognizing the Red Flags

The differentiating factor between OCD and general school anxiety is the nature, or drive, of the distress. In OCD, our minds convince us that we need to complete a compulsion. A compulsion is anything we do to make the distress from the obsession go away. For example, a student may feel they need to leave the classroom in order to feel better, even to the point of causing a disruption in the classroom to be able to leave. This ritualistic behavior goes beyond the typical anxiety-driven behaviors seen in others when experiencing transitional stress or performance nervousness.

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Common OCD fears seen in the school setting:

• Fear of something bad happening to oneself
• Fear of something bad happening to someone else
• Fear of never seeing a parent/family member again
• Fear of vomiting
• Fear of getting sick
• Fear of choking
• Fear of embarrassment
• Fear of saying someone wrong to a friend
• Fear of making a mistake
• Fear of looking stupid
• Fear of classroom changes
• Fear of substitute teachers
• Fear of not knowing what to say
• Fear of getting lost

OCD often impacts a student’s ability to focus in the classroom, or at times, even remain in the classroom, because the mind is so focused on the need to complete the compulsion to eliminate the fear caused by the obsession. This is different from school anxiety where distress normally subsides once the specific situation or time of transition is resolved.

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Common OCD compulsions which can be observed in the classroom by teachers:

• Asking for directions to be repeated multiple times
• Seeking reassurance that someone is doing the assignment correctly
• Asking for a new piece of paper if someone feels they made a mistake
• Continued struggles transitioning at the start of the school day
• Asking to go to the nurse’s office
• Asking if food is safe to eat
• Avoiding students who are sick
• Asking to go home early
• Wanting to see siblings during the day
• Excessive hand washing or use of hand sanitizer
• Counting or repeating things a certain number of times
• Frequently taking bathroom breaks or requesting to go to the counseling office

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Common OCD compulsions which can be seen before/after school by parents:

• Seeking reassurance from parents where they will be during the day
• Asking to be picked up early
• Tantrums when needing to leave for school
• Calling throughout the day to talk to parents
• Repeatedly asking the school times and when they will be home
• Confessing any mistakes they may have made during the day
• Seeking reassurance if they are doing homework correctly
• Struggling to get started with homework due to fear of doing it wrong
• Avoiding after school activities or clubs to avoid messing up
• Over-engagement in school clubs to feel they are doing enough
• Rechecking repeatedly to see if an assignment was submitted
• Asking if food at school is safe to eat
• Rumination and worrying about the next school day in the evening
• Challenges transitioning back to school at the end of the weekend

Creating a Supportive Environment

Recognizing when school anxiety seen in most students is different from students who may be showing signs of OCD is crucial for educators, parents, and mental health professionals. The treatment for school anxiety and OCD is different, and the supports within the school are different. For a student with OCD, equipping parents and educators to assist the student in directly facing fears through support rather than accommodation is critical to see changes. Working directly with a mental health professional that specializes in OCD and utilizes evidence-based treatment including ERP or I-CBT will be beneficial to ensure school approaches are effective for both the student and the class. Schools can also provide resources to all parents surrounding expected school anxiety surrounding transitions in the year compared to signs that a child may be struggling with an underlying mental health disorder.

CalmOCD

At CalmOCD, we specialize in treating anxiety in ages 5+ and will provide individualized treatment for your child depending on their unique symptoms and fears. The frequency we meet with a child will also vary depending on severity of symptoms, ranging from every day for several hours to check-ins every few months. We also feel supporting a child is greatly dependent on the involvement of parents, so we provide training and education to all parents in order to support your child effectively without accommodating their OCD.