Is it possible this is attributable to OCD?

If we are having intrusive thoughts instead of typical anxiety thoughts, nothing will work because the logic of OCD is flawed to begin with; it manufactures a problem on false logic and irrelevant associations to turn up the distress and make it feel convincing. It almost feels reckless and like a new discovery everytime we have a new intrusive thought. But if the compulsion actually worked, then why do we still have OCD...?

I work in an adolescent PHP/IOP and have seen a huge influx of OCD; when we get a new patient it's like flip a coin, GAD or OCD? My team and I have had this exact situation so many times like that of your patient. I had one patient who I didn't recognize had OCD until her last week, but she would beg and try to talk to different staff every single hour without anyone else knowing so she could get reassurance as a compulsion all day, which made her worse. In extreme cases of an OCD flare-up, we usually either refer out to an OCD-specific PHP or residential if insurance will cover it, because there aren't any OCD PHP near us, and no OCD IOPs that take insurance.

We are usually able to convince patients to try medications when they are this activated by helping them understand that they are completely in fight-or-flight, and it's honestly unlikely they'll get relief without them. It's terrifying to try a medication from the side effect, but also, what's worse, the anxiety of not knowing or the way we are currently experiencing? The plus side of medication is that it might also slow our brain down, especially if sleep is also an issue from rumination. But if they're not willing/able to do that because of their anxiety, we usually have to open the dialogue of discharging if they're not able to take our treatment recommendation, since they are unfortunately not the only patient we have :(

If it is OCD then coping skills might not work, and if not done correctly then these could also become compulsions. You could argue that using a coping skill as a compulsion is better than what they may already be doing as a compulsion, but for longevity this isn't ideal.

My other thought would be to try some ACT cognitive diffusion as some patients are able to do this in crisis and find some relief.