Let me relate to the second parto of your question. Although you did not mention the exact age of your patient, my experience is indeed that children find it difficult to spell out what their fear is. Of course there is not one clearcut answer to your question of how to deal with it.
If the child is very young you might use drawings or concrete examples of different fear and ask the child if his/her fear is like any of the fears you model through the drawing/ example. Based on theory, I assume the fear has to do with damage to self (illness, accidens) to close others, like parents, siblings) or to objects important to self or others (house, car etc). Still, even after this the child may say he/she has a general feeling of threat which he/she cannot further specify. In that case I would try to work with whatever techniques you work and see if the intensity of the threat feeling will diminish.
Maybe this will help you in your thinking.
To my regret there are very few good clinical guidelines ( I do not include standardized manuals in this) to help in OCD work with younger children.
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