My Teen is Counting – Does She Have Obsessive-Compulsive Disorder?

What is Obsessive-Compulsive Disorder (OCD)?

The gold standard diagnostic manual for mental and behavioral health disorders, the DSM-V, defines Obsessive-Compulsive Disorder as a neurological disorder characterized by obsessions and compulsions that take up at least an hour a day and cause a significant amount of psychological and emotional distress. Statistics show that about one in every two-hundred children and about one in every forty adults meet clinical OCD criteria. OCD typically appears during two different phases of development: pre-adolescence (age 10-12) and early adulthood (age 18-20).

We’ll break down the clinical definition so we’re on the same page.

What Is An Obesession?

Obsessions are repeated thoughts, patterns of thoughts, or mental images that cause significant worry, stress, or anxiety. Common obsessions for children or teens with OCD include excessive:

  • Fear of germs or dirt
  • Worry that harm or danger will befall themselves or a loved one
  • Fear of losing an important or favorite object
  • Need for order and symmetry in common objects at school, work, or home
  • Fear of not being perfect at everything
  • Preoccupation with special numbers or words

What Is A Compulsion?

Compulsions are repeated behaviors performed by an individual in response to obsessive thoughts. Common compulsive behaviors for children or teens with OCD include:

  • Repetitive handwashing and cleaning, constant avoidance of things others have touched, constant avoidance of school cafeterias and other public places because they’re too dirty
  • Continuous, repetitive checking of locks on windows and doors, or checking to make sure the kitchen stove is off
  • Refusing to get rid of or throw away items that have significance for them, but seem insignificant to parents, peers, and others
  • Constant or continuous arranging and rearranging of objects at home or school in a specific, precise, rigid manner
  • Continuous, repetitive revising of homework (erasing things so often there’s a hole in the paper) or re-doing household chores and activities
  • Continuous, repetitive counting or performing activities or rituals the exact same number of times, every time

Obsessions and Compulsions: Different Than Habits and Hobbies

It’s important to remember that everyone develops habits and rituals throughout their lifetime. People have particular ways they like doing certain things. It’s not at all uncommon to go back and double check things every once in a while. It’s also important to note that some hobbies, interests, and pursuits may superficially overlap with OCD symptoms, but are not symptoms of OCD.

For instance, people may collect coins, stamps, sports cards, books, or fan swag from television shows or cartoons. Sports fans may talk endlessly about their favorite team or keep track of every statistic going back years. Teenagers can develop extreme preoccupations with celebrities in music, film, and television. They may cover their walls with posters, stickers, and everything to do with a pop star or athlete. They may recite the same rap lyrics all day every day. Or repeat a joke or catch phrase from a television show ad nauseam. But these preoccupations are not evidence of OCD: these are typical teen behaviors.

The difference between typical quirks, hobbies, or habits and clinical OCD is easy to spot. Non-OCD preoccupations are things people enjoy doing and love to talk about or share with others. People with OCD, on the other hand, neither enjoy or like to talk about their repetitive thoughts and actions. An individual with clinical OCD has extreme difficulty controlling the obsessions (thoughts) and compulsions (behaviors) even when they know they’re excessive. For people with OCD, obsessions and compulsions take up more than one hour per day, every day. They also interfere with home or school activities. Compulsions don’t make the individual feel good, but rather offer temporary relief from the anxiety caused by the obsessions.

Quick OCD Quiz

We adapted the following OCD self-assessment quiz from the consumer mental health resource website A Healthy Place. It’s a condensed version of the longer, clinical assessments used by mental health professionals to diagnose psychiatric patients. This quiz does not take the place of an assessment performed by a licensed therapist, counselor, or psychiatrist. Use the results of this quiz  to help determine if your child needs a full psychiatric assessment performed by a professional. Also,  input from teachers, administrators, and trusted friends can be incredibly valuable.

How To Do It

Ask your teen these questions and write down your answers. Or, print the questions and have your teen answer them on paper. Note: for simplicity’s sake, these are all YES/NO questions. A professional assessment is far more detailed and nuanced. But this quiz is a good first step to take if you’re truly concerned about behaviors you see in your teen.

Home OCD Assessment

  1. Do upsetting or distressing thoughts, impulses, or images show up in your mind over and over again?
  2. Do you feel like you can’t stop the thoughts, impulses, or images referred to in question (1)?
  3. Is it very hard for you to stop counting things, checking on things, re-arranging things, collecting objects others see as useless, repeating actions or activities until they feel right, or repeating words and phrases over and over?
  4. Do you feel like something bad or catastrophic might happen if you don’t repeat the behaviors or patterns in question (3)?
  5. Do your repetitive thoughts or behaviors take up more than an hour of your time every day?
  6. Have your repetitive thoughts or behaviors gotten in the way of your typical daily routine?
  7. Do your repetitive thoughts or behaviors negatively impact your schoolwork?
  8. Do your repetitive thoughts or behaviors negatively impact your social life?

Grade the Quiz

How to Score this assessment:

  • 0-2 YES answers: OCD unlikely
  • 2-4 YES answers: Some OCD symptoms present
  • 4-6 YES answers: Significant OCD symptoms present
  • 6-8 YES answers: Many OCD symptoms present.

This quiz is not an official diagnosis. Only a mental health professional can diagnose OCD and advise a course of treatment.

I Think My Teen Has OCD: What Can I Do?

The first thing to do if you think your teen shows symptoms of clinical OCD is understand that it’s treatable. A typical course of treatment involves psychotherapy like Cognitive Behavioral Therapy (CBT), which is a proven effective approach. Treatment may also inlcude prescription medication such as an antidepressant. Teens can learn techniques to handle previously disruptive or debilitating symptoms so well that they no longer interfere with work, family, or school. While the symptoms of OCD may not disappear entirely, and some cases may require ongoing therapy, most people with OCD learn to manage their symptoms and lead healthy, productive lives.

The second thing to do is find a licensed mental health professional and book an appointment for a full psychiatric evaluation.

Online OCD Resources

Here are some websites to help you and your family learn more about OCD and find professional help:

  • The American Academy of Child and Adolescent Psychiatry maintains an OCD Fact Page and a helpful Psychiatrist Finder.
  • The Beyond OCD website has excellent resources and information on everything OCD related. They even have an OCD page Just For Teens.
  • The Healthy Place website contains lots of easy-to-read information on OCD. We typically don’t link to sites that run on ad revenue. But this site contains accurate content and is transparent about their advertising practices.
  • The National Institute of Mental Health (NIMH) website provides a comprehensive OCD Information Page.
  • The National Alliance on Mental Illness (NAMI) website also provides a comprehensive OCD Information Section similar to the NIMH page.

Finally, please remember this: the sooner you get your teen treatment, the sooner they can learn the skills they need to manage their condition and start living life on their own terms.