OCD Treatment for Youth: Current Standards in Psychiatric Care

Cognitive Behavioral Therapy + Medication are Standard Treatments for Obsessive-Compulsive Disorder in Youth

Here’s something anyone reading this article – teens, parents, therapists, interested members of the public – should understand about OCD:

Treatment for OCD works and can improve quality of life and overall

wellbeing for anyone with OCD.

With that said, we’ll offer a standard, clinical definition of OCD in children and adolescents.

The International OCD Foundation defines obsessive-compulsive disorder (OCD) in youth as follows:

“OCD is an anxiety disorder that consists of obsessions and compulsions. Obsessions are unwanted ideas, thoughts, images or urges that are unpleasant and may cause worry, guilt, or shame. Compulsions, also called rituals, are behaviors the child feels he or she must perform repeatedly to reduce the upsetting feelings or prevent something bad from happening. To be diagnosed as OCD, these behaviors must be time-consuming and interfere with the child’s daily life.”

Additional research indicates that:

“Early-onset obsessive-compulsive disorder (OCD) is one of the more common mental illnesses of children and adolescents. Its manifestations often lead to severe impairment and to conflict in the family.”

What these two definitions mean, in practical terms, is that OCD in youth is not uncommon, and youth with OCD spend significant time and energy handling their symptoms. The more severe the case, the more time they spend managing obsessions and compulsions, and the more those symptoms disrupt their lives. Left untreated, OCD rarely resolves on its own, and most often gets worse – i.e. more disruptive – over time. That’s why early detection and treatment are essential.

Here’s a general introduction to how OCD treatment for youth works:

OCD Treatment for Youth: The Big Picture

• The most common OCD treatment for youth with mild OCD involves one-on-one psychotherapy with an approach called cognitive behavioral therapy (CBT) + exposure response prevention (ERP) once or twice a week. A mental health professional may prescribe medication, but experts advise attempting therapy alone before recommending a combination of therapy + medication.
• For youth with moderate but disruptive OCD, treatment often requires a more immersive level of support. This may include intensive outpatient treatment (IOP) or partial hospitalization treatment (PHP). OCD treatment for youth with moderate but disruptive symptoms often requires medication in addition to psychotherapy.
• In some cases, teens with severe OCD may benefit from immersive therapy in a residential treatment center for teens (adolescent RTC). Teens with severe OCD most often require immersive treatment and medication in order to manage their OCD.

Parents seeking OCD treatment for youth should understand that whether the diagnosis is mild, moderate, or severe, the latest clinical data shows the best treatment for OCD – overall – is cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). For youth with severe OCD, immersive treatment combined with medication is considered the most effective and recognized around the world as the default standard of care.

To read our in-depth article on residential OCD treatment for youth, click here.

Now that we’re on the same page about what OCD is, we’ll answer some basic questions before we discuss approaches to treatment in more detail. First, we’ll discuss how many people have OCD, a.k.a. the prevalence of OCD.

OCD: Facts and Figures

As mentioned above, OCD is a common mental health disorder across the entire population, including youth, adolescents, and adults. We collected the following data and statistics from the National Institute of Mental Health (NIMH), the International OCD Foundation (IOCDF), and the Centers for Disease Control (CDC).

OCD in the United States: General Statistics

• Adults
  • 2.3% of adults in the U.S. reported OCD symptoms in the past year
    • 8% of women
    • 5% of men
  • 51% of adults with OCD reported severe OCD
  • 34.8% reported moderate OCD
  • 14.6% reported mild OCD
• Youth and Teens
  • 2.0% of teens (12-17) reported OCD symptoms in the past year
    • That’s about half a million teens
  • 40% of teens with OCD had chronic, recurring OCD
  • The average age of onset (when symptoms first appear) is about 10 years old
• Co-Occurring Disorders (Diagnosed with OCD + At Least One Additional Mental Health Disorder)
  • 90% of adults with OCD have an additional mental health diagnosis
  • 70% of youth and teens with OCD have an additional mental health diagnosis
• Common Disorders that Co-Occur With OCD
  • Anxiety disorders
  • Mood disorders
  • Eating disorders
  • Attention-deficit/hyperactivity disorder
  • Substance use disorder
• Prevalence of Co-Occurring Disorders Among People with OCD
  • 76% have an anxiety disorder such as:
    • Generalized anxiety disorder (GAD)
    • Specific phobia
    • Post-traumatic stress disorder (PTSD)
  • 63% have a mood disorder such as:
    • Major depressive disorder (MDD)
    • Bipolar disorder (BD)
  • 55.9% have ADHD
  • 38.6% have a substance use disorder (SUD)

We include the statistics on adults here because most cases of OCD go undiagnosed during youth and teen years. Most adults with OCD report that their first symptoms appeared before adolescence, with some indicating their first appearance as early as age eight. This is important to understand, because OCD in kids is real – and an early start on treatment can prevent years of problematic symptoms that can significantly impair life at school, at home, and with friends.

Which brings us to our next topic: OCD treatment for youth.

Teens With OCD: The Current Standard of Care

Evidence-based treatment for youth and adolescents with OCD includes a mixture of therapy, medication, and complementary lifestyle support and/or behavioral modification.

A standard OCD treatment plan revolves around individual therapy with a psychiatrist or counselor who specializes in youth and adolescent OCD. In some cases, treatment plans involve group therapy, family therapy, and/or medication. The most widely used therapeutic approach for teen OCD is cognitive behavioral therapy (CBT).

Click here to read our article about CBT for mental health disorders and OCD in teenagers.

There’s also a new approach to treating OCD called light therapy. You can read about that new approach in our article here.

The first-line treatment – and accepted standard of care – for a teenager recently diagnosed with OCD is individual therapy using CBT + ERP. However, in some cases, medication will help teens with an initial diagnosis of moderate or severe OCD, but rarely for teens with mild OCD. Medications for teens with moderate or severe OCD may include:

• Antidepressants (selective serotonin reuptake inhibitors of SSRIs)
• Other antidepressants (tricyclic antidepressants)

Complementary supports and lifestyle modifications can also help teens with OCD. These supports and lifestyle modifications are called complementary because they work best when offered in addition to typical treatment in order to augment that treatment. Lifestyle supports may include:

• Mindfulness: yoga, meditation, guided relaxation
• Expressive activities: art, drama, music, dance, writing/journaling
• Fitness, exercise, and other enriching activities that support mental health and wellbeing

That’s what OCD treatment for youth at any level of care looks like. The best treatment centers will off some combination of everything you see above.

Now we have two more things to share with you: a general overview of the treatment process, and a promising report about a new approach to treatment-resistant OCD.

OCD Treatment: The Basic Process

A peer-reviewed study on OCD standards of care published recently in India outlined the most common steps in the process of managing OCD, from diagnosis to treatment. Together, the clinician and the diagnosed individual (and their parents/guardians, for teens) go through the following steps:

1. The clinician conducts a detailed assessment of symptoms and identifies any co-occurring disorders.
2. Clinician and family make a decision on the treatment setting and level of care, depending on the severity, duration, and intensity of symptoms. The treatment setting/level of care may include:
   1. Outpatient treatment (OP)
   2. Intensive outpatient program (IOP)
   3. Partial hospitalization program (PHP)
   4. Residential treatment program (RTC)
3. The clinician, teen, and family engage in collaborative psychoeducation that covers:
   1. Information about OCD
   2. Details about OCD treatment
   3. Details about levels of care
   4. Expectations about treatment process and duration
4. The family and teen decide on a course of treatment: CBT + ERP, medication, or both.
5. Clinician, teen, and family create a plan for ongoing care after the planned course of treatment ends.

That last point is crucial. OCD rarely completely disappears. Symptoms will wax and wane over the course of life. They may appear in response to stress, major life changes, or triggers related to the obsessions identified early in the treatment process.

Next, we’ll discuss that new approach to treatment-resistant OCD we mention above.

Report: New Techniques for Treatment-Resistant OCD

Some cases of OCD do not respond to typical treatment, even with a combination of medication and psychotherapy. We’ve used the phrase already: these cases are called treatment-resistant.

Recent research shows that a specialized treatment program may be effective when outpatient options are not. This new approach is called “The Bergen Four Day Intensive,” which is an intensive, immersive four day program that uses CBT + ERP in an inpatient setting. A study on this approach published in 2018 included data on people with severe OCD who completed The Bergen 4-Day Intensive showed that:

• 73% met criteria for remission four months after treatment (remission means absence of symptoms)
• 72% met criteria for being recovered four years after treatment (recovered means months or years with few or no symptoms at all)
• 69% were in remission four years after treatment

These results show that with an accurate diagnosis and appropriate treatment and support, people with OCD can learn to cope with, and move past, the most difficult and disruptive cases of OCD.

How Treatment Helps Youth With OCD

The goal of treatment for OCD is to enable teenagers to live life in the manner of their choosing, rather than a manner dictated by their obsessions and compulsions. For a teenager who lives with OCD, this can change everything. A teen who previously believed that managing their thoughts and behaviors was impossible can learn to do just that: manage the intrusive thoughts and reduce the related time-consuming behaviors.

During OCD treatment, they learn to:

1. Identify obsessive thoughts and compulsive behaviors.
2. Understand the relationship between obsessive thoughts and compulsive behaviors.
3. Realize their obsessive thoughts and compulsive behaviors undermine their wellbeing.
4. Use knowledge about obsessive thoughts and compulsive behavior to manage and move past them.
5. Believe in themselves and know they have the power to take charge of their OCD.

As we mentioned above, a teen with OCD who learns these six primary skills can change their lives completely. They can go from a life dominated by their symptoms to a life spent doing the things a teenager loves, like spending time with friends, pursuing hobbies, and participating in extracurricular activities. For some teens, treatment can mean the difference between being scared of leaving the house at all and leaving the house every morning, motivated for school and everything that comes with it.

The sooner a teen with OCD gets the treatment they need, the sooner that can happen.

Finding Help: Resources for OCD Treatment for Youth

If you’re seeking OCD treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.