Intensive Treatment Helps Teens With Treatment-Resistant Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive Disorder (OCD) is a neurological disorder that can range from mild to severe. Mild OCD is uncomfortable and may be disruptive, but typically responds well to professional treatment and support. Severe OCD, on the other hand, was once classified by the World Health Organization as “one of the most disabling illnesses by lost income and decreased quality of life.”
Severe OCD can be treatment-resistant and may require intensive professional support.
OCD treatment for teenagers with mild OCD typically involves outpatient treatment, once or twice a week. OCD treatment for teenagers with severe and disruptive OCD typically involves a more intensive level of professional support. In some cases, teens with severe OCD may benefit from immersive therapy in a residential treatment center for teens (adolescent RTC).
Parents of teens diagnosed with OCD should understand that whether their teen has mild OCD or severe OCD, research indicates the most effective treatment for OCD is cognitive behavioral therapy (CBT) with exposure and response prevention (ERP). Teens can receive this treatment in outpatient programs (OP), intensive outpatient programs (IOP), partial hospitalization programs (PHP), or at a residential treatment center (RTC).
Evidence shows that intensive treatment for teens with severe OCD is effective. Intensive treatment typically occurs at an OCD residential treatment center.
About OCD: Diagnostic Criteria
The Diagnostic and Statistical Manual of Mental Disorders, Volume Five (DSM-V) defines OCD as the presence of obsessions and compulsions that occupy no less than an hour a day and result in significant psychological and emotional distress.
The typical age of onset – meaning when symptoms first appear – for OCD is either between age 10-12 (early-onset) or age 18-25 (late-onset). In rare cases, OCD can appear in children as young as age 4-5. It may also appear in children between age 5-10, but these cases are still relatively rare.
Obsessions are thoughts, patterns of thoughts, or mental images that cause disruptive levels of worry, stress, or anxiety in the people who have them.
Compulsions are behaviors performed by an individual in response to the disruptive patterns of thought associated with their obsessions.
Common Obsessions: Children and Teens With OCD
- Fear of contamination, i.e. germs or dirt
- Excessive worry about danger or harm to themselves, friends, or family
- Intense fear of losing items of personal significance
- Perfect symmetry in common objects at home or school
- Special words or numbers
- Worry about not being perfect
Common Compulsions: Children and Teens With OCD
- Excessive and repetitive cleaning, including:
- Cleaning items and surfaces that are already clean
- Continuously avoiding touching things other people have touched, including:
- Avoiding school lunchrooms
- Avoiding potentially dirty or unclean public places
- Excessive and repetitive checking and rechecking windows and doors to make sure they’re locked and secure
- Resistance to throwing away personal items that are important to them, but do not seem important to others
- Excessive and constant rearranging of objects at home or school to meet personal criteria for orderliness
- Excessive and constant revisions to schoolwork
- Performing chores or other tasks repetitively, until they meet personal criteria for completion
- Excessive, repetitive counting of typical objects
- Performing activities or personal rituals the exact same way every time
The goal of professional treatment and support for teens who meet the diagnostic criteria for OCD is to teach them that they’re in charge of their life, not their OCD. Experts in treating OCD report that cognitive behavioral therapy (CBT) + exposure and response prevention (ERP) is the preferred first-line treatment for teens with OCD. While medication may be appropriate in some cases, therapists should try CBT + ERP first.
Treatment for Teens With OCD
Treatment for OCD involves a combination of therapy, medication, and complementary supports and/or modifications.
Therapy for OCD typically includes one-on-one, individual therapy with a psychiatrist or counselor who specializes in teen OCD. In some cases, it will involve group therapy and family therapy. As mentioned above, the most common therapeutic approach is cognitive behavioral therapy (CBT).
Click here to learn more about CBT for mental health disorders and OCD in teenagers.
In addition, recent research shows a promising new therapy for OCD: light therapy. Please click here to learn more about light therapy for OCD.
In some cases, medication can help teens with OCD. Medication for teens with OCD may include:
- Antidepressants such as selective serotonin reuptake inhibitors (SSRIs)
- Other antidepressants, such as tricyclic antidepressants
Complementary supports and lifestyle modifications can also help teens with OCD. At all levels of care, from outpatient to residential, complementary support and lifestyle modifications may include:
- Mindfulness activities like yoga, walking, and meditation
- Expressive therapies like visual art, drama, music dance, and writing
- Exercise, fitness, and experiential activities, like surfing, boxing, and hiking
While in treatment for OCD, teens learn six primary skills or tools. These include learning to:
- Identify their obsessive thoughts and compulsive behaviors.
- Understand the relationship between their obsessive thoughts and their compulsive behaviors.
- Realize how their obsessive thoughts and compulsive behaviors undermine their mental health and wellbeing.
- Use their knowledge about their obsessive thoughts and compulsive behaviors to manage and move past them.
- Believe in themselves and learn they have the power to take charge of their OCD.
In some cases, teens with OCD do not improve during outpatient, intensive outpatient, or partial hospitalization programs. These teens often have what’s called treatment-resistant OCD. For these teens, a more immersive level of care, such as residential treatment, may be appropriate.
The Benefits of Residential Treatment Programs for Teens With OCD
Residential treatment for OCD in teens may be appropriate when their symptoms are so severe they don’t respond to typical outpatient programs. Teens who attend an adolescent residential treatment center for OCD live on-site, receive a full day of treatment every day, and often have therapy homework assignments to keep them occupied during the evening hours.
Research into support for treatment-resistant OCD shows that immersive, intensive treatment programs may be effective when outpatient options are not. Although to date, there are few random clinical trials to support this approach, case studies and treatment reports show promising results. A study published in 2018 included data on 77 people with severe OCD who completed a CBT/ERP based program called “The Bergen 4-Day Intensive” showed that:
- 73% of participants met strict international criteria for remission of symptoms at a four month follow-up
- 72% of participants met strict international criteria for being labeled “recovered” on a long-term basis
- 69% of participants met strict international criteria for remission of symptoms at a four year follow-up
These results are indeed promising – and show the value of both immersive, intensive treatment and the CBT/ERP model.
Advantages of a Residential Immersion Program for Teen OCD
- Living in an environment dedicated to healing, treatment, and recovery
- More time for one-on-one therapy with psychiatrists, counselors, and therapists
- More time for group therapy and peer support: sometimes teens are more willing to learn lessons from peers with a shared experience than from adult experts.
- Ample time dedicated to workshops, classes, and group sessions designed specifically to learn and practice recovery skills, stress management techniques, and strategies to prevent relapse.
That last point is crucial. In addition to more time with therapists working through the lessons related to CBT and ERP, teens have time to practice what they learn and develop recovery skills with direct input from therapists, counselors, and peers. In combination with living 24/7 in a focused, treatment-oriented environment, this sets them up for a greater chance of success when they finish treatment, step down to a less immersive level of care.
Finding Help: Resources
If you’re seeking 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.
Angus is a writer from Atlanta, GA. He writes about behavioral health, adolescent development, education, and mindfulness practices like yoga, tai chi, and meditation.