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Obsessive Compulsive Disorder (OCD) in Adolescents

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Adolescence is a challenging phase of life, so it’s not uncommon for teens to develop their own quirks and idiosyncrasies as they attempt to navigate the turbulence.  Unfortunately, for a small percentage of teens, these quirks and unusual behaviors are indicators of a serious mental health issue – obsessive-compulsive disorder.  Typically referred to as OCD for short, this psychiatric disorder can cause significant distress.  In more severe cases of the disorder, OCD can become debilitating.    

Like all parents, you’re faced with the difficult task of determining what’s normal and what’s not when it comes to your teen’s behavior.  This brief guide is designed to help you recognize the signs to watch for and know the steps to take if you believe your teen is suffering from OCD. 

OCD Statistics and Facts

Following are a few statistics and facts pertaining to OCD:

  • OCD frequently starts in late adolescence or early twenties, although it occasionally begins in childhood
  • The onset of OCD occurs by age 14 in approximately 25% of cases
  • An estimated 1% of the population has OCD
  • Between 1% and 3% of children and teens have OCD, making it one of the more common psychiatric disorders in that age group
  • Up to 70% of individuals with OCD also have one or more other psychiatric disorders
  • For at least 4 out of every 10 individuals diagnosed with OCD, it becomes a chronic disorder
  • An estimated 40% of individuals who develop OCD in childhood will recover from the disorder by adulthood; for the other 60%, however, a childhood-onset often means the disorder will be both severe and chronic
  • Individuals with OCD have an increased risk of suicide; this risk is even higher if they also suffer from a mood or anxiety disorder

What is OCD?

Obsessive-compulsive disorder is a mental illness that’s comprised, as the name suggests, of obsessive thoughts and compulsive behaviors.  The obsessions present as repetitive thoughts, mental images, or urges that are both unwanted and intrusive.  They are typically negative and can cause high levels of anxiety and distress.  The frequent or constant bombardment of these unwanted thoughts can make it very difficult for teens to focus at school or work, let alone enjoy life. 

teen with OCD

What Are Obsessions?

Obsessions are recurring thoughts that cause anxiety. These might be fear about things happening, or a specific idea of how things need to happen. One with OCD might constantly worry about whether or not everything is okay. They may also see images or ideas in their head that are are disturbing or frightening. Teen OCD can involve various obsessions or obsessive thoughts. 

Common types of obsessions include:

  • Worry about sexual orientation (often referred to as homosexual OCD or HOCD)
  • Fear of germs or contamination
  • Worry about becoming ill or dying
  • Fear of doing something violent
  • Worry about something bad happening
  • Disturbing sexual thoughts, urges, or images
  • Troubling thoughts that are religious in nature

In an attempt to reduce the anxiety and distress caused by the obsessions, individuals with OCD engage in compulsive behaviors, such as excessive hand washing, putting things in a certain order, or counting. For some individuals with OCD, these compulsive behaviors consume so much of their time that they’re unable to be productive at all.  The compulsive behavior brings temporary relief, at best. 

What Are Compulsions?

Compulsions are a behavior that someone with OCD feels a strong urge to do. These can also be specific rituals that people with OCD have to constantly partake in, or thoughts about it will drive them crazy. These rituals might be an action that they have to take, or something that they have to say in their head or out loud. OCD symptoms in teens will often involve compulsions.

Common compulsions include:

  • Excessive washing or cleaning
  • Constantly putting things in a certain order
  • Counting
  • Constantly checking (e.g. that the door is locked or stove turned off)
  • Doing something over and over until it’s “just right”
  • Constantly seeking reassurance from others
  • Excessive praying

Checking and ordering are the two most common types of OCD.  Compulsive hoarding, also very common, used to be considered a type of OCD.  It’s now classified as a separate disorder. 

OCD is diagnosed only if the obsessions and compulsions are interfering with your teen’s ability to function normally or cause significant distress.  For example, if your teen is a “neat freak”, that doesn’t automatically mean he or she has OCD. 

What Is It Like Living With OCD?

Living with OCD can be very stressful. Most of the time, people with OCD know that the thoughts they have or the rituals they do don’t any make sense. However, trying to stop these actions could leave them with the feeling that something bad will happen. They will partake in their rituals in order to keep bad thoughts and feelings at bay.

Rituals can become more and more complicated as time progresses. Someone with OCD might start with one small ritual, but these can multiply until suddenly they have long, complicated rituals that they feel as though they must partake in on a daily basis. 

OCD rituals can show up in many aspects in life. One might have rituals as a part of their morning routine, commute, or any aspect of their day-to-day life. As OCD progresses, rituals may dominate many aspects of life for those with OCD. OCD in youth can be very difficult to navigate as they deal with the progression of new symptoms.

Co-Occurring OCD Disorders

It’s not uncommon for individuals with OCD to have one or more other psychiatric disorders as well.  The most common co-occurring disorders are:

The presence of another psychiatric disorder often makes it more challenging to successfully treat the OCD.  

Looking for and Recognizing the Signs of OCD

Obsessive-compulsive disorder can have an extremely negative impact on your teen.  That’s why it’s so important to know what to look for and how to recognize the signs of OCD.  The sooner you get your teen into treatment, the better. Without treatment, the obsessions and compulsions typically become worse over time.

Signs of OCD in teens may include:

  • Frequent irrational worries or fears (e.g. constantly worrying the front door isn’t locked even after it’s been checked)
  • Complaints of having frequent disturbing thoughts and feeling they can’t control them
  • Unusual or illogical behaviors that your teen can’t explain (e.g. washing already clean hands several times in a row or until the skin is raw)
  • Becoming upset or anxious if something is out of order, and needing to fix it right away
  • Engaging in unusual rituals, such as turning around three times before walking out the door
  • Compulsive behavior of any kind
  • Difficulties focusing at school or while doing homework
  • Constantly checking and re-checking something
  • Frequent worry that something bad is going to happen
  • Difficulty making or keeping friends
  • Getting upset or angry if they’re unable to engage in a compulsive behavior or if it’s interrupted before they’re finished
  • Depressed mood or frequent anxiety
  • Suicidal thoughts and behaviors*

*Suicidal thoughts and behaviors are a risk associated with many disorders, including OCD.  They should never be ignored.  Don’t assume your teen is just being “dramatic” or manipulative. 

What Triggers OCD in a Teenager?

OCD in teens can be triggered if family members have a history of anxiety or OCD.  OCD can also be triggered if a child has gone through a stressful or traumatic event. 

Occasionally, even a streptococcal infection can cause a child to develop OCD symptoms. Signs of OCD in teens include various obsessions and compulsions. OCD in adolescent can begin to present itself at any time during childhood, teen years, or early 20s. Residential treatment for OCD can be helpful in helping teens manage their symptoms.

helping teens with OCD

Knowing the First Steps to Take 

Following are the first steps to take if you have reason to think your teen has or may be developing OCD:   

1Talk to your teen.  Let your teen know that you’re worried about the behaviors you’ve been observing.  Emphasize that you want to help in any way you can and that you’re available and willing to listen.   

Be prepared for a defensive response or even denial that anything is wrong.  Your teen may feel ashamed of the symptoms he or she is experiencing.  Avoid judgment, criticism, and shaming of any kind, as those will only make things worse. 

2 – Have your teen evaluated.  Your teen’s pediatrician or your family doctor can do an initial evaluation, including a physical examination to rule out any underlying medical issues that may be contributing to or exacerbating his or her symptoms.

Since OCD can be a complex disorder, it’s imperative to have your teen evaluated by a psychologist or psychiatrist.  Look for someone who not only specializes in treating children and adolescents, but who also has substantial experience treating OCD.  Your family doctor or pediatrician may be able to give you a referral or recommendation.

3 – Get your teen into treatment.  OCD symptoms tend to worsen over time, so early intervention is important.  Treatment for OCD typically includes a combination of psychotherapy and medication.  If your teen’s symptoms are more severe or if he or she has another psychiatric disorder as well, a more intensive level of treatment may be required for a period of time.

  • Individual psychotherapy or “talk therapy” – Psychotherapy can help your teen understand the obsessions and compulsions he or she is experiencing, including the underlying issues that drive them. Cognitive Behavioral Therapy (CBT), in the form of Exposure and Response Prevention (ERP), is one of the most effective types of therapy for OCD.   Exposure response prevention involves carefully exposing the individual to the things that make him or her anxious and learning how to cope with the anxiety in a healthy way instead of engaging in the compulsive response.  
  • Medication – Medication can play an important role in the treatment of OCD. Research shows that medication is more effective when used in combination with therapy rather than alone when treating OCD.  The most commonly prescribed medications for OCD are:
    • SSRI antidepressants (selective serotonin reuptake inhibitors), such as Celexa, Paxil, or Zoloft
    • Clomipramine (Anafranil) – a tricyclic antidepressant medication

Medication may also be prescribed to alleviate symptoms of depression, anxiety, and other co-occurring disorders.

  • Family therapy – Family therapy can be an important part of treatment for OCD, as the disorder impacts everyone in the household. It includes teaching parents and other family members how to be supportive without accommodating and enabling your teen.
  • Dual diagnosis treatment – This is usually necessary if there is a co-occurring substance use disorder – see more below
  • Residential treatment – See below.
  • Hospitalization – See below.

Supporting and Encouraging Your Child   

One of the biggest challenges you may face as a parent of a teen with OCD is knowing how to best encourage and support him or her.  Following are some helpful tips:

  • Always remember that OCD is an illness. It isn’t a sign of weakness, nor is it something your teen can simply control or overcome with sheer willpower or determination
  • Learn everything you can about OCD. This will help you to have more empathy towards what your teen is experiencing, and understand what you can do to help
  • Help your teen stay focused on the goals of treatment and be patient with the process
  • Help your teen find ways to relax and manage his or her stress. For example, do yoga with your teen at home or have your teen take a yoga class
  • Don’t judge, criticize, or minimize what your teen is experiencing, not matter how illogical, absurd, or strange your teens worry, fears, and behaviors may seem to you
  • Work with your teen’s therapist to learn how to avoid accommodating your teen’s obsessions and compulsions in a healthy way. Keep expectations and routines at home intact; enabling and accommodating your teen (e.g. by having a sibling do his chores because he’s obsessed with germs) will ultimately make things worse for your teen, not better
  • Make yourself available (and willing) to listen and let your teen know you’re there for him or her
  • Do your best to keep your wits about you even if you’re feeling frustrated or scared; your teen needs to be able to rely on you for support and guidance
  • If situations arise that you’re not sure how to handle, seek guidance from your teen’s therapist or another mental health professional well-versed in OCD
  • Make sure the entire family is involved so no one is sabotaging your teen’s recovery. Consider family therapy or see if your teen’s therapist will meet with the whole family for a few sessions.  Family therapy can also help address the impact mental illness has on the entire family

family therapy to help teen with OCD

Why Do Some People Get OCD But Others Don’t?

Genes play a role in whether or not someone will get OCD. Typically, OCD runs and families and if one person has OCD it’s an indicator that somebody else in the family could also have the condition. A person’s genes affect the structure and chemistry of their brain, thus, some people are simply more prone to getting OCD than others.

OCD causes certain unwanted thoughts to get stuck in the brain. Then, conditions often become worse over time as a person develops more and more rituals that they feel the need to partake in. Teen OCD treatment will be easier and more manageable the sooner that treatment starts.

What to Do When Things Escalate 

Individuals with OCD have an increased risk of suicide, especially if they’re also battling depression, bipolar disorder, or another anxiety disorder.  Their OCD symptoms may also worsen if they’re dealing with something especially stressful or traumatic.  Some teens may engage in non-suicidal self-harm, such as cutting or burning themselves, or turn to alcohol or drugs if they’re having a tough time coping.

If things escalate and your teen’s safety or wellbeing is at risk, don’t hesitate to reach out for help.  You can:

  • Contact your child’s treatment provider asap
  • Enlist the help of a close family member or friend for immediate support or assistance
  • Call an emergency hotline
  • Take your child to the nearest hospital emergency room (if you can do so safely) 
  • Call 911   

When Individual Therapy isn’t Enough  

Teens with mild to moderate OCD may do well with individual therapy or a combination of therapy and medication.  Those with more severe OCD, a comorbid disorder such as depression, bipolar disorder, or an eating disorder, or at risk of suicide may require a higher level of treatment for a period of time.  If your teen:

  • Has symptoms that are interfering with his or her ability to go to school or function in other areas of his or her life
  • Is experiencing severe depression, anxiety, or other psychiatric symptoms that require a higher level of care
  • Is actively suicidal – threatening or planning suicide, and / or engaging in suicide gestures or attempts
  • Is actively using alcohol or drugs

then it’s time to consider a more intensive level of treatment.  This may involve:

Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go.  These programs are often the next step up from regular outpatient treatment.

Dual diagnosis treatment is often necessary if your teen has a substance use disorder in addition to PTSD.  The substance use problem will almost always hinder the effectiveness of individual therapy alone.  Enrolling your teen in a dual diagnosis program allows for both disorders to be treated simultaneously. 

Residential treatment requires having your teen live at a non-hospital treatment facility that specializes in treating adolescents with OCD and other mental health disorders.  Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and how well your teen is progressing in treatment.  

Inpatient psychiatric treatment in a hospital setting is the highest and most intensive level of treatment for adolescents with OCD.   In most cases, this level of treatment is used to treat severe depression, mania, anorexia, and / or suicide risk in teens with OCD, rather than the OCD itself.  Patients are monitored ‘round the clock.  Hospitalization is usually relatively brief.  

Taking Care of Yourself 

Through no fault of his or her own, your teen’s OCD is likely going to take a toll on you at times.  You may feel frustrated, overwhelmed, helpless, or even despairing.  That’s why it’s vital that you take care of yourself as well.  Things that may help include:

  • Finding a support group for parents of teens with OCD or mental health issues in general
  • Reaching out to family, friends, and church for support when you’re exhausted or struggling emotionally
  • Finding ways to manage and reduce your stress, such as yoga, meditation, or exercise
  • Making sure you’re getting sufficient rest

No matter how bleak it may seem, your teen can learn how to manage his or her OCD or even overcome it.  Staying positive and hopeful will benefit both you and your teen.

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