Obsessive Compulsive Disorder (OCD) consists of intrusive, unwanted, disturbing, and morally taboo thoughts that provoke anxiety, uncertainty, and guilt. They are accompanied by urges to perform compulsions (rituals) intended to achieve certainty, reduce anxiety, and alleviate guilt. OCD in teens can add an additional burden to an already challenging developmental stage, where normal issues can become obsessive fears.
What Does OCD Look Like in Teens?
OCD affects about 1-2% of adolescents. Typically, OCD symptoms are latent until childhood or adolescence.1,3 One study found that 80% of adults with OCD recognized the onset of symptoms beginning at age 18.4 There may be a delay in diagnosis and treatment until the stress of biological, psychological, and social change causes symptoms to become more prominent.
OCD can add a serious level of burden and vulnerability to the developmental challenges already underway from childhood to adulthood. Teens are maturing physically, cognitively, emotionally, sexually, socially, and spiritually. They also begin to think about identity and become more independent, but normal issues can become obsessive fears. In over 40% of cases, the disorder persists into adulthood.5
Common Teen OCD Obsessions
Regardless of age, the content of obsessions typically touches on issues that may be considered morally sensitive or unacceptable to the sufferer.
Common obsessions in teens with OCD include thoughts or images about:
- Sex
- Violence
- Blasphemy
- Fear of offending others
- Fear of disappointing others by being imperfect in things like academics, sports, music, or art
- Existential obsessions
It is important to be able to distinguish where “normal” ends and obsession begins. Routines that were established during childhood to cope with the need for order, certainty, and security become inflexible and persistent.
Normal Adolescent Themes vs. OCD in Teens
Being a teenager comes with a lot of ups and downs, self-discovery, and shifting identity. Here are some ways to tell the difference between normal teen behaviors and OCD behaviors and attitudes.
Normal adolescent themes:
- Challenging authority
- Taking risks
- Decisions about substance use
- Existential issues
- Academic achievement
- Enrichment achievement (sports, music, art, etc.)
- Social status
- Sexuality
- Getting a job
- Rebelling against rules and responsibilities at home
- Independence
- Having and expressing autonomous thoughts, feelings, and opinions
Themes for teens with OCD:
- Obsessive fear of
- punishment
- making mistakes or being wrong
- judgment
- rejection
- Avoidance of social gatherings
- Need for perfection
- Need to avoid disagreements
- Uncertain sexuality or sexual orientation
- Overcompliance
- Overdependence to avoid mistakes or disappointing others
Common Compulsions in Teens With OCD
Compulsions (rituals) are any mental or physical behaviors intended to reduce anxiety and emotions. Mental rituals are not observable but may be occurring if the teen looks preoccupied, is stuck in place, or is staring at nothing in particular.
Common signs of compulsions in teens with OCD include:
- Being late for school
- Checking/rechecking schoolwork
- Incomplete or missing homework assignments or tests due to perfectionism
- Rereading & rewriting
- Over-asking questions in class or during teacher’s office hours
- Over-apologizing or confessing intrusive thoughts or imperfections
- Asking for reassurance from parents/siblings
- Repeating behaviors
- Excessive showers and hand-washing, and grooming
- Repeated ordering, arranging, and counting
- Constantly checking appearance and changing clothes
Signs of Emotional & Behavioral Changes Caused by OCD in Teens
As stated, some mild routines and habitual behaviors during childhood become compulsions when they start taking control of functioning, causing difficulty in the person’s ability to redirect their focus on the task at hand.
Important signs of emotional and behavioral changes caused by OCD in teens are:
- Increased dependency on others
- Avoidance of social events, including dating
- Appearing withdrawn and anxious
- Asking repetitive questions for reassurance
- Demanding others to accommodate the OCD such as imposing unrealistic, OCD-related rules in the household
- Not completing school assignments
- Decline in academic work
- Academic perfectionism (e.g., late assignments, sleep deprivation)
- Difficulty with transitions or change
- Overachieving
- Perfectionism in extracurriculars like sports, playing an instrument, artwork, etc.
- Not finishing tasks because they’re making them perfect or “just right”
- Being overwhelmed by how much work there is
- Too much attention to detail/minutiae
- Rigid adherence to rules
What Causes Teen OCD?
OCD is a predisposed genetic neurobiological disorder.2 It is no one’s fault; it lays dormant until activated by stress. It can also be a product of the teen’s environment if a parent has OCD and sets the household rules and norms according to their symptoms.
Because ideas around identity are being questioned, teens with OCD may over-identify with their obsessions and become afraid that they reflect something about their personality. Fear, guilt, and shame are normal reactions to obsessions.
Obsessions may be based on cultural or religious styles of upbringing as well as social experiences. For example, youth from traditionally religious households may be triggered by “blasphemous” thoughts. What may start out as healthy religious practices can become rigid and motivated by a need to be morally perfect, known as scrupulosity OCD. Compulsions will be used to alleviate anxiety and assuage guilt.
Navigating OCD in Teens: Tips for Parents & Peers
It’s difficult to watch a loved one suffer, but it’s important to realize that certain efforts to help teens cope with OCD may actually make matters worse. People may not be aware of what is causing the teen to experience higher levels of distress than others their age. Some parents experience an impulse to protect their child from suffering by making them less responsible.
Teens may be ambivalent about the attention they are getting. On one hand, they want to begin individuating, while on the other, they are frightened and need support. Because the family may try to help by accommodating OCD, this strategy only serves to maintain or worsen the episode.
Potentially harmful accommodating behaviors include:
- Providing reassurance about the obsessive fear
- Engaging in washing, cleaning, checking, arranging, or ordering rituals as demanded by the OCD sufferer
- Waiting until the teen has finished their rituals before beginning a family activity
- Being late for social and family events
- Doing things for the teen that would be triggering
- Changing household rules to accommodate the OCD
- Trying to use logic to answer irrational questions
Treating Teen OCD
A diagnosis of OCD may come from a pediatrician, school counselor, or mental health professional. The earlier the diagnosis, the earlier the teen can receive treatment for OCD and get back on track to achieving their full potential.
Medication for OCD and cognitive behavioral therapy (CBT) are highly effective for treatment at all ages. Many teens combine them. Exposure and response prevention (ERP) is a form of CBT, and the first-line psychological treatment. It consists of helping the teen face their obsessive fear while resisting urges to ritualize.
Final Thoughts
The teenage years are challenging enough without an added level of anxiety and fear brought on by OCD. But teens and their families may be surprised by how many people in their community are also impacted by this disorder. There is a community of people who are going through the same struggle.
