OCD in Teens: Signs & How to Help

What Is Obsessive Compulsive Disorder?

Obsessive compulsive disorder (OCD) is a mental health condition where someone experiences intrusive thoughts called obsessions. These thoughts lead people to complete specific actions called compulsions. The goal of repeating these actions is to reduce the stress and anxiety that comes with the obsessions that the person is experiencing.

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 arenas like academics, sports, music, or art
• Existential obsessions

It is important to be able to distinguish where “normal” thoughts end and obsessions begin. Routines that were established during childhood to cope with the need for order, certainty, and security become inflexible and persistent in teens with OCD.

Common Compulsions in Teens With OCD

Compulsions are any mental or physical behaviors intended to reduce anxiety and the negative emotions caused by obsessions. 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:

• 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, hand-washing, and grooming
• Repeated ordering, arranging, and counting
• Constantly checking appearance and changing clothes

How Common Is OCD in Teens?

OCD affects about 1-2% of teens. Typically, OCD symptoms are latent until later 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.

Recognizing the Signs of OCD in Teens

Mild routines and habitual behaviors during childhood become compulsions when they start taking control of functioning, causing difficulty in the teen’s ability to redirect their focus on the task at hand.

Important signs of emotional and behavioral changes that could be caused by OCD in teens include:

• 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 to get their homework “perfect”)
• 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 to get done
• Too much attention to detail/minutiae
• Rigid adherence to rules

Normal Adolescent Themes Vs. OCD in Teens

Here are some ways to tell the difference between normal teen behaviors and OCD behaviors and attitudes:

What Causes Teen OCD?

OCD is a predisposed genetic 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 like obsessive praying or confessing will be used to alleviate anxiety and assuage guilt.

First Steps for Handling Teen OCD

If you suspect your teen may be dealing with OCD, it’s important that you take action while maintaining their dignity and autonomy as much as possible. Approach the conversation with openness and reassurance that you’re not judging them, you just want to help them feel better.

Talk to Your Teen About What You’re Seeing

Your teen may not want to talk about their OCD or finding help, but it’s important to find safe and approachable ways to bring up the topic. Giving space for their sensitivity on the topic and making sure they are feeling in charge of their care is key. Teens are capable of a lot, and they often just need help making decisions and figuring out what would really help them feel better. Ideally, the discussion should be led by the teen and facilitated by you. This will allow them to feel that they are in the driver’s seat and make them more comfortable opening up about their true feelings.

Have Your Teen Evaluated for 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.

Getting Your Teen OCD Treatment

Medication and therapy are highly effective for OCD treatment at all ages, and people often find the most relief from a combination of the two.

• Exposure and response prevention (ERP) is the first-line psychological treatment for OCD. It consists of helping the teen face their obsessive fear while resisting urges to ritualize.
• Family Therapy: Teenagers interact with many people on a regular basis, so involving these people in treatment can be helpful. A therapist may coordinate with your child’s pediatrician, school counselor, and teacher to provide better care. As a parent or primary caregiver, you also play a crucial role in your child’s recovery from OCD, so a therapist will usually request that you participate in family therapy sessions.
• Medication for OCD is typically the most effective when combined with therapy. Certain antidepressants have been found to be effective.⁹ A psychiatrist or psychiatric nurse practitioner who specializes in working with children would be able to discuss the pros and cons of medication and help you determine whether it should be added to your child’s treatment.

What to Do When Outpatient Treatment Isn’t Enough

If your teen is struggling with outpatient treatment and medication, it is important to consider intensive outpatient programs, which involve multiple individual and group therapy sessions a week as well as homework. If this is not an option or a resource in your area, you may need to consider hospitalization and work with the medical team to figure out a treatment plan and where the barriers are for progress.

How to Support Your Teen With OCD

It’s difficult to watch your child 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.

Here are some tips for supporting your teen through their OCD journey:

• Learn all you can about OCD: Seek high-quality, evidence-based sources of information about OCD to learn more about what your teen is experiencing. Educating yourself can help to empower you and your teen to stick to the treatment plan, and offer hope for the future.
• Don’t judge their behaviors: Remember that your child’s behavior is coming from a place of fear and anxiety. They need you on their team to provide loving acceptance and support.
• Help them find ways to relax: Mindfulness for OCD has been shown to be an effective complementary treatment, and something your family can practice together at home.⁶ Helping your child find alternative ways to cope with stress can play an important part in their healing.
• Try to separate them from their illness: Combat the stigma related to mental health issues and remember that your child is struggling with OCD – they are not OCD. Hold space for all the things that make your child who they are, apart from OCD.
• Model a healthy lifestyle: Research supports exercise as a means of reducing symptoms of OCD.⁷ All of us can benefit from adequate sleep, nutrition and physical activity. Modeling these healthy behaviors can make a difference for your teen.
• Don’t change your household routines or expectations: Participating in your child’s compulsions or restructuring your household routines to accommodate them only serves to perpetuate your teen’s OCD symptoms.⁸ Continue with your boundaries and expectations and support your teen along the way.
• Make sure the whole family is involved: Hold a family meeting and get everyone on board with your child’s treatment plan to prevent any family member from caving to reassurance-seeking or other compulsions. Your teen will feel more secure and be more successful with consistency.
• Find your teen an OCD support group: No one has to go on this journey alone. Encouraging your teen to attend a support group can help them to feel validated and provide valuable social support.
• Stay positive: Believe in your teen’s ability to manage their OCD symptoms, to heal, grow and function well in their life. Your positivity will be their safety net on difficult days.

What to Avoid as a Parent Navigating Teen OCD

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

Taking Care of Yourself

Raising a child with OCD can be challenging. When your teen needs additional support on their journey with OCD, you cannot give what you do not have. Caring for yourself is the first step in being the parent your child needs in the midst of their struggles. Finding a support group for parents of children with OCD can provide a safe space where you can share your experiences and feelings, where they’ll be met with empathy and validation.

As your teen works to manage their anxiety, be sure to manage your own stress by finding healthy coping strategies to calm your body and mind. Exercise, mindfulness, meditation, deep breathing, yoga and other stress-reduction practices can help you to be a peaceful, steady presence for your child.

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.