Understanding OCD in Teens

Obsessive Compulsive Disorder (OCD) can be difficult to deal with at any age. For teens, OCD can be particularly challenging. The adolescent years are a unique developmental period filled with tremendous change and growth that often creates significant distress. It’s a process that isn’t always smooth, and often filled with the teenage angst parents know so well. OCD brings an added layer of distress and presents unique challenges for teens. 

OCD tends to emerge in childhood or the early teen years. While younger children might tell mom or dad what’s happening, teens may be less likely to divulge their struggles. Given where they are developmentally, they may be more inclined to handle it on their own. Their struggle might not be readily apparent. After all, it can be hard to discern when it’s normal teenage struggle and when it’s something more. As a result, it’s not uncommon for OCD to go undiagnosed early on. 

So, what’s a parent to do? Understanding how OCD manifests in teens can help you to recognize your teen’s unique struggle and support them in ways that promote healing and growth. Here’s what you need to know.  

What OCD in Teens Looks Like

Like most mental health disorders, the way OCD manifests in young people is in some ways different from how it might manifest in adults. OCD can be compared to a “bully in your head” that finds your weak spot and then focuses on that in terms of the intrusive thoughts. Consequently, for teens, their obsessions are likely to be focused on age-appropriate concerns or developmental tasks. For example: they may obsess over homework or seating in their classroom or having the correct number of pens. If a teen’s family is especially important to them, they might have intrusive thoughts about hurting them. If they are discovering their sexuality or sexual identity, those topics might be at the center of their OCD. 

Some common obsessions in teens include:

• Doubting and checking – These obsessions center around the need to check and recheck for fear of something bad happening. For example, they may worry excessively about their homework (having it, completing it, perfecting it, losing it, etc.). They may worry excessively about safety (e.g., fearing they didn’t lock their locker or car door.) 
• Fear of contamination – This is a very common obsession that manifests as a strong fear of germs, illness, or getting dirty, leading to behaviors aimed at avoiding potential contamination. 
• Symmetry and order – They may obsess about things needing to be “just right" or in perfect order, often to avoid a vague sense of dread or anxiety. An out of place object creates marked distress. 
• Harm or aggression – These thoughts can be particularly disturbing for teens. They may experience intrusive thoughts about harming oneself or others, often causing distress and a fear of acting on them, even though there is no intent to do so.
• Sexual or religious concerns – While it is normal for teens to think or wonder about sex or religion, obsessions are beyond the norm. They may have intrusive, unwanted thoughts or worry excessively about sexual orientation, unwanted sexual imagery, or inappropriate religious thoughts, leading to feelings of guilt and shame.

To reduce the anxiety or distress that obsessions cause, people often engage in repetitive actions, known as compulsions. 

Some common compulsions in teens include:    

• Excessive cleanliness - Excessive handwashing or showering, excessive cleaning (e.g., insisting they wipe off their desk before sitting), refusal to shake hands or share certain items (e.g., books). 
• Checking and rechecking – Going back multiple times to ensure safety or accuracy, like checking if a door is locked or their homework is in their book bag. They may sometimes compulsively check and recheck to the point of being late or moving on to something else.
• Counting or repeating actions – Engaging in certain actions (like touching an object or repeating a phrase) a set number of times. For example, only sitting in a classroom seat that is 7 steps from the door or only in the 3^rd row. 
• Seeking reassurance – Asking friends, family members, or teachers repeatedly if everything is okay, particularly about things like relationships or behaviors, or repeatedly apologizing needlessly. Seeking reassurance can also take the form of mental compulsions such as reviewing past behaviors over and over in one's mind or searching the internet for reassurance that they are not a “bad person”. 

These obsessions and compulsions can take up hours of the teen’s day, impacting school performance, social relationships, and daily routines. 

Why OCD Is So Challenging for Teens

Adolescence isn’t called the time of sturm und drang (storm and stress) for nothing. It’s a time of tremendous physical and psychological growth characterized by identity formation and an increasing desire for independence. Add in dealing with OCD and it just adds to the stress. 

Social Pressures

The teen years are marked by an expanding social world and the attention shifts from parental influence to peer influence. Their social relationships and experiences are  paramount. They want to fit in and be accepted by their peers. For a teen with OCD, they may worry about being judged, especially if their compulsions are visible. They may go to great lengths to hide these behaviors and even avoid seeking help for fear of their peers finding out. The fear of being stigmatized may heighten worry about what their peers will think of them, and negatively impact their confidence and self-esteem. 

Academic and Extracurricular Pressures

School is a primary focus of the teen years. Dealing with OCD can make it difficult to study, complete assignments, or take tests. For example, a teen with checking compulsions may spend so much time checking and rechecking their homework that they never finish it. They may also avoid tasks that trigger their OCD. The result can be unfinished work, declining grades and diminished confidence and self-esteem.

Extracurricular activities can be problematic too. Masking symptoms can be difficult in a team setting, and the fear of being “found out” may increase feelings of anxiety. For some teens, their OCD symptoms may be so severe that they cannot engage in the activities they enjoy. 

Challenges with Identity and Self-Esteem

Adolescence is a time when teens are figuring out just who they are. For teens struggling with OCD, they may feel as if their OCD defines who they are. Rather than see it as a disorder to be managed, they may internalize their OCD and view it as “who I am”. They may view their OCD as a reflection of personal failure, impacting their self-esteem and sense of worth. 

Adolescence is also a time when teens are making that push for independence and autonomy. They may need support from family but at the same time, wanting to be autonomous, may view support as interference. Their OCD may leave them feeling vulnerable and out of control. It can be confusing and frustrating for a teen trying to find their independence. 

Brain Development

The teen years are time of rapid brain development, particularly in the areas of the brain responsible for decision-making, impulse control, and emotional regulation. Despite the outward appearance of maturity (and maybe even some of that teenage bravado), adolescent brains are still maturing, and this can make it hard for a teen to fully understand or manage their OCD. In addition, they have trouble evaluating long term consequences of their current behavior, which sometimes makes it harder to create motivation for change in terms of the OCD.

With heightened emotional sensitivity and struggle with emotional regulation, feelings of shame or embarrassment and distress related to their OCD may be amplified. And given this stage of brain development, they may not yet have the emotional resilience or skill to use coping strategies well. 

What Parents Can Do

As the parent, you play a crucial role in your teen’s ability to manage their OCD. The key is to work with them. Remember, they are in the season of independence and autonomy. They want and need strategies that honor where they are developmentally. And even if they say they don’t, they do need your support. 

Seek Professional Help

OCD is a disorder that is not likely to respond well to self-help alone and requires professional help. 

• Exposure and Response Prevention (ERP), a specialized form of cognitive behavioral therapy (CBT), is widely considered the gold standard for treating OCD. ERP involves gradually exposing the individual to the source of their anxiety (the obsession) and preventing the compulsive behavior that usually follows. Over time, this helps to reduce the anxiety associated with the obsession and the urge to engage in the compulsion.
• Medication such as a selective serotonin reuptake inhibitor (SSRIs) may be prescribed when symptoms are particularly severe. Medication is typically used in conjunction with therapy rather than as a standalone treatment.
• Family therapy may also be beneficial, helping parents and siblings understand how to support their loved one’s treatment. 

Encourage Open Communication

You and your teen will need to make decisions together. Keeping those lines of communication is vital. 

Teens want and need a safe space to talk openly about their OCD without judgment. Create an environment where your teen feels comfortable discussing their struggles. This openness can prevent feelings of shame, reduce isolation, and encourage them to seek help.

Sometimes, it isn’t easy to know what to say or how to encourage communication:

What to Say

• I love you
• You are beautiful
• You are important
• You are worthy
• Your OCD does not define you

What Not to Say

• Stop checking, counting, worrying (or whatever their compulsion is)
• Just stop (they would if they could) 
• Do not tell other people about your teen’s OCD without their permission
• Do not scold, shame, or punish your teen for acting on their compulsion. It is not something they can control on their own and it is not their fault. ‍Or yours.

Practice Active Listening - When your teen talks, listen. Show genuine interest in what they’re saying. Avoid interrupting or offering solutions immediately. Sometimes, they just need to talk and know, “I hear you.”

Express Empathy - Acknowledge their feelings without judgment. Statements like, “I see this is really hard for you,” validate what they’re feeling and encourage them to open up more.

Be Patient - Your teen may be struggling and not quite ready to talk. They may share in tiny bits. That’s ok. Give them time and let them know you are ready to listen when they are ready to share. 

Focus on Solutions

Instead of focusing on the problem, focus on finding solutions. Learn about OCD together and find ways to address it together. Encouraging your teen to participate in the process helps them gain a sense of empowerment and confidence.

The Takeaway

OCD presents unique challenges for teenagers as they navigate a complicated developmental period. Recognizing their unique challenges and with a combination of effective treatment, family support, and education, teens with OCD can learn how to manage their symptoms and enjoy their teen years. 

References

1. Geller, D. A., Biederman, J., Faraone, S., Agranat, A., Cradock, K., Hagermoser, L., Kim, G., Frazier, J., & Coffey, B. J. (2001). Developmental aspects of obsessive compulsive disorder: findings in children, adolescents, and adults. The Journal of nervous and mental disease, 189(7), 471–477. https://pubmed.ncbi.nlm.nih.gov/11504325/

2. Geller, D., Biederman, J., Faraone, S. V., Frazier, J., Coffey, B. J., Kim, G., & Bellordre, C. A. (2000). Clinical correlates of obsessive compulsive disorder in children and adolescents referred to specialized and non-specialized clinical settings. Depression and anxiety, 11(4), 163–168. https://pubmed.ncbi.nlm.nih.gov/10945136/

3. https://dictionary.apa.org/obsession

4. https://dictionary.apa.org/compulsion

5. The teen brain: 7 things to know. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know