Obsessive-Compulsive Disorder (OCD) in Teens

As teens go through adolescence and eventually make their journey into adulthood, they develop certain traits and behaviors that are unique to their experiences. Some teens may be more laid back and prefer to take things as they come. Other teens may be more keen on structure, routine, and generally being very particular about things. However, there may be times when being too particular and repetitive with certain things can be harmful and disruptive to daily life. This is where obsessive-compulsive disorder (OCD) in teens comes in. Here, we’ll explore this condition and discuss its symptoms, causes, treatment options, and ways to show support.

What is OCD?

OCD is a condition that is characterized by intrusive thoughts and sensations that cause feelings of distress (called obsessions), which a teen might then try to alleviate with repetitive behaviors, also known as compulsions.

Most teens will experience unwanted thoughts occasionally. For individuals without OCD, unwanted thoughts will not cause distress because they are not interpreted as meaningful. However, teens with the condition will experience obsessions and compulsions that lead to adverse effects on daily life. It could be that the unwanted thoughts are severe enough to cause sleeping issues, or repetitive behaviors might be so obstructive that a teen may have trouble leaving the house to participate in their daily routine.

Fortunately, much research has been done on OCD, and there are many treatment options available.

What are Obsessions?

Obsessions, in the context of OCD, are fears that teenagers may not be able to stop thinking about. Teens who have OCD may usually get the feeling that something is “off,” and they are aware that these fearful thoughts aren’t normal. Such thoughts can cause anxiety in teenagers, and despite their best efforts, they are unable to stop thinking about them.

Some common obsessions are detailed below:

• Needing to make sure that every object is placed in a particular, even, orderly manner
• Worrying about things needing to be done in a certain order or else it might lead to a bad outcome
• Fear of getting sick and dying, no matter what they do
• Severe concern that a loved one will get sick, hurt, or die
• Fear of touching objects because they are potentially dirty
• Worrying about breaking a rule and believing they deserve to be punished severely for it

Everybody has unwanted thoughts from time to time. The difference between teens who have OCD and those who don’t is that the former cannot stop thinking about these unwanted thoughts and are paralyzed by them. Most of the time, the obsessions are bad enough that teens cannot stop thinking about them.

What are Compulsions?

Compulsions are repetitive behaviors or mental acts an individual feels the need to do, especially in response to obsessions. Compulsions usually take the form of rituals and are meant to prevent fearful outcomes and alleviate stress.

Teens with OCD feel that they have to do these behaviors repetitively in a certain order. If they do not do these behaviors or mental acts, then the obsessions take over and cause them to worry about negative outcomes. Such behaviors might involve orderliness, safety, cleanliness, or symmetry. They usually have to be done “just right,” or else teens might feel the need to start over. In a way, compulsions give teens a source of power; by doing them, they might feel that they can control what happens next.

Common examples of compulsions include:

• Needing to wash or clean things a certain way
• Thinking of phrases repetitively until it “feels right” or they are said in an exact number of times
• Checking each door in the house multiple times to ensure it is locked
• Needing to redo things in a certain manner multiple times
• Chewing the same number of times on each side of the mouth when eating
• Needing to place things in a specific, even, and symmetrical order

It is important to recognize that compulsions often come from adaptive behaviors. For instance, it is good behavior for a teen to check their homework several times to ensure everything is done properly. However, if your teen ends up checking their homework dozens of times and affects other parts of their day, then it will end up adversely impacting their life.

Prevalence of OCD in Teens

The prevalence of OCD in individuals is up to 4% [*]. A third to a half of newly diagnosed adults have reported that the onset of their symptoms took place in childhood or adolescence, starting as early as six or seven years of age. Four out of 10 individuals with OCD develop it as a chronic condition [*].

OCD Symptoms in Teens

There are many symptoms of OCD in teens, including the following:

• Fear of dirt, germs, or contamination
• Need for order, precision, and symmetry
• Having lucky and unlucky numbers
• Having aggressive thoughts
• Being preoccupied with body wastes
• Having religious obsessions
• Fear of illness or harm coming to oneself or loved ones
• Having intrusive sounds or words
• Needing grooming rituals, including hand washing, teeth brushing, and showering
• Repeating rituals, such as going in and out of doorways, rereading, erasing, and rewriting
• Repeatedly ensuring that an appliance is off or a door is locked
• Performing rituals to undo contact with a “contaminated” person or object
• Ordering or arranging objects repeatedly
• Preoccupation with household items
• Hoarding and collecting objects of no apparent value
• Having cleaning rituals related to the house or other items

Recognizing OCD in teens can be tricky at first, but with enough observation, you will be able to identify which behaviors are normal and which ones may need a more thorough evaluation.

What Causes OCD in Teens?

Some factors may be responsible for the development of OCD in teenagers.

Genetic Factors

Genetics plays a significant role in the development of OCD in teens. While the inheritance pattern of the condition is unclear, the risk of developing it is greater for first-degree relatives of affected individuals [*]. Studies with twins and families show that OCD has a high chance of being inherited as OCD rates are higher in identical twins compared to fraternal twins [*].

Other research shows that OCD occurs more often in families where at least one person has OCD compared to families in a control group with no OCD [*]. The likelihood of OCD increased when first-degree family members had conditions such as OCD, tic disorders, affective disorders, or anxiety disorders

Brain scans also show that there is a slight difference in brain structure between individuals with OCD compared to those without the condition [*].

Environmental Factors

Genetic factors are not the only elements that can cause OCD in adolescents. Environmental factors, including stress, trauma, and even bacteria, can influence the development of OCD.

Stressful life events can cause symptoms of OCD. It has been associated with major life changes, including the loss of a loved one, relationship issues like divorce, abuse, and difficulties with school.

A study found an indirect relationship between the severity of OCD and the presence of childhood trauma, which was influenced by difficulties with attachment and processing emotions [*].

Pediatric autoimmune neuropsychiatric disorder associated with strep (PANDAS) is another risk factor for OCD [*]. This is a rare type of OCD that takes place when strep bacteria triggers an immune reaction, causing OCD-like symptoms. PANDAS can occur between four and 14 years old.

How is OCD Diagnosed in Teens?

The diagnosis of OCD in teens starts with observing the symptoms and raising concerns with your teen’s physician. They can refer you to the right mental health professional. They may also conduct a physical examination to rule out any other issues that could be causing OCD-like symptoms. This also allows them to check for any related complications.

Psychologists specializing in the treatment of OCD will then conduct a psychological evaluation of your teen. This includes discussing their thoughts, feelings, symptoms, and behavioral patterns to determine if obsessions and/or compulsions get in the way of everyday life.

OCD will only be diagnosed if the obsessions and compulsions are impeding your teen’s ability to function and live life normally. They must also cause significant distress. A mental health professional will use the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) to diagnose OCD.

The criteria include:

• Having obsessions, compulsions, or both
• The obsessions or compulsions take up a lot of time, more than an hour each day
• The obsessions or compulsions cause distress or affect your participation in social activities, work responsibilities, or other life events
• The symptoms are not caused by substances, alcohol, medications, or other medical conditions
• The symptoms are not explained by a different mental health condition, such as generalized anxiety disorder, eating disorders, or body dysmorphic disorder

Complications Related to OCD in Teens

Some issues and complications may arise from having OCD. These include but are not limited to the following:

• Health issues, such as contact dermatitis resulting from frequent hand-washing
• Excessive time spent doing ritualistic behaviors
• Difficulty going to school or taking part in social activities
• Troubled relationships
• Thoughts or behaviors related to suicide
• Poor quality of life

Tips for Supporting a Teen with OCD

Whether you take your teen to see a mental health professional, there are things you can do as parents, guardians, and caregivers to support your child. Here are some practical tips we can offer:

• Educate yourself on OCD. Educating yourself will help you better understand what your teen is experiencing and how you can support them.
• Listen and offer emotional support. Let your teen know you are there for them by actively listening and showing emotional support. Be someone they can talk to their OCD about.
• Respect their privacy. If your teen chooses to attend therapy to help manage their OCD, then it is best to respect their privacy throughout the process until they feel ready to share. Their OCD may have caused them feelings of guilt or shame, so respecting their privacy can help them feel that they are recovering independently and at their own pace.
• Provide reassurance. Reassure your teen that you are there for them as they manage their condition. Talk to them about what healthy support looks like for them.

When to Seek Professional Help

It can be difficult to determine when you should seek professional help for your teen’s OCD. Here are some signs that it may be time to contact a mental health expert.

• Your teen doesn’t seem to be able to control their thoughts or behaviors
• The OCD requires medical intervention
• Your teen’s anxiety is not relieved
• Your teen’s life is being affected outside of home
• Relationships are strained
• Functioning in everyday life is compromised

OCD Treatment for Teens

As distressing as OCD might be, there are, fortunately, various treatments that can help.

Therapy

Cognitive behavior therapy (CBT) is considered an effective treatment for teens with OCD. This therapy and others similar to it help patients focus on the connection between their thoughts and behaviors and work towards positive changes.

One of the most important elements of CBT is another form of therapy called Exposure and Response Prevention. This type of therapy aims to expose adolescents to a feared object or obsession gradually. For example, a teen may be very afraid of exposure to dirt for fear of germs. With the guidance of a mental health professional, they can learn how to resist the urge to complete compulsive rituals.

Medications

There are certain psychiatric medications that can help adolescents control the obsessions and compulsions that come with OCD.

Selective serotonin reuptake inhibitors (SSRIs) are a specific class of antidepressants that may help. Here are some that your teen may be prescribed with:

• Zoloft (Sertraline) - children six years of age or older
• Prozac (fluoxetine) - children seven years of age or older
• Fluvoxamine - children eight years of age or older
• Anafranil (clomipramine) - children ten years of age or older

Before going ahead with medication, parents and caregivers should speak with doctors at length to understand the risks and benefits of each medication.

Many teens who go on medication for OCD may be able to stop taking them once they have learned the appropriate skills in therapy and can implement them regularly.

The Bottom Line

Managing OCD in teens and young adults can be difficult, but it is not impossible. Take your time and continue having an open dialogue with your teen who may be dealing with OCD symptoms. Finding a support group can also help you and your teen relate to others experiencing similar issues. While it may feel like a constant struggle, taking that first step is the most important action you can take.

Some teens may benefit from resources on anxiety management to help them cope with OCD symptoms.

References:

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2. Nazeer A, Latif F, Mondal A, et al. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. February 2020.
3. Purty A, Nestadt G, Samuels J, et al. Genetics of obsessive-compulsive disorder. January 2019.
4. Browne H, Gair S, Scharf J, et al. Genetics of Obsessive-Compulsive Disorder and Related Disorders. 23 July 2014.
5. Steinhausen H, Bisgaard C, Jørgensen P, et al. Family Aggregation and Risk Factors of Obsessive–Compulsive Disorders in a Nationwide Three-Generation Study. 6 August 2013.
6. Parmar A & Sarkar S. Neuroimaging Studies in Obsessive Compulsive Disorder: A Narrative Review. 1 September 2016.
7. Carpenter L & Chung M. Childhood trauma in obsessive compulsive disorder: The roles of alexithymia and attachment. 25 February 2011.
8. National Institute of Mental Health. PANDAS—Questions and Answers. 2019.