About 8 in 10 people with OCD experience their first symptoms by age 18.
Obsessive-compulsive disorder (OCD) is a complex anxiety disorder marked by unwanted obsessive thoughts and compulsions.
Obsessions are intrusive thoughts, urges, or images that trigger severe anxiety and fear. Compulsions, whether external or internal, are behaviors carried out in an effort to relieve this anxiety.
If you notice your teen is beginning to engage in compulsions, there are things you can do to help. Here’s what you need to know.
The primary symptoms of OCD are intrusive thoughts and compulsions. These symptoms can be highly distressing and time-consuming, and can cause significant impairment in day-to-day life.
If your teen has OCD, you might notice a few of the following behaviors:
- seems excessively worried about one particular topic
- isolates or withdraws from others
- appears highly anxious or fearful
- exhibits atypical behaviors
- constantly asks for reassurance on a topic (e.g., “Are you sure I can’t get a disease from a public toilet?”)
- seems overly concerned with the safety of family members
- suddenly avoids certain situations or places
- frequently rearranges items so that they’re “even”
Though OCD themes can be about anything, some of the more common obsessional themes for teens include:
- fear of contamination, dirt, or germs
- religious or spiritual themes (e.g., demons, angels, going to heaven/hell)
- fear of harming others
- fear of harm coming to loved ones
- need for symmetry, organization
- sexual orientation anxiety (worrying about being gay when you’re straight or vice versa)
- counting rituals
- repeating rituals
- checking rituals (making sure the door is locked numerous times)
- magical thinking (worrying your thoughts caused an earthquake)
- perfectionism (feeling “off” when things feel uneven)
- fear of losing control
Insight into OCD
People with OCD have varying levels of insight into their obsessions and compulsions. In OCD, “insight” is defined as the ability to see one’s obsessions as illogical or separate from reality.
Although many teens with OCD are able to recognize that their obsessions and compulsions are illogical or extreme, they often feel helpless to stop them.
Some may even feel embarrassed or ashamed of their compulsions. As a result, many teens with OCD often conduct their compulsions in secret. This can mean that their symptoms are “masked” in public settings like school.
OCD is most commonly treated with medication, therapy, or a combination of the two. Generally, therapists will use methods such as exposure and response prevention (ERP) or another type of cognitive behavioral therapy (CBT) to address OCD symptoms.
The method for ERP is to gradually expose a client to their fears until those fears lose their power. A therapist will help teens develop personalized strategies so they can practice exposure techniques outside of therapy sessions.
Other forms of CBT may also be used for managing OCD symptoms. CBT can help treat people how to unlearn unhelpful thinking patterns and implement healthier emotional and behavioral reactions.
Selective serotonin-reuptake inhibitors (SSRIs), including fluoxetine, fluvoxamine, sertraline, and paroxetine, were shown in a 2003 trial to be effective at managing OCD symptoms in children and adolescents.
If one SSRI isn’t improving symptoms after 10-12 weeks, then a different SSRI is usually tried next.
Teens are generally aware that their thoughts and behaviors aren’t typical of their peers. They’ll likely hide their unwanted thoughts and rituals from their friends. Therefore, parents and close family members are likely the first to notice changes in their teen’s behavior.
There are several things you can do to help your teen with OCD.
- Learn as much as you can about OCD. There are numerous websites, videos, support groups, and documentaries about OCD on the internet. OCD can seem very perplexing from an outsider’s point of view, so it’s important to try to understand what’s going on in your teen’s mind.
- Be a safe place. Let your teen know that they can talk to you about their OCD, and they can ask for help anytime. Try not to get frustrated or angry when you see them acting out their behaviors and rituals. If you yell at them to stop their compulsions, they may refrain from opening up to you in the future and do their rituals in secret.
- Make a therapist/psychiatrist appointment. OCD can be a debilitating disorder, and the longer it goes untreated, the more complex the mental confusion can become. Speaking with a mental health professional about treatment options is an important first step for learning ways to manage OCD.
- Consider group therapy. A 2004 study found that group therapy may be as effective as individual therapy in children and adolescents with OCD, as long as the family is involved in the approach.
- Be prepared to set limits. This is a hard one, because there is a fine line between being compassionate and enabling the OCD. If your teen is late for school because of their elaborate rituals or not getting out of the bathroom, it’s important to set boundaries. A therapist will be able to help you set these boundaries in the home.
OCD is a complex mental health disorder characterized by persistent and unwanted obsessions and compulsions. These symptoms can be extremely debilitating and distressing for teens.
The majority of people who develop OCD have onset by age 18. This means that many teens will be experiencing their first OCD symptoms while also trying to balance school, social life, and puberty.
However, with family support and the right treatment — any combination of exposure therapy, CBT, and medication — teens with OCD are more than capable to go on to have fulfilling and productive lives.