Obsessive Compulsive Disorder (OCD) in Teens

The adolescent and teenage years are a challenging phase of life.  During this time, it is fairly common for youth to develop certain habits and quirks in an attempt to manage the various stressors.  Yet for some, these individual “quirks” can indicate the presence of a more significant issue – obsessive-compulsive disorder.

What is OCD?

OCD, or obsessive-compulsive disorder, is a mental health disorder marked by uncontrollable and recurring thoughts (obsessions) and behaviors (compulsions).  The thoughts associated with obsessive-compulsive disorder fuel the urge to act out certain behavior(s) over and over again.  OCD tends to affect all areas of a person’s life, and when it comes to adolescents and teenagers, this means school life, social life, home life, and personal life.  In this guide, we will cover the signs, symptoms, causes and treatment for OCD in teens, and what you can do as a parent, to help.

Obsessions

The repeated thoughts or mental images inherent to obsessive-compulsive disorder commonly surround one of the following areas:

• Germs/contamination – obsessive thoughts about being in contact with germs or contaminated with germs; can cause fear of shaking hands, using doorknobs/handles, etc.
• Order and symmetry – ongoing thoughts and ruminations about having things in a particular and precise order (i.e. – putting items on desk perfectly lined up, or following an exact nighttime routine); usually includes beliefs that if particular order is not followed, disaster will occur (i.e. – he or she will fail the exam).
• Aggression or Violence – thoughts and/or mental images surrounding violent or aggressive acts toward self or others.
• Doubts – obsessive thoughts and doubts about certain acts being completed (i.e. – the door being locked or the oven being turned off); doubts lead to anxiety about catastrophe (i.e. – house burning down, home being burglarized, etc.)

Compulsions

Compulsions are excessive and persistent behaviors, rituals, or mental acts that a person with OCD feels driven to carry out in response to the obsessive thought(s).  In the short-term, carrying out the compulsive behavior(s) can ease the anxiety, and diminish the distress.  For teens and adolescents with obsessive-compulsive disorder, the compulsions can feel near impossible to avoid acting on, and the brief sense of relief reinforces the belief that the behavior is “helpful”.  OCD compulsions often consist of one of the following:

• Washing – excessive and repeated cleaning and/or washing (often of the hands) in response to fear of germs or contamination.
• Arranging or ordering – this compulsion involves the urge to repeatedly place items in a particular order or symmetrical pattern. This compulsion is frequently connected to a need for control.
• Checking – compulsions of checking typically encompass making sure a certain task has been completed, such as locking the door or turning off the oven.
• Counting – many with OCD feel compelled to count in an attempt to decrease anxiety. Often times, individuals with this compulsion count things such as floor tiles or engage in other compulsions a certain number of times (i.e. – locking the door eight times every time).

Signs and Symptoms Your Adolescent or Teenager May Have OCD

Obsessive-compulsive disorder typically starts somewhere between the late adolescent years to early twenties.  Some early signs and symptoms of obsessive-compulsive disorder in youth include:

• Repeated, ongoing worries
• Low self-esteem
• Worries that seem unfounded or irrational
• Difficulty (or inability) to explain a particular action or compulsion (i.e. – multiple hand washing)
• Disciplinary action at school (due to compulsive behavior)
• Isolation or social withdrawal from friends and family
• Trouble making and/or keeping friends
• Withdrawal from usual activities
• Becoming easily upset (showing signs of violence in extreme cases) over minor or insignificant issues
• Difficulty with spontaneity or diverting from one’s regular schedule
• Indecisiveness
• Excessive and/or repeated reassurance seeking (even once the answer or response has been given)
• Difficulty concentrating or staying on task (a symptom often mistakenly attributed to attention-deficit disorder)

Cause of OCD in Adolescents and Teenagers

The exact cause or causes of obsessive-compulsive disorder remain inconclusive.  Regardless, studies indicate certain factors make some adolescents and teenagers far more likely to develop OCD than others.

• Chemical imbalance – commonly, mental health professionals will describe the cause of obsessive-compulsive disorder in terms of biochemical imbalance. When it comes to a chemical imbalance in the brain and OCD, studies focus on the particular neurotransmitter of serotonin.  Serotonin is the primary chemical in the brain responsible for regulating sleep, memory, and anxiety.
• Genetics – genetic studies indicate the tendency towards anxiety runs in families. Thus, if a teenager’s family member suffers from an anxiety disorder, he or she is more likely to develop one as well, including obsessive-compulsive disorder.  In fact, if there is a history of OCD in a teen’s family, he or she is up to four times more likely to have it as well.
• Environmental factors – things such as stress and parenting styles have been cited as environmental factors that may contribute to the development of obsessive-compulsive disorder. Stressful or traumatic events in childhood, and/or anxious personality styles modeled by parents may make it more likely a child will suffer from obsessive-compulsive disorder.

Treatment of OCD in Adolescents and Teenagers

Obsessive-compulsive disorder in adolescents and teens can be effectively treated. Although there is no “cure,” there are many treatment options to help your child learn to manage his or her symptoms and have an overall better quality of life.

Individual therapy

• Cognitive behavioral therapy (CBT) – cognitive behavioral therapy is a widely used treatment for obsessive-compulsive disorder in adolescents and teenagers. CBT is a form of psychotherapy that aims to modify unhealthy thoughts and behaviors, while teaching skills to manage emotions.  CBT has shown lasting results for many youth with OCD.
• Exposure and Response Prevention Therapy (ERP) – a form of cognitive behavioral therapy, ERP therapy has shown significant reduction in OCD symptoms for many individuals. Exposure and Response Prevention Therapy puts the person suffering from OCD in situations where they are exposed to their obsession(s) while at the same time being prevented from performing the compulsion(s) usually used to ease the anxiety.  In short, ERP intentionally induces anxiety in a controlled way, to gradually show the person with OCD that he or she can “survive” the anxiety without acting in a compulsive manner.

Family therapy

Family dynamics can have a significant impact on the treatment outcome of a youth with obsessive-compulsive disorder.  Family therapy, which is often a part of an OCD treatment plan, not only supports the individual with obsessive-compulsive disorder, but also his or her parents and siblings.  Family therapy can assist family members in better coping with and responding to the struggles of the teen or adolescent with OCD.  Family therapy can also help promote understanding and empathy, and support family members in learning how to set limits and boundaries.

Medication

Due to the immense stress and anxiety that can result from obsessive-compulsive disorder in adolescents and teens, sometimes medication (such as selective serotonin reuptake inhibitors) are prescribed to help manage the difficult symptoms.  Medication can provide the necessary relief from the OCD symptoms needed to enable teenagers to engage in, and benefit from, other treatments, such as psychotherapy.

School support

As with most other areas of life, school, for adolescents and teenagers with OCD, is often affected by the symptoms of the disorder.  Frequently, educators will work with the child, parents, and mental health professionals to incorporate certain adaptations to assist the student in better managing the symptoms while at school.

Challenges of Having an Adolescent or Teenager Has OCD

When an adolescent or teenager has obsessive-compulsive disorder, it is not uncommon for the whole family to be affected and home life to become very stressful.  Watching your child behave in seemingly strange ways can cause confusion and be frightening.  Siblings of the teen with obsessive-compulsive disorder may become easily annoyed when the OCD behaviors are displayed, due to a lack of understanding.  Other challenges of having an adolescent or teenager with OCD include:

• Involvement in OCD behaviors – adolescents and teenagers with OCD often involve their parents in their obsessive-compulsive behaviors in various ways: asking a parent the same question over and over again, begging parents and/or siblings to help carry out an OCD ritual, or insisting family members participate in the rituals as well.
• Violence/Rage – adolescents and teenagers with obsessive-compulsive disorder often become extremely angry, have outbursts, and sometimes even become violent when family members do not engage in the OCD behaviors.
• Lack of communication – secrecy is common amongst adolescents and teens. Yet, if your child has obsessive-compulsive disorder and refuses to discuss his or her symptoms, it can be hugely challenging for the parents/caregivers and siblings.

Supporting Your Adolescent or Teenager with OCD

Living with a teenager with obsessive-compulsive disorder can be hugely distressing, but there are things you can do to help support your child and in turn, manage the impact his or her disorder has on the rest of the family.

• Educate yourself – do the research and learn as much as you can about obsessive-compulsive disorder. Familiarize yourself with symptoms, treatment approaches, and ways to support your child.
• Talk to your teen – be open and let your teen know you want to talk. Encourage your child to discuss his or her challenges, worries, etc.  Important to remember is that you although you cannot force your teen to open up, you can let him or her know you are there when he or she is ready to talk.
• Take care of yourself – having an adolescent or teenager with obsessive-compulsive disorder is bound to take a toll on your own mental health and well being. There will be times where you likely feel frustrated, angry, overwhelmed, and/or helpless.  Thus, it is vital you care for yourself.  This may include identifying a support group and/or individual psychotherapist, reaching out to friends and family, incorporating self-care and ways to manage your stress, and getting adequate rest.
• Model a healthy, balanced lifestyle – adolescents and teenagers learn from their parents. Developing and demonstrating a healthy lifestyle (in terms of sleeping, nourishing the body, socializing, self-care, etc.) can help encourage your child to do the same.
• Don’t blame or shame your teen – it can be extremely frustrating to have a child with obsessive-compulsive disorder. Yet many of the difficult behaviors he or she may be displaying are likely not intentional, and thus, it is not helpful to yell, punish, or blame your child.
• Help your teen seek treatment and continue to encourage him or her to follow through with treatment plan and recommended services.

Polaris Teen Center offers residential treatment for mental health disorders, including OCD. For more information on our youth programs, or to speak with an admissions specialist, call 1-844-836-0222 today.