The defining symptoms of obsessive-compulsive disorder (OCD) are the same across all ages, but the unique experiences of adolescence may affect how the condition presents in teenagers. While teens’ obsessions and compulsions may be more likely to center around specific themes, all manifestations of OCD can be effectively treated with exposure and response prevention therapy.
Obsessive-compulsive disorder (OCD) can be hard enough for adults to manage—so, it’s no surprise that it’s especially challenging during puberty. Adolescence marks the moment many people begin to develop their sense of self, and it’s also when OCD often first presents or worsens.
Teens with OCD may experience obsessions and compulsions related to puberty, emerging sexuality, school work, and adolescent social dynamics. While younger children may be quick to speak up about disturbing thoughts or compulsive behaviors, teenagers are more likely to try to handle symptoms on their own. Because most teens live at home, it’s crucial that families understand how best to support adolescents with OCD. Read on to learn more about spotting the signs of OCD and teens, and the best ways to get help.
What are the signs of OCD in teens?
There are two key symptoms of obsessive-compulsive disorder: obsessions and compulsions. Obsessions are recurrent and unwanted thoughts, sensations, images, feelings, or urges that cause distress. Common OCD obsessions include:
- Worries about germs, illness, or death
- Extreme fears over doing something wrong
- Preoccupations with things being perfect or “just right”
- Disturbing and unwanted thoughts or images about harm
- Disturbing and unwanted sexual thoughts or images
- Intense fear of upsetting a higher power
- An outsized sense of responsibility
Dr. Parick McGrath, PhD, and Chief Clinical Officer at NOCD, says many teens with OCD seem to struggle with fears related to sex, sexuality and scrupulosity—an OCD subtype that revolves around religion, ethics, and morals—but obsessions typically vary from person to person. Even when fears aren’t rational, the discomfort they bring on can feel incredibly distressing.
A worrying or intrusive thought might not mean much on its own, but when it occurs frequently enough to disrupt day-to-day life, it can be a sign of OCD. To deal with the discomfort of obsessions, people with OCD engage in compulsions, which are repetitive behaviors or mental acts done in an attempt to ease anxiety, neutralize distressing thoughts, or prevent something “bad” from happening. Common compulsions in adolescents with OCD may include:
- Excessive checking, such as continuously checking that the door is locked
- Constant washing and/or cleaning, including repetitive handwashing
- Repeating actions until they are perfect or “just right”
- Organizing items to be symmetrical or in a particular order
- Mental compulsions, such as excessive prayer or mentally reviewing situations
- Confessing or apologizing excessively
- Saying lucky words or numbers out loud
- Excessively seeking reassurance
OCD’s impact on teenage life
OCD can put strain on home, school, work, and social life, and often interferes with daily functioning. Newfound independence—like access to a car or bank account, or simply having more freedom to do as one pleases—can be especially difficult for teens with OCD to manage. With fewer people guiding their actions, or reassuring them that they’re making the right choices, teenagers may experience more uncertainty—which is typically very difficult for people with OCD.
More independence and less guidance creates more things to have doubt about,”
Dr. Patrick McGrath
Puberty & emerging sexuality
Adolescence is a stressful time in and of itself—and hormonal fluctuations can affect OCD symptoms. “It can definitely play a role,” Dr. McGrath says. “Puberty opens up new areas of ways OCD can interfere with you.” OCD may cause obsessive thoughts or compulsions related to new physical changes, such as:
- Obsessing about experiencing unwanted erections.
- Compulsively praying after experimenting with masturbation, or experiencing wet dreams.
- Experiencing heightened intrusive thoughts before menstrual periods.
- Compulsively watching pornography to try to gain certainty about sexuality.
For teens who have begun dating, or are navigating complex social dynamics, relationship OCD (ROCD) can make challenging interpersonal situations feel even more difficult. Relationship OCD is a subtype of OCD, which is characterized by ongoing intrusive thoughts and compulsive behaviors related to close personal relationships. Your teen might persistently ruminate about whether or not they’re actually attracted to the person they’re dating, or turn to online relationship quizzes for reassurance about their feelings.
School & work
Teens with OCD may struggle with tasks such as making it to school on time, socializing with their peers and co-workers, or engaging in extracurricular activities. Time-consuming compulsions such as re-reading, trying to complete homework perfectly, or engaging in lengthy personal hygiene routines can make it difficult to manage deadlines, show up on time to class, or complete homework assignments. Teens with jobs may experience heightened fears of getting fired, causing them to hyperfocus on small details at work that in turn lead them to fall behind on their other duties.
Family dynamics
It’s not unusual for families to become involved in trying to accommodate a teen’s OCD symptoms. This often takes the form of responding to reassurance-seeking, a common compulsion in which someone asks repeated questions to confirm (or affirm) anxieties driven by intrusive thoughts. While providing continued answers to these questions may seem helpful, it actually serves to reinforce compulsive behavior, exacerbating OCD symptoms.
Families may also find themselves helping teens with OCD try to avoid symptoms, by avoiding situations, people, or objects that may be triggering. However, this, too, is a compulsion that exacerbates the cycle of OCD by giving power to OCD-fueled fears, and fostering isolation.
While it’s natural to want to support a loved one with OCD, families who unintentionally help their teens engage in OCD compulsions such as reassurance-seeking and avoidance may end up deterring their teen from seeking more effective treatment strategies.
Talking to teens about OCD
Feelings of embarrassment or confusion about how to ask for help may make some teenagers more likely to hide their symptoms. Many teenagers already feel overwhelming societal pressure to “fit in,” so it’s crucial to educate yourself on OCD, so you don’t accidentally make further stigmatizing remarks. Create open dialogues to foster conversations about mental health and OCD symptoms.
If you notice your teen engaging in reassurance-seeking as a compulsion, Dr. McGrath recommends gently noting that your teen seems to be asking similar questions repeatedly, despite receiving the same answer. He suggests offering your teen a notebook to write down the answers you’ve already provided, so they can reference them later. If necessary, draw a firm boundary to let your teen know that you will not be discussing these questions further, while gently reminding them they can refer to their book.
While the book might seem like its own form of reassurance, Dr. McGrath says a single set of written answers is typically not enough to satiate someone engaging in reassurance-seeking: “Nobody even looks at the book after a while because they’ve memorized [it].” Dr. McGrath warns that this kind of boundary-setting often results in pushback. It’s likely your teen will be dissatisfied with the notebook, and demand more reassurance. These conversations can be difficult to navigate, but Dr. McGrath says it can open up a bigger discussion about getting assessed by a therapist for OCD, and eventually seeking treatment.
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Treating teens with OCD
As with adults, teen obsessive compulsive disorder is best treated with a form of therapy called exposure and response prevention (ERP) therapy. ERP works by gradually exposing adolescents to potential triggers in a controlled environment, where they’ll learn how to experience obsessive thoughts without engaging in compulsions or receiving reassurance from family. That includes being taught how to sit with any doubts that arise.
ERP therapists often include family members in the therapeutic process, since many teens live with and interact regularly with family. “Families can, without even knowing it, get involved in the OCD compulsions,” Dr. McGrath says. “So, not only are you treating the person with OCD, you really are treating the family.”
Encouraging effective treatment
Some teens may feel scared to embark on treatment, or may be stubborn about starting at all, so it’s important to help them build confidence that this is the right decision. “ A lot of people would like to change, but they’re afraid of the process,” Dr. McGrath says.
If your teen is hesitant to address their OCD, you can help them find motivation by talking together about some of the ways life might improve afterward, or treating them to something special after they finish their ERP sessions or homework—like ice cream, or an hour of extra screen time. ERP is hard work, and it can feel good to engage in something enjoyable afterward.
While managing OCD in teenagers can be challenging, it’s not impossible. Treatment and family support can make a huge difference in your teen’s life.
Key takeaways
- OCD commonly emerges during adolescence, and may coincide with puberty.
- Teenagers may struggle to identify OCD symptoms, or speak up about them, even if they realize something’s not right
- OCD can impact home life, school, work, and interpersonal relationships.
- OCD in teens can be effectively treated with ERP therapy.