OCD in Teenagers: Understanding the Signs and Getting Support

While OCD can happen at any age, it’s most common for people to be diagnosed in their teenage years and during the transition from high school to college. Many adolescents who receive a diagnosis will reflect on how they experienced symptoms much earlier in their lives. This experience is not uncommon, but at the same time, the challenges and changes of the teenage years create a risk that OCD symptoms might go unnoticed. The good news is that by becoming more educated about OCD, we can more readily recognize it and ensure it’s properly treated.

It’s important to acknowledge that teenagers often experience a wide range of adjustment issues, and not all of them are indicative of mental health issues. They’re navigating peer interactions and parental expectations, becoming more independent, and experiencing changes in their bodies and hormones, all of which can lead to increased anxiety and uncertainty about the future. However, sometimes those feelings are caused by something more serious, and it’s important to know when that’s the case.

There are several ways you can identify that your teen may be experiencing OCD symptoms and, by being able to notice these warning signs, you can get them the support they need.

How to tell if something might be wrong

Parents and caregivers usually want to know what specific signs of OCD they should look for in their teenagers. In general, teens will show symptoms of OCD in a similar way to adults, with the primary difference being that teens may have less insight into what they are experiencing. Examples of some common OCD symptoms affecting adults and teens alike are intrusive thoughts about topics that become obsessive and cause a great deal of distress, and compulsions, behaviors done in an attempt to neutralize anxiety and distress.

Though themes of these intrusive thoughts can vastly differ, some categories are more prevalent, with many people reporting obsessions revolving around harming loved ones and themselves; over religion, morals, perfectionism, or things needing to be just right; or even developing some rare disease. Of course, these are just a few, and OCD can be very creative and nuanced. Teenagers may know that something is wrong, but find that they’re not quite able to put it into words, making it difficult to ask for support.

Adding to this issue, social perception is usually very important to teens. Their relationships with peers are often at the forefront of their concerns and, since intrusive thoughts can cause a great deal of shame and guilt, many teens will avoid discussing them with others. This can lead them to feel isolated in what they’re experiencing. This sense that no one can understand what they’re going through can interfere with getting a diagnosis and the proper treatment.

To avoid this, it’s important to recognize the warning signs that a teenager in your life may be struggling with OCD. Difficulty with school—often seen as a change in attendance or grades—is one of the first signs to look for. Maybe they were previously getting B’s and C’s, but now they’re failing. Or perhaps they’re missing school more and more frequently, complaining about various physical problems.

But, while noteworthy, difficulty with school certainly isn’t the only sign to look for. Weight changes, changes in mood, changes in sleep patterns, increased anxiety—really, anything out of the ordinary—should also be assessed. While these changes could be related to many issues, they all have the potential to signal a larger problem.

Ways OCD can present in teens

OCD is very nuanced. The condition can manifest in many different ways and if something isn’t mentioned here, that doesn’t mean there isn’t a chance it could be OCD. With that said, there are several behaviors to look for in teenagers that may warrant an evaluation for OCD.

Intense fears and preoccupations:

Whether these fears and preoccupations are new or have greatly increased, they all share the underlying feature: anxiety—which is why OCD can be misdiagnosed as Generalized Anxiety Disorder (GAD). No matter what subject matter is getting “stuck” in the teenager’s brain, they might feel a sense of doom, distress, and uncertainty surrounding the obsessions, often accompanied by an urgent need to solve the questions that arise as a result.

Like any aspect of OCD, these can take many forms, but here are some more common ways they may present:

• Fears related to germs and/or contamination/body wastes, illness/health, or death and dying
• Fears related to harming self or others, intentionally or accidentally
• Preoccupations with symmetry and order, or a need for things to be “just right”
• Religious or moral preoccupations
• Fears of a sexual nature, such as fears of being attracted to the same sex, or doing something sexually that goes against their beliefs
• Magical thinking, or the belief they can control certain events by how they think or act; preoccupations with numbers, colors, items, etc. that they consider to be special, lucky, or unlucky; or increased superstitious beliefs
• Fears of people not liking them, of having upset someone, or of having done something to emotionally hurt someone else

Behaviors that could be compulsions:

When your teen isn’t sharing their inner fears and thoughts, you might be more likely to notice outward signs of OCD, like compulsions. Compulsions are behaviors that individuals with OCD will engage in to temporarily relieve the feelings brought on by intrusive thoughts or obsessions. Sometimes these behaviors are visible, but they can also happen internally or mentally. Again, the ways OCD presents itself vary greatly, but these are some common compulsions you can look out for:

• Excessive cleaning, showering, or washing of hands, self, items, laundry, etc.
• Confessing thoughts out loud to a trusted person
• Frequently asking for reassurance, such as, “Are you mad at me?”
• Repeating phrases, whether aloud or inside their head
• Excessive praying or asking for forgiveness
• Arranging or ordering things in a specific way, or becoming agitated when this is not done
• Demanding things be a “certain” way, and repeating or starting actions over until they feel “right”
• Excessive checking: if the doors or windows are locked, if the stove is off, etc.

What distinguishes these thoughts and behaviors from those not caused by OCD is their excessive and persistent nature. Symptoms become problematic when they consume more and more time and interfere with day-to-day activities. For those who suffer from OCD, these symptoms will often be debilitating and take up many hours in a day.

How you can help your teenager

Caregivers often want to know what they can do to help their loved ones. Early detection is so important. I know this from my own experience with OCD, and wish I had known what I know today when I was a teenager going through this oftentimes debilitating condition. By paying attention to your teen and looking for signs that they may be struggling, you’ve already taken an important step in helping them. Here are some additional ways you can support your teenager if they’re experiencing OCD symptoms:

• Be present: You don’t necessarily need to “fix” anything, just let them know that you are there for them and that you will listen without judgment.
• Set firm boundaries: Pay attention to your involvement in compulsions. It’s important not to get caught up in providing reassurance or engaging in behaviors alongside your teen.
• Get the help of a specialist: OCD is highly treatable. Exposure and response prevention (ERP) therapy was developed specifically to treat OCD and is backed by decades of clinical research. In ERP, a therapist will alongside your teenager and you to develop a plan to reduce accommodations in your home. While this will seem difficult initially, it’s the most effective way to help your teen in the long run.
• Communicate openly: Let your teen know ahead of time that you will be responding to their OCD symptoms differently than you have in the past.
• Separate them from their symptoms: The teenager in your life is so much more than their OCD symptoms, and it’s important that they know this. Teens with OCD are often overwhelmed with feelings of shame and guilt. Letting them know all of the things you love about them can remind them that they are not what they think and help them learn to practice self-compassion.
• Watch how you respond: Try to not use logic to argue with the symptoms of OCD. Even if your teen can recognize that a fear might be irrational, looking at that fear with logic won’t change how it feels: incredibly real and overwhelming. Instead, it may be more beneficial to help your teen learn how their brain is working, and how OCD can cause its “alarm system” to malfunction.
• Educate your teen (and yourself) on OCD and ERP: Learn the many benefits of therapy and share them with your teen, but give them space if they’re not ready for such a big step. Wherever they are in their journey, building your own knowledge of OCD and ERP will help you be their biggest supporter.
• Find support for yourself: While you’re taking care of your teen, make sure you’re not neglecting your own needs. It might feel selfish to focus on self-care, but it’s one of the most important things you can do and enables you to be a more effective ally for them.

ERP is the gold-standard treatment for OCD

If you think your teenager has OCD, it’s recommended that you seek out someone specialty-trained in ERP therapy. Research shows that this is the most effective therapy for people with OCD, but it can also be beneficial for teens with anxiety. It’s important to note that while traditional talk therapy uses skills that may be helpful for many areas of mental health, it is not the right treatment for OCD.

Remember that your teen is not their OCD, and getting better is possible. If your teenager is struggling and is hesitant to begin treatment, NOCD can help. Our licensed therapists deeply understand OCD, are specialty-trained in treating OCD with ERP, and receive specific training in treating children and adolescents. We work side-by-side with the OCD experts and researchers who designed some of the world’s top treatment programs, ensuring the best care for our members.

You can book a free 15-minute call with our team to learn more about getting your teenager matched with one of our therapists and starting OCD treatment. If you’d like to learn more about the condition and how to best help your teen, you can also ask about our family support sessions. Designed for parents, caregivers, and loved ones, these sessions can help you learn ways to support your teenager as they work to manage their symptoms.