Teens are faced with unique stressors that, for those predisposed to OCD symptoms, can manifest in debilitating ways. Obsessive Compulsive Disorder (OCD) is a mental health condition characterized by unwanted intrusive thoughts (obsessions) and time-consuming mental and physical rituals aimed at resolving them (compulsions). Research suggests that roughly 1-2% of young people will experience at least one episode of clinically diagnosable OCD.
It’s hard enough being a teenager without additional challenges like OCD, but understanding some key issues for teens with OCD can help catch symptoms early, access treatment, and save the whole family from needless suffering:
- Teens have new material to obsess over. OCD sufferers struggle to accept uncertainty about their thoughts. Often for the first time, teens are encountering issues of sexual identity, social status, romantic relationships, changes in their body, increased personal responsibility, and religious and moral identity. All of these issues are naturally filled with uncertainty, and are easy material for the OCD mind to obsess over. As we approach adulthood, we learn how to make educated guesses about many of these issues, but teens with OCD often find themselves paralyzed with fear that their best guesses will come out wrong.
- Teens are not always so excited about having a mental illness. Teens are particularly sensitive to labels, especially being labeled “ill." Although OCD is a treatable disorder that can ultimately be mastered, compassion and patience for a teen who’s not quite ready for therapy is also important. The most effective treatment for OCD is cognitive behavioral therapy (CBT), sometimes with the additional support of medication. Treatment makes a huge difference, but teens may be especially uneasy about associating themselves with a mental health diagnosis, so be gentle in identifying symptoms and invite collaboration rather than order them to just get better.
- It’s not just about washing and checking. While many compulsive behaviors are obvious (excessive checking of locks, washing of hands, showering, or other physical rituals), others are more difficult to uncover. Obsessions related to violent, sexual, religious, or moral content may be internally responded to with avoidance or other mental rituals (such as mental review, thought neutralization, and self reassurance). A teen with OCD may appear to be “in his/her head” a lot, and the symptoms are easily misconstrued as signs of depression, attention deficit disorder, or a defiant personality. Teens may demand family members accommodate their compulsions, but this can lead to worsened, reinforced symptoms. Family members often need to be involved in treatment to help reduce compulsive behaviors at home.
- Academic difficulty can be one of the first signs. OCD symptoms can include repeatedly re-reading or re-writing, excessively checking for mistakes, compulsive slowness in completing schoolwork, getting stuck on issues of exactness in one’s work, excessively seeking reassurance about assignments from teachers and classmates, and difficulty focusing on tasks (due to mental rituals).
- Teens are smarter than their OCD. Teens are quick learners, open to abstract thinking and prone to sudden bursts of insight that naturally lend themselves towards a mindful and cognitive behavioral approach to treatment. Mindfulness involves learning to see oneself as an observer of thoughts and feelings and to accept their presence without judgment. Cognitive therapy focuses on challenging distorted thought patterns and false assumptions that can lead to compulsive behavior. Behavioral therapy, in particular exposure with response prevention (ERP), involves developing specific strategies for confronting fears and resisting compulsive responses. Teens can take a leadership role in their treatment if given the right tools.
Parents concerned about obsessive-compulsive symptoms in their teenagers should seek out resources, but be cautious about immediately diagnosing their children or forcing therapy upon them. Teens who struggle with OCD want their suffering alleviated (as well as the suffering of family members alongside them), but part of being a teenager involves learning to take command of one’s experience. Therefore, fighting OCD by engaging in CBT needs to be self-driven. So the best approach is to provide information, make resources accessible, express unconditional love, minimize hostility and criticism, and point to an open door for treatment. A good place to start is the International OCD Foundation, which has resources for parents and teens, as well as a directory of therapists who treat OCD.
Ultimately, being a teenager under the best of circumstances is often uncomfortable, definitely awkward, and inherently anxiety-producing. OCD capitalizes on this discomfort with demands for certainty and perfection in situations where only acceptance and tolerance can lead to success. But with the right treatment, teens with OCD can not only overcome their symptoms, but also learn lessons of persevering as adults that many of us miss.
Jon Hershfield, MFT is a psychotherapist licensed in Maryland and California and founder of The OCD and Anxiety Center of Greater Baltimore in Hunt Valley, MD.