OCD In Adolescent and Children: Signs And Treatment

According to the International OCD Foundation, it is estimated that at least one in every 200 kids and teens, which is around 500,000 youth in the United States, have OCD. This is approximately the same number of people who live in Atlanta, Georgia. It means that in any average-size elementary school, four or five kids with OCD are likely to be enrolled. In a medium to large high school, there could be 20 students struggling with the challenges caused by OCD.

Signs of OCD in adolescent and children can manifest in two main components—obsessions and compulsions. Common obsessions in children and adolescents mirror those prevalent in adults with OCD, encompassing concerns about germs, illness, death, negative events, imperfection, disturbing thoughts, unwanted sexual images, fear of upsetting God, and responsibility for past events. The persistence of these distressing thoughts, especially when coupled with compulsive behaviors, can signify OCD. 

Compulsions or rituals are actions that individuals with OCD feel compelled to perform in response to their intrusive thoughts. In adolescents, these compulsions may involve excessive checking, constant washing or cleaning, performing repetitive actions to achieve perfection, arranging items in specific ways, mental rituals such as praying, confessing or apologizing excessively, uttering lucky words or numbers, and seeking reassurance excessively.

Treatment for OCD in adolescent and children typically involves cognitive behavioral therapy (CBT), where individuals engage in sessions to understand and practice skills. Therapy is an effective way to understand how OCD (Obsessive-Compulsive Disorder) works by addressing the interaction between thoughts, feelings, and behaviors. It helps in developing coping and calming skills, managing anxious thoughts, resisting compulsive behaviors, and facing fears in a safe manner. Although medication may be used as an additional treatment method, the main focus of therapy is to identify and break the cycle of OCD by viewing it as a brain “trick” that reinforces compulsive rituals.

What is OCD In Adolescent and Children? 

Obsessive-Compulsive Disorder (OCD) is a mental health condition commonly seen in adolescents and children. It is characterized by persistent and distressing thoughts, images, or urges known as obsessions. The condition also involves repetitive behaviors or mental acts known as compulsions.

Children and adolescents with OCD may experience a variety of obsessive themes such as fears of contamination, harm coming to themselves or others, a need for symmetry, or concerns about things being “just right.” The compulsions are repetitive behaviors or mental rituals performed to alleviate anxiety or prevent a feared event. Examples of compulsions include checking, washing, counting, or repeating actions until they feel “right.”

According to data, the onset of OCD occurs by age 14 in approximately 25% of cases. This mental condition affects children and adolescents significantly, leading to poor academic performance, social isolation, and reduced well-being.

However, it is treatable, and cognitive-behavioral therapy, especially Exposure and Response Prevention (ERP), is a highly recommended and effective approach for managing symptoms in this population. In some cases, medication may also be prescribed under the guidance of a healthcare professional. Early identification and prompt intervention are crucial for better outcomes in managing OCD in children and adolescents.

What Are Obsessions?

Obsessions in OCD are repetitive thoughts inducing anxiety, ranging from fears about potential events to specific expectations. Those with OCD may persistently worry about various aspects of their life, accompanied by disturbing or frightening mental images. In teen OCD, these obsessions can take diverse forms. Common types of obsessions encompass concerns about sexual orientation (HOCD), fear of germs, worry about illness or death, fear of violent actions, anxiety about something bad happening, disturbing sexual thoughts, religiously themed troubling thoughts, and more.

To cope with these obsessions, they may engage in compulsive behaviors such as repeated hand washing, arranging items in specific orders, or counting. These compulsions can be so overwhelming that they interfere with daily activities and productivity. However, it is important to note that these compulsions only provide temporary relief and do not address the underlying issues.

What Are Compulsions?

Compulsions are behaviors or rituals individuals feel compelled to perform due to a strong urge. These rituals may involve specific actions or repetitive thoughts that they believe are necessary to prevent distress. Teenagers with OCD often exhibit compulsive behaviors as part of their symptoms.

Common compulsions in obsessive-compulsive disorder (OCD) include excessive washing or cleaning, arranging items in a specific order, counting, constant checking (such as locked doors or turned-off stoves), repetitive actions for perfection, seeking constant reassurance from others, and excessive praying. Checking and ordering are the two most prevalent types of compulsions in OCD.

OCD is diagnosed when obsessions and compulsions significantly interfere with a teen’s normal functioning or cause substantial distress. However, certain behaviors, like being very organized, don’t automatically indicate OCD.

What Are The Signs Of OCD In Teens And Children? 

As mentioned before, obsessive-compulsive disorder (OCD) in kids and teens has two parts: obsessions and compulsions. These obsessions are similar to those experienced by adults with OCD and include: 

  • Anxiety about germs, illness, or death.
  • Intense fears related to negative events or fear of making mistakes.
  • Obsession with things being perfect or meeting specific standards.
  • Intrusive and distressing thoughts or images involving self-harm or harm to others.
  • Unwanted and disturbing sexual thoughts or images.
  • Concerns about upsetting a higher power or god.
  • Worry about engaging in activities that could harm others, such as driving a car.
  • Unwanted thoughts about suicide.
  • Belief in superstitions as a means to prevent negative occurrences.
  • Feeling responsible for past negative events or mistakes.

Frequent intrusive thoughts, though seemingly insignificant on their own, can signal Obsessive-Compulsive Disorder (OCD) when they disrupt daily life, particularly when accompanied by compulsions or rituals. Compulsions are actions individuals with OCD feel compelled to perform to alleviate unwanted obsessions. Common compulsions seen in adolescents with OCD include:

  • Excessive checking, such as repeatedly ensuring the door is locked or the stove is off.
  • Constant washing and cleaning, involving repetitive hand-washing or excessive showering.
  • Repeating actions until they meet perfection or a specific standard, with a tendency to start over if expectations are not initially met.
  • Arranging or ordering items in a particular way, consistently rearranging them if not in the “correct” place.
  • Mental compulsions, like excessive praying or mentally reviewing situations.
  • Confessing or apologizing excessively.
  • Uttering lucky words or numbers out loud.
  • Excessive seeking of reassurance.

What Is It Like Living With OCD?

Living with OCD can be an extremely stressful experience. Most people who suffer from OCD are aware that their thoughts or actions don’t make sense, but stopping these actions can often leave them with a sense of dread as if something bad will happen if they don’t perform their rituals. The reason they continue to take part in these rituals is to keep negative thoughts and feelings at bay.

As time passes, rituals can become increasingly complex. Individuals with OCD may begin with a simple ritual, but these can multiply over time until they develop lengthy and complicated routines that they feel compelled to perform on a daily basis.

OCD rituals can manifest in various aspects of life, such as an individual’s morning routine, commute, or other daily activities. As OCD becomes more severe, these rituals can start to dominate many areas of life for those affected by the disorder. It can be especially challenging for young people with OCD to cope with the progression of new symptoms.

What Triggers OCD in a Teenager?

Obsessive-Compulsive Disorder (OCD) can occur in teenagers if there is a family history of anxiety or OCD. Additionally, OCD can be triggered if a teenager has experienced a stressful or traumatic event. In rare cases, a streptococcal infection may also trigger OCD symptoms. The signs of OCD in teens include both obsessions and compulsions. OCD can first appear during childhood, teenage years, or early adulthood.

What Are The OCD Co-Occurring Disorders? 

It is common for individuals with Obsessive-Compulsive Disorder (OCD) to also experience other psychiatric disorders at the same time. This can make it more complicated to treat their primary condition. The co-occurring disorders can have a significant impact on the overall clinical presentation. Some of the most frequently encountered co-occurring disorders include:

  • Depression: A pervasive and persistent low mood that can interfere with daily functioning.
  • Bipolar Disorders: Conditions characterized by fluctuations between periods of depression and episodes of elevated mood or mania.
  • Substance Use Disorders: Compulsive substance use despite negative consequences, potentially exacerbating the challenges of managing OCD.
  • Eating Disorders: Disordered eating patterns that may manifest as an additional layer of complexity in treatment.
  • ADHD/ADD (Attention-Deficit/Hyperactivity Disorder): Difficulty with attention, hyperactivity, and impulsivity that can coexist with OCD.
  • Anxiety Disorders: Conditions such as social phobia or panic disorder, can intensify overall anxiety levels.

The OCD treatment becomes more complex when it co-exists with other psychiatric disorders. To tackle the challenges presented by each disorder, a comprehensive and customized approach is necessary. Understanding the interplay between these conditions is critical in developing effective therapeutic strategies for people with OCD and other psychiatric conditions.

What Are The First Steps in Handling OCD in Adolescent and Children? 

Here are the initial steps to consider if you suspect your teenager has or is developing Obsessive-Compulsive Disorder (OCD):

  1. Initiate a Conversation: Begin by talking to your teen about the observed behaviors, expressing concern, and emphasizing your willingness to help and listen. Recognize that your teen may respond defensively or deny any issues due to potential feelings of shame. Avoid judgment or criticism, as these reactions can exacerbate the situation.
  1. Seek Evaluation: It is recommended that you arrange for an evaluation for your teenager, starting with their pediatrician or family doctor. The evaluation should include a physical examination to rule out any underlying medical conditions that may be contributing to or worsening their symptoms. Due to the complexity of OCD, it is crucial to involve a psychologist or psychiatrist who has expertise in treating children and adolescents, particularly in the context of OCD. If necessary, seek referrals or recommendations from your family doctor or pediatrician.
  1. Initiate Treatment: Given that OCD symptoms often worsen over time, early intervention is vital. Treatment for OCD typically involves a combination of psychotherapy and medication. If the symptoms are severe or if your teen has coexisting psychiatric disorders, a more intensive level of treatment may be necessary for a certain period. Prioritizing timely and appropriate intervention is essential in addressing the challenges associated with OCD in teenagers.

What Are The Treatments for OCD In Adolescent and Children?

  • Individual Psychotherapy: Psychotherapy, also known as talk therapy, is a key component in treating OCD in teens. It helps the individual comprehend their obsessions and compulsions, addressing underlying issues. Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), stands out as a highly effective therapy for OCD. ERP involves systematically exposing the individual to anxiety triggers, and teaching healthy coping mechanisms instead of engaging in compulsive responses.
  • Medication: Medication plays a significant role in OCD treatment. Studies have shown that a combination of medication and therapy is more effective in treating mental health issues than medication alone. The most commonly prescribed medications for conditions like depression and anxiety are SSRI antidepressants such as Celexa, Paxil, and Zoloft, as well as Clomipramine, a tricyclic antidepressant. Medications can also be prescribed to manage symptoms of co-occurring disorders.
  • Family Therapy: Recognizing that OCD affects the entire household, family therapy is integral to treatment. It educates parents and family members on providing support without enabling the teen’s compulsions.
  • Dual Diagnosis Treatment: If a co-occurring substance use disorder is present, dual diagnosis treatment may be necessary, ensuring comprehensive care for individuals facing both OCD and substance-related challenges.

Why Do Some People Get OCD But Others Don’t?

One’s genetic makeup can influence the likelihood of developing OCD. It is common for OCD to be present in families, and if one family member has the disorder, it is possible that another family member may also develop it. The structure and chemistry of a person’s brain can be impacted by their genes, making some individuals more susceptible to developing OCD than others. 

OCD is characterized by persistent, intrusive thoughts that are difficult to shake off. Over time, people with OCD may develop more elaborate rituals that they feel compelled to perform, resulting in a worsening of their symptoms. Early intervention is critical for teenagers with OCD, as it can make treatment more manageable and effective.

How Bad Can OCD in Teens Escalate?

People who have Obsessive-Compulsive Disorder (OCD) are at a higher risk of suicide, especially if they also have depression, bipolar disorder, or another anxiety disorder. If they experience stressful or traumatic situations, it can worsen their OCD symptoms, and some teenagers may use non-suicidal self-harm, like substance abuse or cutting, to cope. In situations where your teenager’s safety or well-being is in danger, it is important to act quickly, these are some things you can do:

  • Contact your child’s treatment provider urgently.
  • Seek immediate support or assistance from a trusted family member or friend.
  • Call an emergency hotline for professional guidance.
  • Take your child to the nearest hospital emergency room, ensuring safety.
  • Dial 911 for immediate assistance.

Comprehensive OCD Treatment for Teens

Discover the specialized treatment for OCD in adolescents at Bright Path Behavioral Health. Our compassionate and tailored programs are designed to support teenagers on their journey to wellness. We offer a range of programs, including after-school initiatives, adolescent self-harm treatment, outpatient programs for teens, and family involvement programs, to provide comprehensive care and support for mental health. 

Author: Shantel Sullivan Ed.D., LCSW
Dr. Shantel Sullivan, Ed.D., LCSW, serves as the CEO of Bright Path with a rich background in residential adolescent treatment, adult outpatient services, and academia, leveraging over a decade of licensed social work experience in New York and North Carolina. Her academic credentials include a BA in Sociology, an MSW and a graduate certificate in addictions counseling from the University of New England, culminating in a doctoral degree in Educational Leadership focused on transformational leadership. Beyond her clinical expertise, Dr. Sullivan contributes to the field as a national speaker, educator, and editor of the Bright Path Teen Mental Health Blog, committed to enhancing access to evidence-based mental health care for adolescents and their families.
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