OCD (the acronym of obsessive-compulsive disorder) is a term that’s often used colloquially to describe a fixation with things being a certain way. But obsessive-compulsive disorder is a serious mental health disorder that can have a huge impact on teenagers’ lives. When untreated, OCD can disrupt young people’s social and emotional development, lead to social withdrawal from friends and family, and affect their education. It’s also linked to mental health disorders later on in life.
This means that speaking about and raising awareness of OCD matters. Diagnosing and treating OCD early can reduce the harm caused to young people’s lives, supporting development, personal growth, and flourishing.
What Is Obsessive-Compulsive Disorder?
Obsessive-compulsive disorder is an anxiety-related disorder that usually develops during childhood or adolescence. Anyone can develop OCD, regardless of their gender identity, age, ethnicity, religion or background. However, certain experiences make some people more likely to develop OCD than others.
OCD is a serious mental health disorder that can have a big impact on a teenager’s daily life. However, it is treatable, and with the right support, young people can reach full recovery.
Teenagers who live with OCD experience patterns of thinking, feeling, and behaviour known as obsessions and compulsions.
- “Obsessions” are unwanted thoughts, emotions or images that cause anxiety and distress.
- “Compulsions” are behaviours that adolescents with OCD use to try to stop obsessions, but offer only short-term relief before the intrusive thoughts return.
Teenagers with OCD experience vicious cycles of obsessions and compulsions that can feel very difficult to break. These patterns are exhausting and can cause anxiety, depression and other mental health symptoms.
The obsessions that young people experience can involve different themes, such as contamination, harm, moral fears, or the need for things to be “just-right”.
How Is OCD Diagnosed in Adolescents?
Diagnosing OCD in adolescents requires careful developmental contextualisation. Some young people, especially younger adolescents, may struggle to verbalise their obsessions. They may also involve family members in their compulsions, and sometimes, family members can accommodate and enable these rituals.
Evidence-based assessments for OCD usually involve:
- An interview with the young person and their parent or caregiver
- Standard screening assessments
- Assessment of co-occurring mental health symptoms, such as anxiety, depression, and behavioural difficulties
- An evaluation of family accommodation
- An evaluation of the impact of OCD symptoms on their daily life
- A risk assessment, including suicidality and self-harm
Unfortunately, OCD is still often misdiagnosed as other mental health disorders, such as anxiety or perfectionism. This can lead to delays in receiving the effective treatment that young people need.
How Do Families Accommodate OCD?
Family accommodation happens when family members act in ways that make it easier for a person to carry out their compulsions. While often well-intended, family accommodation can help sustain OCD symptoms and make recovery more difficult.
Family accommodation might involve:
- Taking part in the performance of rituals
- Helping a young person avoid situations that make them anxious as a result of intrusive obsessions
Families can take part in rituals and compulsions in different ways, depending on the content of a young person’s obsessions and compulsions. For example, when a young person engages in compulsions related to cleanliness, parents might buy special soap or excessively wash their hands. Or they may answer a phone call and check that a stove is turned off when a young person engages in checking compulsions.
Facilitating the avoidance of anxiety-provoking situations might involve holding doors open for a young person so they don’t have to touch the door handle. Or it might mean avoiding moving the furniture in the house to avoid anxieties about symmetry and perfection.
One study among families of children with OCD found that 46% of parents reported participating in rituals on a daily basis. Almost all parents reported that they engaged in at least some kind of accommodation.
Increased family accommodation is associated with more severe OCD symptoms and more severe functional difficulties in daily life. It’s also linked to difficulties in family functioning.
Families often start accommodating OCD symptoms to make relationships easier and to avoid causing a young person additional distress. This can seem like a way to navigate and manage the impact of OCD on the family. However, in reality, accommodating OCD behaviours tends to cause families additional distress, especially when they become involved in rituals.
Family accommodation is also closely linked to treatment outcomes. Multiple studies suggest that accommodating behaviours among families can hinder and disrupt the recovery process. Higher levels of family accommodation are linked to worse treatment outcomes for young people.
What Are the Risk Factors for OCD in Teens?
OCD is a complex condition that’s impacted by both genetic vulnerabilities and life experiences. While it’s still not clear exactly how OCD develops, research suggests that difficult childhood experiences, such as bullying, trauma, and chronic stress, may interact with genetic factors like personality and character traits to cause OCD symptoms.
Experiences like trauma and chronic stress may intensify certain traits and ways of thinking that underpin OCD. For example, traumatic experiences often increase young people’s sensitivity to and perception of threats and danger in the world around them. This might make them more susceptible to intrusive thoughts that relate to danger or harm.
Trauma, especially complex and ongoing interpersonal trauma, is also connected to feelings of guilt and shame. This can cause young people to feel a sense of heightened responsibility for things that happen, making them more vulnerable to experiencing obsessions.
What Are the Consequences of OCD for Teenagers’ Mental Health?
Child- or adolescent-onset OCD can disrupt important social and emotional developmental processes that shape young people’s well-being as adults. Adolescence is a time of rapid and profound development, as teenagers develop social and emotional skills through friendships and relationships, explore their identities, and find their role in their community.
OCD symptoms can hold young people back from the experiences that facilitate this development. For example, the need to engage in compulsions can make it difficult to attend school and can lead to school refusal, absences and missed school days. Secrecy and shame surrounding OCD symptoms can also make friendships more difficult, causing social withdrawal, loneliness, and isolation.
A study found that among children and adolescents entering a specialist treatment program for OCD, around one in five had only partial or no attendance at school.
Adolescents with OCD are also more likely to develop other mental health disorders, now and later on in life. One study found that among a group of adults who were diagnosed with OCD during adolescence, 71% lived with some type of mental health disorder.
Treating OCD in Teens
There are several evidence-based treatment approaches available that effectively treat obsessive-compulsive disorder in teens. One of the most established approaches is cognitive behavioural therapy (CBT) with exposure and response prevention (ERP).
ERP-based CBT supports young people to gradually encounter and tolerate situations that make them anxious, while engaging in fewer rituals and compulsions in response. ERP programs may include:
- Psychoeducation
- In-session and out-of-session exposure to feared situations
- Family interventions addressing accommodation
For more intense OCD symptoms, treatment plans usually involve a combination of treatment approaches, tailored to their needs. These might include:
- CBT with ERP
- Acceptance and commitment therapy
- Interference-based therapy
- Support groups
- Family therapy
- Medications such as SSRIs
OCD Treatment for Neurodiverse Young People
Many young people living with OCD are neurodiverse. For autistic young people, symptoms of OCD can be difficult to distinguish from fear of change, reliance on routines and restricted interests. This means that diagnosing and treating OCD requires care, openness, flexibility and consideration.
Mental health professionals may need to adapt standard therapeutic tools to match a young person’s communication style, sensory needs and ways of thinking. This might involve using more visual aids and different languages, and paying attention to the sensory elements of a treatment space and instances of exposure.
The Wave Clinic: Transformative Recovery Programs for Young People and Families
The Wave Clinic offers specialist mental health support for young people and families. We take a whole-person approach to mental health care, combining clinical care with enriching experiences, education, and global citizenship. We offer a broad range of evidence-based modalities, based on the most up-to-date medical research.
Our programs are trauma-focused, emphasising the role of past experiences in shaping present lives. We centre the role of the family and other interpersonal relationships as powerful tools in recovery and long-term well-being.
We work from several residential and outpatient treatment spaces in Kuala Lumpur and Dubai. If you’re interested in finding out about our programs, get in touch today.
