The teen who lines up all their shoes and folds their T-shirts just so. Or the one who double-locks (then triple, then quadruple, and on and on) to ensure the door is secure when they leave.
Maybe these teens are just organized and careful. This might sound like a dream to those of us with messy or flighty teens. But if a teen’s behaviors are compulsive and repetitive, and they interfere with normal functioning, it might be a sign of something more. That’s when parents should consider whether the behaviors could be a symptom of obsessive-compulsive disorder, commonly known as OCD.
How do parents know whether their teenager just has a few quirks, or there’s actually a larger issue?
Ginger Lavender Wilkerson, a licensed marriage and family therapist in Long Beach, California, works with teens experiencing anxiety and OCD. She explains that the American Psychiatric Association defines obsessions as intrusive thoughts or images that cause distress or anxiety. Additionally, compulsions as behaviors that a person feels compelled to do in order to ease their anxiety or suppress the thoughts.
Since parents can’t read their teenager’s thoughts, Wilkerson suggests parents look for these three outward signs that could indicate OCD:
- Significant changes in routines, especially if a teen is spending a lot of time on simple tasks such as leaving the house
- Obsessing over certain topics, trends, or ideas
- Compulsions or obsessions that are impairing functioning in school, at home, or around the community. “They might be late, or missing activities, or be overly afraid of making mistakes and not doing things correctly,” Wilkerson says.
Many parents are reluctant to bring up OCD, fearful it will plant an idea that’s not yet there. But that’s rarely the case, says Misti Nicholson, director and clinical psychologist with Austin (Texas) Anxiety & OCD Specialists, who says teens typically experience tremendous relief once the topic of OCD is introduced.
“They are usually already aware that they are doing things that other teens are not,” says Nicholson. “And it can be normalizing to learn both that there is an explanation for their experience. And that they are not alone.”
To start the conversation, she encourages parents to share their observations and ask open-ended questions. For example, you might say, “You’ve seemed preoccupied lately. What’s been on your mind?”
Then ask your teen if they have noticed these behaviors, and if they see them as a problem or something that they cannot control by themselves, suggests Amanda Petrik, LCPC, who often works with teens who have OCD.
Once the problem is identified, you can gently explain how OCD is impacting the family’s functioning. Be careful to emphasize that the teen is not the problem, rather the condition of OCD is the problem. “I often compare mental health issues to physical issues, such as asthma or diabetes. Then I explain that this is not something the child has chosen to have, but that there are treatments that can help,” Petrik says.
Some OCD might be channeled positively in the form of increased attention to grades or sports by certain high-achievers. The downsides, however, indicate that parents should seek out a professional.
Treatment is important because, in addition to living with the uncomfortable symptoms of OCD, a teen may also struggle with related problems, says Wilkerson. These may include:
- Depression, including diminished self-worth due to shame about inability to control impulses
- Difficulty managing friendships or family relationships because of OCD symptoms—for example, when a fear of getting germs leads to avoidance of others
- Other forms of extreme obsession like trichotillomania, the irresistible urge to pull out body hair
Cognitive behavioral therapy (CBT) is the therapy most often recommended for patients with OCD.
CBT can help teens significantly lessen OCD behaviors and substitute supplemental coping skills. “For example, if a teen is worried about germs and constantly washes their hands before moving to the next activity, you could try to go from eight times per day to just four,” Wilkerson suggests.
The good news, experts agree, is that OCD is highly treatable. With help, teens who have OCD are likely to get relief from the weight of their obsessions and compulsions and free up energy and time for the things that really matter to them.