How teenagers experience OCD

Obsessive-compulsive disorder (OCD), a common mental health condition, affects up to 4% of children and adolescents. For teens — who are already in a developmental period of questioning their identity, values, and worldview — OCD can make life feel scary and distressing. 

But treatment for OCD is effective. With the right treatment, the expected outcomes for teen OCD is very positive. With the support of therapy, teens can learn how to confront their OCD fears, better understand their thoughts, and develop healthier ways of responding to their worries.

Signs and symptoms of OCD in teens

The recognized symptoms of OCD, per the Diagnostic and Statistical Manual of Mental Disorders (DSM), are the same for both adults and teens. 

In essence, OCD is characterized by:

• Obsessions: Intrusive and unwanted thoughts, images, or sensations that cause intense feelings of shame, fear, or guilt
• Compulsions: Repetitive and ritualistic behaviors that a person performs to try to ease and/or avoid the emotional distress caused by their obsessions

Research shows that child-onset OCD (which affects teens) can be unique in many ways from adult-onset OCD. Your teen may be experiencing OCD if they:

1. Intrusive thoughts and obsessions

• Have intrusive thoughts related to moral, religious, or sexual ideas that cause distress and lead to compulsive behaviors, like confessing or apologizing
• Show a strong need for symmetry, order, or the feeling that things need to be “just right” to ease discomfort
• Display persistent “magical thinking,” like believing certain thoughts or actions can prevent bad things from happening, even though there’s no logical connection
• Seem preoccupied with catastrophic fears about family members’ safety, even without any immediate threats
• Have excessive fears about contamination and germs

2. Rituals and compulsions

• Engage in rigid routines or rituals that, if interrupted, lead to frustration, anxiety, or emotional outbursts
• Perform compulsive checking behaviors, like repeatedly making sure doors are locked or homework is complete, beyond what would be considered typical
• Experience vague but intense feelings of unease that drive rituals, like repeatedly washing their hands without a clear reason why
• Engage in excessive organizing, counting, or ordering behaviors that disrupt daily life or take up large amounts of time

3. Avoidance and reassurance seeking

• Avoid specific places, people, or objects because of their fears and/or intrusive thoughts
• Repeatedly seek reassurance from parents, teachers, or friends, often about fears of harm, failure, or making mistakes

4. Emotional and behavioral responses

• Demonstrate increased irritability, frustration, or emotional outbursts — especially when their compulsions are interrupted or they can’t achieve a sense of certainty
• Struggle to articulate their thoughts but display visible distress or anxiety-driven behavior that could suggest unspoken obsessions
• Display noticeable changes in mood or increased anxiety during times of major developmental transitions, like starting middle school or preparing for college

5. Perfectionism and decision making

• Show signs of perfectionism, like getting stuck on assignments because they don’t feel they’re “good enough” to submit
• Have difficulty making decisions, even about simple things, because they fear making the “wrong” choice

6. Hoarding behaviors

• Exhibit hoarding behaviors, hold on to objects with little value, and become upset if anyone tries to throw them away

If you notice these signs, it’s important to get an assessment and diagnosis for your teen right away. OCD can be managed with the right treatment and support. But, left untreated, OCD tends to be a chronic condition — and it can increase the risk of additional mental health conditions in adulthood.

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What causes OCD in teenagers?

The causes of OCD are still being studied. Like many other mental health conditions, there’s likely no singular cause of OCD. Rather, multiple factors can come together to increase the risk of OCD in certain people.

Two of the biggest factors leading to OCD in teens are genetics and environmental risk factors when their parent is pregnant with them. Twin studies show that OCD in children and adolescents is up to 65% genetic, which makes OCD in teens more genetic than OCD in adults. Adverse life events in a developing fetus can cause changes in brain function. These changes can make a person more likely to develop OCD.

But environmental risk factors can play a role as well. These risk factors include:

• Childhood trauma (although some studies have found no link between OCD and adverse childhood experiences)
• PANDAS — or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections — a condition in which a streptococcal infection (like strep throat) triggers a sudden onset of OCD symptoms in children
• Certain temperament and personality traits, like perfectionism

How OCD affects teens’ lives

Living with OCD as a teen can make life challenging. Research shows that stress and anxiety is common in all teens, even in those who don’t live with mental health conditions like OCD. Common stressors include academic pressures, family conflicts, and navigating social and romantic relationships. When teens live with OCD, it can make these common sources of anxiety feel even more intense. 

OCD can affect teens in unique ways because of the stage of development they’re in. OCD can cause severe doubts about identity and relationships for some people. While what’s listed below are not official subtypes of OCD, they can provide insight and language to help people communicate about their experiences. For example:

• People with transgender OCD or sexual orientation OCD obsessively question their gender or sexual identity. People with this form of OCD may fear that they don’t know their “true” gender and/or sexual identity. This is different from teens who are exploring their identity or already identify as LGTBTQ+.
• People with relationship OCD worry about whether they really love their partners (or vice versa) or have excessive fears and insecurities about their relationships.
• People with moral scrupulosity OCD (also known as “religious OCD”) question their moral or spiritual “goodness” and compulsively pray, confess, or try to right their perceived “wrongs.” 

For teens, who are just beginning to explore their identities and values, OCD can overwhelm the process with doubt and uncertainty. It can be difficult for people with OCD to differentiate between “normal” worries and OCD fears.

OCD can affect teens in every area of their lives. For example:

1. Academic and extracurricular 

• At school, OCD obsessions can be distracting, which can prevent teens from reaching their full academic potential.
• OCD compulsions can take up hours of the day, which can take time away from other important responsibilities and hobbies.
• Participation in extracurricular activities, like sports or clubs, can be limited by rituals or anxiety.

2. Identity and self-perception

• OCD about identity can affect the healthy process of discovering where one fits into the world.
• OCD can cause feelings of shame or embarrassment, which can lead to other mental health conditions like depression.

3. Social and interpersonal relationships

• OCD can affect relationships. For example, teens may withdraw from friends and family out of fear that their intrusive thoughts or compulsions will be misunderstood or judged.
• Obsessions around perfectionism or fear of making mistakes can also make it difficult for teens to form and/or maintain close friendships.
• Family dynamics can be strained when parents or siblings unintentionally accommodate a teen’s compulsions to avoid conflict or emotional distress.
• Romantic relationships may feel overwhelming if fears about intimacy, contamination, or intrusive thoughts take over.

In addition, both teens and adults with OCD are more likely to live with additional mental health conditions. For example, up to 75% of people with OCD also live with depression.

Finding treatment for teen OCD

Fortunately, treatment for OCD is highly effective. Research shows that most teens with OCD experience reduced symptoms with professional treatment.

The most effective treatment for OCD is a type of cognitive behavioral therapy called exposure and response prevention (ERP). This therapy guides teens in gradually and intentionally triggering obsessive fears while resisting the urge to perform compulsions. This process can be frightening at first, but, over time, the obsessions begin to hold less power. You may continue to experience intrusive thoughts, but you’ll be better able to ignore them and focus on other, more important areas of your life.

In some cases, medication may be recommended to help manage OCD. You should talk to your pediatrician for more guidance on which medications may be safe and effective for your teen.

Find care with Rula

Living with OCD as a teen can feel frightening and overwhelming. But treatment is effective, and, with the right support, teens can learn to manage OCD symptoms at an early age and grow into adulthood with confidence and an eased mind.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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