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Obsessive-compulsive disorder (OCD) 101

Learn about living with OCD and common obsessions and compulsions in teens, such as cleaning, repetitive actions, and aggressive thoughts.

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You've probably heard someone joke around that they’re “so OCD” for arranging their books by color on their shelf, or for applying hand sanitizer on repeat throughout the day. Or if not, maybe you’ve seen OCD portrayed by someone on TV; think Monica from “Friends” or Sheldon on “The Big Bang Theory.” These examples offer a glimpse into life with OCD, or obsessive-compulsive disorder, but the condition is much more than a preference for tidiness or being a self-described germaphobe. 

Obsessive-compulsive disorder is a chronic condition defined by unwanted and recurring thoughts (obsessions) that cause people to engage in repetitive behaviors (compulsions). You can almost think of the compulsions as a response to the obsessions. While it’s possible for teens to experience obsessions without any compulsions, it’s rare and the more likely scenario is that the compulsions are present but not noticed. 

Specific OCD symptoms vary person to person, but some of the most common obsessions and compulsions among children and teens involve cleaning, repetitive thoughts and actions, and aggressive thoughts. This may seem harmless enough, but OCD can cause real distress without understanding and support (more on that later).

By recent count, 2.3 percent of the U.S. adult population has lived with OCD at some point during their life. OCD tends to begin in adolescence, with as many as 1 in 200 children and teens currently living with the condition. Some research shows that boys are affected more often than girls, though the prevalence between genders is similar after adolescence.

Below, we review the research on symptoms, causes, and treatments to support your journey in better understanding obsessive-compulsive disorder for yourself or a loved one. 

How do you receive an OCD diagnosis? 

Right now, you might be wondering if you or a loved one has OCD. To help answer that question, we’ll review the process for diagnosing this increasingly common mental health condition.

An OCD diagnosis requires obsessions and/or compulsions that are time-consuming (present for more than one hour per day), cause significant distress, and affect work or social functioning, according to the American Psychiatric Association. Most pediatric OCD cases are first identified using a six-question screening instrument called the Short OCD Screener (SOCS). From there, a healthcare professional will conduct a separate interview to review a person’s detailed history of obsessions and compulsions, as well as their developmental history.

The Short OCD Screener questions include:

  1. Do you wash or clean a lot?
  2. Do you check things a lot?
  3. Is there any thought that keeps bothering you that you would like to get rid of but you can’t seem to shake?
  4. Do your daily activities take a long time to finish? (i.e., getting ready for school or completing your homework)
  5. Are you concerned about putting things in a special order or are you very upset by messes?
  6. Do these problems trouble you?
Signs and Symptoms of OCD Infographic

Signs and symptoms of OCD

As discussed, there are two components to OCD: obsessions and compulsions. For people living with OCD, these sensations can be overwhelming, debilitating, and affect everything from school to relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety and distress. Some of the most common obsessions seen among kids and teens with OCD include:

  • Fear of germs or contamination
  • Fear of forgetting, losing, or misplacing something
  • Fear of losing control over their actions and behavior
  • Unwanted or taboo thoughts about sex, religion, or harm
  • Need for symmetry, order, and precision
  • Preoccupation with body wastes

Compulsions are unwanted, repetitive behaviors or mental acts that occur in response to an obsessive thought. Common compulsions among kids and teens with OCD include:

  • Excessive hand washing, showering, and teeth brushing
  • Ordering or arranging items in a particular way
  • Repeatedly checking things (i.e., making sure the door is locked or the toilet is flushed)
  • Rituals to prevent harming self or others
  • Hoarding things of no apparent value
  • Other cleaning rituals

Causes of OCD

Like other anxiety conditions, the root cause of OCD remains unclear but it’s believed to stem from a combination of genetic, neurobiological, behavioral, and environmental factors.

OCD and genetics

OCD is hereditary, though you're not destined to develop the condition just because it runs in your family. Research studying the connection between genetics and OCD shows that people with first-degree relatives (such as a parent or sibling) with OCD are more likely than those without a first-degree relative with the condition to develop OCD themselves. That risk is even higher if the relative developed OCD as a child or teen.

OCD and the brain

Another theory for why some people develop OCD involves the way that different sections of the brain communicate with one another. More research is needed, but the idea points to a link between abnormalities in certain areas of the brain and OCD symptoms.

OCD and behavioral/ environmental factors

Some research suggests that stressful life events and childhood trauma are associated with the development of OCD symptoms. It’s also worth noting that the majority of adults who have experienced OCD at some point in their lives will also have at least one other mental disorder, including: anxiety disorders, mood disorders, tic disorders, personality disorders, and attention deficit/hyperactivity disorder (ADHD).

Treating OCD

There's no one cure to solve for a person’s obsessions and compulsions, but there are several proven methods for coping with OCD. Common treatment options include medication, psychotherapy, and lifestyle modifications. 

Therapy

Cognitive behavioral therapy (CBT) is an effective method for treating anxiety disorders like OCD. It’s designed to raise awareness about negative thinking patterns in order to help people change the way they interpret those thoughts so that they can more effectively handle challenging situations. The idea is that by understanding the why and how of negative thought cycles, you’ll have the chance to recognize that the negative thoughts are actually just misinterpretations.

Other forms of evidence-based treatment modalities include dialectical behavior therapy (DBT) skills and mindfulness practices. Family therapy is also a great idea because it allows parents and siblings to better understand how to support their family members.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that are often used to treat OCD in children and teens. Antidepressants are prescription medications designed to balance the levels of chemicals in our brain called neurotransmitters, which can help to improve mood and functioning. 

SSRIs typically take 6 to 12 weeks to be effective. Remember: not all medications will work for everyone, so it's best to speak with a healthcare provider to learn more about which medication is right for you.

The following SSRIs are approved by the FDA for use in children and teens: fluoxetine, sertraline, fluvoxamine, and clomipramine.

Lifestyle modifications

Lifestyle changes alone may not cure your OCD but there are several tips to help you manage stress, anxiety, and any other negative feelings associated with the condition.

  • Eat a healthy diet. This means fruits, vegetables, whole grains, fish, nuts—you know the drill. Some small studies also show that vitamin D is linked to a decrease in OCD symptom severity in children and adolescents, but more research is needed.
  • Create a consistent sleep schedule. 
  • Stay connected with friends and family. No one should have to navigate OCD (or any other mental health condition) on their own, so don’t feel shy about leaning on your loved ones for support.
  • Maintain a regular exercise routine. One small study found individuals with OCD who engaged in aerobic exercise experienced improved mood and a reduction in anxiety and compulsions compared to those who received health education instead.

Find relief with Charlie Health

Living with obsessions and compulsions can be overwhelming, but you don’t have to suffer alone. OCD is manageable, especially when you have the resources and support to cope.

Charlie Health’s intensive outpatient program (IOP) connects each client with a licensed therapist based on their individual needs, preferences, background, and experiences to promote healing in a safe, supportive space. Therapy may sound daunting, but the Charlie Health community is here for you each step of the way.

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