Melissa Mose is a Licensed Marriage and Family Therapist with a private practice in Los Angeles since 1995. She has specialized in the treatment of OCD and anxiety since 2011 and currently trains and supervises associates in her group practice. She is the author of Internal Family Systems Therapy for OCD.
In popular media, obsessive compulsive disorder (OCD) is often portrayed as a set of quirks or odd fixations that may cause inconvenience or prompt eye-rolling reactions from others. In real life, OCD is a painful condition that can wreak havoc on individuals and families.
When she was 8 years-old, my daughter started showing symptoms of OCD. She asked questions on repeat for hours on end, avoided items or whole rooms of the house, and performed mini-rituals and checking behaviors throughout the day. I was well into my career as a mental health professional then, but I was still often confused, frustrated, and mystified about how to help her. Fourteen years after her diagnosis, I am now a specialist in treating OCD and work regularly with parents and kids struggling to cope.
The pre-teen and teen years are difficult enough, with issues like puberty, peer pressure, and the evolving teenage brain, but when OCD strikes, adolescents can be plunged into a level of turmoil that goes beyond the typical challenges. For parents, it also ramps up the stress and anxiety of trying to navigate a child to the shores of adulthood.
Related: I Felt Like a Failure When My Daughter Struggled With Depression
The good news is that there is help. We know much more about the causes of and treatments for OCD than we did even a decade ago. After receiving specialized care and an effective long-term treatment plan, my daughter began to see results within weeks. She soon found it easier to resist the urge to repeat and check and regained the ability to eat freely, without the barrage of reassurance-seeking questions she engaged in before. She is not alone. A strong body of research on OCD now shows that with the right treatment significant relief is not only possible, but likely.
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What Every Parent Should Know about OCD
Any mom or dad watching a child struggle with OCD can feel pressured to become an overnight expert on this condition. That s not necessary, but there are some things ever parents should know.
OCD involves recurrent, unwanted, and intrusive thoughts (obsessions) and repetitive or ritualistic behaviors (compulsions) aimed at relieving the fear and anxiety prompted by the obsessions. Some of the most common forms of OCD are:
- Obsessions about contamination and compulsions to wash or clean excessively.
- Obsessions about causing emotional or physical harm to others. This can lead to repeatedly reviewing a conversation to be sure nothing offensive was said or avoiding certain objects that have the potential to cause harm, e.g., kitchen knives.
- Rightness, symmetry, and order-focused obsessions, which are experienced as feelings or urges to have everything just right. This can lead to compulsions to order everything in a certain pattern, to touch objects with both hands, to finish projects in one sitting, and a host of other ritualistic behaviors.
- Unacceptable or taboo thoughts-focused obsessions, in which sufferers ruminate on content they deem abhorrent. Feelings of shame and fear about possibly having qualities or even simply having thoughts that are offensive to one’s own values are common in this form of OCD.
OCD research tells us that the disorder affects one-to-three percent of children and adolescents. Onset typically occurs in two age windows: between 7-12 and between the late teen years and early adulthood. While OCD s causes aren’t entirely clear, the latest science demonstrates that genetics plays a role in childhood-onset OCD. It’s estimated that between 40 to 60 percent of children diagnosed with OCD have a parent who also has the disorder.
A deeper dive shows further proof that biology plays a major role in OCD. One recent study identified 25 genes that may play a role in the development of this disorder. The potential genetic predisposition may explain why some children develop OCD in response to stressors and others don’t. Additionally, Research on Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep (PANDAS), has shown that infectious, environmental, and metabolic factors may kick off OCD. Stress and trauma can also play a role.
Related: My Daughter’s Anxiety Meant We Both Needed New Coping Skills
How to Recognize and Talk about Symptoms of OCD
Parents concerned that their child may be exhibiting symptoms of OCD should watch out for these warning signs.
Behavioral changes to look for:
- Excessive handwashing, showering, or grooming that goes far beyond normal hygiene;
- Repeatedly checking locks, appliances, or homework assignments;
- Arranging items in specific patterns or becoming distressed when things are “out of place;”
- Avoiding certain rooms, objects, or situations without clear reason;
- Taking unusually long to complete routine tasks like getting dressed or homework;
- Asking the same questions repeatedly, seeking constant reassurance;
- Sudden changes in eating habits or food avoidance.
Emotional and social signs:
- Increased irritability, especially when routines are disrupted;
- Withdrawal from friends or activities they previously enjoyed;
- Expressing fears that seem disproportionate to the situation;
- Extreme distress over “contamination” or germs;
- Perfectionism that interferes with completing tasks.
How to talk to your adolescent about OCD
When approaching your child, bring an open, curious mind and lots of compassion. Avoid speaking to them when you are frustrated or worried, and refrain from dismissing their concerns as bad habits or by saying they are silly.
It also isn’t helpful to urge them to simply stop or try harder. If they could, or knew how, they would! Instead, separate your child from the OCD. Say something like, “It sounds like OCD is giving you a hard time today” rather than “You’re being obsessive.”
Ask open-ended questions that help them identify what is happening: “What is that OCD voice telling you might happen?” This validates their experience while externalizing the disorder.
Getting Help for an Adolescent with OCD
OCD may seem intractable when a child is in the throes of it, but the reality is that a number of evidence-based treatments have been shown to provide long-lasting relief.
They include:
- Exposure and response prevention (ERP) therapy, in which a therapist guides a client in confronting anxiety-producing situations in a gradual way;
- Cognitive-behavioral therapy (CBT), in which clients are taught to detect and counter irrational beliefs and thoughts and replace them with more accurate ones;
- Acceptance and commitment therapy (ACT), which utilizes mindfulness-based strategies;
And new practices and modalities are being developed every day. In my own practice, I’ve seen how integrating internal family systems (IFS) therapy, which acknowledges that the self is made up of distinct components that act together, with ERP, has helped clients manage and overcome symptoms. The important thing is that you find the right outside help for your child.
How to Find a Therapist for Adolescent OCD
When looking for a therapist to treat adolescent OCD, it is important to find someone who has the proper training and lots of experience. Here are a few tips for finding the best fit:
- Seek therapists specifically trained in treating pediatric OCD;
- Ask about credentials from the International OCD Foundation’s Behavior Therapy Training Institute (BTTI);
- Inquire about their experience with exposure and response prevention (ERP) therapy;
- Consider therapists trained in additional modalities like ACT, I-CBT or IFS if they also have experience with evidence-based methods for OCD;
- Ask about their approach to family involvement effective OCD treatment typically includes parent guidance;
- Ensure they can provide concrete homework assignments and between-session support;
- Look for therapists who can explain treatment goals clearly and are willing to discuss realistic timelines;
- Consider whether they offer intensive outpatient programs if your child needs more support;
- Verify they accept your insurance or discuss payment options upfront.
Here are some red flags that indicate a therapist, even a good one, might not be the best fit.
- Therapists who do support talk therapy or focus primarily on exploring “root causes;”
- Those who discourage exposure work or promise unproven “quick fixes;”
- Practitioners who don’t involve parents in the treatment process;
- Anyone who suggests your child will simply “outgrow” OCD without intervention.
Related: Why We Need To Be Talking To Our Teens About Self Harm
Dos and Don’ts for Helping Your Adolescent Cope with OCD
For parents, OCD presents a unique dilemma. In trying to reduce their child s anxiety they often participate in compulsive behaviors a practice known as family accommodation. While it may seem like this provides short-term relief, accommodation bolsters the very obsessions that drive the anxiety. The most effective thing you can do is help your child develop their own capacity to cope with difficult feelings rather than relying on compulsions or family accommodation for relief.
Here are some dos and don’ts:
- DO acknowledge your child s distress while expressing confidence in their ability to cope: I know OCD is making you feel really upset right now, and I believe you can handle this.
- DO slow down when your child is triggered trauma and triggered energy is fast, healing energy is slow.
- DO notice what’s happening inside yourself first before responding to your child s OCD demands.
- DO help your child understand that OCD creates temporary relief but makes the problem worse over time.
- DON’T accommodate OCD demands, even when it temporarily reduces your child s distress (but don t pull all accommodations away at once!).
- DON’T provide repeated reassurances that feed the OCD cycle.
- DON’T make family decisions based on avoiding your child s OCD triggers.
- DON’T participate in checking, cleaning, or other compulsive rituals.
Even for adults, OCD can be a baffling, frustrating, and excruciating condition. For teens and tweens first encountering it alongside the other struggles of adolescence, it can feel devastating. Parents may feel powerless to help, but we are not. Effective treatment exists and when combined with family support, OCD need not hold your child back. I know this as both a mental health professional and a mom.
Looking for more information on how to manage adolescent OCD?
Check out the Melissa Mose’s book, Internal Family Systems Therapy for OCD.
Parenting teens and tweens is hard, but you don’t have to do it alone.These posts may help:
Is It More Than Just Normal Teen Anxiety? When to Seek Outside Advice
It Broke My Heart to See My Son Suffer with Social Anxiety–Here Is How to Help
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