Obsessive Compulsive Disorder (OCD) is a complex mental health disorder than often emerges in childhood or early teen years. The disorder can manifest itself in thoughts and behaviors that are disruptive to the teen’s daily activities and concerning to parents. When the OCD disorder becomes unmanageable, even under the care of a psychiatrist, then residential OCD treatment for teens might be the next step in appropriate interventions.
A residential program for teens with OCD can provide a calm, soothing environment where a closer look at the teen’s obsessions and compulsions can lead to improved and more finely tuned interventions, including reassessing medications and introducing new coping techniques that help to relieve the stress and anxiety that OCD can provoke.
In a residential treatment environment the teen will enjoy a sense of safety, which is conducive to focusing on the treatment elements provided. Full immersion into a residential OCD program for teens allows a more targeted approach to be applied while providing 24-hour support and monitoring.
What is Obsessive-Compulsive Disorder (OCD)?
OCD is a psychological disorder within the anxiety spectrum of mental health disorders that impacts about half a million children or adolescents annually. Pediatric onset OCD is association with a higher risk of developing other mental health disorders in adulthood.
OCD can cause a teen to experience unsettling and intrusive thoughts, called obsessions, which trigger ritualistic, repetitive behaviors, called compulsions, in response to the thoughts. In this ongoing cycle of obsessive thinking and subsequent repetitive behaviors, the teen can become so enmeshed in the symptoms that they become frozen, unable to move forward with usual activities. For example, an obsessive fear of germs may lead to the teen washing their hands 20 times before being emotionally stable enough to then venture from the house.
In essence, the teen becomes controlled by the rituals they must conduct in order to achieve relief from fear or anxiety. So, the compulsive behaviors become a salve for the obsessive worrying. As the condition worsens, the teen will have difficulty in completing tasks, fulfilling schoolwork, or maintaining relationships. Teens with OCD suffer a great deal of emotional distress due to the demands the disorder makes on them and significant impairment. Some of the more common OCD subtypes are:
- Contamination/Washing
- Harm Obsession/Checking
- Hoarding
- Pure Obsession
Obsessions
A teen with OCD will experience recurrent, intrusive, and sometimes inappropriate thoughts or images that cause them to feel anxious and distressed. These unwanted thoughts or worries can cause intense feelings of fear, guilt, or shame. Common obsessions include:
- Fear of germs
- Doubts stemming from fear, such as whether the door is locked or if the stove burner was turned off
- Particular order or exact placement of items
- Impulses to commit a violent act
- Fear of getting sick or dying
- Sexual obsessions regarding a repulsive sex act
Compulsions
The compulsive, repetitive, ritualistic behaviors that follow the obsessive thoughts help the teen manage the emotional distress that results from the obsessions. The teen may feel compelled to practice these actions or behaviors repeatedly in order to feel relief from the upsetting feelings that the obsession has triggered. Common compulsions include:
- Washing or repeated cleaning is a response to the fear of germs obsession
- Checking over and over that some task was properly completed is a response to the harm obsession
- Ordering involves insisting on symmetry and particular order of items and is a response to controlling obsession
- Counting things repeatedly and fixation on numbers helps reduce anxiety related to obsessions about violence or disturbing thoughts
- Repeatedly confessing or apologizing
- Using lucky numbers or words
Concerning Symptoms that Parents Might Notice
Parents are often the first people to become aware of the OCD behaviors and mannerisms. Parents may notice that their child:
- Is overly irritable, upset, or anxious
- Has trouble concentrating on their homework
- Is not engaging in the activities they once enjoyed
- Takes too long to complete basic tasks, like taking a shower or getting dressed
- Becomes demanding of a parent to do or say something in a specific way
- Has difficulty making decisions
- Seems to repeat behaviors too often
- Exhibits excessive, irrational worry
- Gets angry if something is out of place
- Gets upset if they cannot do something perfectly
Diagnosing Teen OCD
Unfortunately, youth-onset OCD is often undetected or diagnosed for years before a proper diagnosis is made. This delay in treatment can result in years of suffering and embarrassment as the teen attempts to hide the symptoms from others.
When a parent suspects their teen might have OCD the first stop will be the primary care provider who can first rule out any medical condition that may be attributed to the symptoms. They may order labs to check thyroid function and other screenings. If no health condition is responsible, then the doctor will refer the teen to a psychiatrist for a psychological evaluation. This will involve interviewing the teen for more detailed information about the symptoms, and then see if they align with the DSM-5 diagnostic criteria for OCD:
- Presence of obsessions, compulsions, or both:
Obsessions:
1. Recurrent and persistent thoughts urges or images that are intrusive and cause anxiety
2. Individual attempts to ignore or suppress them by an action or thought
Compulsions:
3. Repetitive behaviors that the individual feels they need to perform in response to an obsession
4. The behaviors are aimed at preventing or reducing symptoms of anxiety or distress
- The obsessions or compulsions are time-consuming (more than one hour per day) and cause distress and impairment in functioning
- The obsessive-compulsive symptoms are not attributable to a substance disorder or another medical condition
- The disturbance is not better explained by the symptoms of another mental disorder
The short OCD screener is a set of six questions that is helpful in assessing whether a teen has OCD. It includes these questions:
- Do you wash or clean a lot?
- Do you check things a lot?
- Is there any though that keeps bothering you that you would like to get rid of but cannot?
- Do your daily activities take a long time to finish?
- Are you concerned about putting things in a special order or are you very upset by mess?
- Do these problems trouble you?
How OCD Impacts a Teen’s Life
When an adolescent is experiencing the effects of OCD it can make their life miserable. OCD has the ability to cause significant disruption in daily life. Teens may go to extreme measures to hide the manifestations of this impairing mental health disorder from friends and family, as it causes them feelings of intense embarrassment and shame. The effects of OCD on the daily life of a teen include:
- Social isolation. When the compulsive behaviors become so time consuming or obvious to others, they may begin to isolate in order to hide the disorder from others. Also, the rituals can be so lengthy that the teen may miss out on joining peers for social events.
- Problems in school. Teens with OCD struggle with being on time and completing assignments. They may complete and erase assignments over and over again, putting them behind schedule.
- Interpersonal problems. OCD can be exhausting and frustrating for the teen, which can lead to angry or explosive behaviors that can undermine friendships. At home OCD can cause tension in the home. The teen may expect the family members to accommodate or even participate in the compulsions. Family members will find themselves walking on eggshells to avoid triggering the teen into angry or anxious outbursts. Enabling can also be a common problem for parents of teens with OCD.
- Target of bullying. Because the teen with OCD may be viewed as odd because of the affliction, the teen can become a target of ridicule or bullying at school or on social media.
Residential OCD Treatment for Teens
When outpatient interventions, usually behavioral therapies in combination with medication, do not adequately manage the OCD symptoms, and the condition is worsening, a residential OCD treatment program designed specifically for teens will provide a step up in care. Residential programs offer a more focused approach to treatment with a deeper involvement with cognitive behavioral therapy and other associated therapies, such as exposure and response prevention (ERP).
Cognitive behavioral therapy incorporating Exposure and Response Prevention. CBT with ERP is a first-line treatment protocol for adolescent OCD. This is a short-term evidence-based type of psychotherapy that lasts 12-20 weeks. The purpose of using this type of CBT is to help the teen to confront their fears (the obsessions) and then gradually refrain from exercising the compulsive behaviors. The therapist will guide the teen toward incremental exposure to the triggering thought or fear and coach them to allow the anxiety to pass without succumbing to the compulsive behaviors. The therapist will establish a hierarchy of tasks to be carried out during each session, and will assign the teen homework exercises so they can practice the technique within their personal environment. Using the ERP has been clinically associated with a significant reduction of symptoms. This psychotherapy can be prescribed with or without SSRIs.
Antidepressants. Antidepressants alone have not been shown to reduce symptoms as effectively as the CBT/ERP therapy. In fact, some teens are treatment-resistant to antidepressant drug therapy. However, antidepressants can be successfully included as an adjunctive treatment. Antidepressant medications for treating OCD include:
- Clomipramine
- Fluoxetine
- Fluvoxamine
- Paroxetine
- Sertraline
Due to the FDA Black Box warning regarding the risk of suicidal ideation for teens and young adults, use of antidepressants should be carefully monitored. Prior to prescribing the medication, a thorough assessment of the symptoms and whether they include suicide ideation should be carefully considered.
Family therapy. Family therapy is included in the residential program and can be helpful in teaching the family members how to best respond to the teen struggling with OCD. The family is educated about the illness and coached in ways to avoid judging or criticizing them for the behaviors. OCD impacts the whole family, so learning how to be supportive of the teen without being tempted into enabling behaviors is an important aspect of recovery for the teen, and the family members.
Complementary therapies. Incorporating some complementary activities into the overall treatment plan can be beneficial for the teen with OCD. These activities may help to reduce anxiety symptoms and also provide a sense of control.
- Yoga: Asana and pranayama yoga are mind-body holistic activities that combines purposeful movement, stretching, mindfulness, and breath-work to help reduce stress.
- Art therapy: Some teens may find that expressing their fears or emotions through an art medium is helpful in managing feelings of anxiety. Art can give the teen a sense of accomplishment and a finished product that portrays self-expression.
- Exercise: Numerable studies have confirmed the overall health benefits of regular physical activity, for both physical and mental health. Teens should be encouraged to create a regular fitness plan that can assist in curbing anxiety while also providing mood enhancing effects and improved sleep.
While teen OCD presents a significant mental health challenge, the condition can be managed through a multimodal approach to treatment. It is important to locate a mental health provider who has experience treating kids or teens with OCD. If symptoms continue to deteriorate regardless of outpatient efforts, a residential program is an appropriate level of care.
BNI Treatment Centers Provides Residential OCD Treatment for Teens
BNI Treatment Centers is a residential treatment center for teens aged 12-17 located in Los Angeles, California. The BNI psychiatrists who founded and operate the treatment center are experts in the field of treating complex mental health disorders such as OCD in adolescents. Utilizing only the highest standards of care and evidence-based therapies, BNI can make significant strides in helping your teen overcome the disruptive features of OCD and help them manage the symptoms. BNI is teen-specific, so the adjunct therapies offered are tailored specifically to the teen client, including surf therapy, art therapy, equine therapy, and drama therapy. For more information about how BNI Treatment Centers can help your teen manage OCD more effectively, please contact us today a (888) 387-0105.
