OCD Test for Teens: Signs, Screening, and Next Steps

Obsessive-Compulsive Disorder (OCD) is a common yet often misunderstood mental health condition that frequently emerges during adolescence. It involves intrusive, distressing thoughts (obsessions) and repetitive behaviors (compulsions). 

These impact teens' daily life, school performance, and relationships. Due to the pressures of puberty, academic demands, and social dynamics, OCD symptoms may intensify during adolescence.

Early recognition of OCD signs helps with timely intervention and preventing co-occurring challenges like anxiety and depression. Screening and evaluation should be done by a mental health professional who can offer an accurate diagnosis and guide effective treatments such as cognitive-behavioral ERP and medication.

What Is OCD? 

Obsessive Compulsive Disorder (OCD) is a mental health condition characterized by obsessions (intrusive and often distressing thoughts) and compulsions (ritual-like behaviors). 

Symptoms of OCD often intensify during adolescence due to hormonal shifts, academic stress, and social pressures, interfering with school performance, friendships, and daily routines. This can lead to feelings of isolation, shame, and embarrassment.

OCD affects 1-3% of youth, with most showing the first signs of emergence around 14 years of age. Teens with OCD also experience high rates of depression and anxiety disorders, with studies showing that approximately 60% of youth with OCD struggle with co-occurring mental health challenges [1].

Genetic factors account for nearly 45-65% of pediatric OCD risk through serotonin, dopamine, and glutamate pathways. Other research shows environmental triggers like streptococcal infections and early environmental trauma, such as abuse, may provoke onset through inflammation [2][3].   ​

Signs and Symptoms of OCD in Teens

If you notice any of the warning signs below, this could be an indicator that your teen may need a professional OCD evaluation. Besides obsession and compulsions, many OCD teens also struggle with anxiety, depression, shame, isolation, substance use, and suicidal ideation.  

Common Obsessions in Teens 

Magical thinking: Superstitious thinking about bad things happening. Teens with these obsessions might think, “Unless my clothes are perfectly folded, my mom will get in an accident.”

Contamination: Teens with this OCD obsession may get labeled “germophobes.” They worry about things being dirty, infected, and getting sick.

Persecution: Teens have excessive worries about offending god, being sinful, or blasphemous. 

“Just Right” Gut Feeling: Some teens feel they need to do something until they get it “just right”, though they often struggle to explain or not understand why it feels right.

Aggressive thoughts: These teens often think about the bad things they could do, even if they have no intention of hurting anyone.  “What if I hurt someone? What if I kill someone?”

Common Compulsions in Teens 

Cleaning: Excessive cleaning or ritualized hand washing. 

Checking: Overchecking their work for mistakes, constantly checking their phones to make sure they didn’t accidentally post something embarrassing, checking to make sure things are safe, or that things are locked or turned off. 

Repeating: Rereading, rewriting, or repeating actions like going in and out of a doorway, or flicking a light switch a certain number of times.  

Counting: Certain objects, numbers, and words to relieve mental distress. 

Arranging: Ordering things in very specific ways so they are symmetrical or line up in a specific pattern.  

Saving: Hoarding and difficulty throwing things away, including old clothes or toys from when they were kids that they no longer wear or use.   

Superstitious behaviors: This might include touching things or avoiding touching certain things to prevent bad luck. The term “step on a crack, break your mother’s back” is taken very literally for these teens. 

What Does An OCD Evaluation Look Like? 

During an OCD evaluation, the clinician asks questions to the teen and their parents about OCD symptoms such as seeking reassurance, intrusive thoughts, specific fears, or behavioral rituals. 

The evaluation also includes standardized self-report questionnaires like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), completed by the teen and sometimes by the parents, which rates the severity of obsessions and compulsions on a 0-40 scale. This helps understand the severity and frequency of OCD symptoms over time.​ In some cases, the treatment provider may also connect with the school or other adults in the teen's life to understand how these symptoms present across different settings. 

The goal of the evaluation is to understand how these current symptoms impact the teen’s daily life, school performance, social interactions, and family relationships. To ensure accurate diagnosis, medical causes or other mental health conditions are ruled out using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

Hear from OCD Activists at YoungMinds

Youth OCD activists at Young Minds came together to share their thoughts on how OCD has affected their lives and families. As well, they have a few tips on what support helps with their OCD [4]. 

“Navigating friendships when people don’t know you have OCD is really hard. You’re trying to protect other people and also yourself.”

“It can strain relationships – if intrusive thoughts are about a family member, it can take a toll.”

“It helps to talk openly about how it’s affecting the family; otherwise, the young person will ruminate and feel guilty. Work together to come up with a plan to make things better.”   

Tips From Other Youth: What Helped Their OCD?

• Creating a night routine and learning how to wind down in the evenings.

• Doing something with their hands, such as rubbing their fingers together or tapping to calm the mind during an intrusive thought.

• Mindful coloring while listening to music or podcasts. 

• Medication has helped many, reducing the intensity of the thoughts and making participating in therapy easier. 

• Find a specialized therapist who won’t just talk generally about your thoughts, as this can actually increase rumination. Look for a therapist who specializes in adolescent OCD.   

Common Myths About OCD 

There are several myths about OCD. These can increase stigma and make it harder for those who actually struggle with the condition to connect with treatment. Some OCD myths you might have heard before include:

• Everybody is a little OCD 
• She’s so clean, or she’s so organized, so she must have OCD 
• You’re just fussy
• It’s a personality trait that “neat” or “tidy” people have 

How is OCD Treated in Teens? 

Two treatment approaches that have been repeatedly proven to be effective for OCD are a specialized form of cognitive behavior therapy called exposure and response prevention (ERP) and medications such as selective serotonin-reuptake inhibitors (SSRIs). 

ERP is considered the first line of treatment for teens with OCD, either on its own or with medication. In concentrated ERP for teens, 73-91% responded post-treatment, and 68-77% still had reduced symptoms in long-term follow-ups [5].

Medication should be considered when symptoms are moderate to severe, if ERP is not available, or only when partially effective. ERP sessions can support teens with OCD in several ways, including: 

• Exposure Hierarchy: Teens rank fears (e.g., touching a "contaminated" doorknob rated 7/10 in anxiety and gradually face these fears or triggers to reduce anxiety.​

• Response Prevention: Intentionally resisting compulsive behaviors, like handwashing after exposure to a triggering situation, retraining the brain that obsessions aren't threats.​

• Anxiety Tracking: Monitors distress during exposure until it drops by at least half. 

• Imaginal Exposure: For mental obsessions (e.g., teen writes/repeats feared harm scenario without compulsive follow-up prayers).​

• Processing and Support: Discusses insights post-exposure, using mindfulness to accept thoughts, and reducing the OCD cycle. 

Evidence-Based OCD Treatment for Teens in Florida 

Lotus Behavioral Health is a residential treatment facility for teens located in Florida. Our structured inpatient and outpatient programs are designed to support teens and their families with the tools they need to recover from substance abuse and co-occurring mental health disorders. 

Our compassionate team understands the complexity of OCD in teens and the unique challenges of adolescence. We offer a blend of comprehensive mental health services, such as individual therapy, group therapy, medication management, creative arts therapies, and skill-building workshops to help teens recover from depression, anxiety, and other mental health challenges. 

We use evidence-based, gold standard CBT and ERP to treat OCD and can provide medication as well. Contact our admissions team today for the compassionate mental health support that your teen deserves. 

Sources 

[1] Warnke, A. et al. (2011). Obsessive-compulsive disorder in children and adolescents. Deutsches Ärzteblatt International, 108(11), 173–179.

[2] Kim, H. (2006). The genetic studies of obsessive-compulsive disorder and its future directions. Yonsei Medical Journal, 47(4), 443–454.

[3] Handelman, K. et al. (2024). Sudden-Onset Acute Obsessive-Compulsive Disorder Associated with Streptococcus and Brain MRI Hyperintensity in a Young Adult. Healthcare (Basel, Switzerland), 12(2), 226.

[4] YoungMinds. 2023. Obsessive-Compulsive Disorder (OCD). 

[5] Riise, E. et al. Concentrated exposure and response prevention for adolescents with obsessive-compulsive disorder: An effectiveness study. Journal of Obsessive-Compulsive and Related Disorders. 

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