7 missed signs of teen OCD

7 easy to miss signs that your child or teen may have OCD.

Most of us experience many different moods, states of minds, thoughts and feelings throughout the course of a day. And we deal with them very differently on a good day than on a bad day.  For teens, this roller-coaster is much more intense, and for teens with OCD it can be a nightmare. Teens may not want to tell us how they are feeling or why they do the things they do.  Often they aren’t sure themselves. We, as parents, are left to interpret behavior, and that is a very difficult job. It can be hard to tell is a teen is just very organized and motivated to do well, or if they are feeling compelled to check and recheck their work. Temper outbursts may be defiance or uncontrollable frustration. Certain avoidance behaviors may be grounds for a consequence or a sign that there is something disturbing going on. How do you know? And what do you do?

The following are seven particularly confusing behaviors.

Perfectionism At first glance, you are one of the lucky moms. Your kid never loses a sweater at school, never forgets a homework assignment, always checks for mistakes, and refuses to give up on something until its right. But, when you look a little closer, or as time goes by you see that this tendency has become extreme. The perfect English essay was thrown away and re-started numerous times or the backpack needs to checked again and again, not to be sure the homework is in it, but until it feels okay to stop. Eventually these teens may become so bogged down by re-reading, re-writing and checking needs that they are unable to get things done. These behaviors take on the quality of a need or drive rather than a sense of determination or responsibility. Any high achieving student may feel stress if there isn’t enough time to complete an assignment, but a teen with OCD will have a melt down because incompleteness creates such a sense of panic. In order to get a sense of what is going on with your child, ask what would happen if the task weren’t completed. A reasonable consequence or even an exaggerated one is to be expected, but if the notion is intolerable and you hear something like, “I just have to . .” or  “ I don’t know, I just can’t . . .” you may want to consult a professional.

Inattention Teens with OCD are frequently unable to focus in the classroom. Their inattentiveness and inability to follow through on assignments looks very much like ADHD. Sometimes there is also ADHD present, but the OCD may be overlooked. When teens with OCD are having persistent and repetitive thoughts that take over their attention, it is generally not apparent to anyone. They may appear to be daydreaming or lost in thought when they are actually performing mental rituals, and they often don’t want to tell you what is really going on. You may need to ask specifically whether they are having thoughts running through their mind or if they are feeling uncomfortable and trying to deal with it by thinking. A teen with OCD will usually be relieved to hear that others experience such things. You may hear that there is so much going on in their mind that they can’t even begin to describe it. In that case, you may want to consider an evaluation for OCD.

Avoidance The easiest way to keep from experiencing distress is to avoid the situation that appears to be causing it. If the target of avoidance is school or doctor’s appointments, or even public restrooms, parents and teachers will eventually notice. But if the situation that is causing anxiety is a particular article of clothing, a certain number or type of number, a book or a certain kind of book, a specific color or texture or taste, it may be a very long time before anyone notices. It may also seem to be nothing to worry about. A person can get by pretty easily in life without ever wearing green or reading a book with a main character by the name of Tony. Who cares? But unfortunately, it rarely remains so simple. If left un-treated, OCD keeps taking away more and more of a person’s choices until he or she may be painted into a corner.  When a teen with OCD withdraws from all or specific social situations, they may appear as shy or socially anxious when what is actually going on is more complex. Try asking your teen how hard on a scale of 1 -10 it would be to face the issue or situation that he or she is avoiding. And then ask why. If the response you get is puzzling, ask a professional.

Violent thoughts or images concerning self or others Because this is a potentially dangerous sign, we do need to be sure that a teen is not actually suicidal or homicidal, clinically depressed or psychotic. That being said, many teens with OCD have what we call Harm OCD, or Bad Thoughts OCD or Pure O. They experience repetitive and intrusive thoughts and/or images that are very disturbing to them. Unlike ordinary worries or ideas, these obsessions don’t pass, and they are not generally realistic, and they are experienced as horrible and undesirable. People with harm OCD often worry that they may snap and impulsively act out their horrible thoughts, but this is highly unlikely. They worry that they may hurt someone, often a loved one or someone vulnerable such as child. They worry that they may be sociopaths or sexual deviants, or that they may be suicidal, and so their compulsions are elaborately designed to check on those concerns and to prevent acting on the thoughts. Compulsions can include, avoiding, counting, tapping, checking, praying or mentally reviewing their thoughts among other behaviors. It is important to fully assess for Harm OCD because the treatment would be very different than the treatment for a depressed teen who is actually suicidal.

Questioning   To look for reassurance is a completely natural human inclination. But these basic human tendencies can become overly active or out of control. Its pretty typical for small children to ask the same questions any number of times. “Are we there yet?” is a typical example. As parents, we become inured to this sort of thing very easily. It is survival. So it is easy for the questions to slowly creep up in number until it crosses the threshold of awareness and we think “Enough!” You’ve just asked me that 20 times. I’ve given you the same answer every time. For most kids, this is enough. But the child or teen with OCD can’t stop.

Reassurance Seeking Another version of this is reassurance seeking. This compulsion involves asking family members and friends for reassurance that some feared event is not going to happen. Again, we all do this occasionally but with OCD it is a compulsion that is designed to relieve an intensely difficult thought feeling or concern. And it is very rarely stops on its own.

Confessing  A third version of this verbal repetition compulsion is confession. People are always relieved when they tell the truth. Even criminals hooked up to lie detectors show a clear relaxation in their vital signs once they confess even if it means they are going to prison. It works at church, and can be healing in a relationship. However, because it works to relieve anxiety, confession can also become a compulsion.  In fact, there is such a thing as moral scrupulosity, in which people are unable to tell lies without experiencing incredible emotional pain. Sound like something you wish your teens suffered from? Guess again. The fear of having possibly hidden some truth or having forgotten a detail can leave a person wracked by guilt and feeling constantly ashamed.

These are not definite indicators that your child has OCD. If you are concerned about your child you should seek an evaluation by a trained professional. This information is intended only as a guideline.