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Cognitive Behavioral Therapy for Teens with Obsessive Compulsive Disorder

by Dr. Randi Fredricks, Ph.D., Director of San Jose Therapy and Counseling

With all the pressure that teenagers are under, it is no wonder that anxiety disorders in teens are on the rise. In the past, anxiety disorder specialists thought that obsessive-compulsive disorder (OCD) in teens was relatively rare, but emerging evidence has suggested more and more teens are suffering from what scientists now call the “obsessive–compulsive spectrum.” The obsessive–compulsive spectrum is a classification that covers a variety of psychiatric, neurological and/or medical conditions that are related to OCD.

OCD sometimes goes undiagnosed in children for years, becoming worse after the child reaches adolescence. Like other mental health disorders, children tend to suffer in silence because of the social stigma associated with being different from their peers. Children with OCD don’t understand why they can’t control their thoughts and behaviors. When OCD develops in childhood, the child will often go to great efforts to conceal their rituals so no one discovers their secret.

One of the biggest challenges once OCD is identified in a child or adolescent is convincing them that therapy can help. This is largely because of the stigma the child perceived associated with seeing a therapist. In fact, therapy typically helps the child to normalize the challenges associated with OCD in addition to teaching critical coping techniques. It is helpful to begin therapy as early as possible in childhood in an effort to have the disorder in check by the time the child reaches adolescence. This is partially because the stress of becoming a teenager coupled with hormonal changes can exacerbate the symptoms of OCD.

In order to understand the types of therapies that are the most effective for treating children and teens with OCD, it’s helpful to have some basic background information. First of all, OCD appears the same in children as it does in adults. It is comprised of two parts; 1) the obsession, and 2) the compulsion. The obsession varies in form, but it characterized by persistent, intrusive, unwanted thoughts, images, or impulses. The obsessions are typically recognized by the individual as irrational, senseless, intrusive or even inappropriate, but they are unable to control them. The compulsions are distinguished by irresistible urges and repeated behaviors which the person performs in order to reduce anxiety. Compulsive activities vary, but the most some common forms are washing, touching, counting, and checking.

In teenagers, just like adults, obsessions and compulsions can range in intensity. In the worst case scenario, the symptoms become so bad that they interfere with daily functioning and can cause the sufferer, and those around them, a great deal of distress. Common obsessions for teenagers with OCD include preoccupations with cleanliness or order, violent or sexual urges, and fear about loved ones being harmed. In response to obsessions, teenagers with OCD perform compulsive rituals aimed at reducing the distress and anxiety associated with their obsessions. The teen often knows that their obsessions and compulsions are unreasonable, while younger children tend to struggle with the believability of their obsessive thoughts.

In both children and teens, the sufferer sometimes mistakes their obsessions and compulsions for psychotic behaviors, not realizing that they are completely different. The main differentiating factor is that someone experiencing OCD is aware that the thoughts they are having are their own and the actions they are performing have a motive behind them. A person with psychosis does not have this level of awareness.

Teenagers with OCD are struggling with the typical problems associated with adolescence along with intrusive thoughts and impulses and the repetitive rituals that often accompany OCD. When the disorder gets bad enough, the teen will have problems conducting daily routines and difficulties with school performance and social relationships because of the interference cause by the obsessions and compulsions. Additionally, problems with sleep may develop as well as other anxiety disorders.

The most effective treatment for OCD is cognitive behavioral therapy (CBT). A CBT therapist helps the child to see that it is actually normal to experience occasional intrusive thoughts or impulses. One of the goals of CBT is to help the person to understand that these experiences are not threatening and that the level of importance assigned to these thoughts is disproportionate. A teenager with OCD may have fear that they are going to become violent and subsequently believe that they are immoral and will act on that thought, which in turns creates anxiety. The goal of CBT in this instance is to teach the teenager that he or she can manage the anxiety associated with obsessive thoughts without engaging in compulsions or rituals.

A particular type of CBT therapy that is effective with teens is Exposure and Response Prevention (ERP). Anxiety treatment with ERP includes psychoeducation about OCD and how to manage it, cognitive strategies to help the person to respond differently to anxiety and intrusive thoughts, and behavioral strategies to help minimize compulsive behaviors.

ERP and CBT can help teenagers to face their fears, in session and in the real world, and practice new ways of responding to anxiety. With practice and experience facing the fear in a therapy setting, most teens become less disturbed by intrusive thoughts and more able to cope with anxiety and uncertainty.

Dr. Randi Fredricks, Ph.D., is an author, researcher, and Licensed Marriage & Family Therapist (#47803) in San Jose, California. She works with teenagers and adults with anxiety, depression, addiction, and eating disorders. To learn more about Dr. Fredricks' work, visit or

Disclaimer: Internet Special Education Resources (ISER) provides this information in an effort to help parents find local special education professionals and resources. ISER does not recommend or endorse any particular special education referral source, special educational methodological bias, type of special education professional, or specific special education professional.
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