That’s OCD? Recognising OCD & Intrusive Thoughts in Teens

13 Oct

OCD doesn’t always look like excessive handwashing, checking locks or arranging things in a particular order. For some teenagers, much of what is happening is inside their head, which can make it incredibly difficult for parents to spot.

This week, clinical psychologist Dr Netali Levi, Integrated Psychology joined us to look at some of the less obvious signs of OCD, intrusive thoughts and mental compulsions, and importantly, what parents can do at home without unintentionally feeding the OCD.

OCD isn’t always something you can see

We’ve talked in previous sessions about the two main parts of OCD: obsessions, which are unwanted and intrusive thoughts, images or urges, and compulsions, the things someone feels they need to do to reduce the anxiety those thoughts create. But Netali reminded us that compulsions aren't always visible.

A teenager might count in their head, repeat particular words or prayers, replay memories, mentally check something or need to picture something in a certain way until it feels “right”. These internal rituals can be particularly difficult for parents to recognise because they can be happening without anyone else knowing.

One useful distinction is whether your teenager wants to do something a particular way, or feels they have to do it because of fear, anxiety or a sense that something just isn't right. Rather than only looking for obvious rituals, notice whether everyday things are suddenly taking much longer, whether your teenager is avoiding particular situations or whether family life is gradually changing to accommodate something they find difficult.

A thought is just a thought

One of Netali’s most important messages was that we all have intrusive thoughts. The difference with OCD is not necessarily the thought itself, but the significance someone gives it. A teenager may start wondering: Why did I think that? Does having that thought mean something about me? What if it actually happens?

Netali described how intrusive thoughts often centre on the things that matter most to us: our family, relationships, safety, religion or our sense of ourselves as a good person. Helping teenagers understand that having a thought doesn't make it true and doesn't mean they will act on it can begin to take some of its power away.

The short-term fix that keeps OCD going

When something makes us anxious, our natural instinct is to make that feeling go away. A teenager might avoid the situation, carry out a ritual, mentally check something or ask a parent for reassurance. It works, briefly. They feel better. As the brain never gets the opportunity to learn that they can cope with the anxiety without doing the compulsion, the fear returns and they need the reassurance or ritual again. And it isn't always simply a fear that something terrible will happen. Sometimes a teenager is frightened that they won't be able to cope with how anxious or uncomfortable they'll feel if they don't carry out the ritual.

As Netali put it, OCD can be “greedy”. Left unchecked, it can gradually ask for more and spread into other areas of a teen’s life.

When helping can accidentally feed the OCD

This can be particularly difficult for parents. If your teenager repeatedly asks, “Are you sure nothing bad will happen?”, reassuring them feels like exactly what a loving parent should do. Similarly, if touching a door handle causes huge distress, opening the door for them can feel like a small thing that makes life easier. Then, gradually the whole family can begin changing what they do around the OCD.

Netali was very clear that by not reassuring or accommodating them doesn't mean withdrawing warmth or support. The aim is to remain alongside your teenager while gradually helping them rely less on reassurance and accommodation. Rather than trying to change everything at once, it can help to map out what's happening first. What are the visible rituals? Are there mental rituals? What are they avoiding? What reassurance are they asking for? And what has the rest of the family started doing differently because of the OCD?

You can then work together to identify what feels easier to change and what feels much harder. That might mean agreeing to reduce reassurance gradually rather than stopping it overnight, or starting with the easiest ritual rather than tackling the hardest one first. Small steps really count.

Connection before conversation

And then there was something that applies well beyond OCD. Netali talked about having a “connection bank account” with our teenagers.

Every instruction, disagreement or moment when we don't quite understand them can make a withdrawal. So before trying to have a big conversation about OCD, build some connection first: watch television together, go for a walk, chat in the car or simply spend some time alongside them.

Then choose your moment. Be curious rather than telling them what you think is happening. Ask what they think. And, particularly with teenagers, listen more than you talk. Sometimes even saying, “I can see how tough that is” and stopping there can be more helpful than launching into advice.

What if they don’t want another label?

Several parents asked about OCD alongside autism, ADHD and PDA, including teenagers who are resistant to talking to professionals or don't want another diagnosis. Netali suggested that we don't always have to start with the label. You might simply notice that leaving the house is taking a long time, that a particular routine seems frustrating or that something is getting in the way of what they want to do.

And where there is neurodiversity or more than one difficulty, OCD may be just one part of the picture. Rather than trying to separate everything out ourselves, it can be more helpful to look at what is having the biggest impact on our teenager's life right now and what they themselves would most like to change.

The important question can be: what would be better in their life if OCD took up less space? Perhaps bedtime would be shorter. They'd have more time with friends. They could leave the house more easily. Or they'd simply feel freer. Finding something that matters to them, rather than imposing an adult goal, can give a teenager their own reason for wanting things to change.

Treatment works

The recommended psychological treatment for OCD is Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP).

Rather than tackling everything at once, this usually involves identifying the different compulsions and gradually working through them, starting with those that feel easiest to change. Sometimes simply delaying a compulsion for five or ten minutes can be a first step.

If OCD is affecting your teenager's daily life, becoming more complicated or simply isn't improving, speak to your GP or an appropriate mental health professional.

Understand your teenager’s own jigsaw puzzle

Netali left us with a lovely way of thinking about all of this: try to understand your teenager's “individual jigsaw puzzle.” What are the thoughts? What are the rituals, including the ones you can't see? What are they avoiding? What reassurance are they looking for? What is the family doing differently because of the OCD? And, most importantly, what is it like for them? We can't really know how to help until we begin to understand the different pieces.

And getting there may mean fewer questions, less fixing and simply finding ways to stay connected enough that, when they're ready, they'll let us in.

Watch Now

Watch That’s OCD? Recognising OCD & Intrusive Thoughts in Teens with Dr Netali Levi in the Let’s All Talk Mental Health Hub here.

Resources & Recommendations

NICE (2005). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment (CG31)
National clinical guidance on recognising and treating OCD, including cognitive behavioural therapy (CBT) and exposure and response prevention (ERP).

International OCD Foundation (IOCDF) – OCD in Kids
Information and practical resources about OCD in children and teenagers, including guidance for parents.

OCD-UK
A UK charity providing information, advice and support for people with OCD and their families.

Books

For teenagers and their families
Derisley, J., Heyman, I., Robinson, S., & Turner, C. (2008). Breaking Free from OCD: A CBT Guide for Young People and Their Families. Jessica Kingsley Publishers.
A practical guide explaining OCD, CBT and ERP, with exercises for young people and their families.

For parents
Chansky, T. E. (2025). Freeing Your Child from Obsessive-Compulsive Disorder (Revised and updated ed.). Harmony Books.
Practical strategies for understanding OCD, responding to intrusive thoughts and compulsions, and supporting children and teenagers.

For younger children
Huebner, D. (2026). What to Do When Your Brain Gets Stuck: A Kid's Guide to Overcoming OCD (2nd ed.). Magination Press.
An illustrated, CBT-based workbook for children aged approximately 6–12 years.