Writing on Adolescent OCD and Emotional Life

An intrusive thought is not a moral offence, but OCD can make it feel as though it is. For some adolescents, a frightening image or unwanted thought becomes an imagined sin, followed by a private demand for payment: confess, check, avoid, seek reassurance, give something up. This essay considers why the punishment can seem to match the fear, and what may help loosen that cruel logic.

By the time a young person reaches CAMHS, their OCD has usually been described many times. The clinician may know the rituals, the risk concerns and the reassurance being sought at home, yet know very little about the young person. Meltzer helps us think about what enters the room with them: the institution, the pressure for certainty and the fear that an intrusive thought will be treated as a confession. The task is to create an encounter in which thought remains possible.

“I can’t reassure them anymore.” “I feel like I’m failing.” Parents of teenagers with OCD say some version of this to me constantly, and none of them are failing. In this post, Marcus Lewton introduces his new book, When Your Teenager’s Mind Gets Loud, and makes the case that NICE guidance on adolescent OCD, unchanged since 2005, leaves parents carrying more than anyone tells them to expect.

Whenever I find myself working with an adolescent and their family where OCD has begun to take hold, there is a point in the work that arrives with a certain predictability. A parent, often after a period of careful listening and reflection, will ask what they should actually do. By then they usually understand the reassurance seeking cycle. They can see how they’ve been drawn into it, how their responses, given with care, have also been maintaining something that no one real

My experience of health and illness anxiety in adolescents has gradually moved me away from thinking of it as a primarily cognitive problem. This was not where I started. My clinical training pointed clearly in a different direction, and for good reason. The cognitive model of health anxiety is a genuinely compelling one. The account offered in texts like the Oxford Guide to Cognitive Behavioural Therapy, and in the broader clinical literature, makes a strong case: that what

Not all dark thoughts in adolescence are perverse. Some are collapse. Know the difference—and listen for structure, not content.

To many in government, a child’s mind is a datapoint. But some suffering isn’t measurable—it’s symbolic, not yet sayable, still surviving.

Repetitive thoughts aren’t always questions—they’re often cries. Listen beyond logic. It’s not about the answer. It’s about the feeling.

If your child won’t talk about their thoughts, don’t panic. Silence isn’t failure—it’s a signal. Here’s what to do instead.