Obsessive-Compulsive Disorder (OCD) in South African adolescents: family narratives and the added impact of COVID-19

Abstract

Obsessive-compulsive disorder (OCD) is a chronic and impairing mental health condition that often begins in adolescence. OCD remains underdiagnosed and undertreated particularly in low-and middle-income countries where access to specialist mental health care is limited. Few qualitative studies have explored the lived experiences of adolescents with OCD, and none have incorporated both adolescent and parent perspectives, nor considered the additional impact of the COVID-19 pandemic. We sought to address this gap. Participants were South African adolescents (aged 12–18) living with OCD, and their parents. Eight adolescent-parent pairs participated in semi-structured, individual online interviews conducted between August 2022 and February 2023. Adolescents also completed the Children’s Florida Obsessive-Compulsive Inventory (C-FOCI). Interviews were transcribed and analysed using reflexive thematic analysis and ATLAS.ti. Five themes provided insight into participants’ subjective experiences: (1) Recognising and naming OCD, (2) impact on functioning, (3) influence on family and home life, (4) impact on social life, and (5) impact on school life. OCD symptoms were often hidden and misunderstood, leading to delayed help-seeking. Adolescents described significant disruptions to sleep, social interactions, and schoolwork. Mothers highlighted emotional and physical strain, family conflict, and limited support. The COVID-19 pandemic intensified symptoms for some while providing temporary relief from school-related stress and social demands for others. The study underscores the complex, multi-layered impact of OCD on adolescents and their families, exacerbated by the COVID-19 pandemic. Findings suggest the need for accessible, family-focused psychoeducation, early detection of OCD, and school-based mental health initiatives to reduce stigma and promote support.