Moncrieff’s Parenting Expert, David Carey, gives advice on how to spot and deal with OCD in teens.
I feel my 15 daughter has OCD. For example She finds it hard to concentrate at school due to intrusive thoughts and has checking compulsions but I can’t persuade her to go for professional help. Do you have any suggestions which would help me to persuade her to go?
Thank you for your question. At the start I would like to ask you a question. If you daughter was experiencing severe vomiting and a high fever would you be concerned about persuading her to go to a doctor or would you take control and get her to one? The answer is obvious. Of course the comparison isn’t quite equal but the point is, I believe, simple: when a child needs help (and is under age 18) we take them for help. We don’t give them choices. Good parenting means doing what is right and taking charge.
Obsessive compulsive disorder (OCD) is a psychological condition effecting about 1.7 to 4% of the population. It is generally considered that in primary care settings (your GP) it frequently goes undiagnosed and as a consequence untreated. The condition is usually associated with anxiety and the obsession and compulsions are means to control the anxiety. Control is the central factor in OCD. The individual has a deeply rooted fear of loss of control. Rituals and compulsions become attached to the fear and are experienced as anxiety reducing tactics. The resulting cycle can be quite debilitation in some cases.
It will be helpful to look at the best and mostly widely used descriptors of what behaviours or cognitions constitute obsessions and compulsions. This information is taken from the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV) which is used in the United States and Ireland to diagnose mental health conditions.
Obsessions are defined in the DSM-IV by the following 4 criteria:
- Recurrent and persistent thoughts, impulses, or images are experienced at some time during the disturbance as intrusive and inappropriate and cause marked anxiety and distress. Persons with this disorder recognize the pathologic quality of these unwanted thoughts (such as fears of hurting their children) and would not act on them, but the thoughts are very disturbing and difficult to discuss with others.
- The thoughts, impulses, or images are not simply excessive worries about real-life problems.
- The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action.
- The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without, as in thought insertion).
Compulsions are defined in the DSM-IV by the following 2 criteria:
- An individual performs repetitive behaviours (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) in response to an obsession or according to rules that must be applied rigidly. The behaviours are not a result of the direct physiologic effects of a substance or a general medical condition.
- The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. However, these behaviours or mental acts either are not connected in a way that could realistically neutralize or prevent whatever they are meant to address or they are clearly excessive.
I caution the reader that only a qualified mental health practitioner can assess for OCD. Do not use these criteria on your own and come to conclusions. They are meant as guidelines to help you recognise when someone needs professional assessment.
At some point in the course of the disorder the individual will recognise that their symptoms are illogical, out of control, not rational and interfering with life tasks. Reaching this point may take a long time. The people around the individual with OCD usually recognise this before the individual him or herself.
OCD is a condition that, if left untreated, will usually spiral out of control. The number, frequency and severity of obsessions and compulsions can increase dramatically. In severe cases attending to life tasks can become impossible. Children and adolescents with the condition will begin to have difficulties in school and with peers. Often they will try to conceal the symptoms through a variety of means or simply begin to isolate themselves. The earlier you go for help the easier it will be to treat the condition successfully.
OCD is a condition that can usually be treated in an out-patient setting. Anxiety disorders (including OCD) are amongst the easier mental health conditions to treat successfully. Early intervention is essential. Treatment consists of a combination of relaxation therapy, cognitive behaviour therapy, family advisement and patient instruction and education. Even young children can be informed about their OCD and taught how to control it.
In some cases anti-depressant medication is required and it works best when combined with beahviour and cognitive behaviour therapy. Patients typically respond well to behavioural and cognitive interventions and recover well. Sometimes they experience a relapse and a short course of remedial therapy is required. In a small number of cases, the most severe ones, hospitalisation may be necessary. In severe cases there may be suicidal ideation associated with the condition but this is rare.
You need to bring your daughter to a qualified practitioner for assessment and possibly treatment. Get in touch with your GP soon for advice. Left unchecked the condition is likely to get worse. Treatment is usually short-term and quite effective. Your professional will liaise with your GP. Do not be afraid of upsetting your daughter. All children under the age of 18 need to know their parents will take control and get them help, regardless of how much they may oppose you in the process.
Moncrieff’s Parenting slot is every Wednesday at 3pm with David Carey, a psychologist in practice in Stillorgan, Dublin. He is the author of the book, The Essential Guide to Special Education in Ireland.
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