Talking with Teens About OCD
“My parents don’t understand. I want to deal with this myself. If they didn’t interrupt my rituals, I’d be fine.”
Adolescents, in contrast to children, are expected to be more responsible and “grown up.” Yet, there is still tremendous dependence upon parents for all sorts of things. For small children, it is not odd if a parent performs tasks the child should be doing or assists with dressing, bathing, eating. However, as the youth emerges into teenage years, impaired functioning becomes gravely disturbing to parents and to the adolescent sufferer. The hope that the child will “outgrow the quirks” becomes less likely. Interference in day-to-day functioning due to OC symptoms is less well tolerated. When interference in day to day functioning is tolerated, it is done so with excessive accommodation by one or both parents which only fosters dependence and impedes the adolescent’s age appropriate development. Rather than endless arguing and excessive threats of punishment, a clinical, psychiatric consultation may be beneficial.
Knowing the developmental task is to move away from parents emotionally, the adolescent with OCD is really caught in a bind, needing adults more than other peers and, at the same time, resenting it. Feelings of anger and hostility may be more prevalent than expected. Excessively worrying what others think and trying to keep symptoms a secret, can arrest the process of the adolescent developing a positive and self-respecting identity. Societal stigma of mental illness can compound the already existing pressure “to fit in” which the adolescent keenly feels. Some adolescents may feel these pressures and others may be so preoccupied with germs and their OCD thoughts and worries that they don’t have room nor emotional resources to meet these natural developmental tasks. This is one reason why early intervention can be critical with children and adolescents.
The tendency of adolescents to form closely knit peer groups is indispensable to the process of decentering egocentrism. By sharing ideas with peers adolescents try out their theories and discover their weaknesses. The peer group provides some of the comforts of family with an added sense of independence. Furthermore, it is a time to ponder vocation and sexuality. Many of these normal developmental processes are hindered or blocked by OCD. Adolescents with OCD often feel extremely isolated and inadequate. They miss out on this typical experience of peer belongingness and individuation. It is common for them to be very fearful, wondering: “How will I ever be able to work?” and/or ashamed of their behaviors: “Who would marry me?” Should I have kids, or will I pass this on?
Increased internal conflict and a sense of alienation, magnified by coping with OC symptoms, are particularly painful for adolescents when the “normal” developmental tasks are pressing. “But mom, everybody’s doing it.” But not every teen has OCD. It may be cool to get a pierced ear, but it’s not cool to have raw hands from washing or to see a therapist! Adolescents can be difficult to engage. Getting to a support group with other young OCD sufferers may help with this. Also, parents of adolescents with OCD often forget that they are still the parents and can set limits. Expectations to do household chores or participate in family activities should not be altered to accommodate the OCD. This is easier said than done, as so many families have implored that cleaning up the dishes is not as important as getting out of the shower and to school on time. So while it is understandable how small accommodations and decreased expectations for the sufferer begins to occur in families, it is critical for parents to get help for an adolescent before symptoms get out of control.
There are steps the family can take to try to prevent a desperate situation:
- Parents should go to a support group. Talk to other parents and families.
- In a non-judgmental way, encourage the teen to talk about his/her “worries”. Share your information with them and try to get them to a support group with or without you.
- Encourage the family to not change routines or expectations around the house. If the teen takes out the garbage for allowance and stops because of contamination, she should not get it anyway “because she has a problem.” Kids’ homework should not be done for them, and they should not be home schooled if they cannot leave home due to OCD fears. This is only further facilitating avoidance, dependence on systems to accommodate their symptoms and will impede their social development. If they generally do their own laundry and stop because they feel “they can’t”, parents should not do it for them, although they can be there to coach. Remember, this is the developmental phase of gaining independence, not taking it away. In addition, siblings resent taking on extra chores they shouldn’t have to do.
- Family provides role-modeling and a shared sense of problem solving and is essential to help with limit setting. The family should be reminded of adolescent issues and how the OCD intensifies normal concerns - especially setting limits for example - where to draw the line or give in. “Splitting” can also create problems (one parent giving in to the demands of the OCD and the other refuses to do so). It is recommended that parents are unified in their rules and expectations (which may need to be revised given the varying severity of OCD).
- Individual supportive behavioral therapy can assist the adolescent with the process of separation and symptom control.
- Medication can reduce symptoms to a manageable level so that the whole family can cope better.
- Multifamily Psychoeducational Support Groups can provide support and guidance to the person with OCD and all family members.
- OCD teenage “buddy” can offer needed peer support.
- Encouraging the family to set limits around out of control household behaviors and around the sufferer controlling the environment is critical with this age group. Adolescents are testing limits and spheres of control and the more control they experience in their own environment, they will expect in other environments as well. When OC symptoms are severe and family accommodation extreme, we have seen secondary behavioral problems that develop that also need to be treated.
- Family therapy can be helpful for all family members to have a place to talk about how OCD is impacting family, this may be especially supportive for siblings and for parents learning to work together better.
- If a family member has OCD/anxiety disorder or depression refer them for help
Once recovery from the symptoms of OCD begins, it is helpful for family members to realistically appraise their expectations. If the sufferer has “lost” a number of teenage years because of OCD, they have not had the full experience of adolescence. It may take a while longer to obtain a driver’s license, a job, a peer group and close friends, decide on future education or career. This may be discouraging for the OCD sufferer as they look around and see peers doing all these things they feel far from. This can evoke feelings of worthlessness or helplessness. If you can and the parents recognize this or the teen can talk about it, praise the teen for the accomplishment of overcoming the OCD. Remind the teen, with optimism, of skills they have acquired to help themselves and that they will “catch up” with others. With patience and a positive outlook, you can assist them to continue on. Supportive counseling can be beneficial for the sufferer and/or the family. Again, don’t forget about referring to support groups!
If an adolescent refuses to go to see a professional (with or without parents), parents should not forget that they can insist the teen go. This requires a serious commitment on the parents’ part to really support the sufferer to learn all they can about OCD and to seek professional advice. Parents may need to prepare themselves to impose consequences if their home life is deteriorating because the OCD has been difficult to manage. Sometimes accommodation in household routine happens slowly, one change at a time and before long families find themselves embroiled in OCD rules and outbursts if they are not followed. If a family gets to this point, it is crucial to encourage them to be firm, consistent and to follow through. The consequences of not going for treatment vary depending on individual situations. At times, symptoms may be so severe that the teen may risk being placed elsewhere to live or taken to a hospital against his/her will if the symptoms pose a dangerous threat to the sufferer’s life or someone living with them. This should be determined by a skilled psychiatric clinician with knowledge of OCD.