Myths & Misconceptions About How Best to Help Teens with OCD

Obsessive Compulsive Disorder (OCD) is a condition that seems simple on the surface, but that is actually quite confusing and counter-intuitive. We see stereotypical portrayals in movies and press, but they only serve to deepen the misunderstanding about the ways people with OCD suffer and how to help them. Licensed Marriage and Family Therapist, Melissa Mose, specializes in working with OCD, and she has also specialized in working with teens for over twenty years. In addition to her professional experience she also happens to be the mother of a teenage girl who has OCD. Melissa has been working to dispel the myths and confusion about OCD for many years now because she knows how important early detection and proper treatment can be. In this interview she discusses three myths that perpetuate confusion about OCD, and she explains how a better understanding of the disorder can help parents to find the propter help for their teens.

Adolescence is a time in life that is already fraught with fears and insecurities, difficulties with peers and issues with identity. So when a teen has OCD, the myths and misunderstandings about having a mental disorder such as OCD are particularly painful. Similarly, parenting a teen is confusing enough. Parenting a teen with OCD without a clear understanding of the disorder is like navigating a minefield. There are many topics we would never presume to understand without serious research; engineering, physics or botany. But we tend to think that understanding the mind is supposed to be intuitive. OCD lends itself particularly well to these personally biased theories, and this leads to some popular misconceptions that can be very upsetting and even damaging to those with actual Obsessive Compulsive Disorder. Fears of being stigmatized or misunderstood can cause teens to keep their OCD symptoms a secret and to worry excessively about what other people think. With parents and even therapists who may not understand the disorders, teens can develop resentments and resistance to being treated. It is important to do your research, get the facts and let go of common myths that may frustrate and hurt those with OCD.

 Myth #1 – We’re all a little OCD.

Real OCD is not a personality trait. Although many people have tendencies towards obsessive thinking or being compulsive, these thoughts and behaviors do not get in the way of normal functioning and they generally do not cause distress, but rather alleviate it. Some of us have a strong preference for things to be neat and orderly, but one item out of place won’t keep us up all night. We may want to fix something, but those with OCD feel they have to change it. They would rather not spend an hour cleaning an already clean kitchen or straightening everything in the house before bedtime. Their compulsions are not a source of pride, but of shame. Mose explains that, “no one with OCD says, ‘Oh, I’m so OCD about that.’” For example, a person who does not have OCD might worry about germs and wash their hands frequently during the day feeling satisfied that doing this helps to prevent them from getting sick. Someone with OCD washes over and over for various other reasons besides germs and may need to wash even when their hands are cracked and bleeding. This provides no satisfaction, serves no real purpose and is embarrassing, inconvenient and painful. Research has shown that the brains of people with OCD are wired differently, and getting over it is not a matter of self-control or willpower. They can’t turn it off. Even if they can resist it for certain periods of time, like when they are at school, it is always looming and tormenting them. While it’s understandable to describe our own obsessive thinking as “obsessive” and compulsive behaviors as “compulsive” it is also helpful and respectful if we distinguish those tendencies from true Obsessive Compulsive Disorder, which can devastate people’s lives.

Myth # 2 –OCD is a reaction to stress, so reducing expectations will help.

While it is true that OCD is often aggravated by stress and may be triggered by trauma, difficult life situations do not cause OCD. She points out that, “a child does not get OCD because of a divorce or too much stress from school or challenging family dynamics. It is natural to want to comfort a child in distress, but protecting them from anxiety or stress-producing situations is not the solution.” Actually, accommodating the apparent needs someone with OCD makes it worse. Our brains learn from experience. Avoiding stressful situations is an effective way to reduce fear and anxiety in the moment. Unfortunately, for a person with OCD, that experience is quickly consolidated by the brain as a success and repeated even when it is not necessary or desired. Options are reduced, flexibility is limited and procedure requirements begin to skyrocket very quickly. Families will often change their entire routines and expectations for the child with OCD. If there is anxiety associated with a certain place, oftentimes families will avoid going there. If a child doesn’t want to touch certain things, take out the trash, do the dishes, parents may feel that it is easier to just do it for them. This is an understandable reaction when families are trying to get multiple kids to school on time or simply run a household, but it undermines recovery from OCD. While compassion is critical, so is a firm but empathic approach that refuses to allow OCD to run the show. Working with a therapist who can help you find that balance is an important step towards preventing the entire family from becoming embroiled in perpetuating OCD in the name of trying to be helpful. The short term stress of facing OCD symptoms is actually what help a person heal.

Myth #3 – OCD is all about hand-washing and checking things over and over.

Washing and checking rituals are definitely the most commonly known compulsions associated with OCD, but they are just the tip of the ice-berg. Since compulsions are a way to momentarily fix the obsessive thoughts, they can take many forms. Sometimes they aren’t even observable by others. Mental compulsions, for instance, are thoughts, words, or mental activities that someone can be doing all day long without anyone really knowing. Often these are mistaken for inattentiveness, distraction or ADHD. Some compulsions take the form of reassurance seeking or avoidance of certain situations. The ritualized actions that we generally think of as indicative of OCD can also take many forms depending on the type of obsession they are designed to neutralize. Washing is the typical action designed to deal with contamination fears. Other obsessions involve harm to others, sexuality and religion. Mose points out that, “not all people with OCD are obsessively neat, clean and orderly. In fact, sometimes it is quite the opposite. They may actually not feel able to shower or clean their room because of fears of being unable to stop.” It is important to be able to see beyond the stereotypes so that parents and therapists don’t miss cases of OCD. A person needs a very different type of treatment for OCD that they would for ADHD.

 What parents should do

 If you suspect that your teen may have OCD, you should of course find a professional who specializes in OCD and schedule an evaluation. The International OCD Foundation website is a great resource and has a list of professionals who have been trained in working with OCD. You can also visit my website at melissamosemft.com for other resources. But before jumping into action it is important to open up the lines of communication with your teen. Adolescents usually know when they are doing things that are out of the ordinary. Let your teen know that you are open to talking. If it feels safe to talk to a parent or another adult, they can begin to understand that they are not alone. Sometimes teens refuse to talk, and even try to refuse getting evaluated. This is a tough road to navigate but it is not impossible. First, educate yourself as much as possible and encourage your teen to do the same. There are many websites and online support groups directed specifically to teens and their parents. Adolescents often feel more comfortable in this domain at first. Once they can see the value in getting help you are more likely to have a willing participant. Stay positive. OCD does get better with treatment, and your child needs for you to be strong and optimistic. Understand that the stigma of having a mental illness can be frightening to all of us, but especially to teenagers who are already worried about issues of identity and fitting in. Fears can lead to secrecy and feelings of anger, so be prepared and find support for yourself. There are groups for parents out there as well.  On the bright side Mose points says, “If there is a silver lining to be found in all of this it is that the skills your teen will learn in the process of facing down OCD are skills that apply to every aspect of life. People with OCD often use these coping skills even better than others and live very happy and productive lives.”

If your child has OCD, find out how you can better help them. Visit Mose’s website for helpful resources to help your teen and your whole family.

5 Myths about Tics

Myth #1 Children will eventually outgrow their tics.

This is sometimes the case, but it is not to be counted on, since two thirds of all individuals who have tics as children will still experience some tics as adults. Tics occur in 10-25% of school age children, although full Tourette’s syndrome will affect less than 1% of the population. Tics completely resolve in only one third of children who experience them and partially resolve in another third. The last third comprises the population of individuals who will have lifelong tics.  These numbers suggest that roughly  1 out of every 10 children could benefit from some training in how to manage tics.

Myth #2 – There is no real treatment besides medication for tics since it is a neurological disorder.

Your child can actually learn to manage and reduce tics.  A system called CBIT (Comprehensive Behavioral Intervention for Tics) has been found to be better than supportive therapy and better than medication alone in reducing the number and severity of tics. The studies show that the earlier you begin treatment, the better. With roughly ten weeks of treatment with CBIT, tic severity can be greatly reduced and the gains are lasting. It is also a system that your child can learn to use on his or her own so that future tics can be addressed without more therapy.

Myth #3 – Treatment should be avoided because talking about tics will make them worse.

It is true that when you just talk about a tic you may begin to see that the tic happen more, but when you talk about the tics in the context of treatment where you are working on reducing them in a systematic fashion, the severity of the tics is actually reduced over the long term. The increase in the appearance of the tic is only in the moment and will not begin to occur regularly outside of the treatment session.

Myth #4  – Trying to stop tics will result in more tics or new ones..

There is a belief that if you try to stop your tics you are going to get a rebound effect; that if you suppress them there will be this huge explosion of tics later on or that getting rid of one tic will just lead to a new one.  Studies have shown that new tics occur regularly whether a person is in treatment or not. The reduction of specific targeted tics, did not predict the appearance of new tics. Research also shows that there is no rebound in the number of tics after a period of trying to stop them. It should also be noted that true behavioral treatment for tics, does not rely on suppression of tics, but on training in using a competing response, and this is more effective than simply trying to hold tics back.

Myth #5 – Focusing on stopping tics causes anxiety, inattentiveness and behavioral problems in children.

There is a concern that if a person is making an effort to reduce tics, that effort will interfere with a child’s ability to pay attention in class. Studies have detected no cognitive or attentional impairment in individuals as a result of behavioral training to reduce tics. In fact, the self-awareness and self-control that individuals experience as they begin to see results in treatment actually reduced their general anxiety, and improved self-efficacy.  The Comprehensive Behavioral approach to treating tics, teaches the individual to become self-sufficient in the process so that they can learn to identify their tics and work through them on their own after treatment is concluded. This leads to an overall ability to focus and succeed in school because the distraction and distress caused by the tics will be reduced.

Himle & Woods (2006)

Behavior Research and Therapy

Woods et. Al (2003) Journal of Applied Behavioral Analysis.

7 missed signs of teen OCD

7 easy to miss signs that your child or teen may have OCD.

Most of us experience many different moods, states of minds, thoughts and feelings throughout the course of a day. And we deal with them very differently on a good day than on a bad day.  For teens, this roller-coaster is much more intense, and for teens with OCD it can be a nightmare. Teens may not want to tell us how they are feeling or why they do the things they do.  Often they aren’t sure themselves. We, as parents, are left to interpret behavior, and that is a very difficult job. It can be hard to tell is a teen is just very organized and motivated to do well, or if they are feeling compelled to check and recheck their work. Temper outbursts may be defiance or uncontrollable frustration. Certain avoidance behaviors may be grounds for a consequence or a sign that there is something disturbing going on. How do you know? And what do you do?

The following are seven particularly confusing behaviors.

Perfectionism At first glance, you are one of the lucky moms. Your kid never loses a sweater at school, never forgets a homework assignment, always checks for mistakes, and refuses to give up on something until its right. But, when you look a little closer, or as time goes by you see that this tendency has become extreme. The perfect English essay was thrown away and re-started numerous times or the backpack needs to checked again and again, not to be sure the homework is in it, but until it feels okay to stop. Eventually these teens may become so bogged down by re-reading, re-writing and checking needs that they are unable to get things done. These behaviors take on the quality of a need or drive rather than a sense of determination or responsibility. Any high achieving student may feel stress if there isn’t enough time to complete an assignment, but a teen with OCD will have a melt down because incompleteness creates such a sense of panic. In order to get a sense of what is going on with your child, ask what would happen if the task weren’t completed. A reasonable consequence or even an exaggerated one is to be expected, but if the notion is intolerable and you hear something like, “I just have to . .” or  “ I don’t know, I just can’t . . .” you may want to consult a professional.

Inattention Teens with OCD are frequently unable to focus in the classroom. Their inattentiveness and inability to follow through on assignments looks very much like ADHD. Sometimes there is also ADHD present, but the OCD may be overlooked. When teens with OCD are having persistent and repetitive thoughts that take over their attention, it is generally not apparent to anyone. They may appear to be daydreaming or lost in thought when they are actually performing mental rituals, and they often don’t want to tell you what is really going on. You may need to ask specifically whether they are having thoughts running through their mind or if they are feeling uncomfortable and trying to deal with it by thinking. A teen with OCD will usually be relieved to hear that others experience such things. You may hear that there is so much going on in their mind that they can’t even begin to describe it. In that case, you may want to consider an evaluation for OCD.

Avoidance The easiest way to keep from experiencing distress is to avoid the situation that appears to be causing it. If the target of avoidance is school or doctor’s appointments, or even public restrooms, parents and teachers will eventually notice. But if the situation that is causing anxiety is a particular article of clothing, a certain number or type of number, a book or a certain kind of book, a specific color or texture or taste, it may be a very long time before anyone notices. It may also seem to be nothing to worry about. A person can get by pretty easily in life without ever wearing green or reading a book with a main character by the name of Tony. Who cares? But unfortunately, it rarely remains so simple. If left un-treated, OCD keeps taking away more and more of a person’s choices until he or she may be painted into a corner.  When a teen with OCD withdraws from all or specific social situations, they may appear as shy or socially anxious when what is actually going on is more complex. Try asking your teen how hard on a scale of 1 -10 it would be to face the issue or situation that he or she is avoiding. And then ask why. If the response you get is puzzling, ask a professional.

Violent thoughts or images concerning self or others Because this is a potentially dangerous sign, we do need to be sure that a teen is not actually suicidal or homicidal, clinically depressed or psychotic. That being said, many teens with OCD have what we call Harm OCD, or Bad Thoughts OCD or Pure O. They experience repetitive and intrusive thoughts and/or images that are very disturbing to them. Unlike ordinary worries or ideas, these obsessions don’t pass, and they are not generally realistic, and they are experienced as horrible and undesirable. People with harm OCD often worry that they may snap and impulsively act out their horrible thoughts, but this is highly unlikely. They worry that they may hurt someone, often a loved one or someone vulnerable such as child. They worry that they may be sociopaths or sexual deviants, or that they may be suicidal, and so their compulsions are elaborately designed to check on those concerns and to prevent acting on the thoughts. Compulsions can include, avoiding, counting, tapping, checking, praying or mentally reviewing their thoughts among other behaviors. It is important to fully assess for Harm OCD because the treatment would be very different than the treatment for a depressed teen who is actually suicidal.

Questioning   To look for reassurance is a completely natural human inclination. But these basic human tendencies can become overly active or out of control. Its pretty typical for small children to ask the same questions any number of times. “Are we there yet?” is a typical example. As parents, we become inured to this sort of thing very easily. It is survival. So it is easy for the questions to slowly creep up in number until it crosses the threshold of awareness and we think “Enough!” You’ve just asked me that 20 times. I’ve given you the same answer every time. For most kids, this is enough. But the child or teen with OCD can’t stop.

Reassurance Seeking Another version of this is reassurance seeking. This compulsion involves asking family members and friends for reassurance that some feared event is not going to happen. Again, we all do this occasionally but with OCD it is a compulsion that is designed to relieve an intensely difficult thought feeling or concern. And it is very rarely stops on its own.

Confessing  A third version of this verbal repetition compulsion is confession. People are always relieved when they tell the truth. Even criminals hooked up to lie detectors show a clear relaxation in their vital signs once they confess even if it means they are going to prison. It works at church, and can be healing in a relationship. However, because it works to relieve anxiety, confession can also become a compulsion.  In fact, there is such a thing as moral scrupulosity, in which people are unable to tell lies without experiencing incredible emotional pain. Sound like something you wish your teens suffered from? Guess again. The fear of having possibly hidden some truth or having forgotten a detail can leave a person wracked by guilt and feeling constantly ashamed.

These are not definite indicators that your child has OCD. If you are concerned about your child you should seek an evaluation by a trained professional. This information is intended only as a guideline.

When Change Is Good, And Bad, But Ultimately Good: Starting Middle School

school-bus-_-melissa-mose

“You can’t walk me in. I’m really sorry, but it’s middle school, mom. I WILL get teased.” – Parting words from my 11-year old on the first day of school.

The many unsettling changes that occur in and around our children as they enter Middle School provides them with the experiences that they need in order to grow. Nature gives us building blocks – the tools and the abilities – but for us to effectively grow our skills and employ those building blocks, we need nurturing…we require learning.

Today’s world provides a whole new set of experiences that may make this process more challenging than ever. What we know is that middle school is a rite of passage, and while this time in life has always proven incredibly fruitful, there’s no doubt that it’s just as incredibly difficult. Some of the more external adaptations facing today’s new Middle Schoolers includes more stringent academic demands, more kids and new faces, as well as a variety of different classrooms and teachers rather than the single room and teacher they’ve been used to their whole lives, who by the end of the day may spend as much time with a child as his or her parents.

In addition to these external adaptions, there are the internal ones that can weigh quite heavily on a child. Hormonal changes mean that bodies and emotions are in flux, making it much harder to cope with a steady, predictable environment, much less a radically different one. Hormones can also distort thinking, impact judgment and decision-making, wreak havoc on motivation and create strange new obsessions and desires. The bottom line is that a rapidly developing brain means that not all systems are online at all times.

One of the ways this manifests is bullying – kids at this age aren’t always very nice to each other. Sure, adults aren’t either, but Middle School is where it seems to begin. Kids are more vulnerable and scared than ever before, and consequently they are often mean, critical or aggressive, after all, fear and anger are generated in the same part of the brain – they go together. When we are stressed, feeling insecure or depleted many of us are more likely to bark at people or kick the dog. So, why are we surprised when kids do it? Why kids are so mean to each other? That’s when we have to remind ourselves that what seems like a “mean kid” may actually be a small human being who hasn’t yet developed the experience it takes to control intense emotions without acting or reacting. And since acting out is designed to relieve tension, it works. It makes us feel better. So, naturally, we keep doing it.

There are other benefits to being mean. People leave you alone, for instance. The best defense is a good offense. Bullies want an easy target – kill or be killed. Ok, perhaps that was a bit extreme, but these sayings are trite for a reason: they are true. That doesn’t necessarily mean they are productive, healthy, or good for world peace, but there’s no denying that such behavior tends to increase in middle school along with all of the other internal and external changes and stress triggers. And this is how children learn.

I might be writing this because I myself need to hear it – as my daughter enters Middle School, it’s not out of my nature to see her as the easy target and I need to remember all of this so that I don’t “go all mama bear,” as she likes to describe it.

So how do we help our children navigate the myriad of landmines that they potentially face? Is it by protecting them, arming them, or giving them the tools and training for the journey? The answer is all of the above.

There are many researchers and clinicians who have studied and addressed the topic at length. If you have a new Middle Schooler in the family, here are a few books and articles I highly recommend:

Playground Politics: Understanding the Emotional Life of Your School-Age Child by Stanley Greenspan and Jacqueline Salmon.

http://www.psychologytoday.com/blog/liking-the-child-you-love/201402/the-hiddennot-so-hidden-fears-middle-school-students

http://www.education.com/reference/article/emotional-development-middle-school/

http://www.edutopia.org/blog/how-middle-schooler-mind-works-brains-part-one-heather-wolpert-gawron

A Lesson In The Lost Art Of Listening

Melissa Mose_Listening

Sometimes it seems like absolutely nobody really knows how to listen. I suppose it’s odd that I’m bringing this up since listening is one of the reasons that I have a job, but it just seems like the world would be a much more harmonious place if people were more aware of how often they ‘hear’ what others are saying without really ‘listening.’ Exploring why this happens might help us to identify and change our behavior. The good news is, it is actually very understandable. Read More