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.