For parents who worry their teen might have OCD, it has been stressful. You’re feeling helpless as you see your teenager engage in obsessive thoughts and behaviors that seem ridiculous to you. You might have responded in anger, yelling at them for wanting to fold all their clothes perfectly. You might have tried gently to talk them out of their illogical thoughts that someone will die if they don’t leave the house right at 7:07 for school. You may have gotten fed up enough to start working around their compulsive behavior, making sure there are exactly six bites of vegetables on their dinner plate. Whatever the case, it has broken your heart to see your child controlled by obsessions and compulsions. It has also caused enormous aggravation to the whole family. Even your teenager knows it’s ridiculous, but they just can’t stop.
Obsessive-Compulsive Disorder is an anxiety disorder that has a fairly straight-forward treatment protocol. There are some basic steps that are followed. Normally the treatment team includes both a psychiatrist for medication, and a therapist for cognitive-behavioral therapy.
First, the OCD has to be defined. This means that the person suffering with OCD works with the therapist to find out which obsessions lead to which compulsions. For example, a person might be obsessed with the stove being left on. The compulsion is then to check if the stove is left on several times before leaving the home. The therapist also helps clarify what the person is really afraid of. This person might be afraid that their house will burn down, which represents a loss of control. The deep underlying fear is a loss of control.
The person suffering with OCD then goes to meet with the psychiatrist. They explain to the psychiatrist how the OCD is manifested, and the psychiatrist prescribes medication accordingly. Psychiatric medication is extremely effective with OCD. The combination of medication and therapy are found to be even more helpful. Most of these medications take 4-6 weeks to take full effect.
As the medication is building up in the person’s system, the therapist and client work together to confront the anxiety that is playing a role in OCD. This is normally done through a process called “exposure and response prevention.” For the person who really wants to check if their stove is off 6 times, they might start by only checking 5 times. Not checking that last time will give them a strong feeling of discomfort. With the counselor they learn to tolerate the discomfort and talk themselves out of it. Eventually the discomfort passes. They would probably then move on to checking the stove 3 times, 1 time and then not at all. In the meanwhile, a lot of work will be done in therapy to address the fear of losing control. The person will learn to ask themselves, “So what if my house does burn down? Will I be able to handle it?” The answer is that although the house burning down would be extremely stressful, it could be handled.
For someone with an obsession with germs and a compulsion to hand-wash, exposure and response prevention would work similarly. This person would be encouraged to touch things they see as “contaminated” in the counseling office. They would be asked to leave it on their hands until the anxiety passed. Then, if it is appropriate, it would be okay to wash their hands. Sometimes things seen as contaminated don’t really require hand-washing, such as touching a door-knob. In this case, the person would be asked to refrain from washing their hands until a more appropriate time.
This process is done somewhat slowly. Someone with OCD cannot jump right to the finish-line. They cannot fear germs and then immediately put their hands in mud and not wash their hands. Every step is worked up to at a pace that is both slightly challenging and yet tolerable.
OCD is hard on everyone in the house. It causes you stress, your teenager stress, and is frustrating all around. The good news is that OCD is treatable!
Helping teens grow and families improve connection,
Lauren Goodman, MS, MFT