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Obsessive Compulsive Disorder in Adolescents

Obsessive-Compulsive Disorder is common and can be treated and managed, if necessary, with professional help. Adolescents with OCD often keep their unwanted symptoms a secret because they don't want to be seen as different from their peers or even worse, as "weird". However, knowing how to cope with OCD and who to seek for help can be invaluable information.

How do you know if you have OCD and how is it treated? People who suffer from OCD have unwanted and unwarranted or senseless obsessions and compulsions. Obsessions are recurrent and persistent ideas, thoughts or impulses which are experienced as intrusive and time-consuming, and interfere with the daily routine of school, work, and social relationships. Common examples include the fear of germs, of catching diseases, of death and dying, of order and symmetry, or of hoarding and saving. An individual who fears contamination has trouble being in public, using public facilities, and/or eating away from home.

Compulsions, also known as rituals, are deliberate physical or mental behaviors that are the result of obsessions. People perform the rituals to alleviate the worry and discomfort created by the intrusive thoughts. Common themes include excessive washing of the hands, extra long showers to assure oneself of being clean, superstitious rituals such as doing everything in eights (or other numbers), excessive checking of something (hair, clothing, locks on windows and doors) and constant erasing and feeling that work is never good enough.

Cognitive Behavioral Therapy is often used to treat OCD. The object of the treatment is to understand that there is a "brain lock" and that one's thinking is "stuck". The individual relabels the fear as not being real fear but the OCD giving the brain misinformation. The individual corrects the faulty message and stops performing the ritual. This process has to be performed over and over again, much like exercising a weak muscle, for the brain to get stronger and for the thoughts to disappear. Eventually, the thoughts lose their potency and the OCD weakens and disappears. The OCD can return at different times in a persons life (usually stress-related) but if the individual uses the cognitive behavioral coping strategies, the thoughts and rituals can quickly be dealt with and the individual can feel in control. (This is an over-simplification. Overcoming the OCD is a very difficult process depending on whether the symptoms are mild, moderate, or severe).

Some of the Cognitive Behavioral Techniques include relabeling, desensitization, relaxation, and flooding. Behavior therapists use the technique of Exposure and Response Prevention (ERP) where an individual is exposed to the unwanted thought (ex.touching the bathroom door at school) and are prevented from performing the usual ritual (ex. washing hands in hot water for a set number of minutes). The individual experiences tremendous anxiety (the intensity depends on the severity of the OCD---some people have panic attacks, feeling like they are going to pass out or even stop breathing). If the anxiety lasts for an hour or more a trained therapist should be working with the individual. As the person continues to be exposed to the unwanted thoughts and stimuli and does NOT perform the rituals, the anxiety lessens and the individual begins feeling more in control and less fearful. Some teenagers admit that they never use the bathroom at school and never touch the classroom doors at school for fear of contamination.

Medication combined with the therapy can help lower the anxiety. A medical professional should be consulted regarding medication to help alleviate symptoms of OCD.

Addictions and OCD are different in that addictions are behaviors that are pleasurable. For example, individuals who are addicted to alcohol, cigarettes, chocolate, drugs, shopping, or the Internet gain pleasure in the activity but it interferes with daily functioning. OCD thoughts and behaviors are not pleasurable. They are often are annoying, time-consuming and unwanted but feel necessary to alleviate the discomfort of the tension and anxiety.

In general, adults and teenagers have the same OCD themes, however, teenagers often approach it differently due to their stage of development. A professional who specializes in treating adolescents should be consulted to assess the nature and severity of the problem. The school counselor or psychologist or family physician would be a good place to start. Parents need to take their teens concerns seriously and get them help even if they insist they don't have a "problem".

Please feel free to call us at Western Reserve Psychological. Several of the psychologists work with adolescents with OCD and would be glad to do the assessment and make a recommendation for treatment.

Janet Dix, Ph.D.

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