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Obsessive-Compulsive Disorder (OCD)

A Parent’s Guide to Understanding OCD in Teens

Obsessive-compulsive disorder can be an incredibly difficult condition to manage. Even mild cases can present a teen with extraordinary challenges in everyday settings, and adolescence is a particularly difficult time for individuals with OCD due to increased rates of victimization, and the effects of prolonged bullying on the symptoms of OCD themselves. Understanding OCD in teens is incredibly important for parents to know – how it affects their teen’s thinking and behavior, and how they can best help their teen cope with the disorder.

Understanding OCD (Obsessive-Compulsive Disorder)

At its heart, OCD is a mental health condition closely related to anxiety. When a person is diagnosed with OCD, it means that they present with symptoms of two major behavioral and cognitive signs: obsessions and compulsions. Obsessions are deep-seated and intrusive worries that present themselves are unavoidable and persistent in a teen’s mind, much like the little intrusive thoughts we generally experience, but far stronger.

Picture walking past your dog with a pot of boiling hot soup, and for an instant, experiencing the fleeting thought of what might happen if you dropped the pot. Such violent and disturbing thoughts are not harmful in isolation, and if you can ignore and move past them immediately, then they are no cause for concern. But a person with OCD experiences similar thoughts much more consistently, and far more strongly. These thoughts are much harder to shut out or move past, which is why compulsions develop.

Compulsions are behaviors that help someone with obsessive thoughts cope. They may seem completely unrelated or totally nonsensical on the outside, but they provide some measure of momentary or short-term relief before the obsessions start up again. In this way, a teen with OCD is usually stuck within a perpetual cycle of obsessions and compulsions, feeling bombarded by intrusive thoughts which can only be shut out by performing compulsive, ritualistic or repetitive actions.

How OCD Is Commonly Managed

Treatment for OCD in teens differs from individual to individual, depending on the nature and severity of their thoughts and behaviors, but most cases involve behavioral therapy that walks a teen through their thoughts and helps them avoid both the compulsion and the obsession by triggering an obsession and changing their response.

Teens with OCD go through a slow and gradual process of learning to shut out intrusive thoughts, disregard them, and dissociate themselves and their own thinking from the OCD – learning to separate normal logic from their condition. This is part of behavioral therapy. Treatment for OCD isn’t always easy or successful, and it can take time for changes to occur, particularly if the symptoms are severe.

Medication can help with co-occurring issues, such as anxiety issues and depressive thinking as a result of their condition and the effect it has had on their life, but there is no drug that treats OCD itself. Therapy is often a teen’s best bet at learning to manage and cope with their OCD to the point that they can lead a more normal and self-sufficient life.

Common Issues of OCD in Teens

Adolescence is tough enough as it is. But teens with OCD face unique challenges. Dealing with the changes that early adulthood bring while struggling with reality can be painfully difficult, for teens and parents alike. Here are some ways in which the symptoms of OCD may affect your teen’s treatment.

Your Teen Might Struggle With Accepting Their Diagnosis

Mental health issues are still heavily stigmatized, particularly among teens. If your teen has not fully accepted their diagnosis yet, then chances are that it might be difficult for them to come to terms with the idea that they need help. Teens live in a world of labels and groups, and the last thing they want to be is labeled crazy, or in need of medication and therapy.

Furthermore, your teen might have a false understanding of what OCD is, and they might feel that their symptoms don’t fit their preconceptions. They might reject their diagnosis because they worry that going into therapy will affect their chances at getting into a good college or pursuing their dream career.

One way of helping your teen accept their diagnosis is by offering learn more about OCD with them. While they might not like the idea of being “labeled”, their diagnosis is nothing more than a single facet of a whole – and if they don’t try to do something about it now, it will become an all-consuming problem in the future, especially if they’re hoping to avoid therapy as a way to do better in school in preparation for that future.

You May Be Inadvertently Feeding Their Compulsions

When we have children, we want the best for them. We also don’t want to see them suffer. And even though we understand it helps them grow, we sometimes find ourselves in the way of certain challenges that they have to overcome. While managing OCD is scary and difficult, the last thing a parent should do is actively encourage in compulsions.

If you find yourself doing extra loads of laundry or scrubbing surfaces multiple times or otherwise acquiescing to your teen’s strange requests because you think it might help them with their anxiety, understand that compulsions, while effective in the short term, are cyclical, and will always lead back to obsessions.

Therapy works on breaking the cycle. Avoid feeding your teen’s compulsions and avoid excessively reassuring them to help them get out of distress. Instead, work with a professional to learn how to alternatively cope with your teen’s specific obsessions and compulsions and help them avoid them.

Your Teen May Avoid Telling You Things

Obsessive thoughts can be violent, aggressive, and even repelling. Teens are especially caught up with sexuality and their budding feelings for other people, and their OCD might develop in a way that causes them to feel inappropriately towards family, pets, or things. These feelings have nothing to do with your teen themselves but are part of how the disorder takes things we fear or don’t want to think of and thrusts them into the forefront.

As such, your teen may try to hide obsessions and symptoms from you, out of embarrassment and out of fear of judgment. It’s important that both you and your teen understand that you can separate OCD from your child and recognize that it is a very different thing living inside their mind.

OCD Cannot Be Reasoned With

It’s important to remember that OCD does not obey rational thought. It certainly has its own internal logic, but you may not ever understand it, and you cannot simply convince your teen to stop acting a certain way. There is no profound realization to “snap” out of OCD. It takes time and extensive therapy, and lots of adjustment. By supporting your teen throughout the therapeutic process, identifying symptoms, and avoiding anything that might feed them, you can help your teen slowly overcome their condition.

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Addiction ADHD Adolescence Anxiety Bipolar Disorder Depression Mental Health Obsessive-Compulsive Disorder (OCD) Personality Disorder Recovery Social Anxiety Stress

Mental Health and Substance Abuse

Mental illness is a frequent partner of substance abuse and addiction, although the cause-and-effect between the two isn’t always clear. However, the issue is a prevalent one that needs to be considered anytime treatment is sought for substance abuse, because diagnosing both correctly is a key component to a healthy recovery process. There are a number of different types of mental illnesses that are often seen in combination with substance abuse and addiction.

Depression
Depression is one of the most common mental illnesses associated with substance abuse. In some cases, substances may be used to mask the symptoms of depression. Other times, substance abuse may bring on the depression symptoms or make them worse. Symptoms of depression might include:

  • Feelings of worthlessness or hopelessness
  • Persistent feelings of sadness or guilt
  • Loss of interest in or ability to enjoy activities
  • Diminished energy levels and fatigue
  • Difficulty thinking clearly or concentrating
  • Changes to sleep or appetite
  • Suicidal thoughts or ideations

Anxiety
Anxiety disorders are also a frequent problem for those struggling with substance abuse. There are different types of anxiety disorders, including obsessive-compulsive disorder, social anxiety and panic attacks. Substances may be used to lessen the symptoms at first, which often only serves to make the symptoms more intense over time. Symptoms of these conditions might include:

  • Feelings of restlessness or nervousness
  • Excessive and ongoing worry and tension
  • Irritability and fearfulness
  • Sweaty palms, racing heart, shortness of breath
  • Headaches, dizziness or nausea

Attention-Deficit Hyperactivity Disorder
ADHD is a disorder often diagnosed in adolescents and frequently associated with substance abuse. This disorder is characterized by three basic components:

  • Hyperactivity – difficulty sitting still, excessive talking, always seems to be “on the go”
  • Inattention – disorganization, lack of focus, forgetfulness, distraction
  • Impulsivity – impatience, blurting out answers, guessing instead of solving problems

Bipolar Disorder
Bipolar disorder, also known as manic-depressive illness, is a mental disorder characterized by extreme swings of mood and energy levels. During the manic phase, the individual exhibit the following symptoms:

  • Excessive irritability
  • Bursts of energy, requiring little sleep
  • Distracted easily
  • Engage in impulsive, high-risk behaviors

Manic phases are typically followed by depressed states, which may include the following symptoms:

  • Extended periods of sadness or hopelessness
  • Low energy, excessive fatigue
  • Significant changes to appetite and sleep patterns
  • Thoughts and ideations of suicide

When mental illness accompanies a substance abuse disorder, it is imperative to address both disorders simultaneously to give the patient the best odds for a successful recovery. At Visions Adolescent Treatment Centers, we are experienced in treating both of these conditions at the same time, a situation known as dual diagnosis. Our team of healthcare professionals is equipped to work through both disorders and give our patients the best odds of successful sobriety and improved mental health. To learn more about dual diagnosis or our treatment programs, contact Visions Adolescent Treatment Centers at 866-889-3665.

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Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Obsessive-Compulsive Disorder (OCD) Recovery Therapy

Body-Focused Repetitive Disorders

Trichotillomania (TTM) is a type of body-focused repetitive behavior (BFRB) specifically characterized by impulsive pulling out of one’s hair from the scalp, eyebrows, eyelashes, or elsewhere on the body. According to the DSM-IV of the American Psychiatric Association, TTM must meet the following five criteria:

  1. Repetitive pulling of one’s own hair that results in noticeable hair loss.
  2. A feeling of tension prior to pulling or when trying to resist the behavior.
  3. Pleasure, gratification, or relief while engaging in the behavior.
  4. The behavior is not accounted for by another medical (or dermatological) or psychiatric problem (such as schizophrenia).
  5. Hair pulling leads to significant distress or impairment in one or more areas of the person’s life (social, occupational, or work).

Though this criteria is useful, there is some debate within the clinical and scientific communities about whether or not all five of these criteria are present in every case. Since there are many who suffer from debilitating hair pulling behaviors but don’t meet all of these criteria, efficient and effective treatment is still paramount to one’s health and well-being.

Signs and symptoms of Trichotillomania often include:

  • Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but it can be from other body areas as well;
  • A strong urge to pull hair, followed by feelings of relief after the hair is pulled;
  • Patchy bald areas on the scalp or other areas of your body;
  • Sparse or missing eyelashes or eyebrows;
  • Chewing or eating pulled-out hair;
  • Playing with pulled-out hair;
  • Rubbing pulled-out hair across your lips or face.

Onychophagia (nail-biting) and Dermatillomania (skin-picking) are other BFRBs but are characterized by compulsive skin picking and nail biting. Nail-biting is the most common of “nervous habit.” I’m not talking about the occasional cuticle or hangnail, or the occasional blemish that someone may pick or squeeze. Instead, someone who suffers from onychophagia picks or bites their nails or skin until they bleed, finding themselves using Band-Aids like accessories. As those suffering from TTM will wear hats to cover bald spots and the like, nail-biters will keep their hands in their pockets, sit on them, wear gloves or those Band-Aids I mentioned. Those who excessively pick at the skin on their faces will try to cover up with makeup or when things get really bad, go so far as to stay inside and isolate. I mention these two together, because they often make intermittent appearances in the same individual.

Nail-biting (onychophagia) facts include:

  • Common in individuals of all ages.
  • Up to 33% of children ages 7-10 bite their nails.
  • Nail-biting can be triggered by stress, boredom, or nervousness.
  • About half of all children between the ages of 10 and 18 bite their nails at one time or another. Nail-biting occurs most often during puberty.
  • Some young adults, ages 18 to 22 years, bite their nails.
  • Only a small number of other adults bite their nails. Most people stop biting their nails on their own by age 30.
  • Boys bite their nails more often than girls after age 10

Chronic skin picking (dermatillomania)is characterized by:

  • Inability to resist urges to pick at real or perceived blemishes in one’s skin
  • For some, mounting tension before one picks
  • For some, gratification and relaxation while picking
  • Noticeable sores or scarring on the skin
  • Increased distress and/or interference with daily life

BFRBs have been linked to obsessive-compulsive disorder (OCD). They can sometimes be linked to a sign of emotional or psychological disorders. They are all compulsive disorders, but their manifestations have varying presentations: For some, the picking or pulling will occur during sedentary activities like watching TV, reading, driving or being a passenger in a car, talking on the phone, sitting in class, or sitting at a computer or a desk. At times, there might be focused intent which drives the behavior–for example, planning on picking or pulling at an area as soon as one arrives home. At other times, it’s happens without conscious awareness, and the individual only realizes they’ve picked or pulled when they see the resulting pile of hair, open scabs or bleeding fingers.

This can feel overwhelming, but there is help. For starters, you have to say something to someone and let them know you’re suffering.  Your doctor and/or therapist will then work with you and help you redirect the negative behaviors and create new, innocuous behaviors.

The following therapeutic modalities are typically used to treat BFRB:

(Sometimes, elements from some or all of the aforementioned modalities are used to meet the BFRB client’s needs.):

Alternative therapies are also used, but are not as researched or predictable in terms of their success.

Support groups can provide a wonderful place for fellowship and to create positive social reinforcements.

Keep in mind, What works for one person may not work for another. The key will be in finding the treatments that do work and committing to them. Nothing is impossible, but everything takes effort. Feeling better is worth your treatment endeavors.

 

For more info, check out:

https://www.trich.org/

Mayo Clinic

https://www.trich.org/dnld/ExpertGuidelines_000.pdf

Categories
Anxiety Mental Health Obsessive-Compulsive Disorder (OCD)

Destigmatizing OCD

 

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OCD is a form of anxiety occurring when the brain has difficulty dealing with worries and concerns. As a result, someone with OCD will constantly worry and obsess over things that may seem banal to a non-sufferer. For some kids, their worries are focused on cleanliness or germs, resulting in repetitive hand-washing rituals. For others, it could be repeatedly straightening out an area, trying to achieve perfection. These obsessive and repetitive behaviors are done ritualistically or compulsively in order to quell the pervasive anxiety induced as a result of obsessive thought patterns. Often, an OCD sufferer will focus on things being in “order” or “just right,” also as a means to reduce the lingering, scary thoughts infiltrating their minds.  While some kids may recognize they don’t need to act on these behaviors, the disorder itself propels then to do it anyway. It’s not their fault. Interestingly, acting on the repetitive thought patterns does minimally reduce the anxiety, albeit temporarily.

I want to point out that worrying is also a natural part of childhood, so is having small rituals (like wearing your lucky t-shirt before a game), being super organized, double-checking to make sure the door’s locked, et cetera. Kids and teens naturally worry about things, be it school, whether they’re liked, whether they “look cool” for school or to impress that guy or girl, or whether their parents are ever going to get along. With OCD, these rituals become extreme. So, if you notice repetitive, ritualistic, and compulsive behaviors becoming more extreme and negatively impacting one’s day-to-day life, then it’s appropriate to take a closer look at the cause and take action.

That means seeing a psychologist or psychiatrist who will ask questions about obsessions or compulsions. Some of these questions may include:

  • Do you have worries, thoughts, images, feelings, or ideas that bother or upset or scare you?
  • Do you feel you have to check, repeat, ask, or do things over and over again?
  • Do you feel you have to do things a certain number of times, or in a certain pattern?

Once the diagnosis is made, then treatment can begin. Cognitive Behavioral Therapy (CBT) is a preferred treatment for OCD. A CBT therapist will work with a child or adolescent with OCD and help them learn that they are in charge, not the OCD. Often the CBT will integrate Exposure and Response Prevention (ERP) as part of the treatment. With ERP, the strategy is to gradually expose the sufferer to their trigger (fears) so they can develop skills and learn not to respond to them with such urgency. The process allows the OCD sufferer to begin to recognize that their fear is just that: a fear, not a reality; it also helps the brain “reset” the very mechanisms that trigger the obsessive behavior. It’s important to remember that treatment for Obsessive-Compulsive Disorder takes patience, time, diligence and hard work.

Remember, there is no shame in asking for help or in getting treatment. Having OCD doesn’t mean you’re crazy, or broken in some way. There is a solution.

Categories
Addiction Anxiety Depression Mental Health Obsessive-Compulsive Disorder (OCD) PTSD Recovery Therapy Treatment

MDMA: Is This Psychotropic Drug Helpful, Harmful, or Both?

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Last time I wrote about ecstasy, it was about the rise in ER visits and the inherent dangers of using a drug that inevitably depletes one’s levels of serotonin and has the potentiality of long-term brain damage. So, when I came across an article talking about using MDMA (ecstasy) to treat post-traumatic stress syndrome (PTSD), my curiosity was sparked. Psychedelic drugs have been used to treat mental illness before, and with some success: In the 50s and 60s, psychology was in a Freudian phase, viewing psychological issues as conflicts between the conscious and unconscious minds. At that time, psychedelics were used to allow patients to face their unconscious minds while awake, which purportedly eliminated the variables of memory retrieval. Still, these methods of treatment weren’t without controversy.  With the influx of street use, and folks like Timothy Leary telling people to “”Turn on, tune in and drop out,” the use of psychedelia to treat mental illness was met with great discernment and fell to the wayside.

Currently, interest in using MDMA and other psychedelics to treat depression, obsessive-compulsive disorder (OCD) and PTSD is gaining traction. MAPS is doing extended research on this subject, and states that MDMA isn’t the street drug we call ecstasy, noting that while ecstasy contains MDMA, it also may contain ketamine, caffeine, BZP, and other narcotics and stimulants. According the MAPS site they are “undertakinga 10-year, $10 million plan to make MDMA into an FDA-approved prescription medicine.” They are also “currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy. For-profit pharmaceutical companies are not interested in developing MDMA into a medicine because the patent for MDMA has expired. Companies also cannot profit from MDMA because it is only administered a limited number of times, unlike most medications for mental illnesses which are taken on a daily basis.”

The use of this drug has leaned so far from its psychotherapeutic roots, proving to be one of the most popular, highly sought-after street drugs around. Because of this, the useful aspect of this drug may easily be overlooked, forcing us to question how we can take something that has morphed into a social enigma and call it useful. I’m curious, will sufficient research place this drug at the discerning hands of medical professionals once again? And how do we, as a recovery community accept this when we have kids coming in suffering from the long-term, negative effects caused by this very drug?

Related articles:

MDMA May Help Relieve Posttraumatic Stress Disorder(time.com)

Ecstasy As Treatment for PTSD from Sexual Trauma and War? New Research Shows Very Promising Results (alternet.org)

Clinical Study of MDMA Confirms Benefits Noted by Therapists Before It Was Banned (reason.com)

Neuroscience for Kids

Ecstasy Associated With Chronic Change in Brain Function