Sometimes when people think of Obsessive Compulsive Disorder (OCD) they have a narrow view of what the condition involves. The average person may jump to the stereotypical excessive-handwashing version of OCD, or the person who obsessively checks the stove to make sure they turned off the burner. These are examples of how OCD can show up in people’s lives, but it doesn’t tell the whole story.
Anyone who has this anxiety-based condition or has a loved one with OCD can attest to the varying ways it can present itself in thought, feeling and behavior. The hallmark of an OCD diagnosis is the presence of two components; obsessive thoughts that are distressing and repetitious, and compulsive urges to engage in behavior to reduce the stress. It’s not exactly a picnic in the park for teens with this condition, but it is manageable with the right type of treatment.
OCD Treatment for Teens
Obsessive Compulsive Disorder responds well to Cognitive Behavioral Therapy (CBT) because it helps teens dissect thoughts and feelings, while identifying ways to disrupt the urge to engage in the behaviors that can take up so much time and energy. Often the key to breaking up with OCD is learning how to tolerate the strong urges to act on distressing thought without giving in.
For teens who are struggling with this, it may sound impossible; the urge to engage in certain behaviors to reduce stress is powerful, but this is the avenue toward freedom. Think of it like a workout, or a training session for your thoughts and feelings. No one starts out running a 5K on their first day out jogging or benching 300 pounds their first visit to the gym. It’s all about learning the techniques and skills that can help you become an OCD Jedi Master.
Cognitive Behavioral Therapy also helps teens sort out some of the underlying anxieties that drive OCD. Learning about triggers is a helpful way to recognize when symptoms may become more intense. Covid-19 may be a trigger for people who struggle with fears surrounding viruses or infectious illness, for example. For some this may manifest in excessive hand washing, overuse of hand sanitizer or other behaviors to reduce stress.
It is important to remember that the compulsive behaviors of OCD are well beyond the range of typical precaution. Compulsive behaviors are time-consuming and/or disruptive to daily life. CBT can help teens determine where behaviors make the leap into being excessive or disruptive and then work on building tolerance to the distressing thoughts. Teens in treatment can learn to use coping strategies to manage thoughts and urges rather than giving in to them. Medications can also be useful for teens struggling with OCD, but it is crucial to engage in the therapeutic aspect of the work to build skills for managing it. Often CBT is sufficient, and no medications are needed.
How Parents Can Help
Parents of kids with OCD are often flummoxed about how to help. The best thing a parent can do is offer empathy, support, and gentle reminders of coping skills when anxiety triggers are mounting. Remember that teens who are struggling with OCD are distressed by their thoughts and that is what drives the compulsive behaviors. It may be tempting to try to convince them that their thoughts are illogical or baseless, but this approach is likely to cause even more stress, which could increase symptoms.
Remember, your teen will build tolerance for varying thoughts and levels of distress in therapy and will learn to trust their minds with uncomfortable thoughts. Managing OCD is about learning how to keep perspective and recognize that thoughts are “only thoughts” and do not require excessive attention or action. When people with OCD learn to allow thoughts to enter and exit the mind like a passing breeze, it can alleviate a lot of stress and often symptoms begin to subside. Even when anxiety is causing some thoughts to get stuck, treatment can help teens recognize the familiar pattern and use skills learned in counseling to get through a difficult moment without giving in to a compulsive urge.
Parents can also do some research to learn more about OCD and the ways it can affect teens. There are a variety of great resources available, including the McLean Hospital site and Peace of Mind. Both sites are helpful for parents to learn more about OCD and varying treatment methods. Teens will enjoy BeyondOCD.org Just for Teens site.
Regardless of where you are on your journey with OCD, and whether you are a parent or a teen with the condition, relief is possible. When you use CBT tools and practice strategies, you can manage OCD and enjoy your life.
The way we connect with each other as humans influences every aspect of life, from our daily interactions with people around us to the health of our intimate relationships and view of ourselves. Each of us has an attachment style that typically falls within four general categories: secure, avoidant, resistant, and disorganized.
The ways we attach to primary caregivers in early life is a predicting factor of our attachment style. As a “tabula rasa”, or blank slate with no conscious awareness or expectations, infants respond to the reactions of caregivers. Infants who learn that others are not likely to meet their needs consistently sometimes develop attachment problems during their lifespan. This can mean the difference between an infant who knows their needs will be met and one who learns that their needs are a burden or illicit hostility or unpredictable responses. Data from the Early Childhood Longitudinal Study indicates that out of 14,000 kids that participated, 40% had insecure attachment. If the challenges are profound enough and negatively impact a child’s life, it could indicate the presence of an Attachment Disorder, and may warrant mental health intervention.
What is Attachment Disorder?
Attachment Disorder is a diagnostic term used by mental health professionals that explains a range of emotional and behavioral symptoms related to an individual’s inability to establish trusting, loving relationships. In children, this may look like behavioral outbursts and attention seeking behaviors, resistance to connection with parents and others, or conversely, indiscriminate attachment and limited boundaries with others.
Often when we think of Attachment Disorder, we envision scenarios that may contribute to difficulty trusting others, such as negative early childhood experiences. While it is true that disordered attachment usually stems from early interactions, it is important to consider that some issues related to attachment are not as easily explained, and in some cases, it may feel like a complete mystery.
Parents who adopt are often provided with information about attachment issues prior to adopting, to help identify potential signs for early intervention. People who have adopted from infancy, however, may feel as though their child is protected from disordered attachment, since they have been the primary caregivers since day one. Even with adoption from infancy, attachment disorder can sometimes manifest, leaving adopted parents feeling confused, riddled with guilt, and deeply saddened about their child’s emotional suffering.
Neurological Factors in Attachment
The ongoing study of the attachment process has shown that the way we connect with others and establish trust in human relationships is complex and deeply rooted. Attachment is influenced by a variety of factors, including but not limited to the way caregivers respond to infant needs. Babies who are adopted from birth can still have attachment problems unrelated to any experiences out of the womb. This phenomenon shows us that attachment is more than just having one’s needs met at crucial times in our lives. It also happens at the microscopic level, in utero, and is impacted by neurological and genetic factors that are beyond what we can control in an infant’s world.
We have known that trauma changes our brains for decades, but the in-utero impact of trauma on the attachment of unborn babies is relatively new information. A 2017 study of maternal lifetimes stress, cortisol levels during pregnancy and infant reactivity showed significant findings. Mothers who have experienced a greater amount of traumatic experience during their lifespan are more likely to have infants with negative affective reactions.
The maternal Hypothalamic-pituitary-adrenal-axis (HPAA) impacts infant and toddler affect, increasing the likelihood of distress, fear, and behavioral issues. The results of this study show that the impact of maternal stress over the lifespan influences maternal neurobiology and even impact the way unborn babies develop. These changes also compromise attachment wiring in the brain. In short, attachment problems can become intergenerational and hard-wired, even when the infant is raised in a safe, loving home. It is no one’s fault. Fortunately, there is help for addressing attachment issues.
Managing Attachment Disorder in Children
Attachment disorder that is hard-wired may feel futile and hopeless to manage, but it can be addressed with the right tools and support. Professional therapists offer attachment therapy to parents and children as a means of helping to mend some of the barriers that can influence attachment. Early intervention is best, but older children can also benefit from attachment work.
Helping children and parents connect is the focus of attachment therapy, and it is done with careful planning and in consideration of the unique needs of specific families’ circumstances. Parents who have children struggling with attachment issues can experience growth, connection, and greater attachment with a little help.
If going into the woods sounds like an intimidating prospect, or the opposite of a therapeutic experience, it may be worth a second look. Wilderness therapy is growing in popularity because of its effectiveness with a multitude of populations, including kids. In a survey of 858 participants of wilderness therapy, 83% reported that they had maintained progress and made ongoing improvement two years later. Of the group surveyed, 81% felt that outdoor behavioral healthcare treatment is an effective approach. It is so effective a group of wilderness treatment programs built a collaborative in 1996 called Outdoor Behavioral Healthcare Council. This group of licensed mental health providers had seen the effectiveness of the model in practice, and knew that as a group, they could offer more to their clients and share best practices.
Why the Wilderness Heals
What is it about being out in nature that offers such a therapeutic benefit? Is it the fresh air? The trees? The open sky? Yes. It is all these things, and more. Wilderness therapy offers a separation from the everyday experiences of one’s life and helps people recalibrate their perspective. When we are in nature, particularly in a wilderness therapy setting, we are forced to hit pause on our automatic thoughts, shift our focus over to the moment, and tune into a more mindful part of ourselves. The wilderness reminds us that we are a small part of something incredibly beautiful and vast; it reassures us that our challenges will pass, just as the changing leaves, and the water rushing down the river.
Wilderness therapy also builds a sense of self-efficacy. Teens struggling with self-esteem and challenges with depression find that they are more capable than they had realized. Recognizing one’s own resilience is empowering. Pushing their own abilities in rugged terrain reminds teens that they are stronger than they thought; this translates into other aspects of life. Wilderness therapists help kids untangle self-perceptions that no longer serve them and reestablish a sense of self that builds on strengths and abilities.
In my practice, I see a large number of students who identify as something other than male or female. Some are Transgender, or Gender-fluid, or the latest umbrella term, “Gender-Expansive.” Regardless of the definition, parents struggle with knowing how best to support them. Stanford University recently published a study on this very topic.
Tandy Aye, MD, associate professor of pediatrics at Stanford Medicine, and a pediatric endocrinologist at the Stanford Children’s Health Pediatric and Adolescent Gender Clinic, is the senior author of the study. Read the short interview with her through this link, to learn the most important things you can do to support your gender-expansive child.
This research adds to the growing body of evidence that adolescents’ perception of their parents’ support may be the key protective factor in the teens’ mental health. It’s that support that parents want to nurture.
Starting a conversation with your teen can be challenging in the best of times, let alone if you are worried about their well-being and emotional safety. You might be seeing signs of anxiety and depression, or even worried about self-harm or other behaviors indicating they are struggling. How do you broach potentially difficult topics? There is no right answer, but here are a few ideas to spark a connection. Beneath whatever protective exterior your teen is displaying, inside they simply want to know they are loved and cared for. Simply showing an interest can have surprising results.
1. What's your favorite song right now, do you think I'd like it?
2. What is the most embarrassing thing I do?
3. If your life was a TV show, which one would it be?
4. If an alien landed in your class today, what would they be most surprised to see?
5. If you could eat only one food for the rest of your life, what would it be?
1. What would your perfect day look like?
2. What are the best parts and hardest parts of your day?
3. What did you do that you are most proud of today?
4. If you could start today all over again, is there anything you would do differently?
5. Did you see any acts of kindness today at school?
1. What is it that makes you feel sad and why?
2. What do you do when you feel sad or upset?
3. How can I best support you?
4. What do you need from me? (distraction, space, time, etc)
5. How do you soothe yourself when you're feeling scared?
1. I love you, and nothing will ever change that.
2. Even if I don't understand, know that I want to.
3. We are going to get through this together.
4. If you talk to me about what is worrying you, I will do my best to help.
5. You can talk to me, I am always here for you. You can talk to someone else, that's okay too.
While these may start a conversation, remember it's the listening to their responses that is the most important. Encourage with a "hmmm" or "tell me more" to keep the ball rolling. Your teen may not show appreciation in the moment, but they will know you are there, and care.
Often when people hear the term EMDR as a mental health treatment method, they wonder three things: what do the letters stand for, will it hurt, and does it work? The answers to that three-part question are: Eye Movement Desensitization and Reprocessing, no it does not hurt, and yes, it does work remarkably well for many people suffering trauma, and other painful experiences contributing to emotional pain. EMDR can begin to have an impact from the first few sessions of treatment, or can be integrated into existing therapy sessions.
What Happens in EMDR?
EMDR is a non-invasive treatment method developed to help a breadth of needs from attachment wounds to physical trauma. The mechanism of EMDR is fascinating, as it is neurologically based and works through six phases of cognitive, emotional, and physiological interventions. Therapists who are trained in EMDR take people through the process carefully and explain each element of treatment prior to starting.
EMDR essentially helps transfer deeply entrenched trauma and other ingrained experiences away from the automatic physiological responses of PTSD to minimize impact on daily life. When trauma reactions (such as increased heart rate, intrusive thoughts, flashbacks, and heightened cortisol levels) are reduced, our bodies have an opportunity to function properly, resulting in better quality of life and lower stress levels.
Talley Webb, MA, CRMC