Coping with OCD as a Teen: A View from the Inside

In an earlier blog post, I presented part of an in-depth interview with Simone E.,…

Coping with OCD as a Teen: A View from the Inside

In an earlier blog post, I presented part of an in-depth interview with Simone E., a thirteen-year-old living in Northern California who was diagnosed with OCD in September of last year and hospitalized twice. She spoke of obsessions being “as urgent as a car crash,” of not eating or sleeping for a week, of the persistent unhelpfulness of mental hospitals, and of the reawakening brought about by Acceptance and Commitment Therapy.

The first part of the interview related specific experiences with OCD that could be generalized to other teens with the same diagnosis. This second part presents new information, primarily focusing on lesser known aspects of OCD and larger societal issues.

The Interview: Part 2

Robert Kraft: What are distinctive and possibly less familiar symptoms of OCD that you think the general public should know about?

Coping with OCD as a Teen: A View from the Inside

Source: Monstera/Pexels

Simone E.: If music or sounds repeatedly play in your head and bother you, that’s also an intrusive thought that might be a part of OCD. But it’s not simply a catchy tune that you think about for a while. With OCD, the recurring thoughts of music or sounds persist much longer, they feel “sticky” – meaning they demand immediate attention, and they repeatedly get in the way of your day-to-day life.

If you have a compulsive urge for reassurance, that could mean OCD – for example, repeatedly feeling the need to ask a question like “what if I don’t fall asleep tonight?” or “is this person dead?”

Another lesser-known symptom of OCD is body hyperawareness, which I experienced more when I was younger. As a child, I would hyper focus on any tiny pains, assuming they were cancer.

There are so many different and disturbing symptoms that if you have any type of anxiety, it’s best to go to a specialized psychologist or psychiatrist, no matter if you think you have OCD or not.

RK: Why is mental health so urgent these days?

Shvets Production/Pexels

Source: Shvets Production/Pexels

SE: We put so much pressure on our teens and kids in this society. “Get good grades! Get into a good college! Be socially successful! You have to be happy! are just a small handful of pressures we force on teens and kids. With these pressures, it’s only natural to feel frustrated, discouraged, and anxious.

Way less stress on teens is never a bad idea. My friends in high school barely have time to relax, given their stacks and stacks of homework. The people assigning and creating this system have to know that constantly working is never good for mental health.

World problems also contribute to extreme distress, although there are so many influences that it’s hard to pick just one. Covid certainly didn’t help.

RK: What changes would you like to see in society’s influence on mental health problems?

SE: I realize this is a complex issue, but we need more therapy being covered under insurance. I know a lot of people who’ve only had one therapy session because of lack of money, or people who can see a therapist only once a month. I’m glad medication is another option, but in-person therapy is essential in mental health and cannot be replaced by a pill.

RK: Recently, a United States senator openly acknowledged seeking help for his depression. This is an acknowledgment that would not have happened a generation ago. What are your thoughts on that?

SE: I love that this senator acknowledged his depression, and I think it’s impressive the progress we’ve made as a society with mental health. And I can’t imagine how stigmatized it used to be, especially with getting treatment for a condition like OCD.

RK: What are your views on the role of perfectionism in OCD and also the idea that perfectionism can be a productive tendency with some activities?

SE: This is something I haven’t quite conquered yet. My type of perfectionism is more the type where I immediately get very hard on myself and very self-critical if I don’t reach my goals. Perfectionism and procrastination are on a spectrum and it’s better to be in the middle in this case.

RK: What is your experience with the moral focus in OCD?

Thiago Matos/Pexels

Source: Thiago Matos/Pexels

SE: Before I began my treatment, I used to obsess over the morality of my intrusive thoughts. I believed that if I had a bad thought, then I automatically must be a horrible person. I needed to be good. And when “bad” thoughts intruded, that made me a wrong person.

RK: You previously talked about the necessity of others being open to the seriousness of OCD in children and teens. What other advice do you have for parents and other adults who want to help?

SE: You can research OCD and learn more about the specific obsessions, which also might help us get a more accurate diagnosis if we’re not already diagnosed. More specifically, you can get us treatment with Exposure and Response Prevention (ERP) as soon as possible.

Elaboration of ERP as a Treatment for OCD

ERP achieves its effectiveness by addressing the two maladaptive connections that characterize OCD: 1) The connection between distressing thoughts and the situations that produce serious anxiety and 2) the connection between compulsive, ritualistic behaviors and decreasing the anxiety. Manipulating exposure is the main therapeutic tactic to break these connections. According to the noted clinician and researcher Jonathan Abramowitz, treatment of OCD with ERP methods is one of the great success stories within the field of mental health.

Complexities of OCD

OCD is defined by its relentlessly intrusive and unwanted thoughts (obsessions) and repetitive behaviors and rituals (compulsions) designed to reduce the overwhelming anxiety caused by the obsessions. But the distinction between compulsions and obsessions may not be obvious. While many compulsions are observable behaviors, some can be covert and unobservable, such as counting to oneself. And while obsessions are in the realm of the mind, an experience known as thought-action fusion leads to the belief that thinking about something increases the chances that it will happen or is actually equivalent to doing it.

OCD affects an estimated 2 percent of children and teens, which makes it one of the most common psychiatric disorders in that age group. Even so, the variations in each case can challenge our understanding of the disorder. Although generalizations are necessary, it is also necessary to hear first-hand accounts, such as those from Simone E.