My daughter is 15 and has lived with obsessive compulsive disorder (OCD) for some time. Her compulsions change – counting, repetitive actions such as flicking light switches a certain number of times, showering/brushing her teeth in a particular order, placing things in her bedroom in a certain way …
She has had two courses of private therapy, but neither seemed to help. Both focused on the compulsions – for example, they’d encourage her to tackle one ritual at a time and try to eliminate it. It felt as though they were addressing the symptoms rather than the cause – new rituals can come to her in the moment and if one ritual is eliminated, it will quickly be replaced.
It is interfering with her life more and more. She was an avid reader, but now can’t get through a book without compulsively rereading lines, and so has abandoned reading for pleasure, which makes me so sad. She’s often late for school because her morning rituals delay her. School lessons involving note-taking are difficult as she has to scrub out and rewrite words over and over. And she’s becoming more anxious – issues such as war, climate change and the rise of Reform affect her more than they should.
Her school is supportive and gives her extra time in class and exams, which we appreciate, but obviously they are not specialists in this area. I really want to get her help before it escalates any further.
I went to Prof Polly Waite, associate professor of clinical psychology at the University of Oxford, who has a special interest in OCD. She said this is a “really typical presentation of OCD [but no less upsetting for that]. Adolescence is one of the peak times for this to develop, as it’s a time of change and transition and taking on more responsibility, which is central to how we understand OCD.”
I don’t think we realise how much that sense of growing up and being responsible hits our young people, and of course OCD is a way of trying to find micro control in a world where we feel so out of control. Waite said: “If you’re a lovely, caring person, the thought of something bad happening can lead you to try to do something to keep safe. Responsibility and stressful life events can also be a factor.”
We weren’t sure if your daughter has had cognitive behavioural therapy (CBT), which is the National Institute for Health and Care Excellence’s recommended treatment for OCD (find a therapist at babcp.com). CBT should, Pr Waite says, “include exposure response prevention (ERP), you want to learn through doing rather than just talking.” (Although there is talking in CBT therapy.) If she has tried ERP and it didn’t work for her, maybe trying a different therapist is an idea.
The problem, as you’ve said, is that “OCD is a bit of a shapeshifter, new rituals can come in,” says Waite. But in therapy, she explained, your daughter can learn that by “not doing a compulsion and sitting with the anxiety, over time the anxiety will go down. OCD tells you it will go through the roof, but we simply can’t sustain that level of anxiety for too long, and the more you get used to it, the less anxious you will feel.”
Waite continued: “Cognition in OCD treatment is critical because we all have intrusive thoughts – studies show 85% of the population does – but people with OCD latch on to them, treat them as being important and think they need to do something to keep safe. In CBT, you start to unpick the idea that the thought is important, that it has meaning and that you must act on it. You need to increase the belief that the problem is worry, not actual danger, so you don’t need to listen to the OCD. Therapy will not be effective if it’s not experiential.”
Hopefully, with the right support, your daughter can learn that intrusive thoughts are just thoughts, and she doesn’t need to do anything to prevent harm. Then she can begin to reclaim her life and the joy of reading.
The charity OCD-UK has useful resources, and these books may help: Break Free from OCD: Overcoming Obsessive Compulsive Disorder with CBT by Fiona Challacombe et al; and Breaking Free from OCD: A CBT Guide for Young People and Their Families by Jo Derisley et al.
Every week, Annalisa Barbieri addresses a personal problem sent in by a reader. If you would like advice from Annalisa, please send your problem to ask.annalisa@theguardian.com. Annalisa regrets she cannot enter into personal correspondence. Submissions are subject to our terms and conditions. The latest series of Annalisa’s podcast is available here.
