Understanding Potential Challenges and Setbacks in OCD Treatment for Adolescents

OCD Prevalence in Adolescents

OCD is a commonly experienced psychiatric illness. Research has demonstrated that OCD has been found in 1% to 4% of individuals (including children, adolescents and adults) throughout the world. Individuals with OCD are often impacted in terms of education, work and social relationships. 

OCD may start in childhood and approximately 8 out of 10 people who develop OCD will often experience symptoms by 18 years of age. Receiving treatment for OCD in adolescence is, therefore, essential. Teaching tools and skills early on can allow individuals a better chance of enhancing their quality of life.

When experiencing OCD, individuals will speak about experiencing intrusive and unwanted thoughts (i.e., obsessions) and, in response to the unwanted thoughts, repetitive behaviours (i.e., compulsions). These symptoms can take up a significant amount of time in an adolescent’s day and impact them greatly in terms of socializing, education and daily functioning.

While effective OCD treatment does exist for adolescents, there are potential challenges that arise. This blog will explore these possible setbacks as well as describe solutions for youth and loved ones who might be seeking OCD therapy. 

Do I Have Obsessive Compulsive Disorder?

It is very important for individuals to be able to receive early intervention for OCD. OCD counselling early on will allow individuals to receive much needed skills and tools. It will also provide important resources and information for families and loved ones. This allows youth and teens with OCD to manage their symptoms earlier on in the course of their illness and progress to wellness at a younger age.

A barrier to youth receiving OCD therapy can be an inaccurate or missed diagnosis. OCD symptoms are frequently misdiagnosed. This can be due to many different factors. Not all mental health clinicians receive much needed training in the diagnosis of OCD. Also, OCD symptoms are complex and can share similarities with other mental health conditions. Youth and teens might have difficulty revealing their symptoms to anyone, even their parents. 

However, there are steps that can be taken to help youth and teens receive a proper diagnosis as well as OCD counselling:

1. Help parents and educators to recognize early signs of OCD: Early signs of OCD might not be easily recognized by everyone. Parents or educators might initially notice a drop in grades, social isolation or disruptions in appetite or sleep. Any behaviour or personality changes might be significant and should be probed in an open and curious manner. Noticing your teen spending hours in the shower or washroom might be a signal that rituals are taking place. Grooming patterns might change and studying processes might be laborious and ineffective. Adolescence is also a time of change in mood and preoccupation with oneself. Providing a safe space to discuss these things, without being accusatory, might help open up meaningful dialogue. 

2. Find a mental healthcare professional with OCD training: Once you have recognized the signs of OCD, you want to see someone or have your loved one bring you to someone with OCD training. This will allow for proper diagnosis and treatment recommendations. It is important to ask your healthcare professional what their OCD training is and what their approach is to obsessive compulsive disorder treatment.  

3. Increased awareness about OCD symptoms and OCD treatment: Providing key education to educators, guidance counsellors, and healthcare providers is essential. The more that individuals know how to recognize OCD symptoms from a younger age, the more people will get evidence-based OCD counselling.

Adolescents: How to increase motivation for treatment?

Receiving a proper diagnosis for OCD is a wonderful first step for your teen to begin OCD treatment.

What if your teen is not motivated to start OCD counselling?

It can happen that individuals with OCD, although impacted by symptoms, are not motivated to begin treatment for OCD. This is difficult for many reasons. OCD impacts the entire family. Parents are often pulled into an adolescent’s rituals in a best effort attempt to make them feel better. Unfortunately, we know that this maintains the cycle of OCD and strengths compulsions. We refer to this as family accommodation and it is helpful to gain support as a parent if your child has OCD.

Individuals with OCD experience anxiety and distress given their ongoing symptoms, even when not motivated to start treatment. This means that an individual with OCD is likely not living a life that is aligned with their values and who they want to be as a person. Individuals often lose tremendous amounts of time due to their OCD and cannot pursue meaningful activities.

Parents can engage in some helpful actions when their teen is not motivated to begin treatment:

1. Open up conversations when the timing is right. Talking to your teen about intimate and difficult topics can be hard – for parents and youth! Looking for moments that allow for natural and easy conversation can be very helpful in allowing things to be discussed. You might find yourself on a long car ride or going for a bike ride together. See if the conversation can feel natural in those moments. Times like this might feel easier for your teen than sitting down at the kitchen table and trying to discuss the need to begin OCD treatment now. 

2. Seek support for yourself. Meeting with a professional who has OCD training is extremely helpful. Parent OCD counselling can help both parents and youth. During OCD treatment for parents, you will learn skills and tools to navigate the challenges in having a teen with OCD who is not yet seeking help. You will learn ways to talk to your teen when they are engaged in rituals and compulsions. You will learn to set boundaries with compassion and have a safe space to discuss your own feelings of anger, frustration, guilt or shame. 

3. Provide support, encouragement and praise. Speak with your teen about how scary it can be to start treatment. If you have ever been in therapy yourself or faced significant challenges, it can be very meaningful to share this with your teen. You can explain to them how treatment can be helpful and share any resources you might have. You can suggest that they consider meeting with a professional just a few times and see whether it feels like a good fit. If someone feels they can look around for the right therapist, it might help with engagement. Let them know that treatment will be secure and confidential for them and you do not have to attend sessions with them. This might help them to begin the process.

4. Seek out a support group online or in your area. Speaking to other parents who have teens with OCD can be empowering. Look for support groups that you can easily access through online platforms or in-person attendance. 

Adolescents: What to Expect During OCD Therapy? 

If you are a teen or a parent of a teen with OCD, you might be wondering, what should I expect will happen during OCD therapy?

Youth and adolescents will receive a variety of skills and tools when engaging in evidence-based obsessive compulsive disorder treatment. Individuals might engage in more traditional CBT with an emphasis on Exposure and Response Prevention. You might also be offered Inference-Based CBT for OCD. 

In both these approaches to treatment for OCD, adolescents will learn important ways to manage their OCD differently and will begin to engage more with things that are important to them. Quality of life will be enhanced and compulsions/rituals will begin to decrease. The treatment that your teen decides to engage in will vary depending on current functionality, willingness to engage with exposure and response prevention therapy as well as therapy approaches that have been tried in the past. This will be discussed with your treatment team in order to allow your teen to decide on an approach to OCD therapy that will be a best fit. 

Relapse and Maintenance Challenges

An important aspect of any OCD therapy approach is maintaining treatment gains and preventing lapses and relapse. OCD is a chronic illness that can wax and wane over time. Stress and life changes can impact overall anxiety and distress. During these times, we want to be vigilant to our symptoms of OCD and ensure that we are using our skills and tools to manage our anxiety and distress.

Here are some ways that your teen can maintain gains, even once the bulk of OCD treatment has finished:

1. Having a plan for relapse prevention when therapy ends. It is important for any healthcare provider to collaboratively establish a plan with you that allows you to best understand what to do should any OCD symptoms arise. This might involve re-visiting your ERP plans, I-CBT worksheets and other information you have received during your course of OCD therapy. 

2. Helpful Family/Caregiver Coaching. During treatment, family and caregivers should learn what it looks like to coach someone through resisting urges to engage in rituals and compulsions. This can help with ongoing maintenance of gains and relapse prevention. 

3. Check-in sessions with your OCD therapist. Some people find they benefit from meeting with their therapist every month (or more). This can allow for ongoing check-in sessions to discuss any issues that emerge and how they might want to troubleshoot and new or persistent symptoms. You can speak with your healthcare provider and see if this is something they offer. 

Conclusion: Where Can I Find OCD Treatment for Teens?

In this blog, we have reviewed some of the challenges when a teen is seeking treatment for OCD. Overcoming some of these roadblocks might include: early diagnosis and intervention, enhancing the awareness of educators and mental healthcare professionals and receiving OCD therapy from clinicians who have this training. At FTPS, we have a team of clinicians who have experience in working with individuals with OCD, adolescents and adults. We are able to provide diagnostic information and create important collaborative treatment plans. We work with individuals virtually across Canada, providing services throughout Ontario and BC. Contact us today to find out more information and get started on the road to recovery!

References

Glazier K, Swing M, & McGinn LK (2015a). Half of obsessive-compulsive disorder cases misdiagnosed: Vignette-based survey of primary care physicians. Journal of Clinical Psychiatry, 76(6), 761–767. 10.4088/JCP.14m09110

Nazeer A, Latif F, Mondal A, Azeem MW, Greydanus DE. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Transl Pediatr. 2020 Feb;9(Suppl 1):S76-S93. doi: 10.21037/tp.2019.10.02. PMID: 32206586; PMCID: PMC7082239.

Leonardo F. Fontenelle, Humberto Nicolini, Vlasios Brakoulias, Early intervention in obsessive-compulsive disorder: From theory to practice, Comprehensive Psychiatry, Volume 119, 2022.

Veale D, Roberts A. Obsessive-compulsive disorder. BMJ. 2014 Apr 7;348:g2183. doi: 10.1136/bmj.g2183. PMID: 24709802.

www.icbt.online