Ask the expert: I think my son (14) has OCD

Q My 14-year-old son has always been a bit rigid. Things have to be a certain way – if his plate and cup are not put out in the same way on the table, he gets upset. On and off, I notice he has particular obsessions. The most recent one is him blowing his hands several times after he has washed them. To me, it seems to be a little bit like obsessive compulsive disorder. This is something I can identify with as I feel I have these traits myself.

I spoke to him about it and told him that I have the same habits and that it must run in the family. He seemed relieved by this, so that was good. I have never been diagnosed or got formal help and have just managed with what I have read and researched.

However, I wonder if I should get help for my son. I worry about getting him diagnosed and the impact of a label. I don't want to make a deal about it if it is unnecessary. What do you advise?

A Obsessive compulsive disorder (OCD) is a cluster of symptoms that centre on a person developing certain compulsive behaviours that they must do to relieve distress or worry about something. For example, a person might have to go through an elaborate ritual of cleaning their hands to relieve an excessive fear that germs are still on their hands.

Some people can be severely affected by OCD, whereby they spend large amounts of time on their rituals, which can be very disabling for them in daily life. For others it can be a very mild condition that is more of an annoyance or irritation that can get worse at times of stress.

As you have discovered, OCD traits can run in the family with many children being affected when one of their parents experience similar symptoms.

Helping your son

You are right to take time to thoughtfully consider how best to help your son. With mental health issues, having a one-sized approach rarely works and what matters is listening carefully to the child affected and helping them be involved in the decisions going forward. I think it is useful that you have shared with your son that you have had similar issues and this has clearly provided him with some relief.

Often the main issue for young people affected is feeling alone in their experiences or a fear that they are somehow “going mad”. I’m not surprised that hearing that you understand is helpful to your son. This also means that you can share with your son the different strategies you have used to manage and this also might be helpful to him.

OCD and diagnosis

You ask in your question whether you should take your son to access formal help and potentially get a diagnosis. I think the process of mental health assessment and diagnosis is one that has to be done carefully and sensitively.

There can be advantages to diagnosis in that it can provide your son with a helpful understanding that allows him to access psychological and medical treatments but also disadvantages as it may be perceived by him negatively or even become a limiting label that he lives into.

If you do embark on seeking formal help, it is important to focus on the positive aspects of the process such as gaining support, and getting clear ideas and strategies that can help him. It can be helpful to encourage him to be in charge of the diagnosis and treatment. For example, you can suggest that “we will go along and see what the professional thinks and what our options are and then you can decide if that makes sense and what you want to do next”.

A great documentary, A little bit OCD, by the comedian Jon Richardson explores the experience of being OCD and the treatments available in both a light hearted but also informative manner.

Richardson has based his comedy stand- up routine on his OCD traits to great comic effect and, prior to making the documentary, he had never gone for formal diagnosis and treatment. Seeking out role models and examples like this might be a good way to discuss the subject with your son.

Helpful strategies

With or without formal diagnosis, there are

lots of very helpful strategies that your son can employ to overcome the symptoms of OCD and I am sure you have used some of these in your own experience.

Many of these strategies are drawn from cognitive behavioural therapy (CBT) which focuses on helping children understand and challenge the unhelpful or unreasonable thoughts that underpin the OCD.

For example, your son might feel he has to engage in the ritual of blowing his hands as a means of avoiding germs. CBT would help him identify and challenge this belief and then set step-by-step behavioural goals to overcome the associated compulsion.

This might mean he learns to accept and tolerate his compulsion to blow his hands, without acting on it, for an increasing period of time.

Most of the best strategies to tackle OCD can be viewed in the self-help literature that are easily available such as Overcoming obsessive compulsive disorder by David Veale and Rob Wilson or the excellently titled Talking Back to OCD: The Program That Helps Kids and Teens Say 'No Way' – and Parents Say 'Way to Go' by John March.

Dr John Sharry is a social worker and psychotherapist and co-developer of the Parents Plus Programmes. His new book, Bringing Up Happy, Confident Children: A practical guide to nurturing resilience, self-esteem and emotional well-being, is now available. See solutiontalk.ie for details.