Q Thank you for answering our question about how to help our son, who displays symptoms of obsessive compulsive disorder (OCD). My husband and I have a further question about the labelling aspect of having him assessed. Would carrying the OCD label be a burden for him? I know that at the age of 13 his identity, and how he fits in with the peer group, will concern him, and would an official diagnosis and label, especially a mental health one, cause him more concern than relief? Would it stigmatise him?
A Your question about the problems of mental health diagnoses and labels is an important one. As a mental health professional I am aware of the potential "side effects" of using diagnoses in certain situations, and thus am always wary about their overuse. For example, a diagnosis of a mental health disorder such as OCD or depression can be problematic if it makes the young person feel stigmatised; or if it makes them believe that their condition is enduring and long-term and that they have no control over their symptoms; or if the label makes them pessimistic about coping or managing.
For this reason, mental health practitioners should be cautious and judicious in their use of mental health diagnoses and labels. This is especially the case when we consider that most mental health diagnoses are far from objective categories and are really descriptions of collections of behavioural and emotional symptoms that can be open to subjective interpretation.
Using diagnoses constructively
The central issue is how your son might understand a potential diagnosis of OCD and what it might means to him. It matters greatly how he is told and in what context it is explained to him. It makes a difference if the assessment process is collaborative and respectful, and takes into account his thoughts and feelings. The goal is to arrive at a constructive understanding of what is going on for him that provides relief, rather than stigma, and that points him towards solutions, rather than leaving him hopeless about change. There are lots of things you can do to help:
- Emphasise the supportive aspects of the diagnosis. For example: the realisation that he is not alone, that many people have these symptoms and they can manage and overcome them.
- Use the positive aspects of the diagnosis that point towards solutions. For example: "There are very clear strategies that have been shown to work with OCD such as facing fears step by step" (see list in Ask the Expert, June 9th). Don't say a diagnosis is fixed but is, in fact, something more temporary, much like a physical condition such as flu. For example: "You seem to be having some symptoms at the moment; we can help."
- Present the diagnosis as something external to him, rather than being something fixed in his personality. For example, it is helpful to talk of OCD as something separate to him that he is battling against and overcoming: “The OCD can a bit of a pain when it gets you like that . . . Let’s look at ways we can keep it at bay.”
- Allow him to be critical of the label/ diagnosis and to make up his own mind: “The doctor/psychologist thinks that some of your symptoms could be explained by OCD. What do you think? Do you think that is a helpful way to explain things?”
- Help him to think how he might talk about the problem to others. He can, of course, keep it confidential within the family, but it can be helpful to support him to think through how he might talk about his symptoms to others in a positive, explanatory way that makes him feel empowered.
- Point out positive role models, for example: “Sometimes I can be a bit like that too”, or pointing out people in the family or role models the media who might have similar issues.
- Have a sense of humour about it. The comedian Jon Richardson did a poignant documentary about OCD – he feels he has many of the symptoms– but was able to keep the tone light. Indeed the majority of his stand-up routine is all about making fun of his symptoms of OCD: laughing at the problem can reduce its power greatly.
There are lots of great workbooks and resources online for parents and teenagers that explain OCD in the spirit of many of the principles I have listed above. These include 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 S March.
Finally, you don’t have to go down the route of formal diagnosis if you don’t think that would be helpful. Instead you can focus on tackling and overcoming the troublesome symptoms one by one. I have worked with many families where we never used a formal diagnosis and instead worked supportively with them to overcome the anxiety and problematic habits that affected them.
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