Obsessive-Compulsive Disorder

You probably have weeks when you feel like you do the same thing day after day. You wake up, go to school, go to sports practice, go to your part-time job, go home, eat dinner, do homework, and go to bed. Maybe it feels like an endless cycle sometimes, but then an upcoming concert or visit to a college campus looms on the horizon and you start to enjoy the break in your routine.

Some teens, though, find that their lives are a series of endless routines, filled with behaviors they feel compelled to repeat again and again. For teens who experience obsessive-compulsive disorder, it's not boredom that causes that repetitive feeling, but fears and anxieties they can't control.

What Is Obsessive-Compulsive Disorder?
Every kid, teen, and adult has experienced anxiety, fear, or worry at some time - it's completely normal to worry about school, your friends, what people think of you, your appearance , and tons of other stuff. But some teens and kids - about 1 million in the United States - experience obsessive-compulsive disorder (OCD), an anxiety disorder that causes the brain to get stuck on a thought or urge or to behave in a repetitive way. Teens with OCD feel they don't have control over their thoughts or fears and it may cause them to think about them repeatedly. These thoughts or behaviors that need to be repeated may interfere with a teen's life and may cause the teen to feel extremely embarrassed or ashamed.

Teens with OCD often experience two parts of the disorder: obsessions and compulsions. Obsessions are thoughts, impulses, or /images that occur repeatedly, even though the person with OCD doesn't want them to and finds them extremely disturbing. Along with the obsessions, a person with OCD often experiences feelings of fear or anxiety. Teens with OCD try to make their obsessions go away by performing compulsions , which are behaviors or rituals. These behaviors, when repeated the "right" number of times or when performed the "right" way, neutralize or diminish the anxiety. For example, a teen with OCD who has a fear that he forgot to lock the door may try to make the obsession go away by repeatedly checking to see if the door was locked.

Doctors and scientists don't know exactly what causes OCD, although they think it might be related to levels of a chemical in the brain called serotonin (pronounced: sir-uh- toe -nin). Teens with OCD may not have enough serotonin, and this could cause the messages in the brain to be miscommunicated. Scientists haven't discovered a gene that causes OCD, but they do know that it tends to run in families, so if you have a parent with OCD, you have a higher risk of developing it.

Doctors do know that OCD isn't a teen's fault - and he can't stop his thoughts or actions even if he wants to. A lot of teens are so embarrassed by the obsessions and compulsions they experience that they keep it from their parents and friends. "OCD is a private disorder, and it can take years before a parent knows a teen has it," says David Sheslow, PhD, a psychologist who works with teens with OCD in Wilmington , Delaware . "Because the disorder comes with a sense of shame and embarrassment, the teen will keep the rituals very private," Dr. Sheslow says. If you have a friend with OCD, you may not even notice that your friend has it - he may be very good at hiding his behaviors.

OCD often begins during the teen and early adult years, although it's found in kids, too. Guys may be more likely to develop OCD earlier, between the ages of 6 to 15, whereas girls are more likely to develop OCD in the later teen years and early adulthood. In addition, teens with OCD have a higher risk of also having depression , attention deficit/hyperactivity disorder (AD/HD), learning disorders such as dyslexia , and habit disorders such as nail biting or skin picking.

What Are the Signs and Symptoms?
It's not easy being a teen, but it's especially hard to be a teen with OCD. Dealing with obsessions and performing compulsions require time and energy that ordinarily would be spent on school or with friends or boyfriends or girlfriends. Because many teens with OCD feel ashamed and embarrassed, they may have low self-esteem .

Teens with OCD may experience the following common obsessions (a teen may experience multiple obsessions):

The most common compulsions in teens include:

For many teens with OCD, the symptoms may get better for a time and then get worse during stressful events in their lives.

What Do Doctors Do?
OCD isn't like some illnesses - you can't have a blood or other lab test to tell you if you have it. Instead, a doctor such as a psychologist or psychiatrist has to ask you questions about obsessions and compulsions, such as:

Once your doctor has diagnosed you with OCD, two common types of treatment include behavioral therapy and medication. Cognitive-behavioral therapy (CBT) helps you to learn to change your thoughts and feelings by changing your behavior. During CBT, you might be exposed to something you fear so that your fear is decreased - this technique is called exposure therapy .

"If you have an elevator phobia, could you stand it if you stuck your toe in the elevator? How about your foot? What if we asked you to stand in there for 10 minutes? What if you had to stay in for the whole day - would you still be worried about elevators? We help teens to gradually disconnect their obsessions from their compulsions to reduce anxiety," Dr. Sheslow says. Often exposure therapy is used with response prevention , which works to stop the compulsions. For example, a teen who fears germs might be exposed to germs, but may not be allowed to wash his hands.

"OCD treatment can be anxiety provoking because people are asked to 'shake hands' with their fears," Dr. Sheslow says. Just talking about obsessions can make them worse, he says, so it's important to work with a therapist experienced in treating teens who will help you learn how to change your behaviors, too.

Medication also helps many teens with OCD and may be used at the same time as CBT. Because teens with OCD may have low serotonin levels, medication called selective serotonin reuptake inhibitors (SSRIs) may be used to increase serotonin levels in the brain. Common types of SSRIs include fluoxetine , fluvoxamine , paroxetine , and sertaline .

Dealing With OCD
At first, you may feel as if you have no control, but proper treatment can help you gain control of OCD. In addition, you may want to learn all you can about OCD and its treatment through books, articles, and Web sites because the disorder can come and go throughout your life.

You may feel alone if you are dealing with OCD, but you're not. Support groups are a great way to get support and make friendships with other teens with OCD. Your ongoing treatment is important to coping with OCD, too - if you feel like quitting treatment because of the side effects of medication or because you feel uncomfortable, talk to your doctor and your parent right away about your feelings.

Having OCD doesn't mean you're crazy or that you can stop the obsessions and compulsions. Teens with OCD are aware of what they are doing and can think sensibly. Remember - OCD isn't your fault and it isn't something you need to hide or keep secret, even if you are embarrassed or ashamed. Going to the doctor for a cold isn't shameful, and neither is seeking treatment for OCD - with help, you will feel more comfortable and have more time to spend doing things you enjoy.