| Fifteen-year-old Jeremy sat across from me, postured | | | | What this research tells us is that these parents, in their |
| rigidly upright in his chair as he attempted to discreetly | | | | desire to protect their children and to do what is best |
| pick at the scabs on his hands. The sores were the | | | | for them, may be doing more harm than good. Facing |
| byproduct of over 30 daily hand washes. He watched | | | | anxious situations is the way most of us learn how to |
| me with a vacant gaze as his mother appealed to me | | | | deal with them. As we successfully navigate a range |
| for help, her voice faltering every few sentences. | | | | of scary experiences, we gain confidence, too, in our |
| I had just finished reviewing the results of my initial | | | | ability to handle them. If a parent trying to protect us |
| assessment of Jeremy - including the Children's | | | | from being fearful and making even a hypothetical |
| Yale-Brown Obsessive Compulsive Scale-with mother | | | | mistake derails this natural process, our immediate |
| and son. My conclusion: Jeremy had severe | | | | anxiety may be relieved, but our fear of danger will |
| Obsessive-Compulsive Disorder requiring intensive | | | | snowball and our confidence will never grow. In David |
| outpatient therapy. | | | | Clark's "Cognitive Control Model of OCD," obsessions |
| A psychiatrist had reached a similar conclusion about | | | | reach a clinical stage precisely because the individual |
| this young man just a month prior, but his mother, | | | | does not believe they can adequately control their |
| fearful that "the doctor just wanted to make him a | | | | thoughts and, ultimately, their behavioral response, |
| zombie with drugs," came to hear my opinion. Now | | | | fearing they will act upon them even though they do |
| that they heard it, his mother wanted to know only one | | | | not want to. |
| thing: What could she do to help her son, intellectually | | | | Noted anxiety expert David Barlow has theorized that |
| gifted and emotionally sensitive, regain his life from the | | | | a "chronic inability to cope with unpredictable |
| bizarre thoughts and ritualized behaviors that had | | | | uncontrollable negative events" is one of three primary |
| overtaken him? | | | | characteristics that can predispose one to anxiety |
| I explained to her, as I do with all parents in these | | | | disorders. This sense of personal uncontrollability can |
| situations, that medication may be indicated in treating | | | | be fostered in parent-child dynamics that are |
| juvenile OCD and I would be happy to refer them out | | | | over-protective and intrusive. Recent research in the |
| for a consult. However, I emphasized, both individual | | | | field of expressed emotion has added another |
| and family therapy are probably the most powerful | | | | dimension to the role familial interactions can have on |
| weapons in treating children and adolescents with this | | | | the development of and relapse into mentally ill states. |
| illness. | | | | Expressed emotion is the attitude families express |
| A growing body of research indicates that OCD has | | | | toward the disorder and the person experiencing it. |
| strong links to family dynamics that can be treated | | | | The three faces of expressed emotion are hostility (in |
| therapeutically, and there is no better time than | | | | which the family has a negative view of the patient |
| childhood or early adolescence to bring these factors | | | | and blame them for the illness, for not trying hard |
| into focus. This is not to say that families or parents | | | | enough to get better); emotional over-involvement (in |
| cause OCD, but that the way parents and children | | | | which the family members blame themselves for the |
| interact can bring a predisposition towards anxiety into | | | | patient's illness); and criticalness (in which the family |
| full-blown OCD (there is no evidence of a specific | | | | acknowledges factors other than the patient or |
| genetic tendency towards OCD at this time). In an | | | | themselves are involved in the illness but are still critical |
| eye-opening study, researchers Jennifer Hudson and | | | | towards it). There is growing evidence that high levels |
| Ronald Rapee at Macquarie University in Sydney, | | | | of expressed emotion in a family can increase the risk |
| Australia observed mother-child interactions while the | | | | that a young person will develop a disorder such as |
| child completed two cognitive tasks. Three groups of | | | | OCD and may worsen the prognosis for the patient |
| mothers and children were studied: mothers and their | | | | who is undergoing treatment. |
| clinically anxious children, mothers and their | | | | Within the confines of my office, OCD clients recite |
| oppositional-defiant children, and mothers with their | | | | stories of well-meaning moms and dads trying to |
| non-clinical children. The investigators found that | | | | make everything all right for their children, but impeding |
| mothers of the anxious and the oppositional-defiant | | | | their maturation in the process. Others recall feeling left |
| children were more involved and intrusive than those | | | | impotent by intrusive parents who would not let them |
| of the non-clinical kids. Additionally, mothers of the | | | | learn by exploration and mistakes. Many bitterly |
| anxious children were more negative than the rest. | | | | describe families in which they were told to "snap out |
| A later study conducted by Paula Barrett and her | | | | of it" and ridiculed when they couldn't stop washing |
| colleagues at Griffith University in Australia drew similar | | | | their hands, checking the door locks or asking for |
| conclusions. They observed two sets of families- | | | | reassurance. Ultimately, many of these children grow |
| those with a child diagnosed with OCD and those with | | | | into adults with deep resentments against their intrusive |
| non-clinical children-engaged in two five-minute family | | | | parents, but who are apprehensive about expressing |
| discussions about what the child would do if faced with | | | | this anger even now in the safety of the therapeutic |
| a hypothetical physical and social threat. The parents | | | | relationship. |
| could advise, but ultimately the child in each family had | | | | In the final analysis, then, we cannot ignore the |
| to determine what course of action to take in these | | | | importance of psychotherapy for both the individual |
| two perilous situations. The investigators found that | | | | and their immediate family, especially when treating |
| parents of the children with OCD used less positive | | | | children and adolescents. To do so would be |
| problem-solving, were less rewarding of their child's | | | | mortgaging their future happiness and relinquishing a |
| independence, and showed less confidence in their | | | | powerful tool for lasting change. |
| child's ability to handle these fictional situations. | | | | |