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When Does Worry Become Obsessive-Compulsive Disorder? Part 1

The National Institute of Mental Health (NIMH 2009) has produced a 15-point scale that defines various levels of the continuum of normal worrying to clinical obsession or compulsiveness.  At the extreme, a score of 13 to 15, the symptoms of Obsessive-Compulsive Disorder (OCD) require the individual to be closely supervised while eating, sleeping, or even making minor decisions.

At the other end of the scale, 1-3, the individual spends little or no time in excessive thought or behavior that is ritualistic or compulsive, and there is almost no interference in Activities of Daily Living (ADLs).  ADLs include things like the ability to pay attention, groom oneself, engage in meaning social interactions with others, and perform those necessary biological functions related to eating and eliminating in a way that does not interfere with one’s normal emotional functioning.  In the case of children, this would include going to school, studying, making and keep friends, playing with their friends, and engaging in meaningful recreational or physical activity during their spare time.

Thomas Szasz wrote a book in 1966 called The Myth of Mental Illness.  The author basically argued that there was no such thing as mental illness, and that scientists and doctors had attempted to lay the template of the so-called medical model over what he preferred to term as “problems in living.”

If your child is so concerned with making A’s that their worry makes them ineffective at studying, causing them to make C’s when they are capable of making A’s, then this could be termed such a problem in living.

My preference is to use the term problem in learning.  That is, the child is attempting to do the right thing, i.e., study hard and make a good grade, but they have not learned how to moderate or regulate their studying behavior in such as fashion as to achieve the goal of learning well and making an A.

Much has been learning about the nervous system, the workings of the brain, the importance of neurotransmitters, and other biological phenomena since Thomas Szasz wrote his book, and this writer is in no way discounting the importance of biology and the necessity for all of those above systems to be working properly.  However, for the purposes of this article, let’s assume that the biology is good, and your child has somehow learned or acquired some bad study habits that have led to difficulties that appear almost O-CD in nature.

What can you as a parent do to help your child?

Those in sports psychology tell us that it is the process, not the outcome, that needs to be the focus of our attention.  Jamie Rotella, Ph.D., in his book called Golf is Not a Game of Perfect, reports that few golfers hit a perfect shot during the best of rounds.  therefore, rather than concentrating on attempting to hit a perfect shot, that is, the outcome of the swing, we should put our attention into the various parts of the swing that are under our immediate control.  These parts are termed the process of the swing.

One product of this method of instruction is the pre-shot routine.  You may not be able to control the final flight of the ball, but you are able to control how you tee up the ball, where you place your feet prior to the swing, how much you inhale prior to your backswing, and exactly how fast you move the club back as you begin and complete your backswing.

Similarly, in studying, your child could start with their “pre-shot routine.”  For studying, this would include keeping the studying limited to a particular room, chair, or desk.  Some children like absolute quiet, while others like to listen to music or turn on something that serves as “background noise” to drown out the random sounds of the rest of the family.  (Please refer to the excellent article on Mindfulness that appeared in our Parenting blog recently for a further description of how these types of practices could be used.)

Many of my students have told me that, if the room is too quiet, they start listening for the tiniest sounds and noting things like how often the heater or air conditioner fan comes on in a given period of time, for example.  If the pre-shot routine is working, your child will be able to turn off the thinking about the outcome of their studying, i.e., making an A, and concentrate on the actual process of studying. This, of course, increases the likelihood that the student will actually acquire the A as a result of their efforts.

The more the “pre-shot routine” of studying in the same room under the same conditions is used, there should be less anxiety and worry for the student.  This, in turn, should result in a more studious and productive use of time.

In rare cases, of course, the student could become so accustomed to these conditions that they would become unable to study or concentrate unless those exact conditions were precisely met every time.  This could necessitate the need for more clinical intervention.

However, for most students, the type of “pre-shot routine” described above would be an excellent place to begin working with those for whom worrying about the outcome, making an A, has begun to be a problem.

In Part 2, we will look at the “shot” itself, and in Part 3 the “post-shot” routine.

Additional Resources:

Childhood Obsessive – Compulsive Disorder (Child Development Institute)

Talking Back to OCD: The Program That Helps Kids and Teens Say “No Way” — and Parents Say “Way to Go”

David and the Worry Beast: Helping Children Cope with Anxiety

Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child’s Fears, Worries, and Phobias