Hi,
I have a 14 year old daughter who currently has extremely severe OCD (she is currently in hospital on 24 hour watch). It has had an enormous impact on our family (we have a younger son) and we feel like we are sprinting into the darkness with no idea of direction. If anyone has a similar story and can provide guidance on pitfalls, things to try, ways to cope, etc, I would really appreciate it. I will tell the story to give you an idea of how difficult and bizarre it has become. I will try to be brief, but apologise if this gets a bit long;
When she was about 11, DD displayed your garden variety OCD - wash hands a bit long, absolutely had to straighten bed before sleeping, worried clothes were too tight and she wouldn't be able to breath in her sleep, so had to change them, that kind of thing. With the help of a local psychologist we went through CBT and a little ERT and things improved. Not easy, but we got there. the last 6 months of last year, she was almost symptom free.
In February of this year DD said she was feeling unwell and had a couple of nights not sleeping very well at all. the OCD came back a bit (garden variety, mixed with the idea that she was going to turn into someone famous). We went back to the psychologist who recommended she go back to school to distract her. At school she collapsed, started babbling that she was going to turn into this famous person, picked her nose then babbled about not doing it. Ambulance was called. She got admitted to the adolescent unit of a local hospital's psych unit. They initially thought she had some virus, did some tests, but all normal. She was quite uncommunicative for the first week or two of hospital. Lots of fits of crying. When we visited she would latch onto some small thing and accuse us of not caring for her (all said in a fit of uncontrollable crying).
She came out of hospital on Risperidone and an SSRI (can't remember which). She didn't tolerate the two meds very well and after another admission, was eventually swapped to Olanzapine and Chlomipramine. Around the time of the swap, she started to get very irritable at home (usually around 4 or 5pm for an hour or two). Her memory also became really bad (couldn't remember something from the day before) and she became very restless (wandering around the house, not settling on any one activity for any length of time, etc). Her OCD in the meantime had reduced in severity in the sense that the thoughts were no longer torturing her to the point of tears, but there were bouts of depression (head down, non-responsive). Her thoughts still featured the same things;
- worried about turning into this famous person
- thoughts of a sexual nature about almost any male she saw (including me, her father - very hard to take for both me and her and yes, I know they are not real)
- constant doubt and subsequent checking. i mean everything "Can I have a glass of water?" "Can I have this apple?" "I have to touch his penis. Is that OCD?" "Should I wear these clothes today?" "I spilled some food on my top. I washed it off, but should I change it?". It is relentless.
- constantly going to the toilet, or at least worried about having to go to the toilet before she goes anywhere, even if it is only a 5 minute trip
- constant need for hugs and reassurance that we love her or care for her or will forgive her for having behaved badly, etc.
Her irritability started to turn into anger. It was often directed towards us if we were unable to spend the time to talk with her when she had thoughts (which was all the time) or if she did something wrong and we gave consequences (small things that became bigger things when she would not accept the consequences). Her aggression led us to try and go to different rooms to diffuse the situation (including calming down ourselves), but she would follow. If you shut the door she would open it. If you held it shut, she would break it to get in. If we thought it was getting out of control we would try to leave the house. she would run to block us from leaving, sit behind the car so we couldn't pull out, etc. One time she was kicking out at us, punching the walls, etc. We went get our son out of the house. She tried to stop us, so I held her while my wife and son left. She bit me so hard it has scarred. The police were called (not the last time). There were other times when she kicked over furniture, messed up our room when we were out, threw things down the stairs, etc. Most recently she has begun harming herself. We hid the knives, etc, but she will grab a butter knife and scratch up her forehead. She has said she has to do something when angry or stressed, as it makes her feel better.
One other feature of her OCD is the belief that the hospital is the only place she will get better. There are nurses there who can sit with her whenever she wants, chat, draw a picture together, watch her paint her nails, that kind of thing. The doctors have tried to keep her out of hospital for this reason, but last week she called an ambulance herself, twice. We ended up taking her to emergency after she spent the night banging her head against the wall. She was admitted. Since admission last week, she has slipped into catatonic states, fainted several times a day. Will chat away, suddenly stop, stare and drool, then suddenly get up, run to the wall and start banging on it. She has used her fingernails to scratch up her arms, legs and face. We don't know if it is OCD telling her she has to do these things, or something else completely. The nurses think some of it is behavioural. Perhaps a way to show "Look, I am really sick. You will have to help me." She has lost the ability to distinguish any of her thoughts as OCD thoughts, or not. She has said several times recently that she wants to die (though I don't think she has a specific plan of how). I have recently thought, she will kill herself one day. She can't possibly go on like this. She has been off school pretty much all year. The few times she has seemed to be doing better and we have tried to ease her back in (an hour or two a week), she regresses. We have wondered if we should just pull her from school altogether (she said it is a huge stress because she needs to look good everyday, people ask her how she is and she has to answer 'Good thanks' when she is not, lots of kids at the school mean lots of people are looking at her, etc).
We feel more than a bit lost. If it is OCD, we feel like we have not pandered to it, as advised, but also that she (or her OCD) will take things to a level that ensures she gets attention/hospitalisation/etc. Prior to the current hospitalisation we were going to try and lower the olanzapine and increase the chlomipramine (she is on a low dose) in the hope it would help with the aggression and lower the strength of the anxiety. Now that she is off the deep end in hospital, I think they are going to increase the olanzapine. It is a nightmare and I can't see any light in the near or distant future.
Any comments, observations, suggestions will be appreciated.