QUESTION:

My daughter has been diagnosed with Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD) and potentially Bipolar Disorder, but that last diagnosis is not confirmed yet …right now she is unable to go to school - anxiety and panic attack when the morning comes. We are extremely hesitant to go the home-school route, because of the probability of the anxiety transferring to another area –especially if she has not developed the skills to tackle it when she experiences the anxiety/panic.

I saw on your website the concept of getting her to have ‘going back to school’ become her idea …any magical ways of getting that to happen??? Her father and I are at the end of

our creative strategies rope (her father is a clinical psychologist and also has OCD) …words of wisdom?

ANSWER:

You’ve raised a lot of issues here. Let’s first identify each one:

1. OCD/OCPD

2. Possibly Bipolar Disorder

3. Anxiety/Panic

5. Unable [i.e., unwilling] to go to school

Re: OCD/OCPD — Is she on an antidepressant? If so, does it help? A complicating factor is that when anti-depressants are given without mood stabilizers to people with bipolar disorder, the antidepressants may induce mania or hypomania. So her psychiatrist will need about a year of experimentation (the art side of pharmacotherapy) in order to get the right combinations and dosages of medication. It will be important that everyone in the family be patient

with this process.

Re: Bipolar Disorder — Bipolar disorder is difficult to recognize in young people because it does not fit precisely the symptom criteria established for adults, and symptoms can resemble or co-occur with those of other common childhood-onset mental disorders and may be mistaken for normal emotions and behaviors of children and adolescents.

As a result, Bipolar kids are often given any number of psychiatric labels (e.g., ADHD, Oppositional Defiant Disorder, Conduct Disorder, Obsessive Compulsive Disorder, Separation Anxiety Disorder, etc.).

Too often they are treated with stimulants or antidepressants — medications which can actually worsen the bipolar condition.

Having said that, it has been my experience that when bipolar is suspected, it is eventually diagnosed (i.e., if her

doctor believes she may be bipolar, she probably is). Is anyone else in the family bipolar (e.g., uncle, grandparent)? As you probably know, bipolar is highly genetic.

So my advice, based on my experience with others in similar situations, would be to begin focusing on the bipolar issue because (a) she probably is bipolar and (b) once the bipolar symptoms are stabilized, the other symptoms (anxiety, panic, OC behavior, etc.) will get addressed by default (at least from a medical standpoint).

Re: School — Going on the assumption that she is bipolar (and again, it is just an assumption at this point): Bipolar children will not function well in a regular school setting - so that’s out, period!

However, the

bipolar kids I work with do very well in alternative school environments or GED programs where the classes are small and they get sufficient amounts of one-on-one attention.

They do miss a lot of class time (e.g., “I got a headache” “I’m sick to my stomach” bla bla bla), but most alternative schools are willing to deal with poor attendance within reasonable limits.

In any event, your task will be to have a relaxed attitude about all things — model “having a relaxed attitude” throughout the day, everyday!!! Your daughter will pick up on it at an unconscious level. Then you’ll be working your magic.

I CANNOT EMPHASIZE THIS ENOUGH: The more you and your husband develop the

“art of letting go,” the less she will stress. The less she stresses, the fewer symptoms she will experience. The fewer symptoms she experiences, the more she can focus on the really important things in life (relationships, school, work, play, etc.).

It sounds like the whole family may be in “survival mode” (i.e., spending a lot of time and energy just trying to keep the boat from sinking). One can escape from this mode by practicing “having a relaxed attitude,” a “grateful heart” and a “sense of humor.” If you think you simply can’t do this right now, then fake it anyway (i.e., “act as if” you are relaxed, grateful, and finding things to laugh about). With practice, this becomes

habit.

In summary, the real issue here as I see it is “stress.” Everybody is feeling pressure. And I can promise you that if everyone is uptight most of the waking hours — you will have a long, hard road ahead.

Mark Huttenlocker, M.A., is a family therapist who works with teens and pre-teens experiencing emotional/behavioral problems associated with ADHD, Oppositional Defiant Disorder, Conduct Disorder, Bipolar Disorder, Autism, etc. He works with these children and their parents in their homes. You may visit his website here: http://www.MyOutOfControlTeen.com