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Counsellor thinks not OCD now more Aspergers


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14 year old has been diagnosed OCD and is seening CAMHS. Psychiatrist we paid to see suspects Aspergers but we're still waiting for CAMHS on this.

His behaviour is all around the time he takes in the toilet/shower and how things have to be clean. Most counsellor can get out of him is "it stresses me out" but no signs of something bad will happen if I dont etc.

We've found also, he gets worse at times when you mention it. Almost sometimes as if hes got a bit of power (Im in the bathroom and you cant get me out) and he likes it.

In a private chat with counsellor she says it may be more Aspergers/getting hung up on this and bad behaviour more than OCD.

Any comments?

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Dunno about bad behaviour - what about the feeling of it 'not being right' that drives him to clean? Then that would be an OCD thing or Aspergers. A form of ordering his world and thus controlling it? I think this is where overlap between OCD and Aspergers exists. I don't think it's bad behaviour. I think frustration and defiance would occur if things for your son feel or seem disordered (not clean) but it's not 'bad behaviour' for the sake of it. Bad choice of words from that counsellor 

 

The part about Mentioning cleaning making him seem worse is probably his mind being triggered like an intrusive thought where he needs to undo it. Like if someone with a fear of harm stumbled across a news article about knives or something, then their mind is triggered/spiked into obsession and they need to deal with it (compulsion). 

Edited by Orwell1984
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Yes I totally agree Orwell :yes: 

Quite often I think the younger generation have it hard :( because a lot of the time they put it down to teenage attitude and bad behaviour, forgetting they have a disorder and it’s more down to frustration and fear than bad behaviour :( 

Would they say the same if it was an adult acting in the same way? 

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He could suffer/experience both conditions.

Interestingly, is your use of the word power. In a series of  policy documents the British Psychology Society - the Division of Clinical Psychology - use the term power. Power can be positive or negative. The power to influence others or control your living space. Your son probably has very limited power. 

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Angst is right with Aspergers it’s not usually just the case that some one has Asperger they usually have some other health condition too unfortunately (I’m no psychiatrist) but I used to work with young adults who has Autism. Hope this helps xxx

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 OCD is one of the most commonly diagnosed anxiety disorders alongside Aspergers, it seems the two conditions go hand in hand and some people say it’s a symptom of Aspergers and others, like my sons doctors, choose to diagnose it as co-morbid because of the severity of it. In all honesty it doesn’t matter so long as he gets the help and support to manage it. He doesn’t have to believe something bad will happen, my son has loads of OCD and his reason for a lot of it is just a general feeling of disgust (as do I) he describes stuff as “disgusting” a lot of the time. If he has thoughts “this stresses me out” and compulsions “must shower untl I am no longer stressed out” it’s OCD.x

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Yes the comorbidity is pretty high. Accordingly to wikipedia it is like 30%. 30% of people with autism also have OCD. 

 

This study is pretty informative. Many people with OCD have depressive periods in their life. 60-80%. 

Bipolar and OCD have high comorbidity: "Obsessive–compulsive morbidity is also one of the most disabling co-occurring conditions in bipolar disease (BD), and these symptoms are frequently encountered in clinical practice (El-Mallakh and Hollifie" 

 

This is really intresting, because i think i might have bipolar but i have never had any mania, i mean i have periods when i feel bettter than normal but accordingly to this: "When using a wider concept of bipolar spectrum in both clinical and epidemiological studies, lifetime comorbidity rates increased significantly: almost 50% of OCD cases manifest cyclothymic traits and/or some lifetime hypomanic symptoms (Hantouche et al.,"

Borderline personality disorder, schizophrenia, GAD and psychosis also have higher numbers than in the general population. 

It is more likely to have OCD when you have autism than it is to have autism when you have OCD. Accordingly to this is it four times more likely to have autism if you have OCD. Prevalence of OCD is around 2% so i guess it is around 8%. People with autism have OCD in 30% of the cases. https://www.spectrumnews.org/news/sweeping-study-underscores-autisms-overlap-with-obsessions/

I didn't read the whole study above so bare with me, i find this stuff fascinating.

Edited by Isthisreality
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Whatever it is you’ll get through it as a family. If he’s not diagnosed that’s fine if he is that’s also fine there are great people out there who know a lot about these conditions and how to help, my advice research research research xx

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Hi Paul,

Your son definitely does have OCD though, whether that's comorbid with Asperger's or not- that feeling of being stressed if he does not wash enough is typical OCD and he does not need to fear that something bad might happen for it to be OCD.

I think you might be overestimating the power-play issue here- yes he is a teenager and can be stroppy sometimes BUT staying in the bathroom for a long time is best explained as an OCD behaviour, which would most definitely happen even if he was living alone. If he does have comorbid Asperger's syndrome too then he has a lot to deal with and is probably feeling completely overwhelmed by the demands of being a teenager and of having to cope with OCD on top. If your family then challenge him and his OCD from time to time then it's likely that you feel the brunt of his frustration and anger (which his teenage hormones won't be helping either!). 

 

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Also was the private chat with the psychiatrist or with a counsellor? If it was with a Psychiatrist then I still disagree but it's worth asking why s/he thinks that it's not predominantly OCD. If it was a counsellor then they are not trained to diagnose (neither am I but I have studied Psychology at University and have experiential knowledge of OCD!) and I would not really pay too much attention to her opinion.

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I agree with you BelAnna. So many people in this area say so much with such certainty when they actually have no clue about OCD. Psychiatrists can be a mess! I guess it is because they have this inclination to treat you with medicines and CBT are not something which comes in pillform. It is actually very useful to first ask the therapist what experience she/he has about OCD. Has she/he treated others, and so on. 

Edited by Isthisreality
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I read my answer and i saw that i missed to link my source (the source i quoted)! It is such a informative source so i post it now. So much information in it. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243905/

I haven't read the whole and i could have got something wrong. I would also like to add that it seems to be more common to have delayed sleep phase disorder if you have OCD. I think i might have it myself. I once thought about starting a thread about it, but i didn't. 

And please don't think that just because something is more common that this means that you can't differ. Remember that you are just one individual with OCD and those generalizations which are made in studies, will mention bigger groups, because that is needed when you are doing the studies.

Edited by Isthisreality
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20 hours ago, BelAnna said:

Also was the private chat with the psychiatrist or with a counsellor? If it was with a Psychiatrist then I still disagree but it's worth asking why s/he thinks that it's not predominantly OCD. If it was a counsellor then they are not trained to diagnose (neither am I but I have studied Psychology at University and have experiential knowledge of OCD!) and I would not really pay too much attention to her opinion.

Psychiatrist has prescribed him medication for OCD and thinks its 99% Aspergers related.

His intial CAMHS assessment was OCD (they've not started on Aspergers yet). Hes seen this counsellor a few times and shes said its more of an obsession rather than OCD. Not sure what that means!

Of course, as you say, it could all be tied into Aspergers.

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20 hours ago, Isthisreality said:

I agree with you BelAnna. So many people in this area say so much with such certainty when they actually have no clue about OCD. Psychiatrists can be a mess! I guess it is because they have this inclination to treat you with medicines and CBT are not something which comes in pillform. It is actually very useful to first ask the therapist what experience she/he has about OCD. Has she/he treated others, and so on. 


Who knows with the NHS. Im just assuming counsellor is competent and experienced for the role.

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