It seems to me like American teenagers are serious hypochondriacs. Just a rudimentary conversation seems to always reveal a self-diagnosis of ADD or OCD. This has always been puzzling to me. In our country, mental illness is still highly stigmatized, yet it seems trendy to proclaim. Every teen who can’t focus on their homework can’t have ADD, and every lock-checking adolescent isn’t obsessive compulsive.
For all those concerned teens out there, shouldn’t we set the record straight? Below we will define both OCD and ADD/ADHD following the psychological and psychiatric guidelines set out in the manual of mental illness.
Defining Mental Illness
The problem with defining mental illness is that the diagnosis is highly variable. It is not like a physical illness where there are rigidly defined symptoms. Instead, diagnoses can vary between psychologists/psychiatrists, and the rigid lines become a lot more fuzzy.
What scientists have attempted to do is to take the subjectivity out of the equation by creating an objective set of diagnoses for various mental illnesses. This valiant effort comprises the Diagnostics and Statistics Manual.
So what about those hypochondriac teenagers? Just how quirky do you have to be to have OCD? Where is the line between peppy and ADHD? You’ll find that, all kidding aside, the guidelines for diagnosing a mental illness entail something much more serious than any attention-seeking teen gloats about.
According to the Diagnostics and Statistics Manual (DSM IV), the bible of psychiatric diagnosis, OCD symptoms are generally described as:
A. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4):
1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
2. The thoughts, impulses, or images are not simply excessive worries about real-life problems
3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
4. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
Compulsions as defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships.
D. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
This does not characterize the small quirks that are present in all of us; these are life-impairing obsessions that make life very difficult for those with the disorder. Also keep in mind that it is not enough to have just one of these symptoms. You may have to exhibit five concurrent symptoms to be seriously diagnosed.
Likewise, again from the DSM, comes the definition for ADD/ADHD:
A. Either (1) or (2):
(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
(a) often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
(b) often has difficulty sustaining attention in tasks or play activities
(c) often does not seem to listen when spoken to directly
(d) often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
(e) often has difficulty organizing tasks and activities
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities
(2) six (or more) of the following symptoms of hyperactivity/impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
(a) often fidgets with hands or feet or squirms in seat
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(d) often has difficulty playing or engaging in leisure activities quietly
(e) is often “on the go” or often acts as if “driven by a motor”
(f) often talks excessively
(g) often blurts out answers before questions have been completed
(h) often has difficulty awaiting turn
(i) often interrupts or intrudes on others (e.g., butts into conversations or games)
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Likewise with OCD, ADD is not simply losing attention, being hyper, or being “random.” It is far more serious and typically requires corrective therapy in the form of medication.
I have heard many a teen self-diagnose themselves with ADD or OCD. But unless they qualify under the criteria above, they are probably wrong. For a proper context, the American Psychiatric Association states in the DSM that only 3%-7% of school-aged children have ADHD. Additionally, the National Institutes of Mental Health state that only about 1% of American adults have OCD (in any 12-month period). As another comparison, the same institution states that around 11% of US adults will incur severe depression in their lifetime. Based on these statistics, why is it that depression is still a rarely talked about and highly stigmatized disorder, whereas OCD and ADD/ADHD, occurring at much lower rates, are touted about?
Are there any other explanations for these assumed illnesses? Teens are a walking bag of intense hormones. They are going through a transitional point in their lives. They are figuring out their trajectory in life and stepping through the minefield of the dating world. They are cramming for exams to get into a good college, and are at the whims of an increasingly connected global world with 24/7 entertainment. Could any of this have to do with feelings of attention loss, hyperactivity, compulsive checking, or a fluttery mind? Of course. Without the objective symptoms, the hectic life of a teen is simply that, hectic, and your mind follows suit. It’s probably not mental illness.
I am not trying to downplay these mental illnesses. I hope that it is clear that these disorders are very serious and wreak havoc in people’s lives. My point in exemplifying them is to show that self-diagnosis is, unless you are a professional or are currently seeing one, useless. You play up fears, cash in on attention from the stigma mental illness produces, and are horribly subjective. It’s not something to joke about; you don’t see kids bragging about maybe having schizophrenia.
All that being said, if you do think you qualify for a diagnosis, seek help. Thought our society looks down on mental illness, being socially accepted is not worth suffering in silence.