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Navigating the
Surreal Multiverse of
Obsessive-Compulsive Disorder,
Anxiety, Depression & Shame

Tips & Tools for
Teenagers,
Families & Schools
Facing Down Teen
Mental Health Challenges

Sophia S. Catalina







Welcome Fellow Teens,
Families & School Staff

l'm a teenager, and am passionate about sharing key tips and tools l've learned on my recent journey through some surreal parallel realities (what l call the "Multiverse") of OCD and its associated anxiety, depression, and shame.
With time, intention, and practice l found my way out of a crushing overwhelm and despair, and back to a more "normal" life. lt was through my crisis that l also tapped into inner resources l didn’t know l had, and found an empowered new voice.
And to all my fellow teens who are struggling with such mental health challenges:
l want you to feel heard and seen, to know that you are not alone in the world, and to find the effective support that really is available.
And l want everyone — kids, families, school staff — to carry with them new tools and skills into a brighter, more hopeful future. This is not only possible, but very do-able, once we start pulling together.
Toward those ends l've written a guidebook describing some of the awareness and approaches that l found particularly useful.



l emphasize the importance of teamwork among family, friends, teachers, and mental health professionals — together we are weaving a relational fabric of support that is key to the healing process.
This is the guide l wish someone had given me (and my parents and teachers) at the beginning of my journey. My hope is that you might find it useful on yours.

Please explore the tabs below for some highlights and excerpts. You will of course find far more detail in the book itself (more book info at the bottom of this page).


A Weird New World of WTF
some highlights & excerpts from my guidebook

➤  The Other Pandemic
        Yes, there really is a teen mental health crisis
ln a given year it's estimated that at least 4 million Americans face severe "clinical" OCD. Many others have "subclinical" (less debilitating) symptoms. And most of these individuals also struggle with associated anxiety or depressive disorders, and shame.

We all know people whose lives are seriously affected by one or more of these conditions. And teens are often disproportionately suffering.
ln early 2023 the US Centers for Disease Control (CDC) released its biannual set of Youth Risk Behavior Surveys:
Overall, 42% of the American high schoolers surveyed (including 57% of the girls, and 69% of LGBQ+ students) “felt so sad or hopeless almost every day for at least two weeks in a row that they stopped doing their usual activities.” 29% of students overall believed they were experiencing “poor mental health” — including 41% of the girls, and 52% of LGBQ+ students.

Tragically, 30% of girls had seriously considered suicide, 24% had made a plan, and 13% made an attempt.
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As there are somewhere around 17 million American high school students, these data suggest that as many as 7 million high schoolers may be dealing with severe life stress and mental health issues. That would be 4 times the population of Manhattan, or the entire population of Massachusetts.
These numbers have been getting worse. Many schools are offering a variety of new mental health programs and services, but far more resources are needed.

ln the meantime there are many immediate, relational ways to support a suffering teen. Please read on!
➤  The OCD Multiverse ln a Nutshell
        Facing a bizarre new territory
ln my book l talk about how OCD as a whole is a sprawling and bizarre collection of fantastical parallel realities. l call this the OCD Multiverse. Sadly, the daily torment and impairment of a teen surfing this multiverse often can be either invisible or incomprehensible to their loved ones.

For many of us, OCD creeps up on us as kids and then mugs us from behind. Here is a simplified overview of the condition (you will find some specific examples under the other tabs below).

Dysregulated neural networks in the brain of the OCD sufferer create unwelcome and relentless intrusive thoughts. These are overpowering obsessions that drill into our head seemingly out of nowhere — and then take control. ln effect they hijack our nervous system.

These intrusive ideas, impressions, and fears are untethered to any objective reality — they are not likely to be about anything that could (or did) really come to pass in our actual life. Yet we sufferers usually imagine that such events could or (already did) happen.

Like a mobster's extortion racket, the intrusive thoughts of OCD conveniently give us the “fix” that will supposedly relieve our anxiety and/or prevent a terrible harm to ourselves or to someone we love. We are “told” to follow strict orders and rituals (the “compulsions”), often over and over again.

Because our rogue neural networks are telling our nervous system that these terrible events did or will happen, we are compelled to engage in time-consuming ruminations and "protective" behaviors that we truly hate. But we do them anyway, in order to lessen the anxiety and avoid the harm threatened by the intrusive thoughts.
Even more insidious, these obsessions can repeatedly morph to elicit new fears and compulsions, keeping us constantly off balance. Until we learn some new tools and skills, we remain chronically anxious, depressed, and exhausted from the torrent of horrific scenarios.

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ln short, the intrusive thoughts end up dominating our awareness and dictating our feelings and actions, consuming hours or an entire day or days. OCD capsizes our accustomed life (with family, friends, school, job) and leads to continual fear, exhaustion, paralysis, and shame.

Perversely, the other (healthy) parts of the OCD sufferer’s brain often suspect or know that these thoughts, impulses, and actions are unreal, irrational, and ridiculous — that a hijacking of our entire nervous system is underway. Yet still we feel compelled to act out the required compulsion, in order to lessen our anxiety and to avoid the harm promised by the intrusive thoughts if we don’t do what is required.

But we can turn the tables and change all this! My guidebook is all about weaving the relational fabric of support, and developing the tools and skills, that allow us to sideline these rogue neural networks and take back our life.
➤  The Parallel Realities of OCD
        OCD is very real & obvious to me, maybe not so much to you
Mystified by your (or your loved one's) odd and troubling new behaviors? lt took me too long to figure out that l was surfing various layers of the OCD Multiverse. Getting a professional evaluation is key, but in the meantime this tab introduces some (not all) common kinds of intrusive thoughts (obsessions) of OCD.

Obsessions typically involve illusory yet relentless fears, doubts, and ruminations, for example that:
You are personally responsible for the health, safety, and fate of your loved ones.
Your routine, daily activities will inflict harm on yourself or others.
You’ve done terrible things that prove you are a bad person.
You will never be capable of sustaining an intimate relationship.
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Part of the power of the intrusive thoughts of OCD is that they tend to be very “personalized” and hit close to home, promising bad consequences for us or the people we love:

“lf you eat this, your BFF is gonna get raped”.
“lf you don’t repeat this ritual six times, your mom will die.”
“lf you open that book, you’ll get sick”.
“lf you take that medicine, you will instead get even more sick.”
Our rogue neural networks hook us into being scared all the time that the worst will (or already has) come to pass. And then they conveniently give us the “fix” (the “compulsions”) that will supposedly relieve our anxiety and/or prevent a terrible harm to ourselves or someone we love. We are “told” to follow strict orders and rituals. A few examples:
Repeat the word “hamster” twenty times.
Shower and re-shower for an hour.
Continually loop in “playback” mode a memory (now hopelessly distorted) of a social interaction proving what a bad person you are.
Walk back and forth between point A and point B, and back and forth, and back and forth, until the experience feels “just right”.
So long as we are doing what is compelled, we “contain” our anxiety, and nobody’s going to get hurt — until the next intrusive thought arrives, and another cycle of compulsions begins.
We can put a stop to this extortion racket with proven therapy tools. See the tabs below (and my book for much more detail).

The following OCD Multiverse chart from my book summarizes some (not all!) common OCD obsessions, and their possible consequences for the suffering teen, friends, and family.

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➤  No, lt's Not "Just in Your Mind"
        A dysregulated brain hijacks our nervous system
ln my book l emphasize this key point for both the suffering teen and their loved ones: OCD is not just “in your mind”. lt’s a biological condition that hijacks the nervous system.

Scientists are busy investigating the biology and neuro-physiology of OCD. They have strong theories based on brain imaging studies of people with OCD, the effects of specific medications on patients, and even experimental brain surgery. See for example this summary from the Stanford OCD program

One leading set of hypotheses about OCD goes something like this (as l’m no scientist, please understand that this is a total oversimplification):

The complex neurochemical communications among different parts of the brain of the OCD sufferer become impaired (perhaps due to glitches in brain development or function, genetics, inflammation and the immune system, or environmental factors).

This leads to the “dysregulation” of key neurotransmitters (such as serotonin) and the “feel good” neural feedback loops that typically allow people without OCD to return to a state of calm after a stress.
This impaired neural messaging to and from the frontal cortex results in hyperactivity in key regions of the brain, leading to self-reinforcing cycles of elevated “worry inputs” (anxiety), and the behaviors we know as OCD. We get flooded with stress.
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This unseen drama unfolding in the brain suggests one physiological basis for how OCD “hijacks” the nervous system. lt also would help explain why anxiety, depression, and OCD tend to hang together, and why targeted therapy and SSRl medications can be helpful for many sufferers.
➤  Why Teens Can Feel So Alone
        OCD often is a confusing, invisible & isolating affliction
The daily torment and impairment of the teen with OCD can be either invisible or simply incomprehensible to loved ones, friends, and teachers.

The intrusive thoughts (obsessions) of the OCD sufferer are nearly always internal — nobody but the teen themself is aware of them. And many of our odd behaviors (compulsions) are also internal and invisible — for example our looping ruminations, or internal counting, or repeating words or phrases. Also, we teens may only act out our odd behaviors in the privacy of the bedroom or bathroom or on our way to school, to avoid the shame of discovery and ridicule.

All this means it may take some time for our loved ones to notice our problem, or believe it when we start to communicate about our fears and needs. This is a recipe for loneliness, frustration, and despair.
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The official clinical name “Obsessive-Compulsive Disorder” is not entirely helpful. Yes, we have unwelcome obsessive thoughts, impressions, and impulses (called “intrusive thoughts”) about some kind of feared outcome or harm. These intrusive thoughts then compel us to take supposedly protective action (our “compulsions”) to lessen our anxiety and prevent that threatened harm. We are effectively "possessed" by rogue neural networks in our brain.

Yet, lots of people have obsessions, and/or compulsions, without having OCD. As a few examples, we certainly want our electricians, engineers, programmers, architects, building contractors, novelists, filmmakers, veterinarians,
doctors, or lawyers to be passionately fixated on often obscure and minuscule details, until they get it exactly right. Similarly, the garden-variety “clean freak” simply feels more comfortable and relaxed when things are tidy. Most such perfectionist and fastidious individuals do not have OCD.

Adding to the confusion is a widespread misunderstanding of OCD. Many people think that OCD refers to obsessive cleaning, or is all about the individual who excessively washes their hands, counts cracks in sidewalks, or organizes their surroundings into a perfect order or symmetry. While these could be symptoms of OCD, many of us with OCD do not have such behaviors.

lt doesn't help that many people are flip about using the name "OCD" to poke fun at behaviors that are something else entirely: "She's so OCD about getting her eyeliner just right!" "My English teacher is OCD about grammar rules." "Since COVID I'm so OCD about washing my hands!"

The stereotypes and jokes can do real harm. They can make the disorder seem far less medically or socially awful than it really is. After all, regular handwashing reduces the spread of disease, and meticulous housecleaning results in a comfy home, right? And, the famous television detective with OCD always solves the crime with some humor and flourish. So even when these behaviors seem a bit over-the-top, what's not to like?

The problem is that our ignorance or discounting of the real horror of this disorder can make the suffering teen feel unseen, belittled, and utterly alone. lt can delay a professional evaluation, treatment, and important school accommodations. ln my case all of this happened, and my suffering was needlessly prolonged.
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➤  Voices of False Guilt & Shame
        Our hamster wheel of fear & futile striving
As if the lonely and debilitating symptoms of OCD, anxiety, and depression were not enough to deal with, most teens struggling with these afflictions also have to face an accompanying FALSE guilt and shame.

Think about it: The OCD Multiverse has me constantly off-balance and running in circles. l’m not only trying to save myself, but am also feeling personally responsible for possible illness, injury, rape, murder, or mayhem involving friends and loved ones. And to prevent all that l’m slaving away in exhausting and time-consuming ruminations, behaviors, and rituals.

All this sabotages my daily family and social and work life, and tanks my school grades. l waste hours and days. I’m frustrated and angry and demoralized that the normal things that so many teens do without a thought, l can only accomplish with far greater effort and time, or maybe not at all. For good measure, along the way l’m seriously anxious and depressed, often with nausea and heartburn to boot.

How could anyone feel good about themselves under such circumstances? Who wouldn’t feel tremendous responsibility and guilt carrying such a burden? From my vantage point at the bottom of that pit, it seems quite obvious that something is inherently wrong with me. l must be fundamentally defective, cannot possibly meet my burdens of responsibility, and am feeling deeply guilty and ashamed about it all. A punishing "inner critic" continually scolds me that my defects are “simply who l am” — they are here to stay.

All of this is of course complete BS. lt's a false guilt and shame, because we can’t actually put our loved ones at such risk (as concocted by OCD and our anxieties). Nor can we make amends for our imaginary misdeeds or “save” another person from phantom threats with some bizarre compulsive behavior or ritual. Simply put, we are being played by our intrusive thoughts.
That is, there is no inherent flaw for us to fix. But until we realize that our voices of false guilt and shame come from rogue neural networks, we may only see two options: Collapse and withdraw from life, or intensify our spinning on the hamster wheel trying to prove (to ourselves and to the world) that we are worthy and lovable. Either way we feel exhausted and hopeless. ln my case l barely held onto any sense of my value as a human being.
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The ongoing relational support of my friends and family was the key ingredient in my “de-shaming” process, along with a course of therapy that helped me see false guilt and shame for the sham they really are.

l learned that l have an illness (dysregulated neural networks) and a challenge, just like millions of other humans who suffer a chronic health condition through no fault of their own. Having such a condition is no fun, but it doesn't mean l'm a bad person. Simply put, l am much bigger and better than my anxious, depressive, intrusive, or shameful thoughts!


Some First Steps Out of the Abyss

➤  Consider That OCD May Be Hiding in Plain Sight
        The challenge of mistaken identities
Every year tens of millions of Americans experience varying degrees of anxiety and depression. Even if we are fortunate not to face these challenges ourselves, often we can spot the signs in another person.

By contrast, it's not always obvious when someone has OCD. Moreover, the bizarre nature of the disorder simply "doesn't make sense" to most people, and certainly may not be as noticeable as depression or anxiety.

Although anxiety, depression, and OCD are very different, they often travel together, and it's not always easy to tell them apart. ln the early days of my own crisis, it was not at all obvious that my anxiety and depression actually were the symptoms of OCD's intrusive thoughts, which had been gradually sneaking up on me to eventually take over my nervous system.

OCD is not limited to a familiar (or at least readily imagined and “relatable”) set of symptoms. Yes, OCD can show up as a predominant obsession and plainly visible compulsion (such as an outsized fear of contamination leading to continual hand washing). Yet OCD as a whole is a sprawling collection of fantastical parallel realities that l call the OCD Multiverse (see the chart in the tab above).
Each version of this multiverse offers nearly infinite story lines involving a terror or shame that like a laser targets very particular vulnerabilities in the sufferer’s life. Each presents a different and ever-changing extortion demand, which lead to the widely varying compulsive acts of the suffering teen.

All obsessions are internal, as are many compulsions, which means they are not readily observed by the outsider. All this variation can make it nearly impossible for the teen's family, friends, or teachers to “see”, much less grasp, the teen's dire straights.

To make recognition even more difficult, depression, anxiety, and OCD can look very similar on the outside, as they share many symptoms. The chart below illustrates this challenge. The first row of the chart shows some “headline” differences between these three disorders. The remaining rows show some symptoms all three can have in common.

Notice that these overlapping symptoms may overshadow the differences — at times they can drown out the headlines. Can you see the possibility for some initial confusion? Hence the importance of seeking a professional evaluation as soon as possible.
The first row of the chart shows "headline" differences between the three afflictions. The other rows show some overlapping symptoms that can be common to all three.
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➤  Recognize the Emergency
        Then proceed to the nearest emergency exit
lt may seem obvious, but for those of us facing a mental health challenge the very first step toward healing is an honest (and difficult) recognition of our predicament.

To identify the underlying issues and create a treatment plan we will first need to acknowledge that we feel seriously miserable and dysfunctional. And that we’d really, really prefer being stronger and happier. That’s how we’re able to set our intention to adjust the trajectory of our life, and take the necessary action to get there.

Put another way, we begin our healing journey by first getting more authentic and relational with ourself. So l invite you to ask yourself:

“Just how willing am l to acknowledge some unwelcome, unsettling, and really inconvenient new aspects of myself (or my child or loved one or student)?”

How you answer that question is key. lf the teen is in denial, not much can happen. lf teens and parents are not communicating honestly about their experiences, the mental health issue may not be promptly identified, much less timely addressed with a useful treatment plan. lf teachers turn away from potential mental health issues they suspect in a struggling student, an opportunity is lost.

Unfortunately, it’s not always easy to take this first step.There’s a good chance that the teen is flailing in a dim and confused state of overwhelm, courtesy of a glitchy neurochemistry. We (or our parents) may still be in a bit of denial, and don’t yet grasp the full gravity of the mental health emergency. Perhaps we do suspect it, but doubt that it could ever be different, or that we deserve any better. But it can be, and we do.
There’s lots of support available to help us get through the darkness to the emergency exit. But we must first admit to ourselves and to the world: "l'm having an emergency situation here!”

Notice if you resist making this pronouncement. Do you push away the best efforts of friends and family to help? Are you avoiding the opportunities of self-inquiry, therapy, or medication, which may seem strange or uncomfortable for you? Are you leaning on alcohol or drugs to numb yourself to the pain and fear? How are these strategies working out for you?
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"No, you're not in a box. You're in an exit row. And l need you to acknowledge that verbally."

My own first steps were small and do-able, yet still momentous. l started reading medical websites about possible explanations for my experience. l found some really helpful bloggers who honestly and bravely offered their own stories about OCD and similar symptoms and journeys. l began sharing with my trusted adults, and with some close friends who also faced mental health challenges.

The point is that l realized l was not alone, and that l had supportive people, resources, and solutions available to me. l had started making my way toward the emergency exits.
➤  Reach Out & Get Relational
        Start sharing your inner landscape with those you trust
l talk a lot about what l call the "relational fabric" needed to face down any teen mental health challenge, and certainly the insidious terror and exhaustion of OCD and its close buddies anxiety, depression, and shame.

The word “relational” means what it sounds like: The quality of our connections and communication. We become more authentic, attentive, respectful, non-judgmental, and compassionate with ourselves, and with those around us. Why is this so important?

Humans are naturally wired to be social animals — we are literally born into relationships. We develop our unique identity through interacting first with our mother, then with many others. Our supportive, mutual, meaningful relationships — and not only the romantic ones — are known to release the “feel good” brain chemicals (hormones and neurotransmitters) called serotonin, dopamine, endorphins, and oxytocin. Even the occasional positive mirroring and heartfelt support from a friend or classmate, parent, teacher, or boss can work wonders on our mental health.
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lt’s our authenticity, as imperfect and irregular as it can be, which strengthens the relational fabric within and among family, friends, and school staff. lt earns trust and creates safety and pleasure, which get the “feel good” brain chemicals flowing. This is how we grow the ability to effectively face and address mental health challenges as a collaborative team.

Our goal is to start reaching out to trusted family members, friends, and school staff as soon as possible given our circumstances. The point is to minimize the time we feel unseen, unheard, or suffering alone without hope. And to get those "feel good" brain chemicals flowing!

Relational "chemistry" is a real thing!

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"The serotonin is deafening."

➤  Refine Those Communication Skills
        Cultivate presence, patience, perseverance
Teens facing mental health struggles have the task of explaining something that may be largely invisible to others, and (especially in the case of OCD) just plain weird to boot. So mere best intentions don’t guarantee easy, clear, and fruitful conversations.

Even among neurotypical teens and adults it’s not so common to find people who have mastered the art of careful, patient listening and what l call “compassionate cluelessness”. lt’s hard for most of us to see the other people in our life with fresh eyes, and deeply listen to them without interrupting and projecting.

The suffering teen faces additional hurdles, as we are likely reaching out from a place of overwhelm, fear, and shame. We are still trying to wrap our mind around scary new circumstances, and have no easy or comfortable way to talk about it.

Our loved ones are also tested, as they are accustomed to habitual ways of relating with a younger and happier “version” of their teen. Suddenly we are asking them to have fresh eyes and ears, jettison their comfortable preconceptions and attitudes, and shift gears into new ways of interacting with us. What could possibly go wrong?

l had to learn that what was obvious to me about my mental health status was not at all obvious to my loved ones, friends, and teachers. So l became a teacher myself of sorts, helping parents, friends, and school staff move beyond their familiar and comfortable assumptions and projections.

l used time as my ally. As l learned more about my situation, l practiced describing each new piece to my parents and friends. So long as l kept the information flow gradual and bite-sized, rather than dumping everything at once (although that may be necessary at times), my loved ones were able to hear me and digest more and more over time.
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We ask the adults to practice the art of “compassionate cluelessness”. This is a deliberate openness — for the moment you put aside what you think you know or expect about the teen. You instead deeply listen to what they are saying and feeling. You imagine yourself in their shoes. You tolerate sitting in uncertainty, even utter cluelessness, without judgment or analysis or advice or a “fix”. That is, you allow yourself to be OK experiencing something unexpected and unresolved.

Compassionate cluelessness is easier said than done. lt really helps to abandon any notion that you have to do things “perfectly”. Consider instead being the “good enough” parent or friend who weaves the relational fabric of support — you pay attention, listen deeply, and mirror back what you see and hear. You suspend your judgments and lecturing. You make sure your child or friend doesn’t feel alone or unsupported — even and especially when you both may be feeling uncertain and helpless about the immediate situation.

This is not about finding a "fix" (there will be time for that later), but rather cultivating the healing power of an empathic, compassionate, relational presence with a suffering loved one. My book offers more tips and tools about how to go about this.

Turning the Tables on OCD and its
Anxiety, Depression & Shame

➤  Choose to Stand Up to the Mental Mean Girls
        You can overcome this nasty clique of bullies
Anxiety, depression, and OCD are very different, yet often travel together — those of us with OCD are typically dealing with the other afflictions as well. Collectively they engage in relentless campaigns of relational aggression. Which means we have to treat them as the bullies that they are.

Because l'd rather laugh than cry, l call this toxic clique the Mental Mean Girls. We can run but we can’t hide from their bullying, so before we can heal we need to clearly set our intention and then squarely face them.

Think of those actual middle school or high school “mean girls” you may have run into:
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Rather than physically beat you up like some bullies would, your typical school mean girls will gossip, ridicule, backstab, ostracize, manipulate, cyberbully, slut-shame and spread rumors to sabotage your reputation and relationships. They seem to lack any empathy or moral code, and leave a wake of social torment and misery everywhere they go. lf you are their target, at first you probably won’t even know what hit you. But when you get past your initial bewilderment and angst, you’ll notice the nasty residue of toxic slime.
All of that real-life relational aggression also pretty well sums up how l felt when l started dealing with my internal bullies of anxiety, depression, and OCD:
Ridicule and shaming? Check.
Rumors and lies? Check.
Manipulation and sabotage? Check.
Vandalized relationships? Check.
Bewildered angst, overwhelm, and misery? Check.
Feeling unworthy and slimed? Check.
Existential threats to my sense of integrity and morality? Check.
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With either the actual or the metaphorical mean girls, you need a strategy for self-empowerment as well as outside support.

The first step is to acknowledge that you're facing an emergency, and understand which of the mean girls you are dealing with (see the tabs above). You start reaching out to trusted adults (in effect the "yard duty"), and get a timely professional evaluation. As l will briefly describe below, you remember and activate the "Real You", which leads you to new tools and skills.

You are embarking on a program of daily neuroplasticity to empower yourself, while disempowering the bullies.
➤  Remember the Real You
        You are far bigger and better than your dysregulated brain circuits
lf you’re getting bullied by the Mental Mean Girls, consider that a key tool of self-empowerment against their MO of relational aggression is self awareness. Before l can powerfully stand up for myself, l need to understand both who l really am, and who l’m really fighting against.

Throughout the journey one ingredient of our ultimate success is this: We don’t lose the thread of who we really are. No matter how faint they may be, we cultivate our memories of earlier times when we were not under the thumb of these unwelcome and unwanted thoughts and feelings. We enjoyed at least some degree of creative and fulfilling self-determination.

So we stay focused on one essential fact: We were not born a “bad” person. For reasons we may never know, our nervous system became dysregulated, giving us anxious, depressive, intrusive, and/or shameful thoughts and fears that hijack our sense of self.

Yet all our wonderful core qualities are still there — we remain a good person — even while getting pummeled by bullies who are squatting in a small part of our brain for the moment. These bullies cannot take away our essence, only make us forget momentarily who we really are. Put another way, we are experiencing, but do not consist of, our anxious, depressive, intrusive, or shameful thoughts.
Over time we can learn the tools and skills to evict the bullies. We literally re-wire our brain and nervous system to reclaim our power (see the next tab). ln my experience, one super effective way to begin this process is to list our own core qualities — those wonderful parts of ourselves that our disorders try to obliterate from our awareness, but can never extinguish.

Each of us has our unique collection of such attributes, aptitudes, and attitudes. Acknowledging these can help light our way through the toxic snark and shame of the Mental Mean Girls. So even if it seems dumb or cheesy, give yourself a few minutes and make a list of your qualities. You might even practice in front of the mirror naming them out loud. For example:

“Underneath all this stress and darkness I am [curious] [thoughtful] [smart] [big-hearted] [loving] [creative] [fun] [empathic] [compassionate] [a good listener] [fair-minded] [loyal] [trustworthy] [a good friend] [generous], etc.”

By acknowledging and owning your core qualities, you have fortified yourself against the relational aggressions of the mean girls. You are ready to re-wire your brain through a program of daily neuroplasticity.
➤  Reclaim Your Power
        Practice daily neuroplasticity to sideline the Mental Mean Girls

On the healing journey l describe in my guidebook, we find our way using various beacons and landmarks (already mentioned above):
We recognize our emergency, and choose to proceed toward the emergency exits.

We begin reaching out to trusted adults and friends, and refine our communication skills as we go.

We realize that we are not alone, and that we absolutely have options for healing.

We educate ourselves about our new challenges — and understand that our ailments are a dysregulated part of our brain.

We remember and keep reflecting on our core qualities — who we really are.

We identify, rather than identify with, our anxious, depressive, intrusive, or shameful thoughts. They do not make us a bad person.

We decide to face down the bullies.
In short, we are now more fully relational with ourselves, and with our trusted adults and friends. We are ready to begin dismantling the toxic clique of Mental Mean Girls.
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The final piece? The process of working over time (preferably with our qualified therapist) to set clear new boundaries and “rules of engagement”. We quite literally will be re-wiring our brain and nervous system to sideline the bullies. We return to a semblance of “normal.”
How to do this? Successful treatment is essentially about facing our fears. With regard to the OCD Multiverse, l describe in my book how Exposure Response Prevention (“ERP”) therapy is currently considered the “gold standard” for treatment. In my case, an 8-month program of ERP changed my life.

ln a nutshell, therapist and client use ERP to deliberately trigger a chosen obsession, in order to learn how to squarely face and override the associated compulsion. The concept is quite simple. But to actually face it isn’t easy, and can be terrifying at first. Yet it is very do-able, and liberating!

And because ERP helps us overcome the compulsions of OCD, we also alleviate the anxiety, depression, and shame arising from those thoughts and compulsions. It’s a “win-win-win-win”! lt’s estimated that 70% of OCD sufferers may benefit from a combination of ERP and medication.

The ERP approach is effective because my novel act of rebellion against OCD requires the brain to create new neural connections. l already have dominant neural networks screaming “danger!” Every time l indulge a compulsion (to reduce my anxiety or avoid the threatened harm), l am reinforcing that particular neural network — l make it stronger. l am quite literally feeding the OCD and giving it more power over me.

So l need to create alternative neural networks signaling that “This is not a problem!” That is to say, my brain needs a neural “Plan B” if l hope to neutralize any given intrusive thought.

By practicing ERP we are actually changing our neurophysiology: We're eliciting real-time “neuroplasticity” — the term neuroscientists use to describe how we can use deliberate novelty and variation to prompt our brain to change and grow new neural connections.

OCD deviously manages to re-wire our brain to our detriment. With ERP we fight back with our own brain re-wiring — one intrusive thought at a time. We gain the upper hand managing our routine interactions with the OCD Multiverse. You too can create your own powerful program of daily neuroplasticity.
➤  Some Additional Resources
        Books, organizations, therapy, research
A key part of our journey is to explore and learn more about ourselves and the new territory we are navigating. Here's a very partial list of additional resources (beyond my guidebook) that you may find helpful:

Self Help/Workbooks

The OCD Workbook for Teens: Jon Hershfield (New Harbinger Publications, 2021)

When A Family Member has OCD; Jon Hershfield (New Harbinger Publications, 2015)

Calm the Chaos: Overcoming OCD for Teenagers (Cross Border Books, 2022)

Rewire your OCD Brain; Catherine M. Pittman PhD (New Harbinger Publications, 2021) (Neuroscience)

The Self Compassion Workbook for OCD; Kimberley Quinlain LMFT (New Harbinger Publications, 2021)

Loving Someone With OCD: Karen L Landsman PhD (New Harbinger Publications, 2005)

Talking Back to OCD; John S. March MD (Guilford Publications, 2007) (better for younger kids)

Memoirs/Novels

Rewind, Replay, Repeat: A memoir of Obsessive compulsive disorder; Jeff Bell (Jeff Bell 2007)

Because We Are Bad; Lily Bailey (Harper Collins, 2018) (memoir)
Obsessed: Allison Britz (Simon and Schuster, 2018) (teen memoir)

The Man Who Couldn’t Stop; David Adam (Sarah Crichton Books, 2016) (memoir)

ls Fred in the Refrigerator?; Shala Nicely, Reid Wilson (Therapist memoir of own journey) (Nicely Done, LLC, 2018)

Turtles All the Way Down; John Green (Dutton Books, 2017)

Pure; Rose Cartwright (Unbound, 2019)

Organizations / Research / Therapy

lnternational OCD Foundation

American Academy of Child and Adolescent Psychiatry (AACAP)

Columbia University Center for OCD & Related Disorders

Stanford University Obsessive-Compulsive Disorders Program

NOCD

US Centers for Disease Control biannual Youth Risk Behavior Surveys

Santa Rosa (California) Center for Cognitive-Behavioral Therapy

➤  My (very) occasional blog
        Random thoughts about OCD and teen mental health

January 22, 2024

lt’s College Application Time. What Could Go Wrong?

Like a zillion other American high school seniors, l’ve finished my college applications and am waiting for decisions. This process is stressful for everyone, yet OCD can make a grueling experience that much worse.

OCD clamps onto the things we are excited about, what we’re looking forward to, the aspirations we have. l’ve noticed this fully applies to the college applications process.

Choosing a good range of “safety” and “reach” colleges is hard enough. But when l start feeling passionate about going to a certain college, my OCD seizes the opportunity. lt steps in and tries to convince me that my daily, random, insignificant actions will affect the decision of the admissions office. “If you wear that outfit, they’ll reject you”. “lf you use that hair dryer, they’ll revoke their acceptance letter.”

Even worse, OCD would have me believe that following my passion to a particular school would actually squander my chances to do what l’m really meant to do. “Even if you get in, all the people there will hate you.” “And you're gonna fail.”

Needless to say, all these thoughts can be disturbing and exhausting. Continual second-guessing of my excitement and goals really sucks. So l keep reminding myself that it’s just the OCD up to its usual trickery of trying to stop me from living the life l want, and creating the happiness l deserve. l remember to apply my ERP tools. And l return to the “normal” stress of excited anticipation as l await the various admissions decisions — and my own.

END



November 19, 2023

Don’t Allow These Shorter, Darker, Colder Days to Feed OCD

l mention in my book how OCD can act like the predator who identifies the most vulnerable member of the herd to run down — the already stressed out, sad, or anxious teen. Which brings us to the topic of the time change that we've just experienced (in America).

l notice that when the days seem so much shorter and darker and colder, for me at least the intrusive thoughts come knocking. What to do?

Apart from using my ERP tools, l find it very helpful to stick to my usual routine. Even though my body can feel like it’s going into a kind of hibernation mode, l make the effort to stay social, laugh with friends and family, read my page-turners, watch my favorite shows or a new movie, and focus on meaningful projects (such as my educational work around OCD). Such meaningful activities, social connection, and those feel-good relational hormones are like a good bug spray — they really do help repel the intrusive thoughts :)

And if all else fails, l remind myself that the shortest day of the year will soon come and go, and we will have more and more light, both literally and figuratively.

So please hang in there, and Happy Holidays!

END



November 4, 2023

Let's Talk About Early Detection & Treatment of OCD

l wrote my book in large part to help other teens avoid the delayed diagnosis and treatment — and needlessly prolonged suffering — that l experienced. This is of course a worthy goal in itself. And it is very do-able.

Yet there is also a sobering medical urgency that should not be sugarcoated. While it is never too late to begin treatment for OCD, long delays in detection and action can have lifelong consequences.

In 2019 twenty-five OCD experts from around the world — researchers and clinicians — issued a Joint Statement reviewing the data and explaining why early detection and treatment of OCD is critical*. They address a number of themes that l touch on in my book, and l won’t repeat those here. But l want to paraphrase some of their key points that offer hope, as well as others that require our vigilance and quick action.

The hopeful news: These experts confirm that a combination of Exposure Response Prevention therapy (ERP) and SSRl medication can help many (perhaps most) young people lessen and shorten their suffering from OCD. The earlier the identification and treatment, the more successful the outcomes.

Families can play an important role here, by noticing the early, often subtle OCD symptoms of the teen and arranging for a prompt professional evaluation and treatment plan.

The cautionary news: While OCD often first appears in childhood, the warning signs are easily overlooked, owing to the normal family dynamics of childhood and adolescence. ln my case it took two years to get properly evaluated and begin a treatment plan.

Tragically, untreated cases of OCD can be very difficult to alleviate later. That is, without timely and effective treatment (such as ERP and medication), a young person with OCD might go on to endure years of chronic or relapsing illness, and with more associated afflictions (such as anxiety and depression and others).

ln short, our teenage decisions about how we address our OCD can shape the course of our neurochemistry and symptoms for years to come.

So teens and adults, let’s declare the emergency, and get to work. Pulling together, we can do this!
__________________

* N. Fineberg et al. “Early Intervention for Obsessive Compulsive Disorder: An Expert Consensus Statement” (2019): https://pubmed.ncbi.nlm.nih.gov/30773387/

END



October 24, 2023

So Let's Get Started!

l'm super excited to be launching both my book and this website. l really wish someone had been able to give me (and my parents and teachers) these kinds of resources when l was first trying to emerge from my mental health crisis. So l'm thrilled that you are reading this, and l hope it eases your own journey just a little.

As a true introvert, it was doubly challenging to not only climb out of my dark abyss, but then to put myself out in the world in this very public way. l finished writing my book Get the Hell Out of My Head just before my 18th birthday. And now l'm spending a big part of my senior year talking to school districts and organizations to get it distributed as widely as possible (please be in touch if you would like to help get the word out to your local high school or middle school). l feel empowered on so many levels, as well as stressed and anxious at the same time!

Check back periodically as l will be posting occasional thoughts about OCD and teen mental health issues generally, along with elaborations of topics in my book.

See you again soon!

END


➤  Contact the author
Thank you for being in touch! I can't promise that I'll be able to answer all inquiries. Your brevity will be appreciated :) — Sophia







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All text ©2023-24 Sophia S. Catalina

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