Monday, December 7, 2015

9 yr old with OCD and anger overload

Dear Dr. Gottlieb,

We bought your anger overload manual for parents, and it described perfectly what we are seeing in our 9 year old girl who has OCD.

In your experience, are your strategies effective on kids who have anger overload from OCD?  Would any of the techniques you offer need to be modified as we continue to support our daughter?

Are there any other resources you would recommend for this combination of symptoms?

Many thanks.

Hi, A book I have found helpful in working with children with OCD is "Talking Back to OCD" by Dr. John March, a psychiatrist from Duke University.  He has an approach for OCD that is similar to what I recommend for anger overload:  Teach the child how to be the boss of her thoughts.  

Some of my strategies are not actually taught to the child but are employed by the parents, especially at the outset, but then the child becomes a partner and is taught ways to be in control.  For example, one strategy is using mantras.  This is explained in some of my previous blog posts and in my two parents' manuals, and can be used for anger overload and for OCD.  Mantras are ways to help children take a different perspective and thereby help them feel more in control of their anger.  

The strategies in my manual can be employed with children who have OCD.  Think about what some of her routines or obsessive thoughts are, and also think about what some of he anger triggers are.  How much overlap is there?  Does the anger come when she is being rigid and can't adapt well to the demands of the situation.  Will humor and emotional distraction work to help her move on?  Or will new mantras help her look at the situation differently and prevent her getting into a rigid behavior pattern?  

If the problem is obsessive thoughts, and not ritualistic behaviors, try to teach her that she can be the boss of her thoughts, and maybe draw a picture or sing a tune of her "beating" the thoughts.  Dr. March's book and my manuals speak to changing a child's thoughts. Practice the new mantra and admire her whenever she tries to use it.  Make sure she does not expect it to work perfectly, because OCD children sometimes expect themselves to be perfect.  Trying the new strategy would be the goal, whether or not it helps right away.

Do some of her OCD habits come after she is angry?  Does she have negative self-talk and guilt after she explodes in anger.  In that case, you can forestall the OCD by using the strategies in my manuals to lessen anger overload.

Basically, think about how the two issues overlap, and then focus on the initial triggers to to try change her response.  First, you would keep an anger diary, so to speak, in order to see how the two issues interact and what some of the triggers are. Then you would look through the manuals to apply the strategies to those triggers.  

Best, Dr. Dave Gottlieb


  1. My Daughter is 11, and we have been dealing with her anger sence she was a child, with therapy as a child, she was able to controle it better. With fewer fits. She is OCD, but I have noticed that she has started letting go of some things and getting better at controlling her OCD. Now that she is a pre teen and her body is going through changes, the fits have seemed to come back, more abront, more often, and with her being nearly as tall as me, it's really hard to hold her through her fits, I'm worried about her having fits as an adult, and how it will be maintained.she is super smart, very obsessive over being her best at everything, good grades, best at sports. She is the most loveable child I have, and respectfull, never asking for anything, very content in her own world. She has a few friends that she has had most of her life, and they love and except her,these friends she trust. I've noticed her being depressed and holding stuff in and that worried me, because I fear she may hurt herself. She is my baby girl and I just want her to live a healthy normal life.

    1. I would recommend having her talk with a therapist if in addition to the outbursts she seems depressed and is "holding stuff in."

      Also, try to observe what are some of the triggers for her anger. Is it because she is too perfectionistic? Or is there another theme for when she gets angry? If you can identify some triggers, you can develop some mantras (see my manuals for examples) to help her head off disappointment and frustration.