Asperger's, OCD, and Other Mental Health Issues in Teens

Asperger's syndrome / fetishism / obsessive-compulsive disorder (OCD) / bipolar disorder

Hello, doctor.
My daughter is 13 years old and is in the first year of junior high school.
Over the past 3-4 years, based on our observations, she has exhibited many unusual behaviors that are not typically seen in other children.
For example, she shows symptoms similar to Asperger's syndrome: irritability, lack of empathy, and periods of extreme fixation on certain people or objects (for instance, she has recently become very concerned about her appearance and constantly looks in the mirror, whereas a year ago she was very conservative in her clothing choices and indifferent to her appearance).
She performs well academically and has a good understanding of knowledge, but she has poor social skills.
Additionally, she displays compulsive behaviors, such as excessive hand washing.
When faced with setbacks, she expresses thoughts of wanting to die or commit suicide.
Two years ago, she found a black cat outside, and after family discussions, we allowed her to keep it.
However, over the years, I have observed her interactions with the cat, which are very strange and not typical of how people usually interact with pets.
She spends all day holding the cat tightly, with her face pressed against the cat's face for long periods, staring into its eyes for a very long time.
She holds the cat so tightly that it struggles uncomfortably, but she continues to hold on, resulting in scratches on her body.
Doctor, could this be a form of objectophilia?

Youxin, 30~39 year old female. Ask Date: 2013/09/13

Dr. Ding Shuyan reply Psychiatry

As parents of adolescents, we all go through the process of witnessing significant physical and emotional changes in our children.
It can be challenging for parents to discern which of these changes are typical for this developmental stage and which may indicate potential issues.
Irritability, lack of empathy, and a heightened concern for appearance are not necessarily problematic behaviors; they may simply reflect the child's growing independence and desire to assert their own opinions rather than always conforming to adult expectations.

During this stage, adolescents often seek peer approval, care about how others perceive them, and may develop interests in the opposite sex, leading them to pay more attention to their appearance and grooming.
Regarding frequent handwashing, it is important to assess the severity and the underlying thoughts—whether they stem from an excessive fear of dirt or concerns about infectious diseases.
If a child expresses thoughts of wanting to die or suicide, it is crucial to pay attention to their emotional state.
If these thoughts are frequent and accompanied by significant mood fluctuations, it is advisable to consult a trusted physician for further discussion.
I do not have personal experience with the issue of pets, but I have heard from pet owners that the emotional bond between humans and pets can be incredibly strong, comparable to human relationships.
Perhaps this cat serves as an emotional outlet for her, providing comfort amid the pressures of growing up, which may not be a bad thing.
Trained therapy dogs are available both domestically and internationally to provide emotional support to individuals facing physical or psychological challenges, which is remarkable.
Regarding fetishism, if the general definition is an excessive fondness for something, then it is widely accepted and not necessarily problematic.
However, in a medical context, fetishism typically involves a sexual component and is defined more narrowly.
Even so, as long as it does not harm others or violate laws, having an intense affection for a cat is not something to overly worry about.
In fact, it may be the loss of that cat one day that could cause significant distress.
Lastly, whether a child has issues can depend on the perspective from which it is viewed.
Some parents may overlook serious behavioral problems, while others may be overly anxious about relatively minor issues.
It might be helpful for you to speak with teachers at school to gain their insights on your child or invite classmates over to casually ask their opinions about your child.
I am not a specialist in adolescent psychiatry, so please consider my observations as informal advice.

Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2013/09/13

More Info

Understanding the complexities of mental health issues in adolescents, particularly conditions like Asperger's syndrome (now often classified under Autism Spectrum Disorder), Obsessive-Compulsive Disorder (OCD), and other related behavioral patterns, is crucial for parents and caregivers. Your observations about your daughter’s behavior provide important insights into her mental and emotional state, and it’s commendable that you are seeking to understand and support her.

Asperger's Syndrome and Autism Spectrum Disorder
Asperger's syndrome is characterized by difficulties in social interaction, restricted interests, and repetitive behaviors. While it was once considered a distinct diagnosis, it is now generally included under the broader category of Autism Spectrum Disorder (ASD). The symptoms you describe, such as irritability, lack of empathy, and intense focus on specific interests, align with traits often seen in individuals on the autism spectrum.
Your daughter’s recent obsession with her appearance, contrasted with her previous indifference, could indicate a shift in her self-perception or social awareness, which is common during adolescence as children begin to navigate complex social dynamics. It’s important to note that while some level of self-consciousness is typical at this age, extreme preoccupation with appearance can sometimes signal underlying anxiety or other emotional challenges.

Obsessive-Compulsive Disorder (OCD)
The compulsive hand-washing behavior you mentioned is a hallmark of OCD, where individuals engage in repetitive actions to alleviate anxiety or prevent perceived negative outcomes. This behavior can become distressing and interfere with daily functioning. The thoughts of self-harm or suicidal ideation you noted are particularly concerning and should be addressed immediately with a mental health professional. It’s crucial to ensure that your daughter feels safe and supported, and that she knows help is available.

Relationship with Pets
Your description of her interactions with the cat raises questions about attachment and boundaries. While it’s not uncommon for children and adolescents to form strong bonds with pets, the intensity of her behavior—holding the cat tightly and ignoring its discomfort—could suggest difficulties in understanding social cues and empathy, which are often challenges for individuals on the autism spectrum. This behavior is not necessarily indicative of a fetish but may reflect her struggle to navigate emotional connections and boundaries.

Next Steps
1. Professional Evaluation: It is essential to seek a comprehensive evaluation from a child psychologist or psychiatrist who specializes in developmental disorders. They can provide a clearer diagnosis and recommend appropriate interventions.

2. Therapeutic Support: Therapy, particularly cognitive-behavioral therapy (CBT), can be beneficial for addressing OCD symptoms and improving social skills. A therapist can help your daughter develop coping strategies for her anxiety and obsessive thoughts.

3. Family Support: Engaging in family therapy may also be helpful. It can provide a platform for open communication and help family members understand each other’s perspectives and needs.

4. Education and Resources: Educating yourself and your daughter about her condition can empower both of you. There are numerous resources available, including books, support groups, and online communities that focus on autism and OCD.

5. Monitoring Behavior: Keep a close eye on her behaviors and emotional state. Documenting any changes or patterns can be helpful for healthcare providers in understanding her situation better.

Conclusion
Navigating mental health challenges in adolescents can be complex and overwhelming. Your proactive approach in seeking understanding and support for your daughter is vital. By working closely with mental health professionals and fostering an open, supportive environment at home, you can help her develop the skills and resilience she needs to thrive. Remember, early intervention can make a significant difference in outcomes for children and adolescents facing these challenges.

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