Joanna Fortune: My quiet teenager keeps washing her hands repeatedly

You don’t say how long this has been going on at this stage, but regardless of duration or whether it is OCD or more generalised anxiety, it is having a significant impact on your daughter’s quality of life and damaging her skin.

I suggest you refer her to child and adolescent mental health services (Camhs), or you could consult your GP about making a referral. If the wait time is very long, enquire about what supports you can access until the appointment.

You could consider the private route if that is accessible or affordable. Again, your GP can advise you about who is working within your area, but check that the professional has experience working with adolescents.

Engaging in compulsive behaviour is one way of attempting to manage the distress and anxiety. In this context, a compulsion is a repetitive thought (perhaps counting or reciting a particular song) or repetitive behaviour (checking if the door is locked repeatedly, flicking the light switch on and off or handwashing). Someone with OCD will often feel compelled to engage in the compulsive behaviour as a response to or an attempt to manage the obsession.

Generalised anxiety is also a mental health condition whereby the person experiences excessive worry about everyday events. That worry is not rooted in reality, though their worry feels very real and comes with myriad physical and emotional symptoms. This type of anxiety is pervasive and not context-specific.

Neither condition will go away on its own, and anyone experiencing such symptoms deserves appropriate professional help from a qualified mental health professional.

For a diagnosis, the person is generally experiencing symptoms that are more often present than not for at least six months.

It is also possible that symptoms were present longer than you realise, as she may have been able to mask them for some time.

I know you mean well when you tell her there is no need to keep washing her hands, but be aware that this is not a behaviour she can control, and feels compelled to keep doing it.

Respond to her with empathy and nurture. Let her know that you see how difficult this is for her, and she is not alone with these feelings, and that you will support her and get extra support from people who can help with this.

While waiting, let her know that you are available to her and that she doesn’t have to talk or explain how she is feeling that she can come to you even if it’s just for a hug or you can rub soothing lotion onto her hands or go for a walk as a (temporary) distraction from the anxiety.