The journey from concealment to disclosure of an obsessive-compulsive disorder diagnosis in the high school setting: A qualitative study exploring youth perspectives

• Published in: Psychiatry research Vol. 326; p. 115275
• Main Authors: Vallani, Tanisha I., Naqqash, Zainab, Lin, Boyee, Lu, Cynthia, Austin, Jehannine C., Stewart, S. Evelyn
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2023
• Subjects: Adolescent; Concealment; Confidential; Disclosure; Humans; Obsessive-Compulsive Disorder - diagnosis; Obsessive-Compulsive Disorder - therapy; Qualitative Research; School support; Schools; Semi-structured interviews; Social Stigma; Stigma; Trust; Concealment; School support; Stigma; Adolescent; Confidential; Trust; Semi-structured interviews
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2023.115275

•Safe disclosure may allow for earlier school supports and improve functioning.•Education about obsessive-compulsive disorder can increase disclosure in schools.•A safe space allows youth to determine their individualized disclosure boundaries.•Deep and reciprocal connections increase trust and the subsequent details shared.•Confidential and personalized supports empower a youth after a disclosure. Disclosure of an OCD diagnosis in the high school setting could allow for timely provision of individualized school-based supports. As few studies have examined adolescent perspectives on the disclosure process in schools, we adopted a qualitative approach to explore this, and to gather recommendations for making disclosure of OCD at school safer and more helpful. Twelve participants, ranging from 13 to 17 years old, were recruited using maximum variance-based heterogeneous purposive sampling. Semi-structured interviews were conducted and analyzed inductively through Interpretive Description. From participants’ stories, we generated a theoretical model describing the journey from concealment of an OCD diagnosis to disclosure. Four phases of youth disclosure were identified: managing enacted and perceived stigma related to the diagnosis, internal bargaining to determine their individualized disclosure boundaries, trust building with school members, and empowerment by being treated as a person first. Participants’ recommendations for the school setting included meaningful education, safe spaces, deep reciprocal connections, and confidential personalized support. The model we developed can help inform school disclosure strategies and optimize support to promote best outcomes for youth with OCD.