Obsessive-compulsive disorder (OCD) is such a challenging mental health condition. In addition to causing suffering to the person with the diagnosis, OCD can take down a whole family. Parents, siblings, and romantic partners of people with OCD can go through a lot of difficulty themselves. They often don’t know if the things they are doing help their loved one with OCD or make the OCD worse. Whether I’m working with children or adults, I get their support system involved in treatment. Here are a few thoughts on how loved ones can support someone in OCD treatment...
Knowledge is Power
Let’s review the current understanding of OCD and treatment. We have the obsession: an intrusive (unwanted) thought, image, or “urge” that causes the person distress (anxiety, disgust, or a “just not right” feeling). Someone with OCD might be worried about contracting norovirus, the items in their bedroom not being positioned correctly, their potential for accidentally harming others, or the meaning of the universe. To relieve this discomfort, they do a compulsion: an action (e.g., walking through the door opening multiple times), a mental ritual (e.g., keeping a count in their head), a physical ritual (e.g., showering in a lengthy, rigid sequence), or active avoidance (e.g., wearing gloves to open the fridge, so they don’t touch the handle).
People think that the obsession is the problem. What we know is the thing that causes the disorder is the compulsion. We cannot keep thoughts and images out of our heads, but we do not have to respond to them. As we stop responding, they start to calm down on their own. This is what people learn in treatment for OCD, which is called Exposure and Response Prevention (ERP).
Even just understanding that it is better for the person with OCD not to do compulsions can help loved ones in providing support.
Accommodation
Many people with OCD are receiving accommodation from their loved ones, which is the flip side of the coin of compulsions. While compulsions are the action of the person with OCD, accommodations are the actions of their loved ones to try to reduce their distress. A loved one might excessively wash their hands as soon as they enter the home, check all the locks and stoves in the house, avoid leaving the house altogether, or answer worry questions repeatedly. All of these things are done lovingly and to hopefully help the person with OCD, but it seems to fuel the disorder even more.
For parents of youth with OCD, there is a treatment called Supportive Parenting of Anxious Childhood Emotions (SPACE) designed to help them reduce accommodations, which actually helps treat the OCD. For romantic partners, siblings, or friends, although they might not attend a treatment like this, the same principle applies that actually not accommodating is the best thing to do.
Now, first of all, you won’t make this change in the system without the permission of your (adult) loved one with OCD. “Hi, I’ve decided to never answer your questions again!” might not go over so well with your wife. Hopefully someone in treatment would be aware of this concept and asking for support in this way. Additionally, these strategies obviously can cause strife. Even if someone says, “Yes, don’t answer my questions anymore,” in a moment of high anxiety, they might become upset when you stick to the plan. A qualified therapist can help create a solid game plan so that you don’t have to go it alone.
P.S. Remember the thing I said about this wrecking the lives of the people who love the person with OCD? I’m not exaggerating. Some people’s lives are completely turned upside down: they can’t socialize anymore, they’re walking on eggshells in their own home, they’re dealing with scream-crying daily. Just even knowing that you don’t have to be involved in the OCD anymore and there is another (hopefully better way) can provide some hope.
Check out this free resource for caregivers of youth with OCD learning to reduce accommodation.
Reassurance-Seeking
A lot of people with OCD use reassurance-seeking as a compulsion. This means asking a question that is not really a factual question and expecting a specific answer that provides a reduction in anxiety, for the moment. The thing to remember about reassurance-seeking is that getting an answer feels good briefly but the anxiety always comes back anyway. My favorite reassurance-seeking question is this one from little kids:
Child: “Mom and Dad, you’ll never die, right?”
Parents: “Of course not!!”
That, my friends, is a lie! Often the answers genuinely are not factual. How can you be 100% sure that your back won’t break if your child steps on a crack or that yogurt won’t give them intestinal parasites or there won’t be an earthquake in Georgia today?
If the whole point is to separate from the OCD cycle and not provide immediate relief but lasting suffering, we need to find a different way. For a reassurance-seeking question, this means giving an answer without giving an answer. Here are some examples...
Q: “Am I going to die of ebola?”
A: “That’s an interesting question! Is that you talking or OCDanza Esperanza [the child’s name for their OCD]?”
Q: “Are all the doors locked?”
A: “Oh! Thanks for the reminder! I’ve decided to be extra safe, I’m gonna start checking all the locks in town every night. I better get started... see ya at about 6am?” [said in a playful manner]
Q: “Does my hair look even?”
A: “Ooh, you almost got me! I’m not supposed to answer that one, right? You wanna talk about our outfits for Friday?”
The next question I get usually is, “Isn’t this mean?” You know what’s mean: OCD destroying your life!
Support Groups
There are support groups for romantic partners, parents of adults, and other loved ones of those with OCD. Check out the resources through iocdf.org. It can be so nice to know that you’re not alone and share strategies that are working with a community.
Self-Care
Put the oxygen mask on yourself before someone else or you’ll both suffocate. If you’re supporting someone with OCD, you need to make sure that you’re eating and sleeping regularly, engaging in enjoyable activities, and generally taking care of yourself. There could be guilt associated with this but returning to normal life is the goal of OCD treatment!
Loved One Won’t Seek Help
This is the hardest one. For a caregiver of a child, there’s always the option to participate in SPACE, which will treat the OCD without the sufferer having to engage in treatment. Parents of adult children living outside the home, spouses and romantic partners, and roommates and friends might feel they have nowhere to turn. The best thing in this case might be to set loving, healthy boundaries. This might mean expressing validation of the person’s fears while also reducing accommodating behaviors and engaging in some physical separation, as needed.
Being a loved one of someone with OCD is really challenging! I would say the biggest current problem is that there is inadequate access to (evidence-based, actually helpful) treatment and a pervasive lack of knowledge about OCD. Even just being pointed in the right direction can make a huge difference toward tackling OCD within the support system. Just know that if you’re currently in this position, you are such an asset to your loved one.
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