Family Involvement in OCD

by Denise Egan Stack, LMHC

Living with someone with OCD can be challenging. It is difficult to watch someone you care so deeply for suffer so much. The anxiety is debilitating, the rituals are time consuming, and the impact OCD has on their life is devastating. Your attempts to help by assisting with OCD rituals can unexpectedly result in more anxiety and frustration instead of less, and often times you find yourself entangled in OCD symptoms instead of assisting your loved one out of them.

This pattern is vicious and can last for years. OCD therapists recognize the important role that family members often have in their loved ones OCD and involve them in treatment as a way of maximizing progress. They do this by teasing out how family dynamics have been affected by OCD and what accommodating behaviors family members are engaging in, educating the family about why accommodating behaviors don’t work, and teaching them what to do instead.

If your family member has OCD or you have a close relationship with someone with OCD, you are likely impacted by their symptoms. Determining how you are involved, the extent to which you are involved, and the consequences of being involved is important. This information will facilitate goal setting, sets a baseline to help determine progress, and provides motivation for change.

How You Might Be Involved in Your Loved Ones Symptoms

If your loved one has contamination fears, for example, then you may participate in their OCD behaviors by washing your hands or showering frequently. You may also assist in avoidance behaviors by keeping track of clean and dirty sections of the home or by not engaging in certain activities like playing with the neighbor’s dog or using public toilets. You may also facilitate symptomatic behavior by buying excessive amounts of cleaning products or replacing “contaminated” items that have been thrown away over and over again.

In addition, your family routines are probably modified because of OCD symptoms. You might not be able to eat in the house or you may have to change clothes when you come home from work or school. You may also have to take on extra responsibilities around the house because your loved one can’t contribute. You may have to do all of the child care or grocery shopping because contamination fears prevent your loved one from touching people or leaving the house. Finally, if you are doing all of the above, it is likely that your own work and leisure life is negatively impacted. You may have to miss days of work or go into work late because you are helping your loved one with their rituals, and it is probable that OCD symptoms prevent your loved one from participating in family vacations or fun activities outside the house.

Why Your Involvement Ultimately Does Not Help

In order to help family members disentangle from their loved ones OCD symptoms, therapists educate families as to why accommodation behaviors don’t work. Family members learn that these behaviors interfere with the sufferer learning that they can handle difficult things or that their anxiety will alleviate even if they don’t ritualize. Family members also come to realize that their accommodation behaviors are usually done with resentment, hostility and criticism which increase emotional upset instead of decreasing it. Accommodation might happen with the intention of “keeping the peace” or to alleviate one’s own guilt and anxiety, but the solution is short lived as the anxiety in both the family member andthe OCD sufferer returns and the need to accommodate arises again. Finally, family members learn that people with OCD often report that accommodating behaviors are not all that helpful anyway!

Alternative Approaches That Can Work

Once family members learn that – despite their good intentions and best efforts – accommodating OCD is not helpful, they are usually eager to try alternatives. OCD therapists coach family members how to use supportive and encouraging statements without doing rituals for the person with OCD. In order to do this, family members learn how to direct their anger and frustration at the illness and not at the person suffering and practice tolerating their own feelings in response to their loved one’s distress. Family members also learn to make explicit agreements and contracts with the OCD sufferer through calm discussion and negotiations instead of trying to communicate when angry or setting limits without notice. Finally, family members are key to helping someone with OCD maintain motivation for change and hope for the future, therefore, therapists encourage family to give praise for small gains, highlight improvements, and manage discouragement if a relapse occurs.

It is hard to battle OCD and you are doing the right thing by being there for your loved one! It is our hope that this article will help you determine the most effective way to help. For more information, please contact us.