Additional Thoughts On OCD
A few weeks ago I wrote about OCD. I have had a number of conversations with people who have this issue in their families or their relationship. I am writing about the thoughts and feelings shared by those individuals. One thing I have learned is that it is challenging to be in a relationship with someone suffering from OCD. This is true for a number of reasons. One difficulty comes from the concern and worry for the individual about whom you care. That is the person who is suffering from the disruptive and stressful impact of having obsessive or compulsive thoughts and/or behaviors. Another concern is the damaging impact of these behaviors on your life and in your relationship.
In response to the urges and mental preoccupation OCD sufferers have, they develop rituals and behavior sequences which they “know” will help them contain their distress and reduce it. Studies are pretty definite in concluding that over time, these rituals become more demanding and more time consuming, as the coping skills of the sufferer deteriorate. One way to help the sufferers is to encourage them to develop skills in the areas of thought-stopping and reality testing. If they are able to develop these skills, they can limit the time wasted and the mental gyrations they feel they need to go through in order to try to reduce stress.
Understanding OCD for the non-suffering can be challenging. A difficult compulsion often does not have a specific goal. The behavior must be continued until a sense of relief occurs. An example of this is arranging coins on a dresser in preparation for going to sleep at night. There is no identified pattern or specific goal for the arrangement pattern, but the individual spends time rearranging the coins until they feel “right” and then they can relax. The sense of relief often becomes more difficult to attain, leading to more and more rearranging. This is especially relevant when there is a heightened level of global anxiety or stress in the sufferer’s life.
Learning to reality test this urge, and trying to identify and use alternate self-soothing strategies, or to put specific limits on the time spent indulging a response to the compulsive or obsessive intrusive thought will help the sufferer. There are medicines and there are behavioral skills that can be learned and implemented. They are very difficult to use, because the individual sufferer is often resistant and emotionally frustrated when asked to restrict their OCD behaviors. They get angry and defensive. They say you just don’t understand how difficult it is and that if you just leave them alone, everything will work out. They resent the inference that they do not have control of their behavior. Yet, they feel powerless against the obsessive-compulsive thoughts and/or behaviors. They get angry because they feel helpless and they get angry at you because you are asking them to do something they feel they have no control over. Then their anxiety levels increase and they have more urges to ritualize. It becomes a revolving cycle of anxiety, ritualized behavior, shame and anger, producing more anxiety, more ritualized behaviors, and so on.
The issue that I want to address in this blog is the impact of this in the lives of those who care about the OCD sufferer. What I know is that it is very stressful for those individuals (the family and friends) of the sufferer because they are constantly trying to make accommodations and to have an “understanding” of the disorder. But they find themselves limited and manipulated by the ritualized behavioral needs of their loved one. How long should you indulge ritualized behavior preparatory to leaving the house before YOU get angry? They steal time and power from you by expecting you to be understanding and sympathetic. Caring families worry about handling this in the “right” way. They want to be compassionate, understanding, and helpful, BUT they also want to be able to live a healthy life with good boundaries. They want to be treated with the same compassion and respect that they are showing the sufferer. They want to be able to go to a movie and not miss the first 15 minutes of the show because someone had to change their shirt 3 times, they want to make plans and have them happen, they want to not always hear excuses, but see progress.
My clients report is that it is very stressful and guilt provoking for them to always be so “understanding,” “considerate,” and “helpful.” They worry about being heartless, selfish jerks for getting upset with someone who has a disorder. Shouldn’t they be compassionate? Shouldn’t they just cope and make allowances? What if they are out of patience? How can they assert themselves compassionately and say: “This is making me angry, this is causing ME problems. It is MY turn to get MY needs met!” How do they deal with the feelings of resentment and inadequacy this frustrating trap engenders? If I set good boundaries, am I dismissing the needs of the sufferer? If I do not, am I enabling the sufferer to wallow in their disorder and accept, rather than fight it?
I think it is important to help the “helpers” learn that they have normal and predictable frustrations. It IS normal to feel these feelings. They are not bad people for feeling this way or for getting angry and feeling trapped by the rituals they can’t control or limit, but do not personally suffer from. These supporters also need to learn survival skills. They need to be encouraged to tell the sufferer that sometimes other’s needs must be accommodated. Others have a right to do the things which make them feel better, such as being on time or not using the last paper towel. Conversations need to occur which lay out recognition signals and allow for the expression of frustration or a definition of needs without (and this is very important), statements of judgment, anger, or assault being part of the conversation. It is important not to teach the language or conception of victimization. If you suffer from these issues, you have a real definable problem. You do NOT have permission to always claim: “I have issues, I am a victim, so therefore, I am not responsible for the things I need to do to be OK. I am NOT responsible for the way these necessities make you feel.”
What you DO have is a need to learn how to work around the problems you have so that you can have a “normal” life and learn to function in spite of your issues. We call these compensatory strategies and compensatory behaviors. Find behaviors that do not infringe on others, but satisfy the need. This is definitely not an easy task. But if not accomplished, the OCD sufferer will burn bridges and destroy relationships which matter to them. It is necessary for the sufferer to learn to fight back against the issue with an intelligent, realistic, and conscious strategy. This will help to diminish the compulsive behaviors and the obsessive thoughts. Learn about diet, sleep, exercise, mental discipline, self-talk and self-soothing strategies. Know that a structured life is a healthy life and help keep things in control. Learn to make “I” statements instead of “you” statements. Say: “I feel angry” or “I feel out of control” NOT “you caused me to be late, it is your fault I am in trouble.” The sufferer must also learn to hear the needs of others. The world cannot revolve around the sufferer’s needs.
Supporters of OCD suffers need to make the effort to say that I understand, I care, but I also have needs. If these needs are not somewhat honored, it will make me unable to work with you on your issues. The sufferer can say, “I cannot always take care of what you need and do what you want. It will destroy me and it will not help you. If I do not require yourself to be responsible and considerate, no matter how hard it is for you, your suffering will continue to get worse. You cannot live as a victim, with that being your primary sense of self-awareness and have a “normal” healthy life with “normal” healthy relationships. If you proceed this way, you will burnout those you love. You will be miserable, and the things that you fear the most will be realized.”
If you are a helper of someone who suffers from addictions or mental health problems, including OCD, remember that a victim script is damaging and threatening to everyone. Encourage responsibility. In fact, require responsibility and ask directly for what you need. Allow individuals to experience the costs of their choices. Part of being a good helper is having good boundaries. Learn how to assert your boundaries in positive healthy ways, not as anger statements, not with emotional outrage, not aggressively or disrespectfully, but honestly, forthrightly, and with disciplined self-esteem.
If you can do these things, you will feel better, and you will have more energy for coping with the loved one who suffers from OCD. In addition, the sufferer will have a good model for “normal” behaviors that will help them learn to compensate, survive, and be functional, rather than broken. It is a WIN/Win strategy.