OCD, Thoughts for loved ones

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.

 

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16 Responses to OCD, Thoughts for loved ones

  1. Lori Oge says:

    Thanks for the insight on OCD…. I have 2 family members with very “light” OCD symptoms as they do not infringe on our life in a destructive way. I actually find myself laughing at the silliness of it sometimes! But you are correct in saying that it is our responsibility as the one “without” to take care of ourselves during the times the OCD shows up in a way that crosses over. I appreciate your thoughts on these often difficult disorders that affect the sufferer and the ones who love them. Keep it coming!

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    • Brett Newcomb says:

      I am glad you found the site and that it was helpful to you! Trying to be the informed or supportive friend of someone with this disorder is, indeed, a difficult task. Thank you for your response.

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    • Brett Newcomb says:

      Thank you for your response. I have looked at your blog and find it to be helpful and interesting! There is lots of information here about anxiety and issues relating to it. I am glad you found my posting to be useful.

  8. Sandra Franco says:

    I brought an article that triggers my guy’s ocd/anxiety attacks. He says he can’t come to my apartment anymore and I can’t go to his. How do I deal with this?

    • Brett Newcomb says:

      I don’t have enough information to make any suggestions, in particular I would be curious about how the article in question relates to his OCD, in what way is it a trigger and for what kind of behaviors or intrusive thoughts? You mention that you cannot go to his apartment, but do not indicate whether or not it is related to your having bought this “trigger” artifact. Is there some other reason you cannot visit his space? Remember, these types of manifestations are generally displaced anxieties. Would there be something about his relationship with you that would generate severe anxiety? Is he using this event as a convenient trigger so that he does not have to deal with/experience any other aspect of being with you that would cause him distress? He may not know. How does he respond when you try to talk to him about what is going on? Is he on meds for this condition? Does he have regular therapy sessions to deal with it? Are you involved in those at all? I would encourage you to speak with his therapist if he has one about how you might confront this problem with him and be helpful in resolving and understanding it. Brett

  9. Gail says:

    Thank you for a helpful article that has ideas I need to use with my young adult son who has OCD that is disrupting his life and our family life. He has been seeing a therapist for a couple months now but I would say he is spending more time at the rituals not less and his attitude at home seems to be worse. Should we all meet with the therapist to talk through what is happening? My son claims he is doing the exposure exercises but I don’t see any evidence of a disciplined approach. I don’t see how a haphazard approach to the exposure is going to work. Doesn’t the person with OCD need to have a specified plan on how he will expose himself to the triggers with a gradual increase in intensity until the trigger no longer has power over him? He gets angry and defensive if I bring up the subject of his progress with exposure therapy. Any tips for me as a frustrated mom?

    • Brett Newcomb says:

      Hello Gail, I appreciate your question and respect the frustration and concern behind it! Without having any information about your son, his specific rituals, or his efforts to combat them, it would be inappropriate for me to make any global suggestions regarding his treatment. What I would do, is encourage you to express your concerns to his therapist. Schedule a meeting for you and your husband to meet with the therapist and ask the questions you have about their plan and the work they are doing with your son. Ask them what they want you to be doing to be supportive, what you can expect to see from your son as he attempts to fight his OCD issues. He has to do much of the work himself, but he can’t do it alone. I have questions about his environment, the stress he is under, his history of handling stress, your history as a family of responding to and supporting him, etc. I would hope that his therapist has these same questions. I would be wary of formula therapy and a one size fits all approach. Get involved, meet regularly with his therapist to be a positive contributing part of his efforts to get better. I assume that you are paying the bill, he is your son, and you have both a right and a responsibility to be involved,(depending upon his age you may have a legal right, but if he is living with you and you are supporting him, you can insist on being involved,) Insist upon it.

      • Gail says:

        Thanks for the quick reply. Yes, we will meet again with the therapist. We already had a 3-way with him which helped some but we need more guidance. There have been some pretty unpleasant family conflicts over this. He is 22, living with us, financially dependent on us, and a new transfer to local university in a new major. So of course there are the stresses of the new academic career. Plus he has held down a part-time job as a cashier for the past month. That he will probably be quitting to focus full attention on school. He already signed a release to share therapy information with us which was a great thing for him to do. He seems to want to get better but still holds onto some of his contamination fears as genuine fears and not “just OCD.” It seems to me that until he accepts that his thoughts and behaviors are completely over the top and unnecessary he will have trouble committing to a plan to combat them. The rituals of handwashing and picking over his clothing to find ones suitably uncontaminated (sometimes none are good enough!) are taking too long in the morning and he is often running right down to the wire are even late getting out of the house. Most of his rituals are avoidance type: he has given up running, Frisbee, bicycling, cooking, etc. Getting him to do household chores is a real chore and usually unpleasant. I’m trying to deal with my own stress and anxiety relating to his problems. I have been seeing a separate therapist every month or so to help me take care of myself better while coping with the challenges.

        • Brett Newcomb says:

          It sounds like you are focusing on the things you need to be doing. I am glad to hear that you have found your own therapist to help you. I would suggest that more than every few months would be helpful. You need encouragement, a place to vent that is not destructive, and some support strategies for your own boundaries so that you can remain strong. Remember the analogy of flying on an airplane when you have young children. They tell you that if the oxygen masks drop, put yours own before you try to put the children’s on because they need you to survive so that they have a change to survive!

          You have not said whether or not your son is taking any medicine to help him. If you have not considered this, speak to his therapist about it to see if they think it would help. Also, while it is not my business, I would encourage you and your son not to quit his part time job. My thought would be that he needs structured commitments of his time and energy rather than time to sit with his anxieties and get more lost. However, I am tossing that idea in from left field with no information or relationship. It might be a horrible suggestion, depending on the interior resources your son possess at this point in his struggle. Again, encourage him to speak to his therapist for guidance on that. He may need more than one weekly session for the short term immediate future. Good luck. Brett

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