OCD and the Family

One of the unique features of Obsessive-Compulsive Disorder is how it can directly affect the lives of the family members of the person with OCD. Let me use a typical example to illustrate this phenomenon (please note that the following is a fictional description combining features from several actual cases):

In her early 40's, "Jane" has had a moderate case of OCD for the past year. She has the irrational fear that she will contract some terrible contagious disease, even though there is no special reason to think this. She tries to avoid touching all things, even if she is wearing rubber gloves (which lately Jane has taken to doing frequently). She washes her hands in a mixture of bleach and water as often as 30 times each day. At home, she allows no visitor to enter. She has selected certain furniture which only she can sit on, and she sits on no other. She has claimed one of the house's two bathrooms as "hers" - no one else may use it. She is on medical leave from work, and she avoids leaving the home as much as possible. Jane has invented a special "prayer" which she repeats dozens of times every day because it helps calm her for a few minutes. Otherwise, she feels anxious much of the time. It is easy to see just how miserable life has become for Jane. But what about Jane's family? Peter, Jane's husband of 15 years, isn't sure what to do. A gentle and devoted husband, he naturally is very concerned that Jane is so worried. Peter does not share his wife's fear of that she (or he) will catch any serious disease during their everday activities. Nevertheless, she literally will go into a panic if he uses "her" bathroom, invites a friend over for coffee, or even tries to hug her. So to keep his wife calm, he makes these sacrifices. In addition, Jane demands that when he comes home from his job at the factory, he is to change his clothes in the garage (each day she places his just-cleaned bathrobe there), put his work clothes in a fresh plastic garbage bag, and then put them directly in the washer in the basement. Oh, and did I mention that Jane has moved into the spare bedroom because of her obsessive worry? Needless to say, Peter is not very happy with that. But as with all the other demands and limitations placed on him because of Jane's OCD, Peter just can't put his wife into that panic, so he figures these adjustments are simply necessary, even if it's been almost a year since he was allowed to kiss his wife. He tries to make the best of it, but he is very unhappy that Jane has become so anxious, and he feels so cut off from her. And he doubts whether giving in to Jane's panicky demands is really what is in her best interest. Nine year old Debbie is very confused. And sometimes, she gets very mad. An only child, she and Mom used to spend alot of time together - doing art projects and baking were her favorites. Now Mom won't touch her at all. . . no hugs, no braiding her long, straight hair, no playful pats on her rump, and no bedtime kisses. Jane won't even tuck Debbie into bed anymore. This made Debbie really mad at first, but now she has just accepted it. But she still misses how things were with her mom. Then there's dinner time, and Debbie just can't figure out why Mom won't touch anyone else's plates, silverware, or food, why Mom only uses plastic plates and silverware, and why Mom ran from the room crying that one time Debbie sneaked a sip of water from mom's glass. And Debbie is really upset that her friends can't come over anymore. She complained to Dad about it, but he just sighed and told her "I know, I know, but we can't upset Mom, now can we?" Debbie cried that whole night. Debbie has no idea why her mom has started acting so strange, and her dad doesn't do a very good job of explaining it either. Although she would never admit this, she secretly fears that her mom is punishing her for something she did - but what? And one last thing about Debbie: Always described by teachers as one of the most popular kids, she now has become a little withdrawn in school, spending less time with friends and not participating as much in classroom activities.

This story of Jane, Peter, and Debbie unfortunately is quite typical. By its nature, OCD affects not only the person suffering from obsessive worries, but also those whose lives are closely involved. Often, everyone in the house is expected to make some adjustment to help calm their loved one with OCD. These adjustments may be relatively trivial, but in other cases they can be devastating to marital, sibling, or parent-child relationships. Family members are often confused about whether to go along with the obsessive worries, and are stuck weighing the burden of these demands against the distress of the person with OCD. This is a terrible position to be in. Indeed, it may appear to them that their actions are what is causing the panic - but have they done anything wrong? And pretty soon, others in the house are acting as if they had OCD: After all, they now find themselves frequently washing, or not touching things, or performing rituals, etc. etc. I call this "participating in the symptoms" of the person with OCD. But I emphasized the words "as if" because despite doing things which look like OCD symptoms, the family members do not suffer the anxiety of OCD. To them, participating in the symptoms is a nuisance which they begrudgingly accept, and they would experience relief, not anxiety, if the ritual were not done.

Just as family members often get involved in participating in their loved one's OCD, there are several reasons why they also often get involved in the treatment of that OCD. First, the family needs a professional authority to step in and decide whether family members should continue to participate in the patient's symptoms. Second, when family members are to stop participating in the patient's symptoms, it is important that these changes are made in coordination with the treatment. Otherwise, it can cause counterproductive distress (and possibly resentment) in the person with OCD. Third, family members need to learn all about OCD so they know how to understand the unusual behavior of their loved one. Fourth, family members need to understand what the intensive cognitive-behavioral treatment will involve, especially because of its unusual and counter-intuitive techniques. Along these lines, because the treatment will initially evoke alot of anxiety, the supportive help of family members is often a key ingredient in the therapy. And finally, even when the person has successfully overcome his or her OCD, it is sadly true that sometimes damage to family relationships may persist. In these cases, therapy may be required to restore the family's balance and harmony.