by Andrew Thompson
Obsessive Compulsive Disorder or OCD is a challenging and troubling disorder for both the individual who is suffering with the disorder, and for family members who often find it difficult to comprehend, provide adequate support, and seek out the necessary resources. It is a disorder that is often misunderstood and mislabeled due to the complex nature of the symptoms and the difficulty for family members in recognizing the line between idiosyncrasy and eccentricity, and the pathological elements of OCD that cause such marked distress and discomfort. About OCD There are many misconceptions about the disorder, but put most simply, it is a disorder that involves an individual who experiences both obsessions and compulsions, which cause the individual marked distress and create impairment in major domains in the individual’s life (school, work, relationships, hobbies, etc.). OCD affects roughly 1 in 100 adults in Canada and, unlike many other mental health disorders, is seen in both children and teens at a rate of 1 in 200. It is said far too often that someone has ‘OCD’ or is ‘OCD’ without an accurate understanding of the illness and this leads to greater stigmatization and pathologizing behaviour that is a normal part of the human experience. What is it? It is important to know what obsessions and compulsions are and what they are not. When talking about OCD, an obsession is a thought, image or impulse that occurs repetitively and that the individual feels is beyond their control. These thoughts, images and impulses are unwanted and cause the individual uncomfortable emotions such as fear, disgust, guilt or shame. Obsessions are not the occasional or transient fears or anxieties about daily life- sickness, accidents, or finances. Compulsions are repetitive behaviours or thoughts that an individual engages in that helps them neutralize, compensate for, and counterbalance the obsessions. They are a kind of coping strategy that helps an individual deal with the powerful emotions that are driven by the obsessions. In the absence of a better coping strategy or psychological toolkit, the compulsions will become time consuming and impair an individual’s ability to engage in many activities that are important to them (socializing, work, education, etc.). It is important to note that not all behaviours that are repetitive are compulsions. Learning a new hobby, studying for an exam, various religious activities, or even a bedtime routine involves repetition; however, they do not cause great distress to the individual and the individual feels in control of those activities. Finally, behaviours exist in a context. If you work in a library, putting books away in meticulous order would be repetitive and contextually appropriate- this would not be compulsive.
Ways to provide help Having a loved one with OCD can be exceptionally challenging on a number of fronts, but there are some concrete ways that you can provide help and support for your loved one: 1. Educate yourself: read books, videos, and seek the guidance of organizations that can point in the direction of material that will deepen your understanding of the illness. Without a full and complete grasp of the symptoms, etiology and prognosis, it will be difficult to guide and support your loved one. 2. Develop an understanding of “Family Accommodation Behaviours.” With the guidance and support of a counsellor start to understand and put in place a strategy for reducing your participation or help with the behaviours, increasing your assistance in avoiding the behaviours, and how to communicate about their behaviours in a way that will be nonjudgmental and reduce any stigmatization. Over time, families develop ways to accommodate and compensate for their loved one’s behaviour. It is both natural and normal for this to occur, as you want to reduce the distress and suffering that your loved one is experiencing. However, with the help of a counsellor or therapist, you can build a toolkit to help reduce the accommodation and adapt how you help for longterm change. 3. Learn about the different treatments available for OCD in your area and at your disposal: CBT or Exposure and Response Prevention (ERP), medication, support groups, group therapy and family support. It is important to know what services are available, how to access those services, and what your role as a loved one can be in helping them get there. There is no onesize-fits all plan for the treatment of OCD, but we know that a combination of psychotherapy and medication has proven to be most effective. 4. The process of treatment and recovery from OCD can be demanding and unpredictable. It is important to modify our expectations and recognize that change, even when positive, is stressful and pushes someone into the unknown. The pace of recovery varies from person to person and is rarely linear. Changes from day-to- day don’t always represent a slipping back into previous behaviour patterns, but show that making lasting change is a gradual step-by-step process and is affected by a number of things- mood, environment, and medication. It is a helpful process for family members to step back and look at the small and incremental changes that have occurred over the course of treatment and prevent day-to- day comparisons. Remember: lasting change is a gradual upward climb. 5. Finally, it can be challenging and difficult for an individual to accept a diagnosis and start the process of treatment and recovery. It is often the case that a loved one will initially refuse treatment and this may be due to a number of factors. But, be prepared and persistent. It is important to have information in the form of books, videos, or articles to give your loved one about OCD. Offer them encouragement and support to seek treatment and validate the fears, anxieties, and apprehension they may have about getting the help they need. As a family member, it is important that you reach out for support, both to help better understand the illness but also to prevent yourself from getting paralyzed by the isolation, anger, sadness, and guilt that is often present when someone suffers from a mental illness in the family. Lastly, attend a support group. In a supportive and educative environment, a loved one can learn from others about how to guide someone to treatment and some of the stumbling blocks that are present along the way. If a loved one refuses treatment, make it a collaborative effort where you draw on support from a number of different people, resources, and associations.