Caring for someone with OCD can place strain on relationships. This is because the symptoms of OCD take away significant time, effort, and energy needed to make relationships work. As a result, relationships may become strained, causing stress for all parties involved. Four key principles have been identified that are beneficial in helping families who have been affected by OCD. These principles include (1) getting informed, (2) being involved, (3) receiving support, and (4) engaging in effective communication between family members. The following provides a brief summary that may help achieve these principles.
1. Getting Informed:
Being informed about OCD is paramount as it enables a greater understanding of the ups and downs of the treatment process. This ultimately enables you and your family to tackle the condition from a stronger position. For example, knowing how symptoms present can aid in early diagnosis, whereas an awareness of early warning signs can prevent relapse.
The simplest way for obtaining information is asking your treating Psychiatrist or Psychologist for information. They may then lead you to appropriate books and websites that may be of benefit.
2. Being Involved:
As a family member it can often be beneficial to be involved within the treatment process. The treatment that is used in our OCD program is based on the principles of Exposure and Response Prevention (ERP). The treatment aims to expose sufferers to their fears (i.e., their intrusive/obsessional thoughts) while managing the anxiety and discomfort that results using the skills taught within the program instead of engaging in compulsions (i.e., rituals).
3. Receiving Support:
Receiving support as a family unit is one of the most important aspects in treatment. There are several ways support can be obtained for families who are affected by OCD. One way is to read up on information that can assist you and your family. A second way is to join online forums for OCD. Forums can be especially useful to collaborate with and debrief with other people and families who have been affected by OCD. A third way is to call helplines that can be especially useful in times of crisis. Lastly it is beneficial for people to engage in therapy supports individually or as a family unit. Therapeutic supports include processes like couple’s counselling, family therapy, or individual therapy.
Quite often families who have been affected by OCD may not take proper care of themselves because they have become caught up in caring for the family member who has become unwell. Recognizing your own limits and making time for yourself are keys to “self-care.” Engaging in therapeutic interventions, whether individually or as a family unit, can be helpful. Our clinicians at Therapy FiveHT can assist you in providing carer support. Sessions with a Psychologist can be claimed through Medicare by setting up a Mental Health Care Plan with your GP.
4. Effective Communication:
Assertive communication in relationships is a key strategy that can be used to ensure effective communication between family members. Communicating effectively between family members is important because it encourages honesty and a genuine respect for each other’s needs. This does not mean that needs may always get met, but ensures that everyone gets heard.
Key Points to Remember for Assertive Communication
Ask the other person if you can talk to them in an open, honest, and direct manner. Pick a time that is good for both of you and ask to talk to them alone because including others can cause extra stress for both of you. Use “I” statements to assert how you feel, when, and what you would like to see different. Other examples of “I” statements include: “I believe”, “I feel”, “In my opinion”, and “I hear what you are saying”. Remember that above all else, you want to keep this relationship and that most people would not hurt your feelings on purpose. It is important to remain focused because you can easily get sidetracked. If this happens to you, write down your key points on a card. If something upsets you, you have a right to speak up about it – do not allow yourself to avoid a situation. Keep your voice calm and level. Stick to your point. Maintain good eye contact. Stand up straight. Do not apologise for your feelings – you are allowed to have them. Give the other person the benefit of the doubt. They may not have done anything intentionally so your comments may come as a surprise. If the other person does not seem to be hearing you, repeat your message calmly and clearly and then let it go for now. Sometimes people need to go away and think about a situation before they can fully understand your point. (Adapted from Rosoman, C. (2008). Therapy to go: Gourmet fast food handouts for working with adult clients. Jessica Kingsley Publishers: London.)
5. Final Word & Things to Note:
Families can be effected by OCD in two key ways. Families can either get caught up in the compulsive behaviour or they can react with denial. Families and partners often become caught up in compulsive behaviour because they believe that they are easing the suffering that their loved one is experiencing. What ensues instead is a rapid cycle of intrusive thoughts and compulsive behaviours that cripple relationships and accomodates the OCD. For example, in one family a wife may require her children to change into “clean and safe” clothes before entering the house to ensure that the house remains sterile. In another, family members may provide sufferers with reassurance that no harm has become of anyone.
Families who often respond with denial may do so because they find it difficult to understand why their loved one with OCD cannot “just stop” acting out the ritual. Families faced with the behaviours associated with OCD often experience complex and uncomfortable emotions. As the symptoms of OCD become more severe, the emotions that family members experience may also become more severe simply because they are no longer able to communicate effectively. These emotions strain relationships and affect all aspects of the relationship to the point where the tension that it brings can become as hurtful as the disorder itself. For this reason it is important to get support for not only sufferers of OCD, but for the carers and family members involved.
How to Relate to Your Family Member with OCD
- Learn as much as you can about OCD and its treatment. Being informed will help you understand the illness and help your relative to make changes.
- View your relative’s OCD behaviours as symptoms, not character flaws. Remember that your relative is a person with a disorder, but that they are also healthy and able in many other ways. Focus on the whole person.
- Refer to the OCD in the third person (e.g., “what is your OCD telling you to do?”). This will help distance the OCD from not only the sufferer but from the family too.
- Do not allow the OCD symptoms to take over family life. As much as possible, keep family life normal.
- Do not participate in your relative’s rituals. If you have helped with rituals in the past, it may take time and practise to change this pattern. In order for people with OCD to make progress, family and friends must resist helping with rituals. Supporting the rituals, including reassurance rituals, hinders progress.
- Communicate assertively. State what you want to happen, rather than criticising your relative for past behaviours. Avoiding personal criticism can help your relative feel accepted while he or she is engaging in treatment. Remember that ERP is hard work for all involved, and like anything else that involves change, it will take time.
- Keep calm. Not losing your temper creates a good atmosphere and sends the message that your are there for support.
- Remember that life is a marathon, not a sprint. Progress is made in small steps. There are times when no progress is made at all. Reward progress when times are good (e.g., “well done, we’re so proud of you”) and provide encouragement when times are bad. Your support benefits your loved one.
- Mix humour with caring. Support does not always have to be serious. People with OCD know that their fears are irrational. They can often see the funny side of their symptoms, so it makes it “ok” to use humour as long as it does not feel disrespectful or critical. Family members say that humour can often help their relative become more detached from OCD symptoms.
- Know the signs that show your relative is struggling with his or her OCD. Here are some of the signs noted by family members:
- Repeating tasks/rituals or an increase in rituals.
- Increase in low mood thoughts (e.g., “I can’t be bothered”) and feelings
- Decrease in self care and hygiene
- Withdrawal from previously enjoyed tasks and isolation.
- Difficulty completing an ERP task
- Arriving late because of rituals (i.e., checking, washing, difficulty making a decision)
- Feeling overly responsible for harm that may come to others
- Constantly asking for reassurance
- Becoming irritable when rituals are interfered with.
- Support your relative’s medication and treatment program.
- Do not forget that you are only human. While you do your best to support your relative, you will sometimes find yourself participating in a ritual or giving reassurance. Try not to judge yourself when you fall into old routines, in the same way you try not to judge your relative. Just start again. No one is perfect.
- Take care of yourself. This can be done by (a) keeping your own support network, (b) avoiding isolation, (c) knowing what situations within your family are most stressful in coping with OCD, (d) developing interests outside the family, (e) creating a low-stress environment for yourself, and (f) taking a little time each day just for you.
NB: This list is adapted from the Centre for Addiction and Mental Health (www.camh.net).
Signed: Dr Celin Gelgec and the Team at Melbourne Wellbeing Group