Guidance For Families Affected by OCD

Obsessive-compulsive disorder consists of a constellation of obsessive, irrational thoughts and compulsive behaviors, occurring frequently enough to disrupt ordinary daily activities. Persons with OCD often engage family members by seeking verbal reassurance or enlisting them to participate in compulsive behaviors.

For example, a person whose irrational thoughts focus on infection and contamination might, if they hear someone coughing in the theater, repeatedly ask their spouse for reassurance on the drive home, chewing up many minutes unproductively. This same person might demand that their spouse take unnecessary hygiene precautions, such as wiping down every surface in the car after every single trip.

The best thing family members can do, for themselves and the affected individual, is to avoid reinforcing irrational tracks of thought by giving reassurance or joining in the compulsive behavior. Reinforcement generally makes any behavior occur with greater frequency.

When fears and compulsions involve everyday activities, like hygiene, it can be a judgment call about what is frankly irrational and what amounts to an ordinary difference of opinion. Clinicians define a behavior as compulsive and excessive when it interrupts regular, productive activity, for no real gain.

One objective benchmark I use to define irrationality is the expression of intense emotionality when discussing risk and benefit. It is not productive to debate with that kind of locked-in thinking, but one can ask an afflicted person how they are reasoning through risk and benefit. Persons with OCD generally recognize that their fixed ideas are irrational. Interestingly, misguided ideas that propagate through group affiliation are harder to dislodge than the fears of OCD.

The alternative to satisfying the demand for reassurance or compliance is to remind the person with OCD how to manage: “You know what to do. Interrupt this track of thought, distract yourself, and the anxiety level will go down,” or: “If you don’t act on the behavior, the anxiety will go up, but you know it goes down over time.” Persons with OCD can only make progress at their own pace. It does not work to push them, but a program of non-reinforcement by loved ones can help an individual find their own natural motivations to overcome fears and compulsions.

When family members feel ready to disengage from compulsive behavior and irrational ideas, it works best to sit down with the affected individual in a calm moment, prepare them for the change, and try to enlist their buy-in.

These guidelines for families, of course, are easier to draw up on paper than to implement in practice, because the emotional pressure of anxiety can be irresistible. Even if family members are not always able to stick to the program of non-reinforcement, small steps in the right direction are almost always helpful, because it conveys to the burdened person, more effectively than words, that another approach to life is possible.