When a loved one has OCD, it can feel daunting. You are stuck with not knowing what will help, make it worse, strain the relationship, or worsen your own mental health.
OCD is a different ball game. What we think makes it better, actually makes it worse. This is tricky at first, but once you understand the cycle it will become clear.
At its core, OCD is maintained by compulsions. These are behaviors (either physical or mental) that the sufferer engages in to try to manage the distress from obsessions. In exposure with response prevention (ERP) treatment, the individual is working to reduce compulsions and respond to their obsessions differently.
They are likely doing this gradually, working from least distressing to most distressing. It takes time, patience, and resilience. Giving your loved one credit for each step of recovery is important.
Where do family members / loved ones come in?
Symptom accommodation gets in the way of treatment and can derail progress. Learning how you may be participating in rituals, or accommodating symptoms is important for all parties. It can take a toll on your own mental health, but it's also moving your loved one further away from their goal of recovery. Here are some examples:
Sean has harm OCD. His obsessions come as questions, such as “what if I am too dangerous to be holding this knife?” “What if I snap and harm my friend?”. In response to these obsessions, Sean asks his dad for reassurance. Sean’s dad responds, multiple times a day, “don't worry you would never do that, I promise.” Without realizing it, Sean’s dad has reinforced the OCD.
Mollie has hit & run OCD. Her OCD tells her she may have hit someone without realizing it, and is too dangerous to drive. Mollie’s partner accommodates by doing 100% of the driving, even when he doesn’t feel like it. In addition, he gives Mollie reassurance that he hasn’t hit anyone, when he's driving.
Toby has contamination OCD. It makes it difficult to eat out at restaurants and go to public spaces. To lessen the stress, Toby’s mother opens all doors for him, and makes sure she always has hand sanitizer. When she notices Toby becoming distressed, she quickly pulls out the hand gel to mitigate the situation.
All of these loved ones have good intentions: to lessen the stress of their child, partner, sister, father, etc. Unfortunately, they are all helping the OCD, not their beloved family member. The goal is for you two to be on a team together, against the OCD.
Tip #1 - Reduce Accommodation Gradually
Accommodation refers to participating in rituals or attempting to mitigate the anxiety of the sufferer. Accommodation has likely built up slowly, over time. What was once a quick help to defuse a stressful morning became the norm.Therefore, it's important to reduce it gradually. To start, identify what accommodation is occurring and come up with a plan to reduce. The Family Accommodation Scale for OCD (by Anthony Pinto, Ph.D., Barbara Van Noppen, Ph.D., & Lisa Calvocoressi, Ph.D.) is a good place to start.
Tip #2 - Talk to your loved one openly and with compassion
It's natural to be frustrated by your loved one’s OCD. You may have seen their spark diminish under the weight of the disorder. It may be taking a toll on your relationship or family. All of those feelings are valid. And, taking out frustration and anger on your loved one won’t help. Aim to have compassion and understanding, while also holding firm boundaries for what you will / will not engage in.
For example: “I can see how much the OCD is affecting you. It is affecting me too. At this moment, xyz compulsions are taking a toll on our family, what is our game plan with treatment? How can I support you in recovery? I believe in you.”
Tip #3 - Encourage, not reassure
Supporting without giving reassurance is an important skill to develop. This can look like providing validation and encouragement. Examples…
Instead of “Don’t worry it will all be okay” → Try “I can see how hard this is for you. I know you can make room for this feeling right now, I believe in you”
Instead of “Those things will never happen stop worrying about that” → Try “This is so challenging. I can’t provide reassurance but I can support you and cheer you on. What skills can you use in this moment?”
Tip #4 - Ask their therapist how you can support with treatment
It can be very helpful to join a session or book one on your own. Hearing from their provider where they are in treatment, what the treatment goals are, how you can support them without doing compulsions, can do wonders for recovery. We can't help what we don’t understand.