If you don’t have OCD yourself, chances are that you found this website because you are trying to help a loved one. Watching someone suffer from mental illness can be heartrending in any case; and OCD, in particular, has a significant impact on friends and family, for several reasons.
The first is that people with OCD experience “pathological doubt,” which causes them to seek certitude and reassurance compulsively. Very frequently, this includes dragging their friends and family through tortuous reassurance cycles which never satisfy the demands of their ravening anxiety (See this post for a fuller discussion of the cyclical nature of OCD.). For an outsider, this can be very confusing. It might seem like the person with OCD has taken leave of his senses, because there is no apparent reason why he can’t accept rational answers to his questions.
This compulsive quest for reassurance can also be deceptively compelling. It masquerades as honest ignorance. Supporters can easily be tempted to “answer the question,” because the solution seems so obvious. The red flag is that these conversations never quite do the trick; the same or similar questions come up again and again. In fact, the pathological doubt seems to get worse, not better. The person with OCD seems to suffer more, not less.
OCD can also affect friends and family members when its compulsions demand other people to live by the same rigid, irrational rules that the sufferer does. This is particularly obvious when someone with contamination or perfectionist OCD pressures his housemates to adhere to the same excessive standards of cleanliness or order that he does, but it can occur in other areas as well.
Finally, OCD can take a heavy emotional toll on relationships, even beyond the strain caused by the first two affects. As we have seen, OCD is a manifestation of insubordinate fear and anxiety, which rule the actions of the person who suffers. Compulsions are an unproductive attempt to alleviate those feelings, arising from and feeding back into them. Compulsions are irrational and rigid, because they are an expression of fear and anxiety, not reason. The end result is that a person who is governed by OCD can appear to be irrational and rigid.
While these characteristics are actually a symptom of the severity of his illness, deserving of pity and compassion, they can come across as cruelty. This can cause pain and injury to friends and family who don’t understand the internal struggle their loved one is experiencing.
Nevertheless, friends and family do play a large role in their loved one’s recovery from OCD. While the characteristics of a successful support person are good qualities in any relationship, they are particularly difficult to cultivate in the context of OCD. That is why the first step is education, so that friends and family can begin to understand what OCD is, and learn not to take it personally.
Beyond that, I believe a good OCD support person should focus on cultivating two qualities: 1) boundless empathy and compassion for the pain and suffering OCD causes; and 2) intentional support for the healing process, rather than involvement with the content of the obsessions and compulsions.
I cannot over-emphasize the importance of empathy and compassion. Compassion is completely different from enabling the disorder. Compassion says, “Wow, it must be so awful to live in the grip of such intense anxiety all the time. I’m so sorry you are going through that.” Enabling says, “I can see that your anxiety is making you miserable. Let me soothe it with reassurance, so that you don’t have to feel it.” Since reassurance validates and feeds the anxiety, this is like offering whiskey to an alcoholic loved one when you should be driving him to his AA meeting.
Some of the most healing conversations I have ever had were characterized by a deep, mature compassion which validated my pain, rather than my anxiety. While accepting that the anxiety itself was irrational and disproportionate, these support people realized that the pain and damage it was causing were real.
Imagine how you would feel if you your brain thought you were in mortal peril for many hours every day. Terrible, no doubt. Now assume that your loved one has felt that way for years. The pain and emotional trauma they are experiencing are very real.
In light of this, compassion towards the pain caused by OCD is actually a step towards treating the insubordinate passions at its base as irrational. To acknowledge the pain is to rightfully place the blame on those insubordinate passions.
When someone expresses compassion, it can help the person with OCD begin to internalize a more rightly ordered mercy and gentleness towards himself, recognizing his fear and anxiety for the tyrannical liars they are. It chips away at the rigidity with which OCD causes us to treat himself and everyone else.
As for the second component, support for the healing process rather than involvement with the content, this again comes down to conforming one’s attitude with the truth. The truth is that the obsessions and compulsions of OCD are irrational, not reflective of danger; the real problem is the insubordination of the passions of fear and anxiety.
Thus, friends and family should feel free to support their loved one in taking steps to subdue his fear and anxiety (always remembering that they cannot do this for him); but they should be careful not to get sucked into the irrational demands of those insubordinate passions.
Practically speaking, this means that as a support person, you should try very hard not to engage in reassurance. Rather than risking enabling this compulsion, it is better not to discuss what the OCD person is obsessing about at all. Instead, you can ask him how intense the anxiety feels right now, giving him space to expose himself to his fears without reacting compulsively, and refusing to enable or participate in any other compulsions (like excessive cleaning).
You can give him a hug or make him a cup of tea, play a game or laugh with him, any normal activity that expresses your love and support as he goes through this difficult process; those can be healthy ways of coping with anxiety. What your loved one must resist is trying to alleviate his anxiety with compulsions. You cannot help him by intervening in this difficult process of self mastery.
Most of all, pray for your loved one who is suffering. Pray for his courage and fortitude in battling his pathologically insubordinate passions; pray for his healing from mental illness. Pray for wisdom so that you may best support him; and trust that God has a plan.
Catholic and OCD 