When you are living with an OCD family member, it is natural to experience both frustration and a desire to help. Here is how to provide meaningful support that ultimately improves your loved one’s quality of life.

The Role of the Family in OCD Treatment

When family members and close friends watch their loved one struggle with the cycles of obsessions and compulsions that feed obsessive-compulsive disorder (OCD), it is natural to want to help. It is also natural to experience frustrations and setbacks. However, helping someone with OCD is more challenging than many people think, because many of the seemingly helpful behaviors they are accustomed to may actually be fueling the OCD.

As a result, the first place for families to start when they are trying to help a loved one with OCD is to learn what help means in the context of OCD. Often, the behavior family members think is helpful ends up being counterproductive due to the cyclical and insidious nature of OCD.

Support is difficult because the best help for OCD sufferers often does not look helpful in the moment, but it leads to success in the long run.

The Family Is an Agent of Change

OCD affects the entire family, including extended family members and close friends. Confusion and conflict between family members is to be expected. Even when family members get frustrated, it is vital to remember that everyone is trying to cope with the situation as best as they can.

The reality is that OCD in one individual can morph into a deep-seated family issue. But just as family members can play into the problem, they can also make support a family effort. When family members learn how to stop the reactions that field OCD and engage in carefully planned responses, they are able to minimize the impact of OCD and strengthen the family unit.

As we like to say: “Family members have to support the person, not the OCD.”

The Dangers of Family Accommodations

An accommodation occurs anytime family members behave or react to OCD symptoms in a way that undermines the therapeutic goals of exposure and response prevention (ERP) or risk taking. Accommodating behaviors occur naturally and seem to make sense at the time because of a family member’s innate desire to help. Attempts to help are often genuine and come from a place of love, but it is critical to remember that there is no such thing as a small accommodation. All accommodations feed OCD, and the best way to help a loved one with OCD is to end all forms of accommodating behavior.

Are you or someone you care about struggling with obsessive-compulsive patterns? PCH can help you understand the line between helping and accommodating. OCD Treatment Options

The Seven Most Common Family Accommodation Traps

When families are trying to help a loved one with OCD, the seven most common accommodation traps they fall into are:

1. Providing Reassurance

It is common for family members to provide reassurance to a loved one struggling with OCD in hopes that these reassurances will make them feel better. For example, family members may say things like:

• “Yes, I am sure you checked.”
• “Yes, I am sure you washed your hands enough.”
• “Yes, I am sure you did not make that mistake.”

Providing reassuring answers to what-if questions may seem helpful at the time, but family members ultimately end up playing into obsessive thoughts or irrational fears by trying to convince their loved one that these are false or will not occur.

When this happens, a loved one may ask the same question repeatedly or reword the question in different ways to get reassurance. The most detrimental part about these small reassurances is that family members can become part of the ritual over time, making it more difficult to resolve later on.

2. Avoidance

Family members may find themselves going through their daily routine only to suddenly stop out of fear they might trigger their loved one’s OCD. For example, they may avoid going to certain places, touching or moving specific objects, or discussing sensitive topics simply to prevent distress for their loved one.

However, avoidance ultimately reinforces the belief that triggers are dangerous and that uncertainty or anxiety cannot be tolerated. Participating in avoidance narrows the scope of your loved one’s life and creates problems of an ever-expanding magnitude. Avoidance of one place or trigger (a public bathroom, for example) can grow into avoidance of many places (all public bathrooms).

3. Participating in Time-Consuming Rituals

OCD can grow slowly and insidiously until rituals require significant participation by family members. Initially, a family member may start helping out with a ritual in order to make the ritual go faster, but eventually they become a necessary element of successfully completing the ritual.

When OCD is severe, it is common for a family member (or even several family members) to engage in rituals to the point that they neglect major responsibilities. For example, family members may assist with checking rituals in the morning (e.g., locks, stove burners, electrical appliances) or cleaning rituals (e.g., repeatedly washing hands or household objects).

Family members must remember that if they want to help their loved one challenge their OCD, they cannot cooperate with or participate in rituals.

4. Assistance With Decisions or Simple Tasks

Family members trying to help a loved one with OCD commonly report that they feel they need to take over decision-making for their loved one. They may facilitate or make decisions for their loved one to prevent cognitive gridlock, or they may agree to take over simple or complex tasks to limit time-consuming rituals.

However, as with all accommodations, assisting in decision-making undermines the goals of risk taking by guarding against the possibility that a loved one may make the “wrong” decision instead of allowing them to learn. Taking on ritual tasks also ends up enabling rather than helping and only grows worse with time.

5. Adjusting Responsibilities and Routines

Rituals can become involved enough that family members may make significant changes to their work, family, or social responsibilities. For example, a family member may skip social plans with friends because their loved one thinks outsiders are “contaminated,” or a family member may arrive late to work because they had to accommodate reassurance-seeking rituals.

When this happens, it is more beneficial for family members to establish that they will not adjust their responsibilities or routines to accommodate rituals. One small accommodation can evolve into an intricate pattern of requirements for reassurance months later.

6. Assuming a Loved One’s Responsibilities

OCD can reach the point where a loved one is no longer willing or able to fulfill basic responsibilities. They may find certain tasks overwhelming and opt out. For example, they may no longer go shopping, pay bills, drive, clean the house, or care for their children.

When family members step in to take care of a loved one’s responsibilities, they are furthering their loved one’s avoidance agenda and supporting the OCD. While it may be difficult to set a boundary and step out of the avoidance role in the heat of the moment, treatment requires that family members and loved ones agree to stop submitting to the OCD.

7. Tolerating Extreme Behaviors

As OCD progresses, a loved one may begin to engage in extreme behaviors, such as taking three-hour showers, removing all sharp objects from the home, or prohibiting guests. Eventually, these rigid rules and behaviors lead family members to face a binary decision: violate an OCD boundary and face the flood of anxiety or capitulate to the rules and support the OCD.

With ongoing support, family members will ultimately feel empowered to set boundaries and push back against OCD—the best thing they can do to help a loved one with OCD.

Has Your Family Been Struggling With How To Help a Loved One With OCD?

Has your family been struggling with accommodating behavior that you thought was helpful? The only way to resolve the issue is by recognizing the accommodations in the first place, and PCH is here to help you understand the line between supportive and accommodating behavior when you are looking for ways to help someone with OCD and anxiety.

If your family could use some help, find out if PCH is right for your family and reach out to our treatment team to take the next steps when you are ready.