Ask Dr. Merry: Obsessive-Compulsive Disorder

» Posted in Ask Dr. Lin, Family Life, Mental Health | 0 comments

I’m writing about my 33 year old daughter who is single and still living with us.  I’m not quite sure how to say this so I’m just going to come straight out and put it on the table as I’m tired of covering up what’s really going on in my home.  I feel like I’ve been held hostage to her for the last 20 years and in the last 10 years, I don’t think I’m exaggerating to say that we’ve been abused by her.  Even writing this I feel guilty and embarrassed but I don’t know how else to describe what’s been going on.  Maybe I can give you a bit of history.  She has always been high-strung as a child but when she became a teenager, she started to do some pretty odd things, like take two hour showers, change her clothes multiple times, and then refuse to go out.  We just chalked it up to teenage hormones so we just learned to work around her, especially since she’d get really mad if we tried to rush her or talk to her about what she was doing.  So it wasn’t worth the fight.  I realize that I probably should have done something about it then but I was busy with my two other kids.  I know it’s no excuse but anyway, we all learned to put with her.  Unfortunately, looking back, I realized that she just kept getting worse and worse and she started to insist that her room had to be cleaned a certain way, and now we aren’t even allowed to wear outside clothes in the house.  She even makes us change in our laundry room into our home clothes before we can come in.  Now it’s so bad that she freaks out if we invite anyone over so we’ve been too embarrassed to have anyone come to our house.  We’ve tried to force her to get some help but we just end up in these huge fights where she flips out and starts hitting us.  We’re like prisoners in our own home!  I love my daughter but I don’t know how much longer I can deal with her.  Can you help us please?

First of all, let me commend you for having the courage to speak out and to recognize that you need help.  Often, family secrets are maintained at any cost, and the unfortunate consequence is that the entire family is held hostage to those secrets.  By bringing it out into the open, you will finally be able to change things for yourself – and hopefully for your daughter as well.

It sounds like your daughter is suffering from a mental illness called Obsessive-Compulsive Disorder (OCD).  At the root of this illness is anxiety as well as a very strong fear response that triggers her “fight or flight” response. When that happens, you will sometimes see very intense responses that seem out of control, much like you describe.  It’s like what happens when an animal gets cornered and goes on the attack – pure reaction without a lot of rational thought.  The problem with this is that when left untreated – like many mental illnesses – the symptoms typically worsen and begin to control the sufferer and often the people who love them.

According to the American Psychiatric Association’s DSM-IV-TR (the “bible” used by clinicians to diagnose mental health issues), OCD is characterized by either obsessions and or compulsions:

Obsessions are defined by:

  • Recurrent and persistent thoughts, impulses, or images that are experienced by the sufferer as intrusive and inappropriate, causing  marked anxiety or distress;
  • The thoughts, impulses or images aren’t simply excessive worries about real-life problems;
  • The person tries to ignore or suppress these thoughts, impulses or images; and
  • The person recognizes that these obsessions are a product of their own mind.

Compulsion are defined by:

  • Repetitive behaviour (e.g., hand-washing, cleaning or checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession or according to rigid rules; and
  • The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviours or mental acts either aren’t connected in a realistic way with what they’re designed to neutralize or are clearly excessive.

OCD is actually more common than people realize, with approximately 2 out of every 100 people meeting the criteria for this diagnosis.  It is likely under-reported because many people who suffer from this disorder try to keep their obsessions and compulsions secret and fail to pursue treatment.  Secrecy and shame often characterize this illness because the sufferer knows that their obsessions and compulsions are irrational. This is unfortunate because it is quite treatable with a combination of medication (depending on the severity) and cognitive behavioural therapy.  This is in fact a common problem we treat at our offices at LifeCare Centres and one that is typically seen by many therapists in your local area.

Although the exact cause of OCD is unknown, it is now widely accepted that there’s a strong physiological component that affects the person’s brain biochemistry.  To simplify it, I often describe it to clients that it’s as if they’re experiencing a brain “fart” which, while uncomfortable, doesn’t have the power to cause harm if the person learns to treat it as such.  I teach them to say to themselves, “ho-HUM” when one of these random, intrusive thoughts occur – HUM standing for Harmless, Unimportant, and Meaningless.  It’s when they focus on these thoughts, begin to panic and try to fight it that the anxiety increases and the likelihood of compulsions increase.

When these brain “farts” occur, what usually happens is that the person’s brain “locks” down, with the brain sending false messages that the person can’t readily ignore.  Like a car that’s stuck in a particular gear, the brain gets stuck and can’t shift to the next thought.  When the brain gets stuck, it may tell the person that they have to wash their hands again even though there’s really no rational reason to do so.  The sufferer then experiences a gnawing feeling they can’t shake off of some doom and gloom consequence if they don’t do what the brain is telling them to do.

By applying behavioural therapy techniques, your daughter can change the way she responds to her thoughts and urges and actually change the way her brain is working.  And so it will be very important that she pursue treatment to help her overcome her OCD.  Perhaps instead of trying to force her to go for treatment initially, it might be more helpful if you empathize with her suffering, help her see that it’s not her fault but it’s an illness much like diabetes that needs to be treated, encourage her to go online to research OCD and treatment approaches, or suggest that she read great resources such as Brain Lock by Jeffrey Schwartz.  Having a sense of control may help her to reach for help, but you will also need to make changes in how you respond to her so that you don’t continue to enable her dysfunctional behaviour and unreasonable demands on the family.  If she refuses to get help even after that, I would strongly encourage you to seek professional counsel yourself to help you navigate how to break free from the stronghold of fear that is gripping your family.  You don’t have to remain hostage to your daughter’s illness, so take heart.  The journey ahead of you will be challenging but it will be worth it.

 

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