New Video on OCD and Siblings

I’ve long noticed that when one child in a family has Obsessive-Compulsive Disorder (OCD), frequently the other children in the family feel the effects of it in many ways. I searched for resources to help siblings, but found few.

Recently, I had the opportunity to record a webinar for the Anxiety and Depression Association of America (ADAA)( https://adaa.org/ )that is meant for siblings who are living with a brother or sister with OCD. It explains what OCD is, what they might be seeing and going through, and ways that they can help themselves (and help their sibling, too). It is also a good video for parents to watch. Enjoy!

 

It’s My Sibling Who Has OCD. So, Why am I Having a Tough Time?

This post originally appeared on the website for the Anxiety and Depression Association of America (ADAA). Read the original post here: https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/its-my-sibling-who-has-ocd

brothers

Katrina was excited. She, her sister, Maia, and their mother were on the way to the park to play handball. Suddenly, Maia screamed and collapsed on the ground, wailing. “A fly landed on me! A fly landed on me!” Her mother tried to calm Maia down, but with no success. “I’m sorry.” Katrina’s mom said, “We have to go home.” Katrina was crushed; her sister’s fears had ruined yet another family outing.

Sam was playing video games with his friend, Kai, and his brother, Marc. At an important point in a big battle against their opponents, Marc seemed to stop playing. Sam looked over to see Marc tapping the controller in an awkward rhythm. Kai, frustrated, turned to Sam and demanded, “Why’s your brother so weird?”

Sara was settling into language arts after recess had ended when a yard supervisor entered her classroom. After talking with the supervisor, Sara’s teacher came over to where she was working. “Sara, your sister is upset and you seem to know how to calm her down. Can you go with Mrs. X to help her?” Not again, thought Sara. I just want to do my work.

When one child in a family has Obsessive-Compulsive Disorder (OCD), they are not the only one impacted. OCD affects the entire family – it demands others accommodate, and family members can be distressed by watching the other suffer. Siblings without OCD can feel the effects of the disorder in many ways. After all, they are frequently witness to meltdowns, have plans derailed by unexpected challenges raised by the disorder, may be the target of their sibling’s OCD, face or fear judgement from friends, and can even be asked by well-meaning people to take responsibility when their sibling is struggling.  Yet, sometimes siblings’ reactions and challenges are overlooked when a family is dealing with the disorder. A bit of awareness, education, and support can go a long way to helping siblings cope better when they have a brother or sister with OCD.

A first step is acknowledging that siblings may be impacted and experiencing a number of feelings and reactions. They may feel confused by their sibling’s behavior, by the disorder itself, or by how others are acting toward their sibling. Anger is another common emotion for siblings who may experience OCD as taking away from family time, individual activities, and even attention from parents. Fear can also be a factor for siblings. Their brother’s or sister’s reactions can seem frightening and, if the OCD is directed at them (e.g., sibling is seen as “contaminated”), they may fear they’ve done something to cause it. Some siblings may feel responsible for taking care of their sibling with OCD – especially if they are frequently asked for help in managing their sibling’s outbursts. Sadness, loneliness – actually any emotion is normal.

Siblings can cope with their brother’s or sister’s OCD diagnosis better if they understand what is going on, feel they have support, and know how they can help. Start a conversation where the sibling can feel safe to share and allowed to feel whatever emotions they are experiencing. Also important is explaining OCD to the sibling, as well as what is going on in treatment to help it, at a level that is age-appropriate. OCD is less frightening when you understand it. If the sibling with OCD is comfortable, it may be helpful for them to share their specific OCD with their sibling. Siblings can meet their brother’s/sister’s OCD therapist and learn about the disorder and how to help. They can learn to assist with exposures and how not to accommodate OCD (some siblings may not want to do this, and that is okay).

Some siblings may do well to have therapy of their own, where they can feel safe to talk about what they are going through and learn more ways to help themselves. Healthier families conquer OCD more successfully. Helping siblings cope with the disorder can bring big strides toward weakening the disorder’s impact on everyone.

“Am I Possessed by a Demon?”

You may be wondering why a psychologist is writing about demonic possession. If so, you may be surprised to learn that, in my work as an Obsessive-Compulsive Disorder (OCD) specialist, it is not uncommon for me to be asked by patients (or potential patients) if they might possibly be possessed. Yes, it is true. Healthy and, by all appearances, rationale people ask me this question. And it doesn’t take me by surprise.

“Wait,” you wonder, “what does working with OCD have to do with demons? Isn’t OCD where people like stuff neat and orderly, or where they check the stove over and over again?”

I’ll explain

Explaining OCD

Let’s start with a quick overview of OCD. Contrary to popular belief, OCD is not about cleanliness, orderliness, or repeatedly checking. OCD is about a person having unwanted and intrusive thoughts, images, and/or impulses that will not go away – usually despite their best efforts. Those thoughts, images, and impulses are called obsessions and they usually create quite a bit of distress or discomfort for the person experiencing them. Some possible obsessions might be thoughts of being contaminated, images of doing something harmful to oneself or others, impulses to say curse words, or fears of having left an appliance on or a door unlocked.

Now, when those obsessions create discomfort or distress, the person tries to find a way of making those yucky feelings go away. This is where compulsions come in. Compulsions are those “best efforts” I mentioned above; they are physical or mental actions a person takes to try to get relief. Possible compulsions might include avoiding potential sources of contamination, trying to think of something besides the disturbing content, repeatedly checking that one did not make a mistake, or mentally reviewing and reassuring oneself that one did not and will not act. Performing these actions often brings about relief – temporary relief, until the obsession woefully comes back again.

In summary, OCD has two parts – obsessions and compulsions. Obsessions bring anxiety and discomfort UP. Compulsions bring anxiety and discomfort temporarily DOWN.

Wait, What About the Possession?

Wasn’t this a post about demonic possession?  Why are you sharing about OCD?

Sometimes OCD obsessions take the form of intrusive thoughts, images, or urges of harming others, such as loved ones. Let’s take a look at a possible scenario:

Sandra is a thirty something devoted mother and wife. One day, while sitting with her family, she imagines herself strangling the child closest to her with the power cord that is nearby. This image, seemingly from out of nowhere, shocks and disturbs her. “Where did that thought come from?” she wonders. She tries to force it out of her head and that seems to work until it comes creeping back in moments later. Now, even more upset, because the image seems so real, she excuses herself from the room. “What is this all about?” she silently asks herself. “This is nothing like me. I love my children. Why on Earth would I be thinking this?” She calms herself down by reminding herself that she is a good, caring mother. She returns to her family and the image leaves her alone for the night. The next day, as she helps the children with their homework and prepares the evening meal, she has a fleeting glimpse of smashing one of the children with the cast iron skillet. Terrified, she calls for her husband to stay in the room and help the children while she tries to cook and to compose herself. On subsequent days, despite trying hard to keep them out of her head, the thoughts and images only come more frequently. To protect them, Sandra never allows herself to be in a room alone with her children.

What’s happening here? Well, in this example, Sandra is having obsessions about harming her children. They cause her to feel incredibly uneasy because they are counter to her valued role of loving parent. So what does Sandra do? She removes herself from the situation, she reminds herself she’s a good parent, she tries to force the thoughts away, and she brings others into the room so she can be sure her children will be protected. In short, she does a number of compulsionsDespite the compulsions bringing some temporary relief, they never really address the thoughts and images and her distress grows and grows.

Now, OCD is a nasty trickster. It generally targets the things a person holds dearest. In our example, Sandra cares deeply about her children and she values being a loving parent. When a person finds their deepest values targeted, they may begin to question what this means about them. They may even question how such horrific thoughts could come about…and therein enters the rationalization by the sufferer (or others) that it must be demons.

Ah, Now the Demons

Imagine you are being tormented by some of the worst thoughts and images that could ever be conjured up (some of you may not need to imagine; you may be experiencing them already, which is why you may be reading this). These thoughts and images seem like something that you, the you you know, could never dream up in a lifetime. Yet, here they are…and they are bombarding your every day. You are living a nightmare. Stressed and overwhelmed, you search for an answer. Or, perhaps, someone jokingly suggests the answer. Demonic possession. These aren’t your thoughts at all. You’ve been inhabited by an evil presence. Preposterous as you might have thought it in another time and place, it seems just possible.

Let’s take a look back at Sandra:

Tormented by her horrible thoughts, Sandra searches for an explanation and stumbles upon an article about demonic possession. “Demons?” she wonders. “Could it be?” Although it sounds somewhat absurd, a little fear plants itself. “Maybe I am possessed by a demon.” She puts the frightful thought out of her head. Yet, the next day, as she wrestles with images of harming her children, a voice in her mind wonders, “Could I be possessed?” That evening, tormented by both fears she will harm her children and the possibility of possession, she touches a crucifix to her forehead, just to see if it burns. It doesn’t. She feels a little silly, but also relieved…for now.

In Sandra’s case, she’s stumbled on demonic possession as as possible reason for the horrific images and thoughts she’s been having. She is definitely not alone. As people search to understand why they are tormented, no possibility may seem too far-fetched. Sandra now has two obsessions, though. One is fear she will harm her children. The new one is that she is possessed by a demon. And her compulsions have a new realm, as well. She begins to seek certainty that she is not possessed – and bringing the crucifix to her forehead is only the beginning. All of this because of OCD. No demons at all.

So It’s Not Demons. What Can Be Done?

OCD is not a demon (in the traditional sense) and is treatable. The treatments shown to be most beneficial are Cognitive Behavior Therapy (CBT – specifically a form of CBT known as Exposure and Response Prevention {ERP}), medication, or a combination of both. Here, I will explain just a little bit about therapy and how it might apply in Sandra’s case.

In ERP therapy, a person is educated about OCD and learns how the things they have been doing to try to cope with their fears are actually growing the problem. Then, together with their therapist, they learn to gradually stand up to their fears without doing their compulsions. Gradually, the sufferer learns to manage discomfort and not to let it direct their lives.

Here’s how it might look with Sandra. After educating her about OCD, Sandra’s therapist would help Sandra identify each of her obsessions and her compulsions. Together, they would create experiments in which Sandra would be in the presence of the thoughts that have been frightening her without doing her compulsions. For example, she might imagine being in the room with her children while thinking her harmful thoughts. At another point, she might practice actually being in the room with her children and the thoughts and not leaving while another adult is in the room. Later, she might practice being in the room alone with her children while purposely thinking the thoughts.

Now these practice sessions would address the intrusive thoughts about harming her children. The fear that she is possessed by a demon would also need to be addressed – often simultaneously. Sandra would practice allowing the thought that she is possessed by a demon to be in her head while eliminating the compulsions of wrestling the thoughts away or checking for signs that she may/may not be possessed.

While it may seem a little scary standing up to these fears, it is done at a pace that patient and therapist agree on together – one that allows for mastery on the sufferer’s own terms. I like to think of the process as one of learning to be brave – of getting comfortable being uncomfortable. In it, the person with OCD learns skills that allow them to stand up to the disorder no matter what it may dish out in the present or the future. As for OCD, while it may try to trick folks into believing in demonic possession, learning the facts and the skills is a far less frightening reality.

For more information on Obsessive-Compulsive Disorder:

  • International OCD Foundation: https://iocdf.org/
  • Anxiety and Depression Association of America: https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd

 

Postpartum OCD: One Therapist’s Reflections

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

One of my colleagues, a well-known expert in OCD, recently made a brave public announcement.  Before I share it, I want to explain one aspect that makes her so effective as an OCD therapist.  She herself suffered with debilitating OCD for many years and overcame it to live a full, productive life – and to help countless others do the same.  Open about her past, she is a role model to her both her patients and her colleagues. However, the joyous occasion of childbirth one year ago brought with it the surprising and unexpected return of her OCD. In this beautiful and personal article, Dr. Jenny C. Yip (PsyD, ABPP) describes her own experience with postpartum OCD and the work it took to triumph over it once again.

About Postpartum OCD

Pregnancy and childbirth can be times when Obsessive-Compulsive Disorder first occurs or reappears. OCD researcher and expert, Jonathan Abramowitz, Ph.D., ABPP, notes thatamong female OCD patients who have given birth, pregnancy and childbirth are the most commonly cited “triggers” of OCD onset.” In addition, “a greater than expected percentage of women with OCD attribute the onset or worsening of their symptoms to pregnancy or the postpartum.”

Women with postpartum OCD may have intrusive thoughts (obsessions) that the child may die or that harm might come to him/her, she may fear harming the baby in some way, or she may fear that she doesn’t love the child enough. Rituals a postpartum woman with OCD might have include checking on the baby to be sure it is still alive, avoiding contact with the baby to avoid harming it, taking extra steps in caring for the child to “prove” she loves it enough, or praying or doing superstitious behaviors to avoid harm befalling the infant. While there are both biological and psychological theories about the causes of postpartum OCD, there currently is not a definitive explanation for it.

While we may not completely understand what causes postpartum OCD, we do know that the same treatments used for OCD that is not related to childbirth can be very effective. Those treatments may include Cognitive Behavior Therapy (CBT) with Exposure and Response Prevention (ERP) and medication. In CBT, a therapist works with the patient to identify the specific thoughts, images, or urges the patient is experiencing, as well as the behaviors (compulsions) the patient engages in to decrease their anxiety and discomfort. Then, the therapist works with the patient to develop a plan to confront the distressing thoughts and to gradually eliminate the compulsive behaviors. In Dr. Yip’s article, she describes some of the steps she took to overcome her OCD.

If you, or someone you know, is struggling with postpartum OCD, there is help. A therapist trained in CBT and ERP may be a good place to begin. There are also excellent resources and information available through organizations, such as the International OCD Foundation and the Anxiety and Depression Association of America.

Anxiety and Depression Association of America: https://adaa.org/

International OCD Foundation: https://iocdf.org/

 

New Support Group Beginning

Image courtesy of Becris at FreeDigitalPhotos.net

I am very excited to announce that I will be starting a new support group for adults (ages 18 and over) this month. The group will be free and will emulate the GOAL model started by Dr. Jonathan Grayson and Gayle Frankel. Potential members may begin at any time.

Why a support group? First, people with OCD often feel isolated and alone with the disorder. They often feel like they are the only person who is going through this. A support group helps sufferers to connect others who are going through similar experiences and helps create a sense of community. In addition, a group can encourage those with OCD to take on challenges they might have been struggling to take on otherwise, and it can help hold individuals accountable to accomplishing a goal.

This group is for those who are all along the OCD recovery spectrum. For those who are in the midst of ERP (exposure and response prevention) treatment, it can help reinforce concepts they are learning to use. For those who have completed treatment or are in maintenance, it can assist them in continuing to do the work of staying healthy. Finally, for those concerned about starting ERP treatment, it can help give them an introduction to what treatment might be like.

For more information about the free adult OCD GOAL Support Group, please visit the Support Group page of my website.

A Very Informative Interview About OCD

There are so many misconceptions about Obsessive-Compulsive Disorder. In particular, people frequently think it is about being neat, tidy, and organized. They often think it doesn’t affect children. Very importantly, people do not realize that OCD requires specialized treatment by someone trained to do a particular kind of Cognitive Behavior Therapy (CBT) know as Exposure with Response Prevention (ERP). In this interview by Alison Dotson, Nathalie Maragoni (who both has OCD and is training to be a therapist) beautifully describes what OCD can look like in a child, ways to educate the school, and resources for adults with OCD and for parents.

Click here to read.

Santa Clarita Grieves (Route 91) Event

I recently had the opportunity to speak and meet with community members at the Child & Family Center in the wake of the Las Vegas shooting. Santa Clarita residents were affected in many ways and the event was held to assist those affected, directly and indirectly, by the shooting. I was also interviewed by our local radio station, KHTS (see video). It was an honor to participate.