Monday, April 21, 2008

Couples and OCD (Obsessive Compulsive Disorder)

Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing the thoughts and reducing the terrible anxiety that accompanies them. In spite of the disorder, many people with OCD function at high levels.

Adrian Monk, the TV detective played by Tony Shalhoub comes to mind as an OCD sufferer plagued by the urgent need to engage in certain rituals to ward off germs or dirt, to keep objects perfectly ordered, to count steps, and to check things repeatedly.

Typically, the treatment for a person with OCD is cognitive-behavioral therapy and medication.

However, two clinical psychologists at the University of North Carolina at Chapel Hill will, for the first time, use cognitive-behavioral therapy (CBT) to treat couples in which one partner has OCD.

According to an article on PsychCentral:

"Jonathan Abramowitz, Ph.D., associate professor and associate chair of the psychology department in UNC’s College of Arts and Sciences, who is also director of UNC’s Anxiety Disorders Clinic, and Donald Baucom, Ph.D., professor of psychology and director of UNC’s Couples Therapy Clinic, will provide treatment for about 20 couples as part of a new study funded by the Obsessive Compulsive Foundation."

“First we will find out about the OCD symptoms and how the couple has been managing with these problems,” Abramowitz said. “Then we will help the couple learn to work together to address the OCD patient’s obsessions and rituals and assume a healthier relationship in which their interactions do not make OCD worse.”

“The hope is that when both partners learn the CBT techniques, the partner without the disorder can be more helpful in encouraging the OCD mate to work through fears realistically,” Abramowitz said. “This would be good for the OCD sufferers and their spouses.”



How can it be that the couple is being seen as the nexus of treatment for OCD "for the first time?"

Couples are intertwined, for better or for worse. We carry our conjoined lives with us wherever we go. One goes to the supermarket and remembers that the household is out of the other's favorite brand of yogurt. We call each other up when one is going to have to stay late at work. Our memories of joys celebrated and injuries inflicted are everlasting. And when one is sick, both lives are dislocated.

When one partner is ill, with OCD, PTSD, GERD, or any other acronym, the other partner is intimately involved. The well partner knows all about the other's diet and bathroom habits, how far she can walk, when well intentioned company begins to tire her out. And the ill partner can read her sweetie's face from across the room and see signs of hope or weariness. One person may do internet research on the ailment, while the other deals with insurance labyrinths. They may go to specialist appointments together and dissect what they heard and understood afterwards.

Whether they talk openly or not about the illness, the illness changes two lives, not one. And the two partners combined have exponentially greater potential for having impact on the experience of illness, also for better for for worse.

After so many years, I can tell what's on Richard's mind by tiny changes in his breathing pattern. He can hear in the first diphthong of the first work I utter when he phones me if I've had a good or a bad day. We carry each other. We defeat each other. We save each other. We grow each other up. Over and over again.

How can this be the first time that the unit of treatment is the couple? I am not suggesting that the patient should abdicate control to the partner. The person in whose body the illness resides gets dibs on making treatment and personal choices. But why would care providers not use the interconnectedness of the couple as a channel for healing?


jeisea said...

This is a very important point. My husband has PTSD from Vietnam. At first all the focus was on the client. Most of the partners had no idea of commonality of symptoms, what they meant and how we could help or make the situation worse. We would all have benefited by shared information and strategies and therapy from the outset. What seems best practice, common sense is taking a long time to get through. No man/woman is an island.

Pk said...

I don't get them saying that either.

My sons both have OCD. My oldest has been medicated, but my youngest went manic when he was on medication. CBT was our only option ...and when OCD is severe neough and CBT is the only option ... it becomes a family event.

My son had a 'working diagnosis' of autism from the ages of 3 to 10 ...and all of the therapeutic modalities that we used involved the whole family ... 24/7. None of them involved just my son. It was all of us, as a family unit.

Sam Curtis said...

I am a humble CBT therapist and I want to know your thoughts. I see a couple where the wife has ocd and the husband says "Your issues are not my responsibility!" meaning, specifically, I will never empty the trash when it is half-full...."That is her problem." This is one example of many "different standards". Ultimately, she takes care of numerous tasks because she can't tolerate them being undone. What is the spouse's responsibility? Where do they draw the line? The trash is one area they struggle over but what if it is something like checking a door several times? Should the spouse have to engage in this behavior also? (By the way, with this couple, standard cbt interventions and communication skills training can often be used as a weapons by a hostile partner.) I welcome your thoughts.

Barbara Kivowitz said...

Hi Sam - you clearly have a difficult, but not uncommon, situation you are dealing with with this couple. And it clearly shows how intertwined the relationship and the illness are.
Without knowing a lot more about this couple it is hard to give advice. My guess is that you have already tried many avenues. So with that, here goes some thoughts:

If they have relationship issues such as control struggles, passive aggressive behavior patterns, etc. these issues will inevitably play out between them in any arena - including her OCD. And anything can become yet another weapon to use. Couples therapy can help them address these underlying issues and patterns(rather than continually act them out in derivative form).

Alternatively (or in parallel), if they are capable of it, perhaps they can negotiate a clear arrangement so that they don't have to battle it out each time. E.g. he will do 1 or 2 things her way, as a gift, not as a capitulation. The rest of her OCD behaviors are up to her to manage. In return she will offer him some behavioral/emotional gift, something that will be for his benefit.

In terms of the issue of whether the well spouse should participate in the OCD behaviors to help the ill partner - where should they draw the line -- that is indeed a tough question and I defer to OCD experts like yourself. Here are some questions this raises for me:

Does he really think she has an illness? Would he be equally unwilling to pitch in if she had leukemia or MS?

Is asking him to participate equivalent to enabling her (if we apply the AA/Al-Anon model) and is it better for her if she deals with her OCD without expecting anything from him?

I hope this helps. Feel free to email me if you'd like to go into this in greater detail. said...

Hi Barbara,

First off, I came across your site and wanted to say thanks for providing a great OCD resource to the community.

I thought you might find this infographic interesting, as it shows detailed information about the social signs of OCD to look for, and has proved to be a great hit with our readers:

Naturally, I’d be delighted if you share this embeddable graphic on , and/or share it with your followers on social. Either way, keep up the great work Barbara!

All the best,

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