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Beware of Enabling the Tyranny of Obsessive Compulsive Disorder

16 Jun

My wife suffers from panic attacks, anxiety, depression, OCD and medical phobias. These issues have been going on for over a decade with no resolution in sight. The problems seemed to start just after a death in the family, and the anxiety just escalated from there until it turned into debilitating OCD, depression etc.

The largest obstacle to overcome seems to be the medical phobia. Because of this phobia, I can't get her to seek treatment, so one thing just escalates into another. At this point she barely speaks to people, doesn't watch television or read etc. This is because any word she associates with medicine sends her into an uncontrollable panic. The words don't have to be medical - she just has to be able to draw some sort of correlation – for instance, hospitality, sounds like hospital.

I've been researching healing with sound, music therapy and guided imagery. The one thing she will do is listen to music without words (since there aren't words to upset her).

Can you suggest anything that might help such an extreme case? She refuses treatment (because of her phobias) so I basically need something that will relax her and calm the fears without her thinking of it as treatment.

Basically, I need a stepping stone - something to get us past the first step so that maybe she'll eventually be more open to treatment, if only we can calm the medical phobia.

Do you have any CD's that might be appropriate? Or anything else? Thanks so much!

Harried Harry

Dear H.H.,

2149bIt sounds like you've had quite a challenge, and you've really hung in there. For starters (but only starters), the short answer is yes, we do have a CD for Obsessive Compulsive Disorder and another for Panic Attacks, and yet another for Depression, but in your wife's case, I suspect that they'll only be somewhat helpful. Her condition is too severe and it's been allowed to go on for too long.

I know this is going to sound cruel to you, but please hear me out. OCD gets worse when it's accommodated. It spreads, gets more generalized, more intense, more frequent and more debilitating if it's allowed to go on. In fact, you're describing this metastasis perfectly when you say it used to be the word "hospital" that would set off her panic; now it's even an associated word like "hospitality".

There is ample clinical evidence and research showing that tiptoeing around the constrictions of OCD is tantamount to dooming the OCD sufferer to get worse.

In fact, a study with kids who have OCD finds this very same dynamic – when the family accommodates the kid's symptoms, the symptoms stick or worsen, even with active treatment. (That citation, if you're interested, is Merlo LJ, Lehmkuhl HD, Geffken GR, Storch EA. Decreased family accommodation associated with improved therapy outcome in pediatric obsessive-compulsive disorder. Journal of Consulting & Clinical Psychology. 2009 Apr;77 (2):355-60.)

You're being held hostage by her distress, Harry, and the only way to help her is to liberate yourself and get some help for both of you. It will take a strong stomach, because her initial terror will be hard on you.

2110bYou need to either find an OCD specialist who knows effective, tried and true behavioral techniques (CBT or cognitive behavioral therapy), plus medication (SRI's or serotonin reuptake inhibitors are the preferred drugs for OCD – Anafranil, Luvox, Prozac, Zoloft and Paxil are examples – and this class of drug is also good for depression.)

Then you need to bring her to the therapist - whether she likes it or not. Maybe you can get some help from a relaxation CD but maybe not. Perhaps an OCD specialist will come to the house - they're used to dealing with phobias. But bottom line: she's now completely dependent on you, which means you have a lot of clout. You can get her to go if you sound like you mean it.

You also might want to pick up an excellent book called Freedom from Obsessive-Compulsive Disorder by Dr. Jonathan Grayson. You'll find some great orientation and coaching in there, to support the idea that you really must interrupt this co-dependent, enabling response of yours to her condition. It's a terrific book – the author has run a successful program for OCD sufferers for years, and it works because, to use a vivid Adlerian phrase, it "spits in the soup" of the sufferer and breaks the cycle. She may need to be hospitalized for a few weeks, but it will be worth it.

I hope you can do this. I know it will be difficult, but you're the one in the pivotal power position with more than enough leverage to help her get well.

Let me know how it goes. Best of luck.


Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award.