July 23, 2021 • 17 mins
Obsessive compulsive order is hard on everyone--both the people experiencing it and those around them. Dr. Saltz tells a listener how to help a friend with OCD.
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Episode Transcript
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Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. Obsessive compulsive disorder or
o c D is a mental disorder that, according to
the National Institute of Mental Health, affects somewhere between one
and two percent of all people interfering with their daily lives.
(00:48):
The numbers may actually be higher than that, as o
c D often goes unreported. So today I'm answering a
question I got about a person who struck with o
c D. Obsessions are uncontrollable thoughts, urges, or mental images.
(01:08):
There are a wide range of types of thoughts one
may have when one has o c D. Sometimes they
are rational thoughts and sometimes they're irrational. For example, they
may include being convinced that something is contaminated, that only
even numbers are safe or comfortable, or that one must
(01:31):
do or check certain things for oneself. Or for other
people to be safe. The thoughts usually fall into one
of several categories, having to do with either a fear
of germs, a fear of unwanted or aggressive thoughts, religious thoughts,
(01:53):
or a desire for symmetry or perfect order. A typical
o c D thought is a fear that bad things
will happen if precautionary routines are not performed. The repetitive
behavior that the person feels must be done to manage
the obsessional thought is what is called a compulsion. Compulsions
(02:17):
are typically some form of cleaning, ordering things, checking, or counting.
Examples are tapping a door twice before opening it and
feeling you need to do that to make sure you
or someone else stays safe, or entering a room with
(02:38):
the right foot first, elsewise something bad might happen. These
thoughts and acts can fall under the category of superstitions,
but when they are taken to an extreme and become
so repetitive that they take up more than an hour
per day and disrupt that person's ability of function well
(03:01):
in their day to day life, then they fall into
the category of o c D. People with obsessive compulsive
disorder understand that their thoughts and behaviors are excessive, but
they can't stop them. In addition, they know these thoughts
(03:22):
and rituals don't really make sense, but they cause them suffering. Nonetheless,
o c D typically begins in childhood or adolescence, though
it can start in adulthood. There seems to be some
genetic component of o c D because there is a
(03:43):
higher incidence in the children of a parent with o
c D, and we do see that first degree relatives
are more often affected. There is also evidence from multiple
studies that there are brain structure differences in people with
o c D, specifically in the area of the brain
(04:04):
called the frontal cortex, and in subcortical structures as well.
Yet it is not clear exactly what the causes are
and what these structural differences may mean. There are two
common methods of treating o c D. The most common
method is psychotherapy, but it can also be treated with medication.
(04:29):
Cognitive behavioral therapy, or CBT, is a common and effective
treatment for obsessive compulsive disorder. The purpose of CBT is
to disrupt the cycle of compulsions being performed and thereby
slowly stop reinforcing the obsessions, which should decrease over time.
(04:54):
This therapy is typically done in an office with a
psychologist once or twice a week. However, tasks are also
assigned for the patient to carry on their treatment daily
at home. CBT has proven effective for almost half of
o c D patients, and CBT strengthens other circuits in
(05:16):
the brain and trains the brain to be comfortable not
giving in to the compulsive task. This can prove to
be very challenging for patients who have had o c
D for a long time because the circuit pathways have
been strengthened over time and are therefore harder to break.
(05:37):
The CBT works when opposite pathways are used enough times
that they become stronger than the obsessive compulsive disordered pathway.
An example of this is not washing your hands, despite
having the urge to do so, doing this repeatedly for
increasingly longer periods of time as the patient can tolerate it.
(06:02):
Over time, the urge to wash decreases, and then later
the thoughts or obsessions about contamination will also decrease. Another
way that o c D is treated is through medication.
A common medication used is the class of drugs called
(06:22):
selective serotonin reuptake inhibitors, or s SR eyes. When given
in high doses, this medication can make it easier for
patients to perform the cognitive behavioral tasks they're learning in
therapy that strengthened the opposite circuits. SSR eyes work by
(06:45):
blocking the reuptake of serotonin, a neurotransmitter in the brain
that is available in the synapse in the pre synaptic neuron,
the place where two nerves basically talk to each other,
thereby increasing the amount of serotonin left available in that area,
(07:07):
effectively raising serotonin levels. Serotonin, this neurotransmitter, which is a
chemical used for communication in the brain, particularly affects mood
and anxiety, but also can affect obsessions and compulsions as
rise are typically used to treat depression and anxiety disorders,
(07:31):
but when given in high doses treat o c D.
Some other medications may also be useful for o c D.
Studies have shown that the best treatment for o c
D is a combination of both medication and psychotherapy. The
thing about treating o c D, and really all mental
(07:53):
health issues, is it's very difficult, sometimes impossible to do
so if the affected person does not want treatment. So
with that I will get to our listeners question and
see how can I help? How can I help? With
(08:15):
Doctor Gale Salts will be back after this short break.
Dear doctor Saltz, I have a good friend who I've
known for almost a decade. She has O c D,
(08:36):
along with both hypochondria and boarding. When we first became friends,
she'd wear short sleeves, sit on the same sofa with
other friends with no issue. But over the time I've
known her, I've seen her relationship with these disorders deteriorate.
It's gotten to the point that you'll only wear long sleeves,
(09:00):
stand instead of sit, and she even lys als her
own hair if it touches the shoulder of her jacket.
She used to wear her hair down no problem, but
not anymore. She's also nearly been evicted from her apartment
because of her hoarding. Other friends have offered to refer
her to professional help, but she's refused. I'd like to
(09:24):
try to encourage her to get help also, but in
an empathic, compassionate way that she'll be receptive to. I'm
not sure how to approach this. Can you offer any suggestions.
It's helpful that you can see this is a mental
illness and not just someone being difficult, because it means
(09:44):
you are able to be sympathetic and supportive rather than
frustrated and annoyed at her behavior. That being said, it
can be sad, disturbing, and frustrating when you can clearly
see this friend is struggling with her illness but unwilling
to get any treatment that could really help her. As
(10:08):
frustrating as it may be for you, I assure you,
it is far more tortuous for her. People avoid treatment
for various reasons. One is that they feel that treatment
is stigmatizing and feel that going to treatment is shameful
and means acknowledging mental illness, which is further shameful. This
(10:33):
sadly arises from years of a culture telling them that,
for years of people around that are telling them that.
Another reason is that they don't believe treatment can actually
help them. They have a deep seated feeling the situation
they find themselves in is somehow unfixable, or they may
(10:58):
not have any insight into their mental illness and therefore
don't really understand the thoughts they are plagued with are
a symptom that can be treated. This happens to some
degree because mental illnesses are illnesses of the brain, the
same brain that houses judgment, and therefore, in some instances,
(11:21):
judgment can be affected by the very mental illness that
is plaguing a patient, making it difficult for them to
understand what is happening is an illness. They may be afraid.
Illness can drive paranoia for some people, and certainly anxiety
(11:42):
and the idea of focusing on the very thing that
frightens them feels untenable, and so they avoid treatment. As
her friend, all you can do is to try to
address the possibilities, discuss, treat it as something you know
other people do, even bring in a real life story,
(12:06):
something that is not deserving of stigma. In your opinion
that if she, for example, had diabetes, you would help
her to see a different kind of doctor for treatment,
and that you see this no differently, that an illness
is robbing her of joy and a comfortable life, and
treatment is an appropriate thing to do with no shame.
(12:31):
If you have ever gone to treatment, tell her about it,
or tell her someone else's story that you're allowed to
tell about treatment. Real life stories can really help diminish stigma.
Tell her that she will get to decide what she
wants to do in treatment and not have to do
(12:51):
anything that she doesn't want to have to do. Many
times patients are afraid that someone will force them into
something they don't want, which of course is really never
the case. Offer to help her find someone who specializes
in treating o c D, because often when a person
(13:11):
is really ill, the idea of finding someone of organizing
themselves to seek and then get an appointment can really
be overwhelming. Help her find someone and, even if need be,
take her to a first appointment in terms of her
understanding that much of what is happening to her now
(13:34):
is illness and treatment. Can help her bring her a
book or two on o c D that she can
relate to. For example, one I often recommend is The
Boy who Couldn't Stop Washing. The Experience and Treatment of
Obsessive Compulsive Disorder by Judith Rappaport. It's a classic, and
(13:55):
it's really a story about people who have o c
D and about how their treatment helped them. Reading about
the experiences of others and noting the similarities can really
help her consider her situation more objectively. But you should
also know that sometimes it's not possible to get someone
(14:19):
to get help unless you can see that her life
is truly at imminent risk, in which case a person
can be hospitalized even if they don't want to be.
There is no way to compel a person to treatment
who is over the age of eighteen and refusing to go.
(14:41):
It's a very painful reality of serious psychiatric illness. Sometimes
a person has to get worse and worse until they
truly run out of any other option in their own mind. Hopefully, though,
if you take on an empathetic stance the I will
(15:02):
help you do this thing. You'd be brave to do
this thing. Along with some information about O c D
and treatments, she will allow herself to go. It may
take time. What is not helpful is participating in her compulsions.
For example, don't agree to help her clean or spray
(15:27):
liceol on herself, because even though she might feel better
in the moment, performing the patient's compulsions serves to lock
the symptoms in further because it makes them feel better
in the short run, which drives more obsessions and more compulsions,
(15:47):
and therefore, in the long run this actually will make
her illness worse. Remember there be only helps for people
who ultimately agree to be helped. I hope this was helpful.
O c D can range from mild to severe, and
(16:09):
it can wax and wane during a lifetime. According can
be part of o c D. High stress situations can
set off a worsening period. While there is no cure
for o c D, symptoms can be managed and greatly
reduced with the use of psychotherapy and or medication. Many
(16:33):
successful people struggle with o c D. They work to
manage their symptoms so that they can participate to their
fullest in their lives. Do you have a problem I
can help with? If so, email me yet? How can
I help? At Seneca women dot Com, all centers remain
(16:55):
anonymous and listen every Friday too. How can I help
with me? Doctor Gale Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. Obsessive compulsive disorder or
o c D is a mental disorder that, according to
the National Institute of Mental Health, affects somewhere between one
and two percent of all people interfering with their daily lives.
(00:48):
The numbers may actually be higher than that, as o
c D often goes unreported. So today I'm answering a
question I got about a person who struck with o
c D. Obsessions are uncontrollable thoughts, urges, or mental images.
(01:08):
There are a wide range of types of thoughts one
may have when one has o c D. Sometimes they
are rational thoughts and sometimes they're irrational. For example, they
may include being convinced that something is contaminated, that only
even numbers are safe or comfortable, or that one must
(01:31):
do or check certain things for oneself. Or for other
people to be safe. The thoughts usually fall into one
of several categories, having to do with either a fear
of germs, a fear of unwanted or aggressive thoughts, religious thoughts,
(01:53):
or a desire for symmetry or perfect order. A typical
o c D thought is a fear that bad things
will happen if precautionary routines are not performed. The repetitive
behavior that the person feels must be done to manage
the obsessional thought is what is called a compulsion. Compulsions
(02:17):
are typically some form of cleaning, ordering things, checking, or counting.
Examples are tapping a door twice before opening it and
feeling you need to do that to make sure you
or someone else stays safe, or entering a room with
(02:38):
the right foot first, elsewise something bad might happen. These
thoughts and acts can fall under the category of superstitions,
but when they are taken to an extreme and become
so repetitive that they take up more than an hour
per day and disrupt that person's ability of function well
(03:01):
in their day to day life, then they fall into
the category of o c D. People with obsessive compulsive
disorder understand that their thoughts and behaviors are excessive, but
they can't stop them. In addition, they know these thoughts
(03:22):
and rituals don't really make sense, but they cause them suffering. Nonetheless,
o c D typically begins in childhood or adolescence, though
it can start in adulthood. There seems to be some
genetic component of o c D because there is a
(03:43):
higher incidence in the children of a parent with o
c D, and we do see that first degree relatives
are more often affected. There is also evidence from multiple
studies that there are brain structure differences in people with
o c D, specifically in the area of the brain
(04:04):
called the frontal cortex, and in subcortical structures as well.
Yet it is not clear exactly what the causes are
and what these structural differences may mean. There are two
common methods of treating o c D. The most common
method is psychotherapy, but it can also be treated with medication.
(04:29):
Cognitive behavioral therapy, or CBT, is a common and effective
treatment for obsessive compulsive disorder. The purpose of CBT is
to disrupt the cycle of compulsions being performed and thereby
slowly stop reinforcing the obsessions, which should decrease over time.
(04:54):
This therapy is typically done in an office with a
psychologist once or twice a week. However, tasks are also
assigned for the patient to carry on their treatment daily
at home. CBT has proven effective for almost half of
o c D patients, and CBT strengthens other circuits in
(05:16):
the brain and trains the brain to be comfortable not
giving in to the compulsive task. This can prove to
be very challenging for patients who have had o c
D for a long time because the circuit pathways have
been strengthened over time and are therefore harder to break.
(05:37):
The CBT works when opposite pathways are used enough times
that they become stronger than the obsessive compulsive disordered pathway.
An example of this is not washing your hands, despite
having the urge to do so, doing this repeatedly for
increasingly longer periods of time as the patient can tolerate it.
(06:02):
Over time, the urge to wash decreases, and then later
the thoughts or obsessions about contamination will also decrease. Another
way that o c D is treated is through medication.
A common medication used is the class of drugs called
(06:22):
selective serotonin reuptake inhibitors, or s SR eyes. When given
in high doses, this medication can make it easier for
patients to perform the cognitive behavioral tasks they're learning in
therapy that strengthened the opposite circuits. SSR eyes work by
(06:45):
blocking the reuptake of serotonin, a neurotransmitter in the brain
that is available in the synapse in the pre synaptic neuron,
the place where two nerves basically talk to each other,
thereby increasing the amount of serotonin left available in that area,
(07:07):
effectively raising serotonin levels. Serotonin, this neurotransmitter, which is a
chemical used for communication in the brain, particularly affects mood
and anxiety, but also can affect obsessions and compulsions as
rise are typically used to treat depression and anxiety disorders,
(07:31):
but when given in high doses treat o c D.
Some other medications may also be useful for o c D.
Studies have shown that the best treatment for o c
D is a combination of both medication and psychotherapy. The
thing about treating o c D, and really all mental
(07:53):
health issues, is it's very difficult, sometimes impossible to do
so if the affected person does not want treatment. So
with that I will get to our listeners question and
see how can I help? How can I help? With
(08:15):
Doctor Gale Salts will be back after this short break.
Dear doctor Saltz, I have a good friend who I've
known for almost a decade. She has O c D,
(08:36):
along with both hypochondria and boarding. When we first became friends,
she'd wear short sleeves, sit on the same sofa with
other friends with no issue. But over the time I've
known her, I've seen her relationship with these disorders deteriorate.
It's gotten to the point that you'll only wear long sleeves,
(09:00):
stand instead of sit, and she even lys als her
own hair if it touches the shoulder of her jacket.
She used to wear her hair down no problem, but
not anymore. She's also nearly been evicted from her apartment
because of her hoarding. Other friends have offered to refer
her to professional help, but she's refused. I'd like to
(09:24):
try to encourage her to get help also, but in
an empathic, compassionate way that she'll be receptive to. I'm
not sure how to approach this. Can you offer any suggestions.
It's helpful that you can see this is a mental
illness and not just someone being difficult, because it means
(09:44):
you are able to be sympathetic and supportive rather than
frustrated and annoyed at her behavior. That being said, it
can be sad, disturbing, and frustrating when you can clearly
see this friend is struggling with her illness but unwilling
to get any treatment that could really help her. As
(10:08):
frustrating as it may be for you, I assure you,
it is far more tortuous for her. People avoid treatment
for various reasons. One is that they feel that treatment
is stigmatizing and feel that going to treatment is shameful
and means acknowledging mental illness, which is further shameful. This
(10:33):
sadly arises from years of a culture telling them that,
for years of people around that are telling them that.
Another reason is that they don't believe treatment can actually
help them. They have a deep seated feeling the situation
they find themselves in is somehow unfixable, or they may
(10:58):
not have any insight into their mental illness and therefore
don't really understand the thoughts they are plagued with are
a symptom that can be treated. This happens to some
degree because mental illnesses are illnesses of the brain, the
same brain that houses judgment, and therefore, in some instances,
(11:21):
judgment can be affected by the very mental illness that
is plaguing a patient, making it difficult for them to
understand what is happening is an illness. They may be afraid.
Illness can drive paranoia for some people, and certainly anxiety
(11:42):
and the idea of focusing on the very thing that
frightens them feels untenable, and so they avoid treatment. As
her friend, all you can do is to try to
address the possibilities, discuss, treat it as something you know
other people do, even bring in a real life story,
(12:06):
something that is not deserving of stigma. In your opinion
that if she, for example, had diabetes, you would help
her to see a different kind of doctor for treatment,
and that you see this no differently, that an illness
is robbing her of joy and a comfortable life, and
treatment is an appropriate thing to do with no shame.
(12:31):
If you have ever gone to treatment, tell her about it,
or tell her someone else's story that you're allowed to
tell about treatment. Real life stories can really help diminish stigma.
Tell her that she will get to decide what she
wants to do in treatment and not have to do
(12:51):
anything that she doesn't want to have to do. Many
times patients are afraid that someone will force them into
something they don't want, which of course is really never
the case. Offer to help her find someone who specializes
in treating o c D, because often when a person
(13:11):
is really ill, the idea of finding someone of organizing
themselves to seek and then get an appointment can really
be overwhelming. Help her find someone and, even if need be,
take her to a first appointment in terms of her
understanding that much of what is happening to her now
(13:34):
is illness and treatment. Can help her bring her a
book or two on o c D that she can
relate to. For example, one I often recommend is The
Boy who Couldn't Stop Washing. The Experience and Treatment of
Obsessive Compulsive Disorder by Judith Rappaport. It's a classic, and
(13:55):
it's really a story about people who have o c
D and about how their treatment helped them. Reading about
the experiences of others and noting the similarities can really
help her consider her situation more objectively. But you should
also know that sometimes it's not possible to get someone
(14:19):
to get help unless you can see that her life
is truly at imminent risk, in which case a person
can be hospitalized even if they don't want to be.
There is no way to compel a person to treatment
who is over the age of eighteen and refusing to go.
(14:41):
It's a very painful reality of serious psychiatric illness. Sometimes
a person has to get worse and worse until they
truly run out of any other option in their own mind. Hopefully, though,
if you take on an empathetic stance the I will
(15:02):
help you do this thing. You'd be brave to do
this thing. Along with some information about O c D
and treatments, she will allow herself to go. It may
take time. What is not helpful is participating in her compulsions.
For example, don't agree to help her clean or spray
(15:27):
liceol on herself, because even though she might feel better
in the moment, performing the patient's compulsions serves to lock
the symptoms in further because it makes them feel better
in the short run, which drives more obsessions and more compulsions,
(15:47):
and therefore, in the long run this actually will make
her illness worse. Remember there be only helps for people
who ultimately agree to be helped. I hope this was helpful.
O c D can range from mild to severe, and
(16:09):
it can wax and wane during a lifetime. According can
be part of o c D. High stress situations can
set off a worsening period. While there is no cure
for o c D, symptoms can be managed and greatly
reduced with the use of psychotherapy and or medication. Many
(16:33):
successful people struggle with o c D. They work to
manage their symptoms so that they can participate to their
fullest in their lives. Do you have a problem I
can help with? If so, email me yet? How can
I help? At Seneca women dot Com, all centers remain
(16:55):
anonymous and listen every Friday too. How can I help
with me? Doctor Gale Salts
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