I’m absolutely thrilled that my Open University Professor, Frederick Toates, kindly agreed to write a guest blog for me today on recognition of OCD Week of Action. Thank you Fred.
On OCD, I speak with two hats: sufferer and psychologist with an interest in the subject.
First it can be useful to discriminate between 4 different features of obsessional behaviour, as follows:
- Obsessional quirks
- Obsessional personality
- Obsessional personality disorder
- Obsessive-compulsive disorder
Concerning (1), as far as I know, I was the first to coin the expression ‘obsessional quirks’. It refers to harmless and not very disturbing bits of behaviour, such as needing to tap every lamppost as you pass it or not stepping on the cracks of the pavement. Such quirks are surprisingly common. They might be viewed as a little odd by a partner but probably nothing more than that.
The obsessional personality (2) is one characterized by an extreme need for control, orderliness and an intolerance of ambiguity, sometimes expressed as ‘control freak’. Within bounds, this need not be problematic and might even be an effective way of organizing one’s life. However, when the behaviour becomes problematic to the individual, we have obsessional personality disorder (3). Of course, the behaviour might be problematic for a spouse even when not seen as problematic for the individual concerned, which can generate tension in a relationship.
The fourth category, obsessive compulsive disorder is a serious condition, best known by the examples of hand-washing and checking. However, it can also involve cognitive rituals that might have little obvious manifestation to others, such as painful endless problem-solving along the lines of ‘why is there evil in the world’.
Obsessive-compulsive disorder (OCD) is likely to impact upon a partner, though least of all if the problem is cognitive without any associated abnormal behaviour. Whole rooms can be put out of bounds in the interests of protecting against contamination, while the bathroom might be occupied for hours on end in an attempt to clean away imagined contamination. Hands damaged by excessive washing can be difficult to look at and embarrassing for a partner in company. Excessive need for cleanliness can impinge upon a harmonious sexual relationship. Checking can become very disruptive in a family, as in endlessly going round the house at night testing window and doors before retiring to bed. Another example that I have met twice is of a driver fearing that he has killed a pedestrian. This requires repeated visits along the route travelled and searches by the side of the road. Also the police can be contacted repeatedly for reassurance that there was no such accident.
In such situations, there can be several very different types of problems for a partner. First, there is the temptation to fight back, e.g. in the case of a compulsive hand-washer by turning off the water at the mains. I would suggest that this is a temptation to be resisted, since it can only provoke conflict. Second, there is the temptation to try to analyse the situation and to reason logically with the obsessional individual, e.g. we all know that washing hands in London cannot prevent a terrible accident to a loved one in Edinburgh, so what is it with you that can’t accept this? I would also resist this. Thirdly, there is the temptation to give reassurance. For example, the obsessional might ask in the middle of the night – do you think that I did sufficient checking of the house? To give reassurance can buy temporary peace but at the price of reinforcing the condition in the long term.
The most useful thing could be to give support and encourage the obsessional to seek professional help in the form of cognitive behaviour therapy. There are charities available for guidance, such as OCD Action.
Frederick Toates (together with his wife, Olga Coschug-Toates) is author of a book ‘Obsessive Compulsive Behaviour’ Class Publishing.