It takes on average from 14 to 17 years old for people who will be diagnosed with obsessive-compulsive disorder (OCD) after they begin to experience symptoms. According to Alexandra McNulty, a Baltimore-based therapist who specializes in the condition, which is characterized by unwanted thoughts and repetitive behaviors, one of the reasons many “suffer in silence” is the shame that covers their days.
“The problem is that OCD is often filled with very disturbing thoughts that go against someone's values and morals,” she says. This may mean repeated thoughts of hurting yourself by jumping in front of traffic, committing a violent act such as murder, or engaging in taboo sexual activities. “Because of this shame, people often do not feel comfortable explaining to others, including their providers, what they are experiencing.”
When they do open up—finally share their internal dialogue with loved ones—they are often bombarded with well-meaning but harmful comments that only fuel the embarrassment they feel about the thoughts, images, and impulses running through their minds. This can exacerbate the cycle of obsessions and compulsions, which is why if you're on the receiving end, it's so important to consider your response. We asked experts to tell us the worst thing you can say to someone with OCD, and what words really help.
– Don't worry, everything will be fine.
If someone you love is struggling with anxious thoughts, it's natural to want to reassure them. But this is the worst thing you can do. Telling them everything will be fine “may provide temporary relief, but the problem is that the only thing you can truly be sure of in this world is that there will always be uncertainty,” says Alyssa Jerood, an assistant professor of psychiatry at the University of Pennsylvania. “When someone provides that kind of reassurance, it might work for a while, but then the brain will say, 'Wait, what if they're wrong?' Or: “What if this time everything is fine, but next time it’s not?”
This causes a yo-yo effect: the person you love will feel anxious, then relieved, then worried, and then desperate for reassurance again. It's a vicious circle that you don't want to get caught up in.
Instead, say, “I know this is hard for you, and I know you can do hard things.”
Jerud's clients often tell her that resisting OCD's demands is too painful, difficult, and anxiety-provoking. That's why it's so important to remind your loved ones that they are capable of difficult things and to celebrate their efforts. “Living with OCD is hard,” she says, “and it can be very rewarding to recognize that and know that others believe in you.”
“Do you have such thoughts? It's disgusting.”
People with OCD may have debilitating intrusive thoughts that feel taboo, such as sexual abuse or other harm to themselves or others. They are not a reflection of their true essence. If someone you love confesses to you what they are going through, don't react with shock or horror. “The worst thing you can do is add to the shame, guilt and disgust they already feel,” says Hardis.
Instead, say, “Our brain generates many thoughts.”
It's better to respond in a way that normalizes the fact that you, too, sometimes have strange, disturbing thoughts. Aim for a neutral tone, advises Hardis. If your child just told you about a worrying thought, for example, explain that the brain generates thousands of thoughts a day, and not all of them mean anything. She suggests adding, “I understand how scary this must be for you.”
“I’m so OCD too!”
OCD, like any other mental health disorder, should never be used as an adjective. However, people have seized on the term as a way to express how hyper-organized they are or how worried they are about germs. On the other hand, some exclaim that they wish they had OCD because they could afford to be more careful.
Read more: Stop Saying These 5 Things to People with Social Anxiety
“It misses the enormous suffering that a person can experience,” says Joanna Hardis, a therapist in Cleveland Heights, Ohio, who specializes in treating OCD and anxiety disorders. “You may see someone washing their hands, but what you don't see is the relentless and intrusive thoughts that may be driving it. You have absolutely no idea of the level of torment the thought behind that behavior causes.”
Instead, say, “If you ever want me to help you find a therapist who provides highly effective, evidence-based treatment for OCD, I would be happy to do so.”
“This may be the most helpful thing you can say to someone with OCD,” Jerud says. Exposure and Response Prevention (ERP) therapy is gold standard of treatment for OCD, but it's not always easy to find a supplier (especially one that is accessible and affordable). Offering to do some legwork in finding a doctor can go a long way.
“Sometimes people don't even realize they have OCD. They just think that's what they do. That's how they live in the world,” Jerud says. “Letting them know that you're happy to consider it for them if it would be helpful suggests that there might be an alternative path – maybe they won't always have to struggle this way.” This can provide a much-needed sense of hope, she adds.
“You're overreacting.”
Telling someone there's no reason to worry is “incredibly dismissive,” McNulty says. She compares this to saying, “I don’t see any problem, so your reaction doesn’t make any sense.”
“People with OCD constantly have horror movies with worst-case scenarios playing in their heads,” she says. “Their brains can't differentiate between what's happening and what's happening.” could happen. To say they are overreacting – well, no, their emotions and anxiety are actually quite justified given the story their mind is telling them.”
Instead, say, “Your anxiety is real, but the story your mind is telling you may not be. You can trust what your feelings are telling you.”
McNulty sometimes explains OCD this way: Let's say you had a dream that your husband cheated on you, and when you woke up, you were angry at him, despite knowing that your emotions were not based in reality. “The emotion is real, but the story is not real,” she says. “This is what people with OCD experience when they are awake.”
Read more: The worst thing you can say to someone who is depressed
Of course, being able to talk to someone with OCD about how their brain works requires a detailed understanding of what they are going through. That's why she recommends attending a treatment session with a loved one so you can learn all about OCD and how to support the person you care about. There are also many support groups that family members can join, who can offer valuable communication tips.
“If you do this again, there will be no screens for a week!”
Punitive statements are rarely, if ever, appropriate, including when talking to someone with OCD. “Would you punish a child who has diabetes because their blood sugar levels are low?” – asks Jerud. “We don't know exactly what causes OCD, but there are certainly biological components. Why would we punish someone if that's how their brain is wired?”
Instead, say, “That was very brave of you. Keep it up!”
People with OCD tend to cause trouble for themselves. According to Jerud, when they become fixated on an obsession, they reach a critical point of choice: They can either give in to their urges or try to somehow reduce their anxiety, which seems risky and difficult. “Every time they do this, they get a little stronger and their OCD gets a little weaker,” she says. “When we build on those tiny wins, it can help them keep going.”
“Just stop.”
If your loved one has to tap their body four times in a row before moving on to a new task, or insists on rewriting an email until it's right, you might be tempted to ask them to give it up. They can control their behavior, right? Not really. “OCD is not a lack of willpower,” McNulty says. “In reality, it requires a lot of willpower—my clients often end up struggling throughout their lives to be able to do what they like, despite their obsessions and compulsions.”
Instead, say, “I understand this is a difficult time. How can I, as your supporter, help you during this time?”
The same tactics won't help every OCD sufferer calm their mind, but grounding practices that focus on engaging your senses in the present moment are often valuable. You can suggest, for example, going for a walk with your loved one or listening to your favorite album together. If you're not sure what would be most helpful, McNulty suggests asking, “What can we do right now to help get you out of these really scary stories your mind is telling you?”
Read more: What does it really mean to have intrusive thoughts?
It's also a good idea to take the time to learn what OCD is and ask your loved one questions about their experiences. Instead of making assumptions, be curious: “What is your mind telling you right now?” “If you don’t understand, ask,” she says. “Give someone the opportunity to share their life experiences and listen without judgment.”
Want to know what to say in a difficult social situation? E-mail [email protected]
