As my OCD patients get better with treatment, they are relieved that their obsessions are less frequent and less intense and they have more control over performing rituals. This they expect. But what can be unexpected is the feeling of mourning as symptoms dissipate. Often my patients have lived most of their lives struggling with upsetting obsessions and engaging in rituals that can consume hours of time. Their lives have been severely compromised by the disorder. They certainly don’t like having OCD, but it’s familiar to them. Some comments from my patients include: “I’m just used to it”. “It’s like a shadow...always there.” “What will my life look like without OCD?” “What do I think about if I don’t have these obsessions so constantly?”
Early on in treatment, along with Exposure and Response Prevention, I introduce my patients to the idea that as they start to show a reduction in symptoms they need to start thinking about how they want to live a life without being controlled by OCD. I acknowledge that it may seem odd that they may feel a sense of loss as they get better, but it’s actually a common feeling. Helping my patients move from identifying themselves primarily by their OCD to discovering what is fulfilling to them includes asking them to describe what they’ve missed out on by having the disorder and to make a list of those things. We work on incorporating these unfulfilled activities and desires in their daily life, as the OCD symptoms recede.
We also talk about how loved ones may have inadvertently exacerbated their OCD symptoms due to misguided attempts to show care and attention. My OCD patients need to find other ways to engage with loved ones that do not involve talking about OCD or engage family members in rituals, such as reassurance seeking. I always include family members in my sessions to discuss ways they can be engaged with the OCD sufferer, but not to indulge the OCD. This can take some time, but it’s critically important to help the client discover who they are without the disorder controlling them and to change the fundamental interactions with family members, which can ultimately lead to healthier and happier relationships.
When OCD is controlling your brain, there isn’t a lot of room to engage with other thoughts or to do things in your life that give you pleasure. Now, as OCD loosens it’s grip, you no longer need to be defined by OCD. There are plenty of other aspects of your life to discover and enjoy.
Patricia Thornton, Ph.D. specializes in the treatment of anxiety disorders and OCD.
She practices in New York City.