Ms. S was 35 years old when, after one year of social withdrawal, she tried to kill herself twice because of the pathological belief that she had been ostracized for “a mistake” she made. Worried about a lack of visits from her acquaintances, Ms. S grew suspicious. Could she be the reason for others not visiting her?
Her husband told her otherwise, but she continued to mutter to herself about the issue. Eventually, her worry swelled into an all-consuming obsession, which then morphed into a tear-ridden death wish. Upon hospitalization, Ms. S was diagnosed with psychosis and was given risperidone (an antipsychotic medicine) to which she did not respond.
Could it be OCD?
Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder wherein a person faces obsessions, that is, intrusive and unwanted thoughts, impulses, urges, or images that repetitively disturb the conscious mind. Obsessions almost always come with compulsions. Compulsions are behaviours or mental rituals that the person will perform in order to soften the anxiety their obsessions cause.
One kind of compulsion is checking. A person with obsessive thoughts about danger might check and re-check the stove to make sure it’s turned off before leaving their house. Another person might drive around town to see if they hit someone with their car on the way home from work, in case they don’t remember doing so.
Only under detailed clinical examination did Ms. S admit to having frequent anxiety-provoking thoughts that made her believe she had done something wrong and therefore needed comfort and forgiveness from others. Ms. S’s obsession, triggered by a baseless thought, was fear of persecution. What was her compulsion? Excessive reassurance-seeking (ERS).
ERS is “a type of interpersonally focussed checking behaviour” wherein both paediatric and adult OCD sufferers ask their caregivers, put simply, if everything is okay.
Let’s say you’re a caregiver or carer. You have good intentions toward your partner who suffers from moderate to severe OCD. You want to soothe them when they’re in distress. Maybe you comfort them, so you don’t have to deal with the madness of their obsessions. You provide reassurance and get where you need to be on-time because your partner doesn’t stop to finger the stove dials while you’re on your way out the door.
But what if your reassurance makes their OCD worse? Unwittingly engaging with your partner’s compulsion to prevent or temporarily alleviate their OCD symptoms means the root condition remains unaddressed. Psychologists call this occurrence symptom accommodation.
In his aim to understand the reasons why carers provide or do not provide reassurance, and the effect ERS has on them, Brynjar Halldorsson, clinical psychologist and postdoctoral research fellow at the National Institute of Health Research in the UK, noted that symptom accommodation may “transfer perceived responsibility to another person.” He noted this in a 2015 study published in the Journal of Obsessive-Compulsive and Related Disorders (JOCRD).
The human costs of ERS
Halldorsson and his team interviewed ten carers about their experience with providing reassurance to the adult OCD sufferers in their lives. The interview questions were extensive, demanding full, elaborate answers that would capture their motivations and feelings about being carers.
Most carers provided reassurance to show moral support and avoid any negative behavioural responses that lack of assurance might elicit. As an example, one participant, a mother, reported that her daughter who has severe contamination fears ceased to function when she withheld reassurance from her. The daughter stopped eating and wouldn’t get out of bed.
While carers give in because they don’t want to see their loved ones suffer, Halldorsson noticed one theme that cut across the varied experiences he was analyzing: frustration.
“I get frustrated…mostly because I know she knows what’s going on…knowing that it doesn’t really help, and it doesn’t help in the long-term management of OCD,” says one participant.
OCD sufferers also feel frustrated at the fact that they act under compulsion and inevitably strain their personal relationships.
Acceptance and Commitment Therapy (ACT) encourages OCD sufferers to move toward a values-based, goal-orientated, independent life with—not without—their anxiety.
The psychologist who developed it, Steven Hayes, did so partially through his own experiences. “We as a culture seem to be dedicated to the idea that ‘negative’ human emotions need to be fixed, managed, or changed—not experienced as part of a whole life,” says Hayes. “We need to develop a modern integrated style of consciousness that can take us out of our minds and into our lives. Acceptance, mindfulness, and values are key psychological tools needed for that transformative shift.”