18 yr old son contamination OCD

[ImAWorriedMum]

My 18 yr old son has very extreme contamination OCD and is extremely depressed and anxious. He has Dysautonomia (dysfunction of his nervous system) which has kept him mainly housebound since 14.

We're at breaking point and I feel like all my help is making him worse. 

The OCD has got rapidly worse since Xmas and my son won't touch anything touched by anyone else at all or anything where there is a possibility of an insect or cobweb having touched it. He's stay in his room most of the day and won't go outside at all or even near an open door or window. Just going in or out of his room triggers him in case a fly gets in. Because his condition means he can't stand for long (couple of minutes) or bend I basically have to do lots of his cleaning compulsions for him to try and keep him calmer/make him feel safe. I can't do them all because of me touching some things but he's still in an almost permanent state of panic with very severe panic attacks. He's now hurting himself by biting, hitting etc.  I completely understand that I'm assisting the OCD by doing the compulsions but his OCD therapist says he's in such a bad state at the moment I need to while we wait for medication to help his depression. We were doing exposure response therapy but we were getting nowhere due to the bad depression and we're waiting for help for that. We are calling to he crisis line more and more. 

I'm torn in trying to keep him as calm as I can and not letting him hurt himself or worse and feeling like I'm making him worse even though I know he can't cope without help. All the time waiting for referrals/assessment/medication prescriptions etc. I don't feel I can pull back on any of my 'accomodations' without him hurting himself. Even tiny little things I try to get him to 'live' with for a short time or if I let the panic wear itself out are not working for him. He really gets frustrated that he can't cope without doing the compulsions and really is trying to improve and get help but just isn't coping at all. We're getting little sleep as evening and bedtime are the worst and then have to wake up for husband's work and his brothers school. We're all utterly exhausted and just living hour to hour trying to cope. 

Am I doing my best and wait for medication or can anyone tell me if they've managed improvement from a similar situation? 

 

 

[snowbear]

Hi ImAWorriedMum,

It sounds like a particularly difficult situation your family is going through.

I have mental contamination and for me everything touched by humans is contaminated. Everything in the world is contaminated in a way - including any crawling or flying insects. So I really get where he's coming from and just how restrictive and problematic this must be for you.

Hurting himself will be from the frustration your son is feeling. That, to my mind, should be the first thing tackled. It has to stop. Self-harm never helps the situation. Have you tried talking to him about why he hurts himself, what it achieves for him? Then think about other ways of achieving that together which don't involve self-harm.

Next is tackling the amount of compulsions he asks/ needs you to do.

Personally I think nobody should be asked to do ERP until they've undergone some cognitive therapy to look objectively (or as objectively as they can in the mental place they're in at the time) at what they're thinking, what meaning they give the thoughts, what they believe the compulsions are achieving, and how valid (or invalid) those things are. He could benefit from learning how thoughts, feelings and behaviours interact so that he can begin the process of moving from 'automated' OCD choices to more rational choices.  THEN you start the ERP and work on stopping the compulsions - fully aware that they don't really achieve what you once believed they did and knowing there are better/alternative behaviours available.

So it always disappoints me when mental health teams defer therapy (especially the cognitive part of CBT therapy) on the excuse the person's depression or other problems have to be addressed first. CBT works for depression too and is a valid alternative or adjunct to medication, so no need to defer it unless the person is psychotic (detached from reality and unaware that they are so.)

I agree that the way things are at present you probably do need to assist with at least some of his compulsions. You can withdraw your help in stages once the compulsions are being systematically reduced through a hierarchy system. And it may be that hierarchy will need to be based on what he is physically able to do for himself, building his confidence and physical strength, rather than the usual route of lesser fears up to biggest fears.

Don't blame yourself for making him worse. You're most likely not. OCD will take and take. If you're not actively running against the treadmill just to stand still,  it will naturally get worse with time. Focus on getting him to accept/ start therapy and in the meantime just aim to not allow the situation to get worse.

Look after yourself as priority number one. And try to keep family life as normal as possible while this goes on 'in the background' as much as you can.

Key to change is getting that cognitive therapy started so he can begin to see the world in a different way - not give such importance to cobwebs and things that have been touched, building to a full understanding that the contamination he's trying to avoid isn't actually life-threatening or harmful and doesn't even exist outside his head.

Perhaps have a chat with his OCD therapist about teaching him the vicious flower diagram (thoughts/feelings/behaviour interaction) and ask him/her to start cognitive therapy for OCD/ depression now instead of waiting.