When family becomes part of the ritual
A woman with longstanding OCD, with severe family accommodation, presented to us — where her family members had become involved in her rituals, and repeatedly had to provide reassurance to help reduce her anxiety. At home, family members were asked to check things repeatedly, follow specific routines like taking a bath repeatedly, washing hands after touching things, answer the same questions, or participate in behaviours that temporarily relieved her distress.
A pattern confined to home
Interestingly, she was able to resist performing many of these rituals outside the home. Because her compulsions were largely confined to her home environment, her family found it difficult to understand why she was behaving a certain way at home and not outside. They sometimes felt that she was capable of controlling the behaviour, and therefore believed she was "acting," or choosing to behave this way.
In reality, the difference between her behaviour at home and outside was not evidence of pretending or attention-seeking. This is a common occurrence in OCD, where people with OCD tend to have symptoms most strongly at their own home, where the home is considered an extension of themselves.
Strain on the whole family
Over time, the condition placed considerable strain on family relationships. Family members felt frustrated and exhausted, while she felt misunderstood, guilty, and increasingly dependent on them to manage her anxiety.
Treating the OCD, and the accommodation around it
Treatment focused not only on her OCD symptoms, but also on reducing family accommodation. With appropriate OCD-focused therapy, including Exposure and Response Prevention (ERP), the family gradually learned how to respond without participating in rituals or providing repeated reassurance. This helped her build confidence in tolerating anxiety and uncertainty independently.
OCD can look different at home than anywhere else
This case highlights an important point: OCD can look very different at home and outside the home. The ability to resist a compulsion in certain situations does not mean that the person is pretending, or that the OCD is not severe.
If your family has been drawn into checking, reassuring, or accommodating rituals to keep the peace, treatment can involve the whole household — not just the person with OCD. To read more about how OCD is treated in general, including ERP and Deep TMS, see our blog post OCD in Pregnancy and Postpartum: What New Mothers Should Know.
Dr. Swetha Reddy. S
MBBS · DNB (Psychiatry) · Consulting Psychiatrist, Co-founder & Director at Synapse Mind Clinics. Read full bio →
