People with symptoms of OCD and BDD may experience marked pain and suffering, however they are not the only one affected by the disorder. As a family member or friend of someone with these symptoms, you may be feeling various emotions including fear, anger, confusion, and guilt (Wilhelm, 2006). It is undoubtedly difficult to watch someone you love suffer and you may be unsure of the best way to help. Fortunately, there are things that you can do to support your loved one. Read below for some tips on how to help a family member or friend with BDD, OCD, or a related disorder.
The first step to helping your loved one is to educate yourself about OCD, BDD, or a related disorder. The more informed you are about the disorder, the more effective you can be in understanding what your loved one is experiencing and how to help them.
How to do this:
a. Gather resources for yourself in order to learn about the disorder.
Internet, book, and audio resources are available especially for family members of those with OCD, BDD, and related disorders.
- For families of an individual with OCD, visit OCD and Families, a website created by our colleague, Dr. Lee Baer,
the family section of the International OCD Foundation.
- For families of an individual with BDD, visit BDD Central
- For families of an individual with Tics or Tourette Syndrome, visit the National Tourette Syndrome Association
- For more information about books and other recommended readings, visit our program’s recommended reading page
the International OCD Foundation books resource page.
b. Check out support groups for family members of individuals with OCD and related disorders.
Many people find it helpful to attend a support group for individuals and family members of those with OCD, BDD, or a related disorder. Participation in these groups will allow you to talk with and receive advice from other individuals and families in similar circumstances. To find a support group near you, visit the International OCD Foundation support group page for OCD and related disorders, or the National Tourette Syndrome Association for Tourette Syndrome or Tics.
Many kinds of treatment are available for OCD, BDD, and related disorders. The best treatment for your loved one may depend on their specific symptoms, severity of symptoms, and/or their particular treatment preferences. Treatments for OCD and related disorders include outpatient therapy, psychiatric medication, residential treatment, or self-help approaches.
For various reasons, your loved one may be reluctant to seek treatment. Commonly endorsed reasons among individuals with OCD and BDD for hesitation towards seeking treatment include shame about one’s symptoms, concern about the cost of treatment, and skepticism about whether the treatment will work for them (Marques et al., 2010; Marques, Weingarden, LeBlanc, & Wilhelm, 2011). However, you may be able to help your loved one gain the courage to learn more about treatment options.
How to do this:
a. Calmly approach your loved one about their symptoms.
Tell you family member or friend about the symptoms you have noticed. Be calm, direct, and specific. For example, you could say something like, “I have noticed that you seem to think and talk a lot about cleanliness. You spend a lot of time washing and showering, and lately you’ve had trouble getting to work on time. You seem so anxious and unhappy. I’m really worried about you” (Wilhelm, 2006). You cannot force your loved one to get treatment, but you can genuinely and non-judgmentally express your concerns and observations.
b. Engage in a discussion of the next steps to take.
Listen non-judgmentally to what your loved one has to say. Tell your family member or friend that you want to help them feel better in whatever way you can. Engage them in a discussion about what you have learned about their symptoms through your research and offer to help them find treatment providers that specialize in the disorder (Wilhelm, 2006). If you live in the Boston area, you can contact us at 617-726-6766 about treatment options. To find treatment providers near you visit the International OCD Foundation.
c. Provide resources.
When talking to your loved one about their symptoms, bring readings and resources about their symptoms. Offer the information to your family member. If they seem reluctant to engage with the resources, leave them around so they can read or listen to them when they feel ready.
d. Take the first steps together.
Taking the first step of going to treatment can be especially scary. If your loved one is hesitant about seeking treatment, offer to go with them to the first few sessions. If applicable to your situation, you can even suggest going to family or couples therapy.
e. Offer hope.
Many people with BDD, OCD, and related disorders are hesitant to receive treatment because they do not believe it will work for them. Reiterate to your loved one that most people experience a reduction in symptoms after receiving empirically-validated treatment for their disorder, such as Cognitive Behavioral Therapy (CBT) or medication.
If they have already tried one form of treatment, encourage them to seek an alternative type of treatment. If multiple courses of outpatient therapy have yielded little success in the past, suggest looking into residential treatment programs that specialize in the treatment of OCD, BDD, or related disorders (Wilhelm, 2006). For information about intensive treatment programs, visit the International OCD Foundation.
Importantly, if your loved one expresses thoughts of suicide, take this seriously and be sure to seek emergency help.
Family members of individuals with OCD and BDD sometimes engage in behaviors with or for the person in an effort to alleviate their loved one’s distress or avoid confrontation and anger. Common family behaviors include helping a loved one with his or her rituals, replying to requests for reassurance, or doing tasks for the person that he or she wants to avoid. Although these behaviors or reassurances may mitigate your loved one’s distress and anxiety in the moment, they are ultimately not beneficial to his or her psychological wellbeing in the long run.
Given that OCD and BDD are often accompanied by severe distress and anxiety, not engaging in these accommodation behaviors with your loved one may be difficult for you and your family member both. However, there are ways you can support your loved one and help alleviate their distress without strengthening their disorder. Thinking about your loved one as separate from his or her disorder can sometimes be helpful for family and friends. A good question to ask yourself is: “Are my behaviors helping my loved one or their disorder?”
How to do this:
Sometimes family members do not even realize they are engaging in behaviors or conversations that enable their loved one’s disorder. Instead, their intention is often to lessen the intense distress their family member is experiencing. As such, it’s important to be able to recognize these behaviors. Please read the International OCD Foundation's list of common family accommodation behaviors.
Although it is crucial to stop enabling the disorder, these accommodation behaviors may have been going on for a long time. Thus, family members and friends should not suddenly stop all ritual involvement and reassurance. Instead, discontinuing family accommodation behaviors should be done gradually and with the support of a professional.
Let your family member know that you will be decreasing your involvement in their rituals and explain why. You can inform your loved one that you are available to help them reduce their symptoms and feel better, but engaging in the behaviors with them or providing excessive reassurance will only make their symptoms worsen.
Develop a plan together about how you will handle the situation when disordered behaviors arise. Dr. Wilhelm notes that some individuals with BDD find it helpful when family members “make certain statements as reminders of the big picture” when they are engaging in BDD-related behaviors. For instance, “Is your nose really more important than going to your sister’s graduation right now?” Or, “How likely is it that people will be thinking about your nose at this event?” (Wilhelm, 2006).
Set realistic goals together with your loved one about reducing behaviors. If you are gradually decreasing your involvement in rituals, create a limit on the amount of times you will help with rituals or provide reassurance per day. For instance, if your family member asks for reassurance more times than your predetermined limit, you can reply; “We’ve agreed that I will answer these kinds of questions only once a day, and I’ve already answered this morning, so I’m not going to respond right now” (Wilhelm, 2006). Some families even find it helpful to create a family contract to collaboratively agree upon ways to diminish compulsions.
In reducing these behaviors, it is important to be compassionate, firm, and consistent. Seek advice from a professional for help in developing a plan.
c. Validate your loved one’s feelings of distress.
Not engaging in rituals or providing reassurance for your loved one does not mean you must ignore him or her. Let your family member or friend know you see that they are distressed or anxious, and that you are willing to support them in any way so long as it’s not making their disorder worsen.
For individuals with BDD and OCD whose obsessions may appear delusional or excessive, do not engage in lengthy conversations or arguments with them concerning the actuality of their concerns. For example, do not argue with them about whether their perceived flaws in appearance are real or imagined. To them, the anxiety and stress associated with the obsessions are exceptionally real.
d. Keep your normal family routines.
A more subtle form of accommodation behavior is altering household routines or rules in the process of conceding to your loved one’s disorder. Examples include not having guests over or avoiding certain rooms or places. You should make changes gradually, but it is important to preserve your “normal” family routines and activities. Do things that make you happy and maintain your peace. Encourage your loved one to do the same.
Creating a positive and supportive environment can be essential to your loved one. Your family member may take comfort in knowing that they have you as an ally with whom to fight their disorder, as well as someone to acknowledge their accomplishments.
How to do this:
a. Let go of guilt and blame.
Many family members find themselves feeling guilty as if their loved one’s disorder is their fault. Blaming yourself is counterproductive and dwelling on those painful feelings will only make you feel worse. Instead, focus on productive action you can take to improve your current situation and work towards a brighter future for you and your loved ones (Wilhelm, 2006).
Similarly, having a mental illness is not your loved one’s fault or choice, nor is it a reflection of weakness or defect of character. Watching your family member or friend with OCD, BDD or a related disorder engage in seemingly useless rituals and avoidance behaviors may indeed make you feel angry and frustrated at times. However, statements such as “just get over it!” or “why can’t you just stop?” are futile. Instead, let go of blame and work on ways you can fight the disorder together.
b. Take it slowly and recognize that everyone responds to treatment differently.
There is no overnight cure for OCD, BDD, or related disorders. Recovering is indeed possible, but it takes time to change deep-seeded negative beliefs and avoidance behaviors. Moreover, the treatment process will involve ups and downs. Accordingly, be sure to avoid day-today comparisons of progress as some days will be better than others. Instead, focus on the big picture and remind your loved one that tomorrow is a new day to make an effort.
Furthermore, people recover at different rates. Encourage your loved one to do the best that they can, independent of other people’s expectations or anticipated rate of symptom improvement. There is no “perfect” way to get better.
c. Acknowledge small victories and effort.
Recognize your loved one’s achievements no matter how small or trivial they may seem. Let your family member or friend know when they have done a good job or when you see them putting forth a significant effort, even if they don’t complete their goal. Such praise can be a powerful motivator for your loved one to keep trying. Make your loved one aware that you believe in their ability to transcend his or her problem.
Marques, L., LeBlanc, N.J., Weingarden, H.M., Timpano, K.R., Jenike, M., & Wilhelm, S. (2010). Barriers to treatment and service utilization in an Internet sample of individuals with obsessive-compulsive symptoms. Depression and Anxiety, 27, 470-475.
Marques, L., Weingarden, H.M., LeBlanc, N.J., & Wilhelm, S. (2011). Treatment utilization and barriers to treatment engagement among people with body dysmorphic symptoms. Journal of Psychosomatic Research, 70, 286-293.
Van Noppen, B., & Pato, M. (2010). “What can I do to help?” Retrieved from: http://www.ocfoundation.org/EO_FamilyTips.aspx
Van Noppen, B., & Pato, M. (2010). Living With Someone Who Has OCD: Guidelines for Family Members (From Learning to Live with OCD). Retrieved from: http://www.ocfoundation.org/EO_FamilyGuidelines.aspx.
Wilhelm, S. (2006). Feeling Good About the Way You Look: A Guide for Overcoming Body Image Problems. New York, NY: The Guilford Press.