Abstract
For over 25 years, Professor Abramowitz has worked at the forefront of OCD research and clinical practice. In his most recent book, he aims to provide support and practical guidance specifically for families of individuals experiencing OCD. In setting out his rationale, he explains that OCD is a common and debilitating mental health condition, affecting approximately 1–4% of the population. It is characterised by repetitive and intrusive ‘obsessions’ (thoughts, images, doubts or urges), heightened levels of anxiety and the presence of physical and mental ‘compulsions’, which serve to reduce distress in the short term. In almost all cases, OCD also has a significant impact on family members, who become pulled into assisting with rituals, providing excessive reassurance and adapting their own daily routine. This ‘accommodation’ sometimes results in OCD being as impairing and frustrating for family members as for the individual themselves. The key, Abramowitz suggests, ‘is to provide the kind of consistent support that helps their relative develop confidence and skills to manage OCD in a healthier way’. While you cannot change your loved one’s behaviour, you do have the power to change your own responses to OCD and to ‘reclaim your own life’.
The book is targeted at any family member of an individual experiencing OCD, whatever the stage of their recovery. This includes individuals who, for a range of reasons, are not yet ready, willing, or able to start their own therapy journey. The language throughout is simple, compassionate and empowering, detailing a comprehensive and largely behavioural approach that sits solidly within the current evidence-base. Throughout the book, the author clearly sets out what he is going to do and then does it, mirroring cleverly the approach that family members will need to take with their loved ones. Part 1 (chapters 1–4) provides an overview of OCD and its effect on individuals and their relatives. Part 2 (chapters 5–7) helps families prepare thoughtfully and thoroughly for the changes that will need to be made. Part 3 (chapters 8–13) then outlines a step-by-step programme to begin to fight back against OCD in the home. To conclude, Part 4 guides families how to seek the right kind of professional help and to provide effective support, should their loved one decide to engage with treatment.
Across the chapters, the author threads four recurring case studies to bring the challenges and strategies to life. These examples serve to capture the heterogeneity of OCD itself, along with the multitude of ways that it can impact individuals and families. For example, we meet Eduardo, a 17-year-old whose contamination fears have left him room-bound and dependent on 24-hour parental support. We also learn about Linda, a grandmother whose sexual intrusive thoughts have caused her and her husband to distance themselves from their new grandchild. The strength of these case studies lies in their severity and variety. They help to capture the chronic and worsening nature of untreated OCD, while providing comfort and perspective for families at all ends of the OCD spectrum. While many books are targeted at either children or adults with OCD, this one demonstrates that the impact on and the advice for family members is universal. Spanning the lifespan in this way feels refreshing, important and skilful.
Several chapters and messages stand out as particularly important. Chapter 5, for example, lays a crucial foundation in supporting relatives to prepare themselves for change. It kindly and firmly encourages family members to prioritise themselves, engage in self-care and to develop more helpful thinking styles. Chapter 7 then provides clear guidance and examples about how to communicate effectively and assertively with individuals with OCD, even in moments of extreme anxiety. This preparatory section is vital. It is incredibly hard for families to change their response to OCD and to feel confident that they are doing the right thing. They are often experiencing longstanding shame and confusion, as their attempts to relieve their relative’s distress have only served to exacerbate the problem. This book provides valuable confirmation from an expert that standing up to OCD is not selfish, it is not going to cause harm and that it is the most effective way to support their loved one’s recovery.
In Part 3, the author walks families step-by-step through the changes they will need to make. In essence, it is an approach grounded in behavioural principles, encouraging families to reduce their own involvement in OCD rituals in a gradual and supportive way. By doing so, their family member will be exposed more directly to their fears and will learn to experience and tolerate anxiety more effectively. It may even increase their incentive to engage in treatment themselves. For me, the book does well to tackle some of the more severe responses that family members might observe. Often, the fear of physical aggression, or suicidal and self-harming behaviours is enough to discourage families from standing up to OCD at home. Here, the author addresses these concerns head on, in a manner that falls clearly in line with other experts in the field. For example, this approach mirrors the excellent work of Dr Eli Lebowitz and Dr Haim Omer in this area.
In terms of limitations, the book could have gone further in addressing the diversity of families affected by OCD. While the author’s case studies highlight differences in age and OCD presentation, there was less attention paid to different family structures and compositions. For example, single parents or households comprising multiple generations may experience some unique challenges. The impact of OCD on siblings would also warrant consideration. The book would have benefitted from further exploration of the role of cultural factors on families’ experiences of OCD. Although there are advantages of addressing OCD across the lifespan, this approach does limit the detail of content for particular age groups. For example, parents of children with OCD might hope for more detail about how to help their child navigate challenges with school or with peers. Understandably, the book’s summary of ‘how to find the right treatment provider’ is quite USA-focussed in content but guidance is also given for a more international readership.
In summary, Abramowitz’s book is an excellent resource for families, providing practical, enthusiastic and evidence-based guidance for how to support a loved one with OCD. It is easy-to-read, compassionate and packed with clear examples from other families in a similar situation. As a Clinical Psychologist working within a specialist young people’s OCD service, I am often particularly selective about self-help advice for families affected by OCD. However, within a week of reading this book, I had already recommended it to six families on my caseload. For me, that is certainly a marker of success.