The offspring of parents with Obsessive Compulsive Disorder possess an increased risk of suffering from social, emotional and anxiety-related disorders as compared to offspring with normal parents. All anxiety disorders are based on an overactivation of the fear system in our brains – this fear involves unwanted thoughts, impulses, or images and the attempts to suppress or neutralize them with compulsive behaviors or mental acts. Anxiety in turn is not a fear of a thing; it is a fear of the way we think about a thing. People with OCD start to imagine greater and greater probabilities that the things they fear might actually happen, despite the true probability of their happening. These thoughts are indeed illogical, nevertheless patients feel overwhelmed by them. A response to such obsessions includes a person performing compulsive behaviors in an attempt to somehow get rid of or neutralize the obsessions. Additionally, OCD is not a communicable disease; it is a disorder hence it develops based on how an individual’s brain processes information from his or her environment and that individual’s resulting actions. One without OCD may touch a garbage can and think nothing of it, while one with OCD may touch it and develop fear of being contaminated to the point of obsession. It is not influenced purely by our genes; if it were, every time an identical twin developed OCD, the other twin would as well. Therefore, it is the interaction of our environment and our brain that leads to the development of this disorder. More commonly, parental, school, or religious expectations are considered to be the root of the obsessive-compulsive behaviors. The ritual or avoidance behaviors conducted by patients are what affects others the most. OCD however, is a disorder that can be treated. Patients of OCD can therefore learn to live healthy and productive lives in the future. Their high levels of general anxiety and low mood can thus be combated against. An environmental aspect is further present that encourages the development of OCD behaviors in children of parents with OCD. Yet if this was the only factor, then these children would most likely have the same obsessions and compulsions as their parents, but this is rare. Statistically, males tend to develop OCD earlier than females; otherwise, the course and prevalence of OCD appear the same across genders. It is important to note that OCD may spring from abuse, illness, death of a loved one, relationship problems, or changes in living situation. While the exact cause of this disorder is still not clear, it is likely to be caused by a combination of biological and environmental factors.
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The risks and susceptibilities to someone who develops OCD are immense. According to the National Institute of Mental Health, 2.2 million Americans are diagnosed with OCD. In effect, obsessions go away only for a certain period of time. When they return however, getting rid of them takes a bit more effort than it did the previous time. Anxiety disorders make their sufferers feel disproportionately anxious or fearful – in OCD, obsessive thoughts, images or impulsive that are intrusive cause a great deal of distress. One way people with OCD attempt to get rid of a thought is to suppress it – they try convincing themselves not to think of it and ignore it. Unfortunately, this is often as unsuccessful as getting a song out one’s head that one has been singing all day by not thinking about it. Therefore they enter the compulsion as a result of trying to get rid of the obsession. In addition, as the OCD progresses in the sufferer, rituals increase more and more often. Everything has to be in order and done the correct way; a person might straighten a picture that is not hanging straight to satisfy his discomfort or this may be a mental compulsion such as saying a prayer the correct way a number of times. Recent research has also shown that new parents are at a higher than average risk of OCD, possibly because of the increased stress that having a baby can bring to their lives and their possible obsessive focus on the safety of their new child. It also appears that one’s risks of developing OCD are increased if one has a family member with OCD, if one has some of the chromosomal markers for the disorder, if one has certain abnormalities in specific parts of one’s brain, and if one reacts to intrusive thoughts, images, or impulses in such a way that one believes having these thoughts, impulses, or images can somehow make them come true. In scientific fact, if anyone in one’s immediate family has OCD, one’s chance of having it is about 20 percent, versus around 2.5 percent in the general population.
OCD is a very serious disorder – of all the mental health disorders, it is considered one of the most serious in terms of the amount of burden it causes the population of the world. This is a result of several factors: the ability of OCD to affect people across the age spectrum (from children to senior citizens), the difficulty in finding specialized treatment, and the devastating effects it can have on people who suffer from it. Some may suffer from OCD so severely that they engage in behaviors that are highly painful or isolating. For example, some individuals shower for over twenty-four hours straight to wash off germs, live in only one room of their home for years to avoid spreading any contamination, or go to confession on a daily basis because they are afraid that they might have committed a sin. Also, as avoidance behaviors are allowed to continue unchecked, they will lead to more and more rituals, as well as possibly more involved rituals, such as adding more steps to the ritual or having to do the ritual for longer and longer periods of time to reach the desired calm. Reassurance from others then becomes like an addictive drug. As a result of this, preoccupied with the needs of the patient, and feeling blamed and burdened, family members may pull away from their usual social contacts and become increasingly isolated themselves. Thus regardless of whether patients with OCD live with partners or with parents or other relatives, it is clear that OCD can have adverse effect on the quality of family life and family interaction. Many families become dysfunctional as a result of a family member’s OCD symptoms and the family’s involvement in those symptoms. Some family members become involved in the sufferer’s avoidance behaviors and compulsions in an effort to relieve the fear and anxiety that the sufferer is feeling. To date, only two studies have closely examined the familial effects of OCD, both focusing on family accommodation. Calvocoressi et al. (1995 surveyed family accommodation to OCD symptoms by interviewing 34 family members of patients who were diagnosed with OCD. She reported that nearly one-third of family members reported frequently reassuring the patient. A third participated in behaviors related to the patient’s compulsions, and the same number reported taking over activities that were the patient’s responsibility. Family and leisure-time routines and activities were modified at least moderately in order to accommodate the patient for 35-40% of families. These modifications in family plans appeared to be at least partly efforts to manage the patient’s distress, as evident from the moderate to severe anxiety and anger reactions shown by 40% of patients. Clearly, these accommodation efforts also led family members to experience distress, with 35% showing moderate distress and 23% severe or extreme distress. OCD parents tend to never put their kids first and are often abusive. Some obsessionals are able to dominate their families completely with their rituals, to the extent that literally every action in the household revolves round their cleaning. There are instances where the bathroom might be put out of bounds to other family members for hours on end each day. These days, the ratio of women affected by OCD to men is about 1.5 to 1.
There are three reactions to OCD – one will either fight it off, run away from it, or freeze and hope it passes by. Children become pressured to meet the perfectionistic demands of the parents. Seeking security and acceptance from the parents, the child will strive to meet these demands. In time the child internalizes these standards and becomes perfectionistic. The perfectionistic demands intensify and when they can no longer be met, the child becomes anxious. In one circumstance, the wife of a man with extreme hoarding rituals had to raise their children in a single room of a large home, which her husband had filled completely with papers, wood, and a variety of objects from the trash that he considered is potentially useful. In addition, he became violent whenever she had attempted to remove items or insist that he do so. Also, a high percentage of adults with OCD do no marry. Some studies have reported that 60-70% of patients were single (e.g., Coryell, 1981; Hafner 1988; Steketee, 1993). Marital discord, divorce and separation, alcohol abuse, and poor school performance are commonly reported results of the stress that OCD puts on the patient and family members. Children who experience more negative life events in turn have lower self-confidence. Other clinical studies have reported elevated levels of perfectionism in the families of OCD patients. The child’s response to his affected parents is often nonspecific, such as social withdrawal and the long-term effects vary according to the child’s history, maturity and his social supports. These children also often suffer emotional abuse or neglect from their parents. Moreover, some doctors and therapists have come to opposite assessments of character traits of obsessionals. For example, obsessionals have variously been described as both immature and mature, self-deprecating and arrogant, as well as both timid and aggressive. They might swing from one extreme on a scale to another, depending on the context in which they find themselves. Their children thus will not receive the proper care that they need. The way OCD affects other people in the family may thus be quite different. Some might feel angry or frustrated with OCD. Some people may feel sad about how difficult the OCD patient makes things for them, others might not seem to care at all. Family members may think that the sufferer is weird and ignore him. Sometimes, it may also appear to OCD patients that people in their family are upset or frustrated with them, rather than the OCD.
Marital problems are extremely common in patients with OCD. Emmelkamp, de Haan, and Hoogduin (1990) found that nearly half of their sample of 50 married OCD sufferers reported experiencing marital distress. According to Khanna et al. (1986), married patients sought treatment later than unmarried ones. Hand (1988) suggested that in some cases, a spouse or family member might develop their own obsessive-compulsive symptoms in response to a patient’s symptoms, but this assertion has only anecdotal support. The risk of disturbed child development is greatly increased by marital conflict. Apart from causing direct distress to the child, the parents may disagree in their views about child care, causing inconsistency and poor limit setting; they may show less affection to the child, and they may be poor role models for the child, for example in household tasks, decision making or conflict resolution. To study the direct emotional effects of psychiatric illness on children becomes difficult as it may not be possible to separate them from indirect effects of the illness such as unemployment and social disadvantage. Socio-economic problems and being a lone parent are important factors that contribute to parental stress that may result in maltreatment of the children. In addition to this, the parent may become an unskilled breadwinner, which is a great disadvantage to the child, making his life more difficult.
The attitudes of family members towards each other may contribute greatly to the child’s development. Harder & Greenwald (1992) found that positive family interactions and good recovery of the mentally ill parent after hospitalization, protected sons from distress. In other situations, some family members will have the opposite reaction and start treating OCD suffers within the family in a negative way, and avoid interaction with them. OCD behaviors may make people uncomfortable. More likely, relatives may wonder why sufferers have only recently started behaving in ways they don’t understand. They might think that the sufferer is trying to be difficult or different, or get attention for the sake of it.
Inefficient parenting due to OCD may cause adverse effects on the children. An older child may become particularly embroiled in parental marital difficulties as a result of a close confiding relationship with one parent and may prematurely take on a parenting role with younger siblings. Furthermore, Bowlby’s attachment theory (Bowlby, 1969) proposed that the child’s early relationships with parents are internalized as ‘working models’ for later relationships, which may be greatly affected for the worse. This relationship includes the parent ensuring safety and providing structure and discipline, and participating in join activities such as play, games or conversation about each other’s lives. There has however been rather inconsistent support for this theory. Lo (1967) also theorized that perfectionism in parents leads to perfectionism in offspring and subsequently OCD symptoms. Anxious children are further more likely to experience posttraumatic stress. Thus these anecdotal reports and contact with clinic patients make it clear that OCD rarely leaves the family system unaffected.
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It has also been found that there many times where children of OCD parents are left only very slightly affected. Child psychiatrists and other professionals may observe relatively subtle behavioral changes such as anxiety and fearfulness. Others have found little or no difference between families of OCD patients and normal families (e.g., McKeon & Murray, 1987). Despite these inconsistencies, there is mounting evidence for increased rates of obsessive compulsive disorder (and general psychiatric disorders) among family members of obsessive compulsive patients.
The understanding between parent and child is crucial in a child’s development. It may e that a psychotic or severe depressive episode is understood by the child as an illness, and therefore not really part of the relationship. Conversely, it may be experienced by the child as part of the identity of the parent, and hence pose a challenge to the continuity of a child’s experience of the parent and their relationship. Either way, the child has to make sense of very dramatic changes in the mental state of the parent. Thus this means that the quality of the relationship between parent and child outside of the episodes of disturbance is likely to be crucial. A number of studies of family interaction have looked at the effects of family communication on the developing child. High levels of negative expressed emotion and particularly critical comments by depressed or anxious parents are associated with a number of disorders, including depression, substance misuse and conduct disorder in children (Schwartz et al., 1990; Hirshfield et al., 1997) and, when pervasive, may be considered a form of emotional abuse (Hall, 2002). Every family is different, and no family will cope with OCD in the same way. Thus it is best for other family members to be patient and supportive of the sufferer in his fight against OCD, and it is equally important for the sufferer to be patient and supportive of family members who are struggling to understand what the sufferer is experiencing. Some families accommodate OCD symptoms to such an extent that their lifestyles revolve around the patient’s requests. Other families become isolated, losing contact with extended family and friends outside of the home. Within the home, living situations can often become very restricted due to cleaning and washing rituals, fear of contamination, and hoarding that confines living space. A strong relationship and understanding is therefore essential between parent and child, as severely negative or rejecting reactions would exacerbate anxiety and depression, as well as obsessions and compulsions.
Parents with OCD often behave in unacceptable ways. They may use their disorder as a king of bargaining chip with which to extract favors or make threats to their children. In other instances, an OCD parent may come into conflict with the law as an indirect rather than direct consequence of the disorder. Isaac Marks wrote of a woman who washed her hands as much as a hundred times every day, occupying hours of time and making her skin bleed. Her salary was not sufficient to pay for the quantities of soap and disinfectants required by her behavior. She was arrested for shoplifting, and children in effect may think of this as an acceptable behavior when it is not.
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