Understanding Recovery Avoidance in OCD
Dan would sit in a chair for hours, "stuck" and unable to move. He couldn't eat, socialize, or enter most buildings. My son was suffering from severe OCD, yet I couldn't help but feel lucky. The reason? He was willing to do whatever it took to get better.
This is not always the case. In this wonderful article on recovery avoidance, the authors suggest that recovery avoidance is one of the main reasons why the majority of OCD sufferers do not receive appropriate treatment. I personally know of some young adults with significant OCD who are living at home and not receiving treatment of any kind. As an advocate for OCD awareness, I jumped at the chance to enlighten their families as to the benefits of Exposure Response Prevention Therapy. Turns out they already knew about this therapy and where and how to get help. But their loved one was not willing, or able, to accept this help. This can be heartbreaking for the entire family.
While I can certainly relate to avoiding a problem or difficult situation, I could never really understand choosing to live with a debilitating disorder when there is effective treatment available. Again, the authors of the article give us insight into the factors involved in recovery avoidance:
"We believe there are two main reasons why some people avoid recovery. The first reason is fear. Those who do not have OCD often fail to appreciate the level of fear an OCD sufferer experiences. The fear may not be based on realistic concerns, but that does not matter. What a person perceives determines the level of fear. The very thought of giving up the avoidance and compulsions can be overwhelming to an OCD sufferer. These counterproductive ways of coping create an illusion of safety and control that is not always easily surrendered. Nobody wants to be disabled, but some OCD sufferers are terrified of getting better. The second reason some people avoid recovery is what we term incentive deficits. Incentives are things that push a person to act. Money, for example, motivates people to go to work. Money is an incentive. Human behavior is influenced largely by incentives, and recovery behavior is no exception……We can summarize the relationship between fear, incentive, and recovery behavior with a general proposition: All things being equal, a person will not seek recovery unless the incentive to get better is stronger than the fear of getting better."
In my son's case, the above analysis makes perfect sense. Dan is an artist and has been passionate about becoming an animator for years. His hard work paid off when he was accepted into one of the best colleges in the world for animation. When OCD struck with a vengeance toward the end of his freshman year, there was no way he was going to give up his dream. Pursuing thisdream was his main incentive to get better. In fact, he wanted help so badly that he couldn't wait to spend his summer at a world-renowned residential treatment program for OCD.
We are fortunate that Dan found his passion at such a young age, as it served as such a powerful incentive for him to recover. Also, before severe OCD struck, Dan was a happy child with a lot of joy in his life. I think this knowledge of how wonderful life could be was also a strong incentive for Dan. He had a great life and he wanted it back. For those OCD sufferers who havestruggled at length with depression or have never known happiness, the incentive to recover from OCD may not outweigh their fears.
Dan was at home for a month before entering the aforementioned treatment program, and at this point the scales tipped for him. He had completed his freshman year successfully, so what was his incentive at this point? Sure, he wanted his life back, but he knew he would be getting intensive treatment soon. He told us, "I'm tired of fighting, it is just too hard, and I need a break." Though it was only for a short time, I saw how this lack of incentive to fight allowed his OCD to once again gain control over him. It truly is a battle.
So how do we help those with recovery avoidance win this battle, when they are not even fighting?I feel one of the most important things we can do is have a heartfelt conversation with our loved ones where we express our concern and desire for them to get well. Included in that conversation should be the declaration that we will no longer be enabling their OCD. The other thing families need to do, which I know is not always easy, is to continue on with their lives in a positive way. Humor has always been a big part of my family's life, and even during his darkest days, Dan could still laugh, and for a moment all would be well. Being around others who are living productive, happy lives, in addition to not enabling, may just add some of that needed incentive to seek treatment.
Those with OCD certainly cannot be forced to seek treatment, especially when it involves such anxiety provoking therapy as ERP. While we can offer the proper support to our loved ones,the decision to work toward recovery is ultimately theirs alone. And if we're lucky, at some point their incentives to recover will outweigh their fears.