Dear Patti,

My brother and I never knew our dad’s parents as they died before we were born. The only grandparents we’ve known were our mom’s parents and — even though they lived back east — they’d visit on holidays and always send presents and cards. I never had a chance to get to know them but I always felt like they were part of the family. Three years ago my grandfather died and about a year-and-a-half ago my parents were worried and had my grandmother come live with us.

I feel guilty writing this because I love her and know she needs our support but I wish she hadn’t moved in. She’s generous financially to our family and my mother’s very close to her. The problem is that my grandmother has an obsessive-compulsive disorder. She expects my brother and me to clean the house constantly. She throws out our things if she thinks they’re dirty or “full of germs” and is always buying new cleansers and disinfectants. My brother and I are pushed to the breaking point because of her demands. I guess my mom is used to this behavior and my dad ignores it but the whole family is affected by her illness. Is there any way to help the situation?
— Brittany

Dear Brittany,

When someone is afflicted with a psychiatric illness such as obsessive-compulsive disorder, it’s often their entire family that suffers with them. In trying to help a loved one — and still take care of their own needs — they can feel angry, sad and confused. I know it might be difficult, but put your guilt aside, sit down with your parents and explain what you explained to me. While it’s the responsibility of the family to help your grandmother, it’s the responsibility of your parents to make sure the quality of life for you and your brother isn’t compromised because of her condition. This is a very difficult situation, but not an impossible one.

It’s imperative your grandmother see a trained professional who specializes in this disorder. I also recommend family counseling in order for all of you to get guidance on how to support your grandmother, not her illness. While you and your family are trying to be kind and reasonable, too much accommodating the symptoms of her disorder can undermine the therapeutic goal of change — that’s done by challenge, risk-taking and exposure.

As you and your brother have observed, the unrelenting thoughts and behaviors associated with obsessive-compulsive disorder can become tyrannical, with rules and rituals that hinder daily functioning and relationships with others. An obsession is a thought or mental picture that invades a person’s mind, refuses to let go and causes intense worry, concern and anxiety. A compulsion is a behavior that’s done repeatedly in response to that obsessive thought in order to relieve the anxiety. Compulsions take multiple forms such as (1) checking (making sure doors and windows are locked, appliances are turned off, mail has been brought in), (2) ordering (systematically aligning clothes and other items), (3) washing and cleaning, (4) hoarding (keeping large quantities of useless items).

Another compulsion is extreme scrupulosity, where one obsesses over personal sins, or their family’s personal sins, and entertains trivial thoughts or moot religious points leading to repeated confessions or bathing rituals over sexual thoughts.
Typical traps families get into are providing constant reassurance (“Yes, I cleaned the stove”), avoidance (not going into the kitchen because she might insist you wash the floor), participating in time-consuming rituals and tolerating abnormal behaviors. It sounds as if your grandmother has a lot of cleaning rituals in response to obsessions about germs and dirt.

Your grandmother needs to face — not run away from — the feelings that are dictating her behaviors and crippling her life by always having to keep her anxiety in check. In addition to a treatment plan that includes cognitive-behavioral psychotherapy and medication, a therapist can work with her to challenge the thought patterns behind her obsessions, expose her to distressing situations without the usual compulsive ritual, and encourage her to process the exposed feelings. For example, a therapist might assign her to sit in the kitchen without attempting to clean, allow the tension to build, and then deal with the feelings that arise. Make sure you give your grandmother lots of love and support, as this will be an emotionally difficult process for her. Just don’t let oppressive symptoms ruin your lives.