When you stop reassuring or checking or whatever you are currently doing for your OC spouse, child, or other family member, she may feel a great deal of distress. This is not necessarily because you seem to be withdrawing your support. It may well be because “this time” it feels different. There really is a sore on her skin that looks like a manifestation of AIDS, she really did leave the stove on because she was distracted … and so on. As strange as it may sound to you, each time can feel like a new crisis to a person who has OCD.

If you're familiar with the British and American improvisational-comedy TV program Whose Line Is It, Anyway?, you've probably seen a game called “Improbable Mission.” In this take-off on the late 1960s/ early 1970s classic adventure show Mission Impossible, participants use extraordinary means, such as imaginary jet-powered devices, to take on ridiculously simple tasks. So instead of performing daring acts to preserve national security, they lower themselves into a lady's bedroom from the rooftop, for instance, in order to wax her bikini line. The game is all in fun, but that's how it can feel to have OCD: The smallest tasks often seem to require outsized effort.

To a person who has OCD, the world can seem like a place teeming with terror. A routine activity or situation that you might not think twice about can hold an OCD sufferer in dread. Example: You accidentally drop an apple slice on your kitchen floor. You answer the phone in another room and return later to pick up and discard the apple fragment. A person who has OCD (depending on what kind) might have the same experience. But, perhaps after finishing the call, he remembers the fallen apple slice and envisions rats scampering out of the woodwork, attracted by the fragment, to invade his kitchen and entire home. He may have similar thoughts many times a day; they might even have become a kind of “background music” that he scarcely takes much notice of anymore, though you can be sure they take a considerable toll.

Roadblock to Recovery

For many OCD sufferers, the biggest obstacle to recovery is fear. And fear of fear.

Many people, both those with OCD and those without, fear the long-term consequences of medications on their health or even on their lives. Often, CBT or other therapies present anxiety-making situations for the person who has OCD. He may agonize about seeing a therapist whose office is in a hospital or in a run-down part of town, or about whether he'll be expected to shake hands at his first meeting, whether other people will find out that he's in therapy (and even why), or any number of things. Although you may feel frustrated by what seems to be excuse making, keep in mind that such worries can be very daunting for a person with an anxiety disorder. Everyday activities can look, to the OCD sufferer, as dangerous as climbing an icy mountain inhabited by half-starved grizzlies.

Doing What You Fear

If your friend already knows that CBT involves doing the very things that frighten her to pieces as it is, she might understandably feel a paralyzing terror when she thinks about this kind of therapy. (However, the good news is, it's probable that on another level, she would like nothing more than to be able, eventually, to do the things she's so afraid of now.)

In any case, change of any kind is often scary. And, as we've discussed, uncertainty can be among the most feared things.