Need help with OCD patients

I had a lovely 90-ish lady with OCD and I really loved taking care of her.
Of course, it took 45 minutes to get her ready for bed, and more if someone tried to rush her (she'd get upset and have to "start over again") or forcer her to change her routine.
She was too old to change--one LPN who bulled her way into the unit, tried unsuccessfully to force her to change, and just made it worse -- even though Velma knew she was "clean" she simply couldn't help herself.
She also had one of the cleanest, most well-irrigated colosomy bags in the WORLD.
As I got to know her hx, I could see what happened to her. She was taught to do sterile dressing changes for her husband and he gradually deteriorated and died. She was alone. Then she had to have a colostomy.
That became a sterile procedure when the bag broke open on her a couple of times in the night.
So....it was her coping mechanism.

She's gone now, God love 'er, but I still miss chatting with her while I irrigated her colostomy bag of every single drop of it....

I think these folks need a lotta comfort and patience. They need to know they can follow their routine, and they will, even if it means getting less sleep. And they may not be able to change.

So if you want someone to go to Group for instance, and their routine gets in the way, try asking them what time they need to wake up in order to fit it into their schedule.

Had a support group with 30 women with OCD (one of the most fun times of my working career) ten years ago as part of a research study...

NEVER say "just stop it". They hear that a lot and it makes them more anxious and thus the OCD gets worse.

Be aware that the outward compulsive acts are usually done in response to inward mental obsessions -- which the patient will be very reluctant to tell you about. Obsessions tend to be horrifying thoughts that the patient would NEVER act on but is afraid s/he might (example: an image of cutting off a beloved grandchild's head); so the patient engages in counting, or cleaning, or other compulsive acts to allay the anxiety.

Intellectually the patient is fully aware how bizarre the behaviors and thoughts are. And may even have a well-developed sense of humor about it. But still, can't stop the actions.

It kind of helps your understanding, if you remember when you were a little kid, and couldn't step on a sidewalk crack for fear of hurting your mom...when you were doing it, it really seemed real...for a person with OCD, it's real ALL THE TIME and it's a lot more than sidewalk cracks.

OCD can be treated with behavioral modification or SSRIs or a combination. Behavioral mod can take a looong time but it does work as well as (if not better than) medication. Of course, sessions with a specialist psychologist are not inexpensive...and neither are SSRIs.

There's some thought that the OCD might be in reponse to something that happened when the person was a child (such as molestation or death of a loved one) and still in the "magical thinking stage" (where if s/he does something special, the bad thing won't happen again). The original trauma may be forgotten or lost. Anyway, the kid gets in that rut and can't get out again.

Can't think of any books offhand, but there are some good ones out there...there's at least one that teaches the person how to identify and avoid or nullify thoughts that may prompt the obsessive thoughts; it's been a long time. I'll try to think of the title for you. Had a copy, but don't know if I still have it; moved 7 times since then...

Hope this is helpful!

AHHHH!! OCD now here is a real challenge. In my psych practice, borderline and OCD were always the most challenging folks to work with for sure. I had a lot of sucess working a few individuals with OCD. The key nto my sucess was patience more patience, and then some more patience. Also my unconditional positive regard and acceptance for these souls was also an invaluable asset. You cannot treat OCD from a book so don't even try. The best therapy method for these individuals is CBT. Cognitive Behavior Therapy. It is rarely practiced outside of private practice as it is intense and very long term treatment. Most people with OCD are very aware of their behavior and sometimes that makes it worse because they know what they are doing but are powerless to stop the behavior. I have always maintained and demanded from staff that these folks be treat with dignty and respect and above all patience and tolerance. DEADNURSE