Verified by 
Key points
- Defiance is normal when accommodations are reduced.
- Pushback is a sign of frustration, not of personal hatred.
- Family members often protest and argue for accommodations they no longer enjoy.
- Oppositional behaviors can become violent or lead to self-harm; family can address them through communication.
My daughter has compulsive tendencies but also oppositional behavior, meaning we fight efforts to help her. What strategies might we use to help her stop despite her fighting us? —A concerned parent
It’s common for parents to experience oppositional behavior from children with obsessive-compulsive disorder (OCD) and related disorders. One reason is that stopping the accommodation of compulsive behaviors can be very difficult for both parties. It’s counterintuitive not to offer a loved one immediate assistance. For the sufferer, it’s daunting to face “alone” the resulting torrent of anxious energy triggered by fear once accommodations are relaxed. That said, reducing accommodations is an important step to attaining progress in both therapy for the sufferer and peace for the family at home.
In The Family Guide to Getting Over OCD (2021), Jonathan Abramowitz offers several evidence-based techniques to address oppositional behaviors. We’ll address a few strategies to address oppositional behavior in OCD by understanding pushback, verbal protests and arguments, violent behavior, and threats of suicide or self-harm.
Understanding Pushback
It’s normal to expect your loved one with OCD to push back when you reduce accommodations to their obsessional triggers and cycles. In a psychological sense, this phenomenon illustrates an extinction burst, in which some behavior (i.e., the accommodation) is terminated, resulting in an emotion-laden attempt to get it back (i.e., a burst of anger, etc.) (Abramowitz, 2021; Abramowitz et al., 2019). Remember, don’t take the pushback personally because the loved one is in pain, not hateful of your existence.
Verbal Protests and Arguments
Family members who feel abandoned by their loved ones often lash out through arguments, passive-aggressive behavior, emotional appeals, or other attempts to push their buttons. It is a normal response to retrieve something (a temporary sense of security) they feel they have lost. In response, family members should focus on communication.
Indeed, communication among family members to set clear boundaries is perhaps the most critical element in responding to oppositional behavior (Culkin & Culkin, 2021). First, the family must all agree on their approach to reducing accommodations and their responses to their loved one’s anticipated reactions. Next, they must calmly convey to their loved one, in a synchronized message, that they will support her, establish clear boundaries and expectations, and listen to her (Abramowitz, 2021). Doing so will not erase arguments or outbursts but help establish healthy boundaries and expectations of acceptable behavior.
Violent Behavior
Anxiety can result in a “fight” or aggressive type of behavioral response (Abramowitz, 2021). It does not necessarily change the need for communication noted above. In fact, to establish the conditions for such communication, family members may consider some or all of the following tips to collaborate with the loved one:
- Schedule a quiet time and a safe place for a sit-in for at least an hour, especially after the sufferer has a violent episode.
- Sit down in your loved one’s presence and ensure neither is angry.
- Tell them how they broke your expectations—e.g., “This morning, when Mom refused to wash your dishes a second time, you opened the liquid detergent container and threw it at her, staining her dress. This is unacceptable, and we will stay here and wait for you to suggest a solution to this problem. We are not punishing you but cannot accept this behavior in our home” (Abramowitz, 2021).
- Leave the room quietly after a reasonable solution is offered.
Threats of Suicide or Self-Harm
Always take threats of self-harm seriously, regardless of the loved one’s age. This normally means taking him or her to the nearest emergency room where a mental health professional can assess their safety. There can be an increased risk of suicidal intent in OCD sufferers with comorbid conditions of depression, substance abuse, or impulse-control disorders (Clark, 2020). Mindful tools emphasizing presence, self-compassion, forgiveness, empathy, and patience can reinforce lessons learned from therapeutic practices (Didonna, 2020). That said, communication with your loved one remains the primary defense: a means to understand their concerns, needs, and limits.
Conclusion
Although OCD affects families in unique ways, it is common for sufferers to push back against their loved ones who reduce accommodations for obsessional fears. We reviewed some strategies to address oppositional behavior in OCD by understanding pushback, verbal protests and arguments, violent behavior, and threats of suicide or self-harm. Communication to set healthy boundaries is a foundational skill to counter oppositional behaviors.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
References
Abramowitz, J. (2021). The Family Guide to Getting Over OCD. Guilford.
Abramowitz, J., Deacon, B., & Whiteside, S. (2019). Exposure Therapy for Anxiety: Principles and Practice (2nd ed.). Guilford.
Clark, D. (2020). Cognitive-Behavioral Therapy for OCD and Its Subtypes (2nd ed.). Guilford.
Culkin, D., & Culkin, M. (2021). OCD and Marriage: Pathways to Reshaping Your Lives Together. Specialty Press, Inc.
Didonna, F. (2020). Mindfulness-Based Cognitive Therapy for OCD: A Treatment Manual. Guilford.
