Experiencing compulsive behaviour

Obsessing over hygeine and compulsive washing of hands and bathing in fear of contamination is a medical condition that can be treated with professional help. Vasuprada Kartic, Psychologist and Dr Purnima Nagaraja, Psychiatrist discuss the issue at length.

I am a 17-year-old boy...I have a younger brother aged 15.
Problem is with him that he gets extremely violent at times. He repeatedly washes hands, spends hours bathing, feels the world is full of contaminants and forces me also to bathe repeatedly.
Of late, he is locking himself in his room. My parents are very worried and force me to be with him. My studies are affected due to this...I don't go out anywhere. I am extremely upset and depressed and can't see a way out. My parents don't take him for medical help as they are afraid of his violent behaviour. I have been suicidal of late. Please help my brother, my family and me.

Hi! First let me appreciate you for managing yourself so well through this till now! I understand your difficulty as an older brother, having to balance your brother’s as well as your own emotions since you have to spend so much time with him. It may be a challenge to relate to him fully because of his behaviour.

Even though your brother’s violence is what stands out to your family it is important to look out for the triggers. Control, or the lack of it, plays a significant role. Outbursts can be seen as a reaction towards feeling isolated, and not being able to understand why he feels the need to behave the way he does. Stress can make it more difficult, I advise you to stay calm, not to debate too much with him, and not have heavy expectations or restrictions at the moment, as that can add to his tension. Focusing only on ‘problem’ behaviour causes wrong behaviour, so engaging in neutral conversations or things that are of common interest, is advisable.

Your brother is experiencing compulsive behaviour, which means feeling extreme need for repetitive actions like washing hands, or cleaning again and again, etc. Most of the time, these actions are a result of a fear or anxiety that something bad could happen or something should go right. In the initial stages these may seem as quirky habits but tend to get worse later due to stressors, change, challenging situations, etc.

This also affects students and study skills because they will find it difficult to manage time as starting, stopping and restarting from the beginning any learning is a pattern.
I understand your concern about your brother locking himself in the room, as repetitive negative thoughts can also cause depressive symptoms and aggravate obsessional thoughts, mostly negative ones.

Your feelings of being depressed are probably because of carrying the responsibility of your brother, when most of your peer group is leading quite care-free lives. Sometimes, there is a possibility that you feel you are not a priority for your family, as attention and effort seem to go to your brother. Whatever it is, suicide is NOT a solution! Talk about your feelings and seek help – Mental health professionals can comfortably guide your family to initiate help to your brother without causing outbursts, can guide you with your feelings and study skills and your family as a whole, to bring back balance. You then will be able to create time for yourself, for all activities that matter to you.

- Vasuprada Kartic,
Anthroposophic Counsellor
and Psychotherapist.

Your plate certainly seems to be piled high. Let me divide it into relevant portions understand it better and look for systematic solutions. Firstly: your brother and his behaviour. Second: your parents' angst and their inability to manage him. Third: your own emotional burden.
Let me start with your brother.

From what you have written, he seems to have symptoms of psychiatric illness and/or personality traits that could be obsessive in nature (you would get more clarity about his condition once you see a professional).

Kindly approach a mental health professional for help.

Advice your parents to take advice on how to convince him to visit a professional, how to communicate with him, and manage him until he seeks help.

They can also seek help by subscribing to online counselling and advice for themselves and your brother. Maybe it might help convince your brother to seek help.
Second: A little advice for mom and dad.

It is unfortunate that their fear is incapacitating them so much that they are unable to see that your brother needs help.

My advice to them would be… “please take help and support both professional and from family to empower you to.”

Seek counseling: Counselling will help you deal with your fears, denial and other emotions, which are interfering with acting out and dealing with the issues that you are facing with your child.

Please remember that he is only 15 and has a long way to go. He certainly deserves a better quality of life.

Also, please understand that your older child is also only 17. While it is certainly good to involve him in the caregiving process, too much will cause a burn out, depression and frustration...which already seems to have set in.

Take turns in managing your younger son...that way everyone gets to understand him better.
Practice 'firm love': Which means conveying to him that 'though we love you unconditionally, some behaviors such as violence have to stop.

Be optimistic and cheerful around him..it will make him less anxious. Talk to him with kindness and empathy and not harshness. Never use a physically or verbally violent approach when dealing with him…it will only make matters worse. Your younger son needs all the love, patience and understanding he can get.

Dear parents, I can understand your anguish...but please take help…for him and for yourselves.
Now for you my friend!
Please don't sink into despair… I feel your parents see you as strong, stable and resilient person and probably that's why they lean on you emotionally.

Gently convey to then that you are feeling overwhelmed. Take short breaks out with your friends or cousins.

Take personal therapy to help you un burden yourself as well as to understand your brother’s condition.

Always remember that there is light at the end of the tunnel. Don’t contemplate suicide…you have many wonderful things ahead of you in life.
Please understand that your brother isn't doing this on purpose and that he needs support and help to move ahead.

Help him to help himself...focus on days when he wasn't like this and relive those happy times.
Those memories will invigourate you and sharpen your determination to see him again.

Remember, wonderful things are waiting to happen in your life.
Stay strong! Stay resilient! Stay positive!

-Dr Purnima Nagaraja
Consultant Psychiatrist
and Psychotherapist.

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