In my years as a therapist, I've seen countless people through the sometimes devastating aftermath of infidelity. Of course, no two relationships are alike, and the immediate days and weeks following the discovery can be full of extremely strong emotions that vary by the minute. Will your relationship survive — and should it? Will you ever be able to trust again — and would you want to? What does all of it mean, and how did your relationship get to this point? Was it ever what you thought it was?
All of those questions will take time and exploration to answer. Now, however, you can take a few important steps to find your footing. Address your physical and logistical needs. If there was an argument, do you have a safe place to sleep? Are there close friends or family that need to be on standby to help with logistical issues if you or your partner have decided to get some space from each other? Are there children or pets that need to be prioritized in order to not let things get outwardly explosive? The more intertwined your lives have become, the more mindful you need to be that as emotional as you may be feeling, there are logistical considerations to be taken care of, so that you keep the nuts and bolts of your daily life stable.
Mobilize your coping strategies. Though you may not be ready to make any decisions yet, you need to lay a solid foundation where you can think decisions through, enact a plan, and begin the healing process. This means doing everything you can to get sleep when you can, get fresh air and exercise, decide who in your social circle might be helpful to have know about this, and try — even in the chaos — to make time for things that usually help you relax, like exercise, meditation, artistic hobbies, or yoga. Don't look at it as getting through one event, but rather taking care of yourself through a period of life that will have several different stages.
Plan communication. Depending on how the discovery of infidelity happened, and how much you are entrenched with your partner in terms of living situation and family, you may be doing anything from pretending everything is normal while you have breakfast with your children to screaming at each other nonstop to giving each other the silent treatment.
Whatever you do, make sure it is an autonomous choice, and that you are not being goaded into talking — or not talking — out of pressure. Do you want to sit down and have a conversation about it once you are feeling more calm? Do you want to talk it over in a therapist's office? Do you want to meet in a neutral place to discuss a plan for the coming weeks while you get your bearings? Now is the time to figure out how to communicate in as reasoned a manner as you can muster, because games and stunts will not be helpful in the long run.
Enlist your support network. One of the toughest parts of the initial stages of something like this is that you may feel very alone. You may be embarrassed to talk about it to others, or you might want to tell everyone you've ever met — but know that you should not. Choose carefully.
The decision of what to say and what not to say is a personal one, but you should keep several things in mind. Tell the people who you know will have your best interests at heart and be in the position to offer emotional support. The level of detail is up to you, but don't tell someone solely out of anger. It might come back to haunt you if you decide to make amends with your partner. And make sure that you remind yourself that just because a loved one has a certain opinion about your relationship or your partner — for better or for worse — doesn't absolutely mean you should agree with it.
From hoarding to handwashing to forever checking the stove, obsessive-compulsive disorder (OCD) takes many forms. It is an anxiety disorder that traps people in repetitive thoughts and behavioral rituals that can be completely disabling.
Surveys conducted by the National Institute of Mental Health show that 2 percent of the population suffers from OCD—that's more than those who experience other mental illnesses like schizophrenia, bipolar disorder, and panic disorder. OCD might begin in childhood, but it most often manifests during adolescence or early adulthood. Scientists believe that both a neurobiological predisposition and environmental factors jointly cause the unwanted, intrusive thoughts and the compulsive behavior patterns that appease the unwanted thoughts.
Unless treated, the disorder tends to be chronic—lasting for years, even decades—although the severity of the symptoms may wax and wane over the years. Both pharmacological and behavioral approaches have proven effective as treatments; often a combination of both is most helpful. For more on causes, symptoms and treatments, see our Diagnosis Dictionary.
The Varieties and Symptoms of Obsessions
These uncontrollable thoughts or behaviors can interfere with a person's work, school, and relationships. Though the behaviors may give the person momentary relief from his overall anxiety, he doesn’t derive pleasure from the obsessiveness. People suffering from obsessive-compulsive habits may also contend with motor tics or repetitive movements, such as grimacing and jerking. Research into OCD is ongoing. For example, defects called micro-structural abnormalities have been found in the brain’s white matter of those who suffer OCD, and frontline treatment for this disorder includes exposure and response prevention, as well as plain old empathy and compassion in delivering therapy.
The first symptoms are the obsessions—the unwanted ideas or impulses that occur over and over again and are meant to drive out fears, often of harm or contamination. "This bowl is not clean enough. I must keep washing it." "I may have left the door unlocked." Or "I know I forgot to put a stamp on that letter." The compulsions appear after that—repetitive behaviors such as handwashing, lock-checking, and hoarding. Such behaviors are intended to mitigate fear and reduce the threat of harm. But the effect does not last and the unwanted thoughts soon intrude all over again.
Sufferers may understand the uselessness of their obsessions and compulsions, but that is no protection against them. OCD can become so severe that it keeps people from leaving their homes. The condition strikes males and females in equal proportions.
What Causes OCD?
Current scientific thinking holds that OCD results from a confluence of factors—a biological predisposition, environmental factors including experiences and attitudes acquired in childhood, and faulty thought patterns.
The fact that many OCD patients respond to SSRI antidepressants suggests the involvement of dysfunction in the serotonin neurotransmitter system. Ongoing research suggests there may be a defect in other chemical messenger systems in the brain.
OCD may coexist with depression, eating disorders, or attention-deficit/hyperactivity disorder, and it may be related to disorders such as Tourette's syndrome, and hypochondria, though the nature of the overlap is the subject of scientific debate.
How to Treat Obsessions and Compulsions
Either psychotherapy or medication, or both, may be prescribed for OCD, and patients may respond better to one form of treatment than to the other. Studies conducted by the NIMH, however, show that combination drug-psychotherapy is best for young people. The drugs given are typically one of the so-called SSRIs, or selective serotonin reuptake inhibitors. The SSRIs fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil) have been specifically approved for the treatment of OCD. These drugs have been shown to reduce the frequency and severity of obsessions and compulsions in more than half of patients, although discontinuation of drugs often leads to relapse. Behavioral therapy for OCD tends to produce long-lasting effects. Psychotherapy generally focuses on two aspects of the disorder: unraveling the irrational thoughts involved in the condition and gradually exposing sufferers to the feared object or idea until they are desensitized to it and can tolerate anxiety without engaging in compulsive rituals.
Is OCD on the Rise?
Rates of OCD have not gone up, but public interest in the disease (and its various forms) has. Hoarders and those compelled to engage in rituals to ward off disturbing thoughts have lately appeared as characters on the big and small screens. A slew of real-life sufferers of OCD have written memoirs and sought help in the public eye. There is also evidence that subclinical obsessiveness about cleaning and germs could be on the rise.
About a third of adults with OCD developed the disorder as children. The repeated rituals those with OCD engage in, such as constant handwashing or hair-pulling, are meant to allay anxiety, but the relief does not last for long. As with many other mental health conditions in children, the best and most durable treatment is psychotherapy.
A critically important clinical feature of obsessive-compulsive disorder (OCD) is the pervasive secrecy of patients suffering from the condition. OCD involves recurrent, disturbing thoughts and recurrent and excessive behaviors, including rituals and constant checking. Secrecy about OCD symptoms has been responsible for a long-standing, marked underestimation of the true incidence of the illness. Although clinical recognition has increased, patients' secrecy, shame and denial continue to have an impact on assessment, treatment, and the validity of research results.
More than with many other many psychiatric disorders, OCD patients do not spontaneously or voluntarily report their symptoms to health providers or even intimate family members. OCD patients fear that revealing their symptoms will lead to severe censure and disapproval because the symptoms are often ego-dystonic and seemingly antisocial or bizarre in nature: repetitive obscene or blasphemous phrases, for example, or thoughts of attacking children or loved ones or removing one's clothes in public. Also, there is reason to believe that secrecy has its own function in both the formation and perpetuation of OCD symptoms, which serve to protect against painful anxiety.
The feelings of shame and desire for secrecy strongly influence patients' open acknowledgment of the senselessness of symptoms. OCD patients are characteristically highly concerned with approval from other people, and their acknowledgment or denial of symptom senselessness is often determined by assumptions about the expectations of interviewers, raters or administrators of self-report measures, rather than provisions of truthful accounts. There is very likely somewhat more acknowledgment of senselessness in those indulging in checking or else cleanliness behaviors, the latter being more congruent with the values of middle-class culture and therefore more individually and socially acceptable.
Attempts at diagnostic measurement, including studies of accompanying personality disorder symptoms, have been extensively confounded by the problem of shame and secrecy. These studies have shown markedly variable results. Such wide variation in itself suggests unreliability of diagnostic instruments, but less shameful-feeling obsessive-compulsive personality disorder (OCPD) patients are also secretive about reporting certain behaviors and characteristics—in this case, irrational control, hoarding, rigidity, miserliness, and meticulous perfectionism.
Sensitive extended clinical evaluations, because of trust and familiarity developed, reveal a full range of OCD patterns. Patients will readily supply answers when asked simple questions in an unthreatening manner. The questions must rely on voluntary report and in each case, the patient should be asked to evaluate the excessiveness and inappropriateness of behaviors stipulated.
How much is "excessive"? It is up to the trained clinician together with the patient to determine the answer. This orientation is also necessary for ongoing treatment and the following of specific features of the illness. In order to determine whether the patient engages in excessive checking behavior, information is gathered about job histories, including whether one repeats tasks. If so, how often?
At home, how many times is the lock on the door tested when the patient goes out, how often are the stove burners checked, how long does it take to dress in the morning? In order to assess cleanliness, the patient is asked about patterns of housekeeping, showering and handwashing. Are particular places avoided because of possible contamination or dirt? For symmetry and order, questions are directed toward preferred placement of objects in the home, pictures on the wall, and preferences about physical work environments.
For assessment of obsessional thinking, information is effectively evoked by identifying everyday difficulties in living and performing. Commonly reported problems in sleeping are followed by questions about the possibility of bothersome or repetitive thoughts that keep the patient awake. Similarly, if a patient reports distractions and inability to concentrate at work or at school, questions are asked about mental preoccupations
Obsessive disorder has long been hidden and difficult for both sufferers and therapists. Currently, various treatments are available with varying degrees of promise. A number of SSRI medications have shown beneficial effects, including clomipramine, fluoxetine, paroxetine, sertraline, and fluvoxamine—and psychotherapy is an absolute must.
Thom Kessler, LMFT, RAS
Marriage & Family Therapist and Registered Addiction Specialist