Severe OCD and Aggression: A Family's Struggle

Q: Severe OCD and Aggression: A Family's Struggle

Hello, Xiong Ni： It seems that your brother is exhibiting symptoms similar to obsessive-compulsive disorder, along with increased irritability and a heightened risk of violence. <br>I recommend that you gather evidence of any violent behavior or property destruction (such as phot

Hello, doctor?

I have a younger brother who is 21 years old.
About two years ago, he started showing symptoms of excessive handwashing.
Initially, he was just washing his hands more frequently, but it later escalated to washing for long periods using a lot of soap, and then he began taking multiple showers a day.
Eventually, he started splashing water around the house.
His temper became very irritable; he would get angry easily, throw things around, and even physically confront others.
He began to control when we could go out and come home, with whom we could go out, and demanded to be informed of all our activities.
He became fearful of going out, maintaining a distance from others, and developed a strong dislike for everyone.
He would often curse at anyone who displeased him and threatened to destroy their belongings or harm them.
There was an incident where he fought with our father, and the police were called, but since there were no visible injuries and our father was concerned about him having a criminal record, he told the police that everything was fine.

During a second incident, neighbors called the police again.
The police arrived, but since our father was involved, they instructed him not to accompany my brother, so our mother went instead.
She was also worried that he might end up with a record for parricide and feared he would be harmed in treatment, so she also told the doctor that he was fine.
The police allowed him to return home.
Later, my father explained the entire situation to the police, detailing all of his symptoms over the past three years, but the police stated that the law requires direct evidence to be collected, and another incident would be necessary for mandatory treatment.
My father expressed that he is now exploding in anger daily, throwing things around, and he fears that if another incident occurs, it could be disastrous.

We sought help from the social services, but they said it was government policy, and we truly don't know what to do anymore.
Recently, my mother mentioned that he is troubled by nocturnal emissions, which he finds very irritating and feels he cannot control.
This has been ongoing for many years, contributing to his irritability and reluctance to go out because he finds the situation sticky and disgusting.
He is also unwilling to seek treatment; we previously took him to see a psychiatrist, but he wouldn't speak, so the doctor could only prescribe sleep aids, which he refuses to take, complaining that he has been on medication since childhood and questioning how long he has to continue.

Now, no one dares to live with him; we live in constant fear and even dread going home.
We are at a loss for what to do.
I searched online and found this place, hoping to seek help.
Thank you.

Xiong Ni, 20~29 year old female. Ask Date: 2017/06/10

Dr. Lin Mianzhang reply Psychiatry

Hello, Xiong Ni: It seems that your brother is exhibiting symptoms similar to obsessive-compulsive disorder, along with increased irritability and a heightened risk of violence.
I recommend that you gather evidence of any violent behavior or property destruction (such as photos or videos).
If he poses a danger to himself or others again, you should contact the police.
According to Article 19 of the Police Authority Enforcement Act and Article 32 of the Mental Health Act, the police have the authority to take him to a hospital for a medical evaluation.
If the physician determines that he meets the criteria for involuntary hospitalization, the procedure for involuntary admission can be initiated.
Take care!

Reply Date: 2017/06/10

More Info

It sounds like your brother is experiencing severe symptoms of Obsessive-Compulsive Disorder (OCD) along with aggressive behavior, which can be incredibly distressing for both him and your family. OCD is characterized by intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions) aimed at reducing anxiety. In your brother's case, the compulsive hand washing and bathing, along with the excessive cleaning behaviors, are classic signs of OCD. However, the escalation to aggression and controlling behavior indicates that there may be additional underlying issues that need to be addressed.

The aggressive outbursts, such as throwing things and threatening violence, are concerning and suggest that your brother may be struggling with more than just OCD. It is not uncommon for individuals with OCD to experience heightened anxiety and frustration, which can lead to irritability and aggression, especially if they feel overwhelmed by their compulsions or if they perceive a lack of control over their environment.

Given the situation, it is crucial to seek professional help. Here are some steps you can take:
1. Immediate Safety: The safety of everyone in the household is paramount. If your brother's behavior poses a risk to himself or others, it may be necessary to contact emergency services or a mental health crisis team. They can assess the situation and provide immediate support.

2. Professional Evaluation: It is essential for your brother to undergo a comprehensive evaluation by a mental health professional. This evaluation should include a thorough assessment of his symptoms, history, and any co-occurring conditions such as anxiety disorders, depression, or possible personality disorders. A psychiatrist or psychologist can provide a diagnosis and recommend appropriate treatment options.

3. Therapeutic Interventions: Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for OCD. Exposure and Response Prevention (ERP), a specific type of CBT, helps individuals confront their fears and gradually reduce their compulsive behaviors. Additionally, medication, such as selective serotonin reuptake inhibitors (SSRIs), can be beneficial in managing OCD symptoms and associated anxiety.

4. Family Support: It is important for your family to seek support as well. Family therapy can help improve communication and understanding within the family unit. It can also provide you and your parents with coping strategies to deal with the stress and emotional toll of living with someone who has severe OCD and aggression.

5. Crisis Planning: Given the history of aggression and the involvement of law enforcement, it may be helpful to create a crisis plan. This plan should outline steps to take if your brother becomes violent again, including who to contact and how to ensure everyone's safety.

6. Education and Resources: Educating yourselves about OCD and its treatment can empower your family to better understand what your brother is going through. There are many resources available, including support groups for families dealing with OCD and mental health issues.

7. Encourage Treatment: While it may be challenging, encouraging your brother to engage in treatment is vital. He may resist initially, but expressing concern for his well-being and the impact of his behavior on the family can help. It may be beneficial to approach the conversation when he is calm and receptive.

In summary, your brother's situation is serious and requires immediate attention from mental health professionals. The combination of OCD symptoms and aggressive behavior can be complex, and a tailored treatment plan is essential for his recovery and the safety of your family. Remember, you are not alone in this struggle, and there are resources and support available to help navigate this difficult time.

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