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We have a relative with some sort of undiagnosed mental illness who (among other symptoms) compulsively cleans everything regularly with fairly strong bleach. Her fear of germs and infection is the most apparent symptom to my kids, who don't get hugs and know that Relative's house always smells like the pool and she's always vacuuming and wearing many layers of clothing to keep out infection.

What are some ways that I can explain Relative's condition? I want to be honest and sympathetic about it, and explain how it reduces our ability to see her as often as we would like (she rarely leaves her home, and doesn't particularly welcome visitors since it requires additional disinfecting) -- we're not avoiding Relative, but it does interfere with normal interaction.

The children in this case range from 3 to 10, and I'd readily expect that the discussion would change as they get older and more mature.

  • I'm actually not sure your change in terminology was accurate. For example, I have mild Health Anxiety. I don't have the OCD symptoms, though; I think Dan's right that at least in the particular case of your relative, OCD is likely the genesis of the cleaning and avoidance. (I'm not a mental health professional, though I think Dan is or at least seems very knowledgeable of the subject, but from the explanations of OCD it very often manifests in precisely this manner). OCD is based in very strong, often crippling anxiety. – Joe Nov 11 '14 at 17:17
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    I'm reluctant to debate the symptoms and diagnosis because I think it's distracting from the broader question. In this particular case, she's never been "formally" diagnosed and the OCD or health anxiety is not the only symptom/problem, it's just the most intrusive to her interactions with faimly. There's another family member with schizophrenia and one with PTSD and I'd also like to be able to have conversations about them when/if appropriate, but their illnesses aren't as "obvious" to kids. I'm going to edit and see if it's salvagable, or possibly just re-ask :| I appreciate the feedback. – Acire Nov 11 '14 at 17:24
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    Understood, and i'm certainly not the person to debate that with anyway - I was largely basing this off of Dan's original comments... I would suggest perhaps just removing the terms entirely and just give the broad description that you did. – Joe Nov 11 '14 at 17:25
  • That said, I think to some extent it is relevant, because of exactly what Dan answered with: for specific things, and hers certainly sounds that way, there are very good materials out there. Whether it's officially OCD or not, the basis is the same (severe, almost crippling anxiety), and that first link in his answer is very good - it made some things in my head click together and I'm certainly not the target audience. Basically - don't be afraid of resources that seem to pin down the disease when it's not that simple; they're still helpful for kids even if the term is not exactly right. – Joe Nov 11 '14 at 17:26
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    The children's book The Wide Window, number 3 in the Lemony Snicket series, includes the issue of rational-versus-irrational fears, and could help to prompt discussion/debate with your older kids. – A E Nov 11 '14 at 18:39
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Our 10 year-old has obvious mental and physical symptoms of her cerebral palsy, so we've had this conversation many times.

We've found that adults are the ones who have problems coming up with explanations. They try to overcomplicate it and be too politically correct. Kids are usually satisfied with something simple and direct. They ask out of honest curiosity, not out of malice.

We often have kids ask, "What's wrong with her?" While their parents are still stammering, we answer, "Her brain is hurt because it got squished a little when she was born." Sometimes they ask follow-up questions, which we answer just as directly, but usually the first answer is satisfactory. The most common response is "Oh," then they carry on with whatever they were doing before.

In your situation, I would wait until the kids bring it up with something like, "Why couldn't Relative come?" Then just be direct. "She stays home a lot because she's worried about germs, but I'm sure she misses you too." If they ask follow-up questions, answer those as directly as possible without going into long-winded explanations.

I would leave the illness out of it as much as possible, especially since it appears you don't understand it very well yourself. Explain the symptoms in a matter-of-fact way, as a part of who she is, but not the defining part. Tell the kids other nice things about her that maybe aren't as obvious. Explain about the accommodations you expect them to make for her, but emphasize that outside those areas she should be treated the same as anyone else. Honestly though, kids have a lot easier time accepting people's differences than adults do.

  • I agree. Most kids have an awareness of 'germs' as (at least) ubiquitous vague entities that cause illness. It's hard to go wrong with She's very afraid of germs. – anongoodnurse Nov 11 '14 at 19:59
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    I largely think this is perfect. The only concern I have is that I know what my 3 year old would follow up with: "Should I worry about germs too?" Be prepared for that follow-up, and for explaining that she's too worried (maybe in a less-judgy way, but I'm not that good at phrasing at 5pm on a tuesday). You can't entirely avoid discussing the illness, assuming the child is inquisitive like mine are, because they'll wonder why they aren't like that. – Joe Nov 11 '14 at 22:55
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    That's a good point, @Joe. I would probably word a response to that follow-up like, "Her brain works differently than most people's do, which makes her get worried about things you don't need to worry about." – Karl Bielefeldt Nov 12 '14 at 16:39
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    +1, kids do well with direct answers, there's no need to complicate things. – MDMoore313 Nov 12 '14 at 17:21
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    +1. I like that this answer mixes physical issues with mental illness. If you can explain a chronic injury or illness, you should be able to explain mental illness, too. – user11394 Nov 12 '14 at 23:12
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I'm late to this party, but the turn taken in comments is compelling me to speak up.

I don't think political correctness is the goal here; humanity and humility are. If this were another illness - say molluscum contagiosum - would it be OK for a stranger to come up to your children and say "Your mother is a walking sexually transmitted disease, a pox of shame is on her"? Of course not. Why anyone would feel entitled to do this with a mental illness is incomprehensible to me.

Mental illness is an illness, not a choice. People don't usually enjoy their obsessive compulsions. Schizophrenics are not all negligent parents, and I doubt that they are indifferent when their children suffer because of it.

If you have a close relationship with children who are suffering, then do feel free to tell them that this is not the new normal, that their suffering is not their fault, that their parent is mentally ill. Then support them as best as you can. That might involve getting them to see their school counselors, or even calling Children's Services. But you, as a stranger, have no right to upset these kids and walk away, thinking you've done them a favor. If a kid's father beats him because he's a mean drunk and you care about the kid, then do something about it.

With regard to the specific case in the OP's question, fear should be a common vocabulary word, and phobia not far behind. If Relative doesn't visit because she has an irrational fear (phobia) of germs, then make that clear, so that the kids don't think Relative doesn't visit or invite them over because she doesn't like them. They can handle the truth better than the confusion. The same goes for any mental illness. Grandma doesn't visit anyone, not just us, because she's afraid of leaving the house. It's not because she doesn't love you. Her mind is tricking her into being afraid of the world, like if it was filled with scarey biting dogs everywhere she goes. She's afraid to go out. Reassure them that it's not contagious, not hereditary (unless it is), and not a reflection on them. Uncle Pete sometimes talks out loud to nobody because his mind is tricking him into thinking someone is talking to him. You know how you used to be afraid that something was under your bed, but it wasn't real? Well, he has something like that, but he doesn't know it's not real. It doesn't happen to everyone, and it won't happen to you.

That Grandma and Uncle Pete have a mental illness doesn't give any stranger the right to say, "That [old lady/your uncle] is as crazy as a loon, kid. Live with it." This is most definitely not a kindness, either.

The less we stigmatize mental illness, the easier it is to talk about, and the more open your kids can be about asking questions. The more openly they can talk about depression or anxiety, the more freely they can admit it if they experience it themselves. There is no reason people with mental illnesses should feel isolation or shame.

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    A lot of this is a response to another Answer, but I deeply appreciate the thought and sentiment that went into it. In particular, the last paragraph is the balance I'm hoping to strike. – Acire Nov 14 '14 at 17:56
  • I rather like the A POX OF SHAME idea. That's hilarious. On a more serious note the "It doesn't happen to everyone, and it won't happen to you." is strictly speaking a lie. They SHOULD be concerned. The risk for a twin of someone who suffers from schizophrenia is around 50%. Children are at lower risk (12%). But 12% sure isn't the 1% risk the general population has. – ggb667 May 20 '15 at 14:57
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"Hypochondria" is a stigmatising judgemental term. Use Obsessive-Compulsive Disorder (a narrow term that covers some health anxiety) or Anxiety Disorder (a broad term that covers OCD and health anxieties) or Health Anxiety (a perhaps too narrow term).

You don't say how old the children are. For young children you use short sentences. You explain the person is ill. You explain that the person is getting help with the illness. Older children will want to talk about emotions and what they've seen and how they feel about it.

Here's a guide to obsessive compulsive disorder written for young children. http://www.ocduk.org/childrens-ocd-guide

Here's another guide which has some nice information about the difference between normal worry and OCD. http://kidshealth.org/kid/feeling/emotion/ocd.html#

Here's a guide for adults about OCD. http://www.nhs.uk/Conditions/Obsessive-compulsive-disorder/Pages/Introduction.aspx

The NICE guide for OCD and BDD (Body Dysmorphic Disorder) has a section about support for families of a person with OCD, and the support they can expect. http://www.nice.org.uk/guidance/cg031

  • Is hypochondria always directly related to OCD? Or is it that in this case it clearly is? – Joe Nov 11 '14 at 15:52
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    I understand OCD as being a broader problem. I've updated the original question to remove hypochondria. – Acire Nov 11 '14 at 16:22
  • @Joe, This is a tricky question. "There are similarities between hypochondria and anxiety disorders such as panic disorder and obsessive-compulsive disorder." Source: mayoclinic.org/diseases-conditions/hypochondria/basics/causes/… - - - Anyway, this relative doesn't fear having an undiagnosed serious illness, as far as we know, so it seems the consensus to call her problem OCD makes sense. – aparente001 May 21 '15 at 3:28
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Ok, my wife was 11 before some kind stranger told her her mother was mentally ill. It's a pretty simple concept. I'm sorry Christine, but your mother is sick. Until then she thought her mother's bizarre behavior was normal.

If someone had just explained it to her earlier a LOT of trauma could have been avoided. Her mother has severe schizophrenia or whatever they are calling it these days, but because her grandmother was too "ashamed" or whatever to give it to her straight it really screwed up my wife's childhood. Kids aren't dumb. Tell them what is going on so they can make sense out of the world.

The same goes double for drugs and triple for sex. If mother is a drug-addicted prostitute, say that. You can follow this up with a more nuanced explanation like "It's not because of anything you did, and it's not because she doesn't love you, or that you're not worthy of love, it's because she's addicted and she HAS to do anything she can to get a fix, even if it means hurting those around her." Now little Greg is armed with reality and can defend himself properly as much as possible both physically and mentally.

NOT telling your child is the moral equivalent having them cross the street blindfolded. Nothing bad MIGHT happen but you sure as hell are responsible if it DOES. Misguidedly trying to preserve innocence is not preventing harm here, it's causing it. Just go straight for the throat of the problem and tear it out. This goes for everyone with a problem, fathers who drink and beat people, crazy relatives, drug addicts, pedophiles whatever. Lay it out so the child knows which side is up.

Lots of people are stuck in bad situations where the other choice is something worse. But to a child, KNOWING that things aren't NORMAL gives them a chance to have a normal healthy life. Denying them basic reality is like locking them in a closet so you don't have to see them cry.

In the case of something mild like OCD just say "Yea, something's wrong with her, she's a bit crazy when it comes to cleaning, and that's not normal." You can then go on with "It's probably nothing to worry about. If you see her doing something else thats really strange, talk to another adult about it. We want to keep her safe." Kids want reassurance and a way to calibrate 'normal' with what they see.

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    I don't think being told one's mother is crazy or nuts is particularly kind, either. Nor is it a stranger's duty to point it out. Finally, are there any men in your world who have problems, or is it only women? +1 for dealing straightforwardly with Mental Illness. -1 for misogyny and disrespect of the afflicted. Net = 0. – anongoodnurse Nov 11 '14 at 22:21
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    GG, I'm all for clarity (and am a little dismayed by the amount of straightfaced PC in this post), but I think calling someone with a touch of OCD "nuts" is a little severe, however applicable the word may be to your -- or anyone's -- mother-in-law. How about "she just worries about germs much too much"? – Malvolio Nov 12 '14 at 0:05
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    There are a lot of forms of mental illness which aren't dangerous to others. While brutal honesty may be best in some cases, I'd rather have a respectfully truthful conversation about it with my kids. – Acire Nov 12 '14 at 1:19
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    Calling someone "crazy" or "nuts" is NOT being honest, nor kind, and you need to be both honest AND kind to children. Using derogatory labels to describe someone with a legitimate illness is dishonest, because it teaches stereotypes and stigma, not the truth. The truth is that the individual has a health issue, which is likely outside of their control. If a child is taught only how to label, and not understand the real situation, it's the moral equivalent of teaching them to judge people by their race, religion, gender, or any other arbitrary criteria. – user11394 Nov 13 '14 at 0:26
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    It's not "feel good" gobbeldygook, it's the truth. It's not about being PC, it's about being accurate. You can have clarity with children, without demeaning them by using overly simplified, derogatory language, and without being lazy in your explanations. Children will respond better to someone being genuine and kind. Once they're old enough to realize you're giving them half-baked answers (the most professionals wouldn't agree with), you'll start to lose that trust you've supposedly gained. – user11394 Nov 14 '14 at 0:31
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Working as in a facility where we welcome all children, I've had this conversation many times with children.

One of the kids that comes to our facility regularly has Down syndrome. The past summer she started attending our summer camp, and she was put in my group of 4 year olds. I had a few come up to me and ask what's wrong with her.... I just replied with a simple answer "Sometimes when you're inside mommy's tummy uh oh happen, and then that baby is born a little different."

It worked for them, and they seemed to understand and after that they were very helpful and understanding of the little girl with Down syndrome.

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    Down's kids are the sweetest . . . it's as if the intellectual deficit allows some deeper aspect of humanity to shine brighter. – Marc Nov 17 '14 at 5:32
  • What is "uh oh"? – Arsak Mar 6 '18 at 22:17
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Maybe a complete opposite approach is worth to try. Focus on what you want. I assume the interaction between Relative and your children is as safe as they are with you. (Keep in mind that things you want consist of positive acts that create synergy, altruism is key).

What could create a stronger bond between Relative and your children? What do you like Relative for yourself? What does Relative bring for positive things in the world with his/her existence? Focus on that, keep that in mind, tell that to your children. What can you do to make both Relative and your children experience the best of what the relation of Relative <-> children can be? Use your will power to create just that. How would that feel, to you, to Relative, to your children?

I believe that if you do all this with a sane (knowledgeable) mind, you will make the most out of the situation.

Addition

Relative is thinking about a pink elephant in the living room, which isn't there, but the idea is bothering her. Now you are talking about a pink elephant in the room, which isn't there, but you are now also thinking about that pink elephant int he living room. Relative behaves different because of the idea of the pink elephant in the living room, which is very stuck in her mind. You want to explain her behavior to your children by discussing the pink elephant sympathetically. Now there are 4 of you, thinking about this pink elephant, which ins't there. Relative wants to hold on to the pink elephant, because she is afraid to let it go. It is affecting you, and you are affecting your children, so the elephant is to stay. Now your children have to think about the pink elephant as well, which isn't there, but it helps them to understand Relative's behavior...

Logically reasoning you should loose the pink elephant and the problem is solved. Stay as close to the solution as possible. I understand this isn't easy, and it is not Relative's choice to have that pink elephant in the room. But she wants it to go away as well, but she is afraid to think about letting the pink elephant go. If you want a practical answer: Tell relative to calm down when your child sneezes. No discussing of the pink elephant required. And you are the example figure to your children. You define what is normal behavior (at least your children trust you more in it, than they do trust Relative on that matter).

Yes, Relative will be annoyed by the fact that you don't believe in the pink elephant. Because she thinks that pink elephant is required to protect her from illness (or whatever her fear might be).

why is Mommy ignoring Relative? what's up with this pink elephant anyway?

There is a nuanced difference about ignoring and not going along with it. You can show sympathy for the fact that Relative suffers from a pink elephant in the living room. That doesn't mean you agree it is there, you agree with it being a burden to Relative. So you stil show empathy, but you stay with the solution of removing the pink elephant.

still sends no clear message to the kids

Yes there might be conflicts. But is this about avoiding conflicts or about doing what is best for your children? Do you want your children to learn how to get rid of pink elephants that jump around in their own minds? To track them down, face them and remove them by focusing on what they do want. Or do you want to learn them that other people should mind those pink elephants inside your childrens mind, or otherwise your children have all the right to become annoyed towards those people?

Now to put this more clearly I am convinced that everybody has pink elephants in their minds. Because everybody has fears (or atleast 99.99% of the population does). Relative has big pink elephant and yours, your childrens and mine may be quiet a bit smaller.

I think by acting solely towards Relative about what is the normal behavior (on a moment is matters) is a clear message for your children when they witness the situation. They will also feel that you have a strong mind and will. You will be their example, they can trust you. You know what is right, and you dare to act upon it. You don't burden your children with all the problems in the world, but you teach them to focus (and therefore experience) all the great things life has to offer. So they will dare to do the same. meanwhile you have shown your empathy as well, which your children will also show towards others that act upon their pink elephants.

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    Well, it's arguably not "as safe" from an emotional standpoint. Take a sneeze: at home I'd ask the child to blow their nose and wash their hands, but Relative gets very concerned and pushes for an immediate ER visit (for the sneezy kid, not for herself). They're scared and confused by this. I encourage positive stories to be shared by extended family, but I also need a way to explain the irrational side of her because they notice. Her problems are part of her, and when they interfere with other interaction, limiting kids' exposure and sympathetically explaining the issue is my goal. – Acire Nov 14 '14 at 13:44
  • Relative worries about sneezes, now you are worried about your children sneezing their. Are you going to make your children worry about it also by talking about the OCD? Then you are all caught in Relative's drama. Try to break free from it. That is what relative wants but is becoming more difficult if you are trapped in the drama aswell. – Mike de Klerk Nov 14 '14 at 15:28
  • I'm not sure I understand your approach. A sneeze happens and Relative pushes for a doctor's visit because Child may have pneumonia or influenza. How does avoiding an explanation that this concern is misplaced help the kids sort out the mixed message (I say sneezes are normal, she implies they're harbingers of doom)? Also, Relative doesn't want to create drama, it's just a side effect. She can't help what she's feeling or saying (and addressing the irrationality directly with her is neither my place, nor necessarily possible). – Acire Nov 14 '14 at 15:53
  • See the update in the answer. – Mike de Klerk Nov 14 '14 at 17:33
  • I understand better where you're coming from now, but I still disagree with the method. This approach has literally never worked for us; refusing to discuss the pink elephant increases Relative's agitation (why is nobody concerned about the pink elephant!) and still sends no clear message to the kids (why is Mommy ignoring Relative? what's up with this pink elephant anyway?). While I am well-practiced at coping with the various "pink elephants" (I don't, for example, indulge her and take Sneezy to the ER immediately), denying a full explanation to Sneezy doesn't feel appropriate. – Acire Nov 14 '14 at 17:53

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