Obsessive-Compulsive Disorder (OCD)
Feeling driven to perform rituals over and over may indicate that you have obsessive-compulsive disorder (OCD). If you have OCD, intrusive thoughts and ritualistic behaviours may literally take over your life. You have distressing, unwanted thoughts or images that do not make sense to you. These thoughts or images keep coming back despite your efforts to ignore them. You may strive to hide OCD from friends and co-workers for fear of being labelled "crazy".
OCD includes both obsessions (intrusive repeated thoughts) as well as compulsions (repeated actions which you cannot resist). OCD symptoms can be severe and time-consuming. For instance, someone who feels that his or her hands have become contaminated by germs — an obsession — may spend hours washing them each day — a compulsion. The focus on hand washing may be that severe, that the person suffering from OCD is unable to accomplish daily life tasks and / or is unable to function anymore.
OCD obsessions are repeated, persistent, unwanted ideas, thoughts, images or impulses that you experience involuntarily and that appear to be senseless. These obsessions typically intrude when you are trying to think of or do other things.
Typical OCD obsessions revolve around:
- Insistence on symmetry
Examples of OCD symptoms involving obsessions:
- Fear of being contaminated by shaking hands or by touching objects which others have touched
- Doubts that you have locked the door or turned off the stove
- Repeated thoughts that you have hurt someone in a traffic accident
- Intense distress when objects are not orderly, lined up properly or facing the right way
- Images of hurting your child
- Impulses to shout obscenities in inappropriate situations
- Avoidance of situations that can trigger obsessions, such as shaking hands
- Replaying pornographic images in your mind
- Dermatitis because of frequent hand washing
- Skin lesions because of picking at the skin
- Hair loss or bald spots because of hair pulling
Compulsions are repetitive behaviours that you feel driven to perform. These repetitive behaviours are meant to prevent or reduce anxiety or distress related to your obsessions. For instance, if you have a strong believe that you may have ran over someone in your car (although this is not the case), you may return to the scene over and over again because you are just unable to shake off your doubts. You may even make up rules or rituals to follow that help control the anxiety you feel when having obsessive thoughts.
Typical compulsions revolve around:
- Washing and cleaning
- Demanding reassurances
- Arranging or making items appear orderly
Examples of OCD symptoms involving compulsions:
- Washing hands until the skin becomes raw
- Checking doors repeatedly to make sure they are locked
- Checking the stove repeatedly to make sure it is off
- Counting in certain patterns
OCD is more common than you think. It can affect both adults and children. Because the obessions and compulsions can be so hard to disregard, OCD can become disabling and chronic. But the good news is that treatment can help bring OCD under control.
The causes of OCD are probably multifactorial, with genetic and biological influences, as well as environmental influences.
Having parents or other family members with the disorder can increase your risk of developing OCD. Stressful events may also trigger intrusive thoughts, rituals and emotional distress characteristic of OCD. Furthermore, some studies show that pregnant women and new mothers face an increased risk. In these cases, OCD symptoms centre mainly on thoughts of harming the baby.
When to seek medical advice
There is a difference between being a perfectionist and having OCD. Perhaps you keep the floors in your house so clean that you could eat off them. Or you like your knickknacks arranged just so. That does not necessarily mean that you have OCD.
In OCD, your quality of life can decrease dramatically as the condition dictates most of your days and you become consumed with carrying out compulsive behaviors and rituals. Most adults can recognise that their obsessions and compulsions do not make sense. Children, however, may not understand what is wrong. But the lives of both children and adults can be severely affected by OCD. Children may find it difficult to attend school, and adults may find it difficult to work. Relationships may suffer. When the symptoms have such an influence on your daily functioning, it is more likely that you are suffering from OCD.
If your obsessions and compulsions are affecting your life, talk to your healthcare professional, such as your primary care doctor or a mental health professional. It is common for people with OCD to be ashamed and embarrassed about the condition. But even if your rituals are deeply ingrained, treatment can help.
Treatment and drugs
Most OCD specialists agree that a combination of medicines and a specific behavioural type of psychotherapy is the best treatment for OCD.
Several medications have been proven effective in helping people with OCD, such as antidepressants (for example clomipramine, fluoxetine, fluvoxamine and paroxetine). If one drug is not effective, others should be tried. A number of other medications are currently being studied.
A type of behavioural therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and then, is taught the techniques to avoid performing the compulsive rituals and to deal with the anxiety.
Appointment and Enquiry
In NUH, we run a specialised clinic for anxiety disorders. In this clinic, you can expect the latest evidence-based care for anxiety disorders. Anxiety workshops will also be provided on a regular basis. If needed, rating scales will be used to objectify your symptoms. A psychologist and nurse are part of the team.
To make an appointment, call the NUH Neuroscience Clinic at 6772 4850.
For more information on anxiety disorders, visit the website of the Anxiety Disorders Association of America: http://www.adaa.org/