Obsessive Compulsive Disorder

Occasionally, our mind wanders onto something unpleasant that we did not want or expect to think about. This is very common and all of us would have experienced this before. However, in obsessive-compulsive disorder (OCD), these unwanted thoughts or images, also known as obsessions, are persistent and recur all the time. These obsessions cause much distress to sufferers of OCD and they often try to counteract them with other thoughts or actions, otherwise known as compulsions.


The distress combined with the large amount of time spent obsessing and carrying out the compulsions leads to considerable impairment in the sufferer’s ability to carry out daily activities. Obsessions most often revolve around fears of dirt or germs (“My hands must be dirty, I need to wash them now.”), fears of harming others (“I am going to harm my child accidently, I need to be extremely careful”), or pathological doubt (“I think I did not lock up the house, I’d better go home and check now.”). OCD sufferers are often aware that these obsessions do not make sense, but yet because of their fear that something terrible will happen, they feel that the obsessions might still be true. This thus compels them to carry out the compulsions, which are normally grouped into 5 different types: cleaning, checking, repeating, ordering/arranging, and counting. The obsessions cause the person anxiety and the compulsions reduce the anxiety somewhat but only for a short while.


A recent survey showed that almost 3% of people in Singapore will suffer from OCD in their lifetime which is one of the highest figures in the world. OCD most likely begins in late adolescence or early adulthood.


What causes OCD?
Biological
Research has shown that the brains of people with OCD function in slightly different ways from others and this may cause them to have an increased number of obsessions. An increase in a chemical called serotonin has also been thought to contribute to the development of OCD.

 

Genes
Research has found that the immediate family members of an OCD sufferer are more likely to develop OCD.

 

Personality
OCD sufferers may have more anxious personalities. They may also have an increased sense of responsibility, leading them to feel responsible for the bad thoughts that they may have.


How do you know if someone is suffering from OCD?
A person may be suffering from OCD if he or she has had repeating thoughts that are not about real-life problems (e.g., thoughts that he or she will cause serious harm to others one day). He or she may regularly repeat the same activity for an abnormally high number of times a day in the same orderly manner (e.g., constantly doing washing hands in a particular and rigid way). You may also notice that the obsessions and compulsions take up more than an hour per day and also cause difficulty for the sufferer in carrying out their daily activities.


How do you help someone with OCD?
You can help by understanding that OCD behaviours are symptoms of an illness and not something the person with OCD wants. Do not criticize the person for his or her behaviour. Instead, encourage them to seek help from a mental health professional. Be patient with the person and support their treatment program as it is usually a long process.


If you suffer from OCD, how do you help yourself?
Do try to learn as much as you about OCD. Keep a diary of your obsessions to keep track of where and when each obsession occurred, and also what they consisted of. Try your best not to act out your compulsions and figure out in what situations your obsessions occur. Then come up with strategies to confront these situations in better ways instead of avoiding them. You can manage your stress by practicing relaxation techniques such as deep breathing or muscle relaxation techniques. Developing good health habits such getting regular exercise, eating regularly and getting enough sleep will also calm you down. It is important that you seek help from a mental health professional.


How is OCD treated?
Both medication and psychotherapy have been found to be effective in the treatment of OCD. The decision to use medication, psychotherapy or both should be made by both the patient and the mental health professional.


Drug treatment
Studies have shown that antidepressant medications are useful in the treatment of OCD. However, there is a high chance of relapse when medications are discontinued.


Psychotherapy

  • Cognitive-behavioural therapy (CBT) has been found by multiple studies to be effective for the treatment of OCD.
  • A key component is exposure and response prevention. This involves putting the OCD sufferer in contact with situations that make him or her feel anxious followed by a commitment by the sufferer to not carry out the compulsive act until there is a considerable fall in anxiety.
  • Doing this repeatedly allows the person to learn that nothing bad will happen following the obsession or coming into contact with the object that makes him or her anxious.


Khoo Teck Puat Hospital Department of Psychological Medicine provides comprehensive treatment and management of anxiety disorders. We have a dedicated multidisciplinary team of psychiatrists and psychologists that can provide assessment and treatment for your psychological and emotional distress.


It is never too late to seek help. If you would like to obtain an assessment, please obtain a referral from your doctor or call 65558828 for an appointment.