Understanding Obsessive Compulsive Disorder

    26-Dec-2019
Dr Meesha Haorongbam
We’ve all heard of obsessive compulsive disorder (OCD) and we presume we know what it is: cleanliness, maintenance of symmetry etc.  We generally associate it with our pet peeves.  We have also come across numerous jokes about OCD. E.g. “I have CDO. It’s OCD only in alphabetical order, the way it should be” or “The first rule of OCD Club is that there is a second rule so we have an even number of rules.” 170 million people across the world suffering from OCD have had their illness reduced to a careless joke. This has cheapened a mental illness which is highly debilitating and has even led to the most lethal of all consequences- suicide.
We all have that one friend or relative who prides in being a perfectionist- the one who gets annoyed by, let’s say, misaligned tiles on the floor. But when their desire for perfection adversely affects their behaviour i.e they are unable to enter a room with misaligned tiles on the floor, then they might have OCD.
OCD, as mentioned earlier, is a serious psychiatric disorder that is frequently misunderstood by society and healthcare professionals alike. As its names suggest, it has two components- obsessions and compulsions. Obsessions are repetitive and intrusive thoughts, impulses or images while compulsions are “acts” people engage in to relieve anxiety caused by the distressing obsessions. For example, people might engage in excessive cleaning to relieve the obsessive thoughts of germs and contamination.
Those who are obsessed with safety may repeatedly check their doors before leaving their house. Others engage in certain rituals or repetitive acts because of the fear that something bad will happen if they don’t carry out those rituals.  Some have only obsessions while others have only compulsions. But the vast majority of those with OCD have both components.
As simple as this sound, OCD can be difficult to understand even by those who have it, because obsessions rarely make much sense, rituals can be hard to explain, and they struggle to express their symptoms. Individuals with OCD tend to hide their symptoms for fear of embarrassment or being called crazy. This often leads to OCD being undiagnosed for years. People affected have little to no control over their obsessive thoughts and compulsive behaviours which tend to be time-consuming and interfere with their work and social life to the point of causing significant distress. This “distress” is what separates OCD from those who may only be meticulous.
Many with OCD understand the relationship between their obsessions and compulsions. The fact that they are aware of their irrationality and yet can’t control them is what makes it distressing. They often report feeling as if they are losing their mind for experiencing anxiety based on irrational thoughts and finding it difficult to control them.
The symptoms of OCD include but are not limited to:
1.    Obsessions about dirt and contamination. Eg. Fear of contracting illness
2.    Obsessive need for order or symmetry or hoarding or saving e.g. refusal to throw away anything because it “may be needed in future”
3.    Obsessions with Sexual Content e.g. fears that one may be homosexual
4.    Repetitive Rituals e.g. repeating routine activities for no logical reason
5.    Religious Obsessions e.g. blasphemous thoughts
6.    Obsessions with Food and Weight e.g. not letting foods touch on plate
7.    Superstitious Fears e.g. lucky or unlucky numbers
8.    Compulsions about Having Things Just Right e.g. need for symmetry
9.    Checking Compulsions e.g. repeatedly checking to see if a door is locked
10.    Other Compulsions e.g. the need to avoid stepping on cracks in sidewalk or a feeling of dread if some arbitrary act is not performed
OCD has an early age of onset and it spares no gender, ethnicity or social status. Around 3% of the population around the world have OCD. It affects men and women equally though females have a later age of onset. So what causes OCD? The frustrating answer is that we really don’t know for sure.  It is generally believed to occur due to interaction between the following factors:
1.    Genetic: OCD is a familial disorder with close relatives of people with OCD significantly more likely to develop OCD themselves. So far, no single gene has been proven as the “cause” of OCD.
2.    Autoimmune: OCD in children may be due to Group A streptococcal infections which cause dysfunction in certain parts of the brain.
3.    Behavioural: OCD sufferers’ brains are hardwired to associate certain objects or situations with fear. They avoid those things or learn to perform “rituals” to reduce the generated fear.  Once the connection between an object and the feeling of fear becomes established, they begin to avoid that object and the fear it generates, rather than confronting or tolerating the fear.
4.    Cognitive: We sometimes have unwelcome or intrusive thoughts. While we tend to shrug them off, people with OCD misinterpret and exaggerates those thoughts. As long as those thoughts are misinterpreted as cataclysmic and true, they continue the avoidance and ritual behaviours.
5.    Neurological: Researchers have implicated three regions of the brain which are variously involved in social behaviour and complex cognitive planning, voluntary movement, and emotional and motivational responses. OCD is also associated with low levels of a neurochemical called serotonin which helps regulate vital processes such as mood, aggression, impulse control, sleep etc.
The good news is that there are effective treatments. If left untreated, it usually develops into a chronic condition with episodes where symptoms seem to improve. Without treatment, remission rates are low, at around 20 percent. Treatment for OCD depends on how much the condition affects the person’s ability to function.
Some may be started on medications while others may receive both medication and behavioural therapies. Resistant cases might also be taken up for electroconvulsive therapy or surgical procedures such as deep brain stimulation.
OCD is a big fat lie. It’s difficult to believe that one’s own thoughts can be lies but OCD makes you believe that. It can be agonizing to know that your own brain is lying to you as well as leaving you unable to resist its commands. OCD is a terrible monster that can be crippling.  While there is no magic wand to make it all go away, you definitely can beat it. Thousands have done it and so can you.
The writer is M.D. Psychiatry and can be reached at [email protected]