Obsessive-Compulsive Disorder (OCD)

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While keeping your place clean, double-checking your locks and staying well-organized are all healthy habits, when they turn into obsessions, it gets quite problematic (and not to mention, unhealthy). Having a stubborn perfectionism (for the cleanliness of your surroundings and the order in which the things are kept or done), which is often glorified in our society, can be a sign of a condition called obsessive-compulsive disorder. 

According to multiple studies done over the past few years, OCD is one of the most common mental health conditions in Singapore. It is the third most prevalent disorder in the country. 

Obsessive-compulsive disorder (OCD) is a mental illness in which is categorized by uncontrollable, recurring thoughts and unreasonable fears which lead to compulsive behaviours and sensations. A person with OCD may have either of the two symptoms (obsessions and compulsions), or both. This causes severe disruption and distress in a person’s emotional, social, and occupational spheres of life. 

The signs of this condition appear slowly and gradually with age but can still be identified in the initial stages. Early intervention can help you overcome this disorder far more easily.

Signs and Symptoms of OCD

The symptoms of OCD include obsessions and compulsions. They are explained in detail below:

Obsessions:

Obsessions are repetitive thoughts, urges, or sensations that are unwanted and cause unpleasant feelings like anxiety, stress, etc. Examples are; fear of contamination or catching an infectious disease, intrusive thoughts, forbidden or taboo sexual thoughts,wanting to keep objects excessively neat and orderly i.e in symmetry, etc. Such thoughts may also be the early indicators of OCD.

Compulsions:

Compulsions are repetitive behaviours that involve the urge to do something over and over again. Examples include excessive cleaning and handwashing, ordering and arranging things symmetrically or in the “perfect” order i.e by colour, size, etc., checking on things over and over like the lock on a door or a gas knob. 

The cycle of OCD begins with the obsessive thoughts, then the person feels anxiety as a result of the obsessive thought, and due to the anxiety, the person ends up behaving compulsively, after which there is a temporary relief from the unpleasant feelings caused by the thoughts. This cycle then continues several times during the day. 

These symptoms can be easily confused with unhelpful or helpful habits that a healthy person may have. The differentiator between OCD’s symptoms and normal, regular habits of people is the fact that these compulsions and obsessions consume at least one hour of the day, are beyond the person’s control, are very unpleasant and not enjoyable at all, and interfere with the person’s life severely and cause a lot of distress and anxiety.

Types of OCD

The types of OCD involve a set of compulsion and obsessions. Most of the time persons with OCD experience one subtype of such symptoms and also, occasionally, other subtypes from other categories of OCD. They are as follows: 

Fear Of Contamination: Obsessions with Cleaning and Washing

A person who’s affected by this type of symptom will be constantly focused on their fear of contamination and the feelings and distress that comes with it. They may wash their hands and clean objects around them or themselves and their body excessively repetitively.A person might also be obsessed with quarantining themselves and may self isolate in extreme cases when their obsessions and compulsions are at a peak. Daily life tasks become very difficult at this point. 

Fear of Harm and Violence: Repetitively Checking

A person who experiences this subtype of symptoms will be obsessed with constantly checking on their surroundings to an extent that they spend most of their time doing it. They usually have rituals in which they check multiple objects in their environment. They may repeat the ritual itself many times. This involves catastrophic thinking, just like with most other obsessive thoughts associated with OCD. 

Obsession with Order and Symmetry: Constantly Arranging things Symmetrically, and counting objects

People with this subtype of symptom may constantly arrange things neatly by various categories. It may be symmetry, color, number, size, etc. They also constantly count things. 

They have an urge to continue to do so until they feel it’s “perfect” or “just right”.

Obsessions with No Visual Compulsions  

This may involve thoughts about sex, religions, or aggressive acts. A person with this subtype of symptoms may recite a set of words in his head repetitively, or a song or he/she may pray to relieve anxiety. 

Hoarding

This is now a separately diagnosed disorder according to DSM-5. It is characterised by a fear of losing items or extreme emotional attachment to a thing. It comes with the compulsion of excessively hoarding such objects that ends up becoming a huge clutter and a burden for the affected person. Examples are hoarding letters, notes, old clothes, broken items, magazines, etc. 

 Causes of OCD

The exact cause of OCD isn’t yet discovered by doctors. However certain risk factors can increase the likelihood of having OCD. Some of them are:

• Having a close relative with OCD
• Physical abnormalities in the brain
• Depression, anxiety, or tics.
• Trauma
• Experience of physical or sexual abuse as a child

Treatments for OCD

Psychotherapy:

Cognitive behavioural therapy can help a person identify their cognitive distortions and replace them with helpful habits. This is very effective for treating OCD as stated earlier the beginning of the OCD cycle is the obsessive thought. This thought can be tackled efficiently with CBT and the tools it can equip us with. Moreover, research into a type of therapy called eye movement desensitisation reprocessing (EMDR) shows remarkable promise for OCD treatment, as well. It potentiates anxiety reduction through desensitisation and reprocessing of the neural networks associated with memory, which makes it an efficacious, time-efficient and much more comfortable than the other kinds of therapy used for treating OCD. 

Exposure response prevention (ERP) therapy along with EMDR or CBT also helps. 

Medication:

Selective serotonin reuptake inhibitors help persons with OCD control their obsessions and compulsions. They take 2-4 months to start working. 

TMS (Transcranial Magnetic Stimulation):

Using a non-invasive device called the TMS unit, a magnetic field is induced. It targets a specific part of the brain. This helps reduce the symptoms.

Frequently Asked Questions on Obsessive-Compulsive Disorder:

Q. At what age does OCD begin?

The symptoms of OCD can be experienced for the first time as early as during the preschool years of a child and continue into adulthood. The onset age in males is earlier than that of females. For males, it is between the age of 6 to 15 years and for females it is between the age of 20 to 29 years.

Q. How effective are the treatments of OCD?

Medication i.e serotonin reuptake inhibitors show reduced symptoms in 40-60% of the patients with OCD. Cognitive Behavioural Therapy (CBT) also proves to be very effective as those who have gone for CBT treatment report a 60-80% reduction in symptoms.