“I have a bit of OCD”, “she is so OCD”. These are statements we hear banded around a lot. There is a familiar notion that Obsessive Compulsive Disorder (OCD) is a set of quirky characteristics claimed by or given to people who are controlling of things, perfectionists, excessively conscientious or fastidious about cleanliness. There is even a bit of pride being expressed by some claiming with a smile to be ‘a bit OCD’ with an acknowledgment that there is some underlying anxiety. We often use the word ‘obsessive’ when we talk about people who do things over and over e.g. she is obsessive about shoes, for someone who talks about them and buys a lot.
Many of the general population have intrusive thoughts, images and at times their content can seem similar to those with OCD e.g. having an urge to push someone under a train, thinking about throwing something, thinking about shoplifting, thinking about a disgusting sex act (Purdon and Clark 1992) are all common. The difference between a normal intrusive thought and an obsessional thought lies both in the meaning that individuals with OCD attach to the occurrence or content and then their response to the intrusive thought or image.
So what is Clinical OCD?
An obsession is an intrusive usually unwanted thought, image or urge that repeatedly enters the mind, causing feelings of anxiety, disgust or unease.
A compulsion is a repetitive behaviour or mental act that you feel you need to carry out to temporarily relieve the unpleasant feelings brought on by the obsessive thought.
David Veale 2007 has described the most common obsessions as;
- The prevention of harm to self or others resulting from contamination (e.g. dirt, germs, bodily fluids, faeces or dangerous chemicals.)
- The prevention of harm resulting from making a mistake (e.g. leaving a door unlocked, or the oven on)
- Intrusive religious or blasphemous thoughts
- Intrusive sexual thoughts (e.g. of being a sexual deviant or committing a sexual crime)
- Intrusive thoughts of violence or aggression
- The need for order or symmetry
Compulsions are actions that are repeated to avoid discomfort. Common compulsions are things like washing, checking, counting, hoarding, mentally repeating phrases, repeatedly seeking reassurance, rituals and avoidance. Compulsions are never pleasurable. A diagnosis is given when the obsessions and compulsions consume excessive amounts of time (over an hour or more), when they cause significant distress and they interfere with social activities, work, or relationships.
A study in 2010 from the Institute of Mental Health and Ministry of Health into mental health found that OCD in Singapore was prevalent at a higher rate compared to the USA or Europe with around 3% of population having OCD.
When does it start?
It can start at anytime and is found in both men and women. It can start in childhood but is often developed around puberty and young adulthood.
OCD symptoms can go unnoticed as children are unable to verbalise their ‘intrusive thoughts’ or understand that their actions don’t make sense. Like adults, they may experience secrecy resulting from shame regarding their thoughts or behaviours. Parents can also avoid seeking treatment as they think the behaviours are just a phase. OCD can be successfully treated and evidence suggests that the sooner it is treated the better the outcome is likely to be.
What causes OCD?
Biological explanations suggest some families have a genetic predisposition to anxiety which make them more likely to develop OCD.
Psychologists recognise that something called ‘thought action fusion’ occurs, whereby if a person thinks of harming someone, they think they will act on the thought or might have done in the past. People with OCD also have an inflated sense of responsibility for harm and its prevention.
There are some conditions that can appear with OCD these include;
Trichotillomania (urge to pluck hair), Hypochondriasis (fear of suffering from a serious illness), Body Dysmorphic Disorder (a preoccupation with being ugly or having a defect in your appearance) and Tourette’s Syndrome (vocal adn motor tics).
A combination of Cognitive Behavioural Therapy and Medication in the form of antidepressants (selective serotonin reuptake inhibitors SSRI’S) has been found to be the most effective treatment. It is also important to work with the whole family in the management of OCD as this is seen to aid recovery. OCD is treatable.
Veale 2007, Cognitive- Behavioural therapy for obsessive- compulsive disorder, Advances in Psychiatric Treatment, vol 13, 438-446.
Purdon & D, Clark 1992. Obsessive intrusive thoughts in non clinical subjects. Part I Content and relation with depressive, anxious and obsessional symptoms. Behaviour, Research and Therapy 1992: 31: 713-20.
Prof Chong Siow (principle investigator) Singapore Mental Health Study (SMHS) 2010- Institute of Mental Health and Ministry of Health, Nanyang University.
Photo of hand washing https://www.pexels.com/photo/cooking-hands-handwashing-health-545013/
Dr. Ronina (Nina) Stevens