When compulsions take control

By Dr Anjana Kannankara

Obsessive Compulsive Disorder, or OCD, is one of those terms that some people misuse as a way to describe people who like things super-clean or arranged meticulously. But if you have the actual condition that is identified as obsessive-compulsive disorder, the manner in which it affects your life is very real.
OCD usually does not happen all at once. Symptoms start small and to the affected person they seem to be normal behaviours. They can be triggered by a personal crisis, abuse or something negative that affects you drastically, like the death of a loved one or severe family problems. It is more likely if people in your family have OCD or another mental health disorder, such as depression or anxiety.
OCD can be explained as a mental condition where excessive thoughts called obsessions lead to repetitive behaviours termed as compulsions. It is characterised by unreasonable thoughts and fears that lead to compulsive behaviours and rituals.
More than 1 million cases per year is reported in India. It is a bit more common in women than in men.
There are some facts about OCD which everyone should know. The disorder can be treated but cannot be cured. Chronic cases can last for years or be lifelong. OCD requires a medical diagnosis and laboratory tests or imaging is not required.

Warning signs

Everyone has habits or thoughts that repeat sometimes. But OCD can be suspected in an individual when thoughts or actions.
• Take up at least an hour a day or more
• Are beyond the person’s control
• Aren’t enjoyable but causes distress
• Interfere with work, social life, or other areas of life

Symptoms

People may experience:
Behavioural symptoms: Agitation, compulsive behaviour, compulsive hoarding, hypervigilance, impulsivity, meaningless repetition of own words, persistent repetition of words or actions, repetitive movements, ritualistic behaviour, or social isolation
Mood: Anxiety, apprehension, guilt, or panic attack
Psychological symptoms: Depression or fear
Others: Aversion to food, nightmares, repeatedly going over thoughts or ruminating

Categories of OCD cases

Most people with OCD fall into one of the following categories:
• Washers: They are afraid of contamination from germs or dirt. They usually have cleaning or hand-washing compulsions.
• Checkers: They repeatedly check things whether stove is turned off, door is locked, etc. that they associate with harm or danger.
• Doubters and sinners: They are afraid that if everything isn’t perfect or done in right way, something terrible will happen and they or their loved ones will be punished.
• Counters and arrangers: They are obsessed with order and symmetry. They may have superstitions about certain numbers, colours, or arrangements.
• Hoarders: They fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.
Doctors aren’t sure why some people have OCD though genetic and other factors like difference in brain activity have been pointed out by researches. Stress can make symptoms worse. Symptoms often appear in teens or young adults but may become evident later also.
OCD symptoms mainly include obsessions, compulsions, or both.
An obsession is an uncontrollable thought or fear that causes stress. A compulsion is a ritual or action that someone repeats a lot. Compulsions may offer some relief, but only for a little while. If you find yourself helpless with time consuming thought process and rituals that distress you considerably then you are in trouble.
Most people have superstitions or rituals, or fear that they left the door unlocked or the oven on before leaving for work or vacation. If one can control those thoughts or think about them logically, it is probably not OCD. If he or she cannot control them, or they take up pretty much time of the day and cause problems in life, it is a sign that it is time to get help.
Many individuals who have OCD are aware that their thoughts and habits do not make sense. They don’t do them because they enjoy them, but because they cannot quit. And if they stop, they feel so bad that they start again.
Obsessive thoughts can include worries about self or other people getting hurt; constant awareness of blinking, breathing, or other body sensations; and suspicion that a partner is unfaithful, with no reason to believe it. Compulsive habits can include doing tasks in a specific order every time or a certain number of times; needing to count things, like steps or bottles; and fear of touching doorknobs, using public toilets or shaking hands.
Common obsessions often have a theme like fear of germs or dirt where one might be scared to touch things other people have touched, like doorknobs or wouldn’t want to hug or shake hands with others.
One can have extreme need for order and feels stressed when objects are out of place. It’s really hard to leave home until things are arranged in a certain way.
There is also fear of hurting self or someone else or excessive doubt or fear of making a mistake. In the second case, the individual needs constant encouragement or reassurance from others that what he is doing is right.
Some have fear of embarrassment and become afraid that they might yell out curse words in public or behave badly in social situations.
There is also fear of evil or hostile thoughts, including sexual acts or religion where the person imagines troubling sexual or disrespectful scenarios.
Common compulsions also have common themes and symptoms like washing or cleaning where the person washes hands, showers, or takes a bath over and over, or else he feels discomfort and guilt.
Sometimes one checks repeatedly to make sure kitchen appliances are turned off or the door is locked when he leaves home or before sleep.
Some individuals say out loud or to oneself numbers in a certain pattern. Some also feel the need to eat certain foods in a specific order. They arrange all the clothes or kitchen items or furniture in a specific way. Collecting or hoarding is also a common compulsion where an individual cannot stop buying things unnecessarily.
These repetitive routines usually may not have anything to do logically with the obsession the person is trying to fix and can take hours to do.

Diagnosis

The diagnosis process will likely include a physical exam to see if the symptoms are due to a health condition; blood tests to check the blood count, how well thyroid works, and any drugs or alcohol in the system; a psychological test or evaluation about the individual’s feelings, fears, obsessions, compulsions, and actions.

Treatment

There’s no cure for OCD. But it might be possible to manage how the symptoms affect a person’s life. Treatments include psychotherapy, relaxation, medication and neuromodulation.
The reassurance and support of the family and friends is most needed for OCD sufferers. They themselves struggle to get out of the situation but find it impossible which increases the anxiety and stress considerably. Never scold, blame or ignore them since they are not voluntarily doing this to cause discomfort to others. The negative approach of the loved ones will result in tremendous stress and loneliness that in turn will result in worsening the condition and resentment towards life. The family needs to understand the issues that the person has encountered and acknowledge their mistakes if any in the occurrence of such terrible situations. With constant support, the condition can be managed well in most cases.
There is a fine line between helping and enabling our loved ones with OCD. The best way to help and not enable is to learn everything we can about the disorder and the proper way to respond to it.
It is also essential to remember that it’s okay to feel angry, annoyed, frustrated, and overwhelmed, as long as these feelings are directed toward the OCD and not the person we care about. OCD sufferers need the understanding, acceptance, compassion and love of their families, and they deserve no less than that.

(The author is director, TGL
Foundation, and chairperson, CSA)

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