Obsessive Compulsive Disorder, or OCD – as it is commonly known, is a mental disorder that can affect an individual in numerous ways. For some, symptoms are very mild and have little effect on their daily lives. However, for others, dealing with their own thoughts and actions is an everyday battle than can have a detrimental impact on their lives.

Symptoms

While we usually give focus to the aspects of obsession and compulsion in OCD, it actually manifests in three elements:

• obsession, where involuntary, intrusive thoughts, images or urges repeatedly come to and occupy one’s mind. While these extend over a vast range, some common obsessive thoughts include:
• a need for order and symmetry of objects, e.g. all pencils should face the same direction in a box or case, or an even number of an item should always be present
• fear of contamination or infection
• fear of harming oneself or others, intentionally or unintentionally
• repulsive and frightening thoughts of a violent or vulgar nature, which the individual may not necessarily act on

• emotion, where anxiety, unease and distress may be caused by the obsessive thoughts

• compulsion, where the individual performs repetitive mental or behavioural acts in order to ease the emotion triggered by the obsessive thoughts. Compulsive acts also vary largely, and may include:
• mental counting, constantly arranging things and putting them in order, hoarding
• repeatedly or constantly washing/cleaning hands or oneself
• seeking reassurance from others very often
• repeatedly checking on things, e.g. door locks
• avoiding places, people and situations that might trigger their obsessive thoughts
• seeking reassuring thoughts to neutralise obsessive thoughts

Symptoms usually become apparent around early adulthood, although they may start showing as early as puberty.

Complications

In some cases where OCD is more severe, general complications that may arise include:

• depression
• anxiety
• eating disorders

Other complications that are often referred to as Obsessive Compulsive (OC) Related or OC Spectrum Disorders include:

• Hoarding Disorder (HD) – excessive collection of unnecessary items
• Olfactory Reference Syndrome (ORS) – obsession with how one smells
• Body Dysmorphic Disorder (BDD) – obsessions and compulsions related to appearance
• Body Focused Repetitive Behaviour (BFRB) – repetitive habit(s) to feel good

Causes

As with most mental disorders, it is not entirely clear as to what exactly causes OCD. However, the following are believed to be trigger or risk factors for the condition:

• a family history of OCD
• life events such as loss of a loved one, childbirth, neglect, bullying
• anxiety or individuals with a meticulous personality
• presence of areas of high activity in the brain
• low levels of the hormone serotonin

Diagnosis

Quite often, the presence of persistent obsessive thoughts and compulsive behaviours which temporarily relieve the anxiety caused by these thoughts (somewhat cyclic) are tell-tale of OCD. These obsessions and compulsions usually get in the way of day-to-day life and may be noticed by oneself or by those around an affected individual. In such instances, one should seek the advice of a medical professional such as a psychiatrist or a trained psychologist.

Treatment

There are two approaches to take for the treatment of OCD. The first preference is usually therapy without medication, failing which one may seek treatment with medication.

• Psychological therapy usually involves a combination of cognitive behavioural therapy (CBT) with exposure response prevention (ERP) where recurring issues are broken down into mental, emotional and physical aspects. The individual is then encouraged to confront situations that trigger obsession, starting with those that cause the least anxiety first, without allowing compulsive behavioural responses to defuse them. If progress is seen, further obsessions are delved into in a similar manner. Milder cases may show significant improvement after about ten hours of therapy and concurrent home exercises. More severe cases usually need longer to show any improvement.

• Medication usually comes in the form of anti-depressant drugs – selective serotonin reuptake inhibitors (SSRIs). These work by increasing the level of serotonin in the brain, and usually take up to 12 weeks for noticeable improvement. Medication is usually prescribed for a minimum of one year, unless side-effects are apparent.

Cover illustration from Zealous Co.