“I am so OCD!” This phrase has become a common phrase on social media to describe one’s cleaning, checking, or organising behaviours. It’s meant to be a joke, but “OCD” — the abbreviation of “Obsessive Compulsive Disorder”, is one of the most common mental health disorders and it can seriously affect one’s daily functioning. However, there are many misconceptions surrounding this disorder.
Firstly, let’s just do a quick yes/no OCD “quiz”.
Do you consider yourself a clean freak?Do you check your door a few times to make sure that it’s locked before you leave home?Do you feel compelled to organise your desk in a certain way?
Even if you answered “YES” to any of the questions above, that DOES NOT straight-away grant you entry into the OCD club! These may be some of the symptoms commonly observed in people suffering from OCD, but having the neatest desk or the cleanest bedroom does not mean that you have OCD! We have included an evidence-based self-rating scale in a paragraph below if you wish to self-assess your probable OCD symptoms.
So, what is OCD?
OCD, as described by its proper name, is comprised of two main features: i.e. obsessions and compulsions. Obsessions are defined by intrusive and recurrent thoughts, images, or urges that generate intense anxiety, distress, or fear, resulting in a compelling urge to ignore, suppress or to neutralise them by performing compulsions. For example, the intrusive thought of contracting HIV intrudes one’s mind 1,289,346 times per day and he/she feels compelled to sanitise him/herself by engaging in ritualised cleaning in an effort to control the obsession. In another instance, the intrusive thought that one must have hit someone while driving leads to ritualised checking (driving back to the same spot again and again) in an attempt to relieve the anxiety provoked by the obsession.
Thanks to the creativity of the human mind, the obsessions in OCD can take on a wide range of themes. The most common ones include:
A fear of germs or contamination (e.g. catching a deadly disease that will contaminate others too.)Unwanted forbidden or taboo thoughts involving sex, religion, and harm (e.g. fear of turning into a pedophile.)Aggressive thoughts towards others or self (e.g. harming one’s child)A need to arrange things in a symmetrical or in perfect order (e.g. things should be arranged in ascending order or bad things will happen.)
On the other hand, repetitive behaviours or mental acts are performed when the individual feels a strong urge to response to an obsession in the hopes of alleviating the distress caused by the obsession. Common compulsions include:
Excessive cleaning and/or hand washing (e.g. spending hours in the shower)Ordering and arranging things in a particular, precise way, or until it feels “just right”Repeatedly checking on things (e.g. repeatedly checking to see if the door is locked or that the oven is off)Compulsive praying, counting, repeating words silently
Of course, OCD can present itself in many more different ways, on top of all the examples mentioned above. It seems like people suffering from OCD can be very creative people but having this chronic disorder is also very disabling and time-consuming.
How prevalent is OCD?
OCD is a common disorder that affects children, adolescents, and adults all over the world with the 12-month prevalence of 1.1-1.8% internationally. The average age of onset is around 19 years old but earlier onset is relatively more common in boys than in girls.
Who are the “favourite children” of OCD?
Like any other mental disorder, OCD proffers an interesting look into our human minds, and because it comes in so many different manifestations, exposes the complex nature of the human mind and behavior. It’s impossible to establish direct causation when it comes to OCD. However, extensive researches were done to help us derive several possibilities. The first risk factor is temperament. People who are inherently anxious, a tendency to overestimate threats, perfectionists, or a low tolerance for uncertainty are relatively more likely to have OCD. Besides, external factors such as environmental stressors (e.g. physical/ sexual abuse) could play a part in the development of OCD. Lastly, as much as we hate it (because we cannot change it)—genetic disposition. Twin and family studies have shown that people with first-degree relatives (e.g. parent, sibling, or child) who have OCD are at a higher risk for developing OCD themselves. Ongoing imaging studies also have shown differences in the frontal cortex and subcortical structures of the brain between patients with and without OCD. Nonetheless, the connections between OCD and abnormalities in the brain is still being examined and are currently still inconclusive.
How do I know if I have OCD?
If you suspect yourself or a family/ friend might be suffering from OCD, there is an evidence-based assessment tool widely administered by clinicians to aid in the diagnostic process. The Y-BOCS (Yale-Brown Obsessive Compulsive Scale) also has an online version for those who are interested in self-assessment before consulting your doctor/ psychologist. It is highly recommended that you talk to a professional if you happen to score highly in the Y-BOCS. Never make your own judgments when it comes to diagnosis. Consult professionals!
Treatments for OCD?
Although OCD is a chronic disorder and relapse can happen, the good news is that it is a treatable condition! A combination of medications and psychotherapy is the most effective way to alleviate the symptoms of OCD, even though some patients decide to go for EITHER medication or psychotherapy for personal reasons. While most patients with OCD respond to treatment, some patients continue to experience symptoms. Among those who experience symptoms, those who have been through psychotherapy are more confident in managing their OCD symptoms and many can still live a fulfilling life!
Examples of medications that have been proven effective in both adults and children with OCD include clomipramine (a member of an older class of “tricyclic” antidepressants) and several newer “selective serotonin reuptake inhibitors” (SSRIs), including fluoxetine, fluvoxamine, sertraline. In regards to psychotherapy, Exposure and Response Prevention (ERP), a type of cognitive behavior therapy is the first-line treatment for OCD. Research shows that ERP is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to medication.
Despite the fact that OCD is a (rather) common mental illness, those who suffer from OCD tend to be secretive about their symptoms and only seek treatment after years of suffering. It is reported that less than one-third of OCD sufferers receive appropriate pharmacotherapy and even less receive evidence-based psychotherapy (i.e. ERP). This is often because individuals with OCD suffer from embarrassment and shame. In addition, going through treatment and recovery signify giving up their compulsions and rituals, which can be very daunting to them. I bet you can already guess now, people with OCD usually are urged and brought to seek treatment by their family members. Therefore, most people suffering from OCD have very low motivation and readiness for treatment.
My experience in treating people with OCD
During my clinical training in public hospitals, I had several opportunities to work with people with OCD and it was a very interesting experience. When they first consulted me, many were depressed, disengaged, frustrated or felt hopeless about life. OCD has taken so much of their time, happiness and freedom, and strained their relationships with family and friends. One of them almost took her own life as she could not stand the intrusive thoughts in her head anymore. There are serious consequences as a result of OCD being untreated. With medication and/or therapy, many of them regained their independence and freedom in life and I am proud of their courage and perseverance in making the choice that eventually changed their life.
OCD will only grow to be a bigger health issue if we do not confront it and it will consume you and your life. One of my paediatric clients once said, “I am the boss, the OCD monster (intrusive thoughts) need to know that he can come and play but he needs to go home!”. In reality, chances are people still experience intrusive thoughts after treatment. However, there is progress when they can manage them better, their quality of life improved, and most importantly they feel that the OCD no longer control them.
“You don’t have to control your thoughts, you just need to stop letting them control you.”
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.