I was watching ‘Monk’ with my sister. This TV show is about a detective who has OCD and brilliant observation skills that make him one of the best detectives in town. While watching the show there was a particular scene where they showed how Adrian Monk always liked his things in an order and hated mess and was basically very organised. He couldn’t stand a sofa being slightly out-of-place and couldn’t concentrate on anything else. My sister,who is just ten thought that this is what she does to. “I think I have OCD too!” And as she said this,as if to prove her point,she set the pillows in an order. I obviously decided to ignore her because she is just ten and thinks OCD will make her smart,just like Monk. But it got me thinking. There are so many of us who think a simple obsession or maybe some random compulsive act qualifies us as an OCD patient. Sadly, we have started using a real problem which needs attention to something as simple as low grade fever.
Obsessive compulsive disorder or, OCD can be defined as an “occurrence of unwanted and intrusive obsessive thoughts or distressing images; these are usually accompanied by compulsive behaviors performed to neutralize the obsessive thoughts or images or to prevent some dreaded event or situation”. Pretty confusing,yes. Let us try to understand it better.
According to the DSM, OCD can be diagnosed if:
- Either obsession or compulsion
- Obsessions (All four)
- i) Recurrent and persistent thoughts, impulses or images that are experienced at some time as intrusive and cause marked anxiety.
- ii) Thoughts,impulses or images that are not simply excessive worries about real life problems.
iii) Person attempts to ignore or suppress or neutralise them with some other thought or action.
- iv) Person reorganises they are a product of his or her mind.
- Compulsions (Both)
- i) Repetitive behaviours (Hand washing,ordering,checking) or mental acts (praying,counting etc.) the person feels driven to perform in response to an obsession and according to rigid rules.
- ii) Behaviours or mental acts aimed at preventing or reducing distress or situation.
- At least at some point,person recognises the obsessions or compulsions are excessive or unreasonable.
- Obsessions or compulsions cause marked distress, are time-consuming (more than 1 hour) or interfere significantly with normal functioning.
All of us have minor obsessive thoughts,like doubts about the door lock or maybe we left the stove on. These thoughts occur and we generally forget about them and move on. But in OCD, such thoughts are excessive and persistent (often distressing). Other types of obsessions include,
- Fear of contamination
- Fear of harming self or others.
- Pathological doubt
- Need for symmetry
- Sexual obsession etc.
Compulsion refers to a need to perform acts repeatedly that often seem pointless and absurd even to them. It can be
- Counting etc.
Eg: Monk has a habit of touching every even lamppost. He cannot not touch a lamppost that is on the even-numbered position. (In a row,he would touch the second,fourth and so on).
Just like there are many things that are unique to an individual, OCD also has unique differences depending upon the individual. However, there are certain characteristics that are consistent. They are:
1) Anxiety is the affective symptom.
2) Compulsions reduce the anxiety temporarily.
3) Nearly all people afflicted with OCD fear that something will happen to them or others because of them. They tend to judge risk unrealistically (Important feature of OCD),this is why it is also called the ‘what if’ disease sometimes.
Yes,OCD is a lot more than ‘I am neat and organised’ or ‘I wash hands a lot’. It is an anxiety disorder which more prevalent in divorced,separated and unemployed people (Monk is a widower). Such a pattern is seen because of the sudden change in schedule and interpersonal and occupational functioning. There is also an increased amount of difficulties that one has to face. But OCD is not uncommon in late adolescence or early adulthood, the symptoms are similar. It is also seen that OCD is more common in males.
It is a chronic anxiety disorder but the severity of the symptoms waxes and wanes. It co-occurs with some other anxiety disorders like depression (80% of clients have significant depressive symptoms). Depression is a response to OCD. Other anxiety disorders that are seen are: social phobia, panic disorders, Post Traumatic stress disorder.
While OCD may be seen as a very crippling disorder, it is not untreatable.
Many people think medicines are effective treatment. They affect the neurotransmitter serotonin. Medicines like Prozac and Clomipramine appear to reduce the intensity of the symptoms. The effect varies but sadly 30-50% people show no significant improvement. A major disadvantage of medicinal treatment for any anxiety disorder, including OCD, is that when the medication is discontinued, there is a high chance of relapse. Thus, this medication may have to continue indefinitely.
There is also behavioural treatment that combines exposure and response prevention,which is one of the most effective treatments for OCD. The clients are repeatedly exposed to the stimuli that provokes their obsession (for someone with compulsive washing, making them touch dirty shoes) and then preventing them from engaging in their compulsive rituals, which they ordinarily would engage in to reduce the anxiety provoked by their obsessions. Prevention of compulsion is necessary because then they will realise that their anxiety will dissipate slowly if they give it time. The results are considered to be superior than medications.
One recent study shows that a combined treatment (which includes the above mentioned methods) is most effective for children and adolescents suffering from OCD.
It is clear that OCD is a lot more than wanting to organise everything but it is not as simple as some random thing that will treat itself. As outsiders,we cannot judge or imagine the dilemma and anxiety that people suffer when they have OCD. It is high time that we help them by letting them know that it is alright. Let’s be more compassionate and, definitely stop using OCD as an everyday phrase.