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  Obsessive–Compulsive Disorder
Tanuka GuptaTanuka Gupta
 

Introduction

Do I have OCD?

Types of OCD

How to identify OCD from Stress

Is it rare? Why people have OCD?

Can Children have OCD?

Can OCD be cured?

What can I do to help myself?

Some websites on mental health


Introduction

“Will all great Neptune's ocean wash this blood
Clean from my hand? No; this my hand will rather
The multitudinous seas incarnadine,
Making the green one red”.
- Lady Macbeth from Macbeth

- Jenny suffers from a constant fear that her children have met with terrible accidents when they are outside home. She even visualizes scenes of these mishaps in vivid detail. She can’t seem to shake off the thoughts and feels guilty knowing how unreasonable they are.

- Rohit is a successful businessman and a happily married family man. However, since 2 months he is unable to derive pleasures from the regular activities as he is haunted by images of himself being involved in illicit sexual encounters especially with female colleagues. He spends hours in the toilet washing and showering and does not know how to control these ‘gross but untrue’ thoughts. He is unable to talk to his wife as he knows she will misunderstand him.

- Laila spends hours every night making sure that all the locks in the house are in place. She would check and recheck the same locks. This long time “habit” of hers was angering her husband Shakil who felt she was doing this to avoid interacting with him in their privacy. While Laila understands her husband’s resentment she is unable to control the urge to indulge in her daily “ritual.”

All these people mentioned who are leading apparently “normal” lives are actually victims of an exhausting mental condition known as “Obsessive- Compulsive Disorder or OCD.”

Although descriptions of patients with OCD have been reported since the fifteenth century in religious and psychiatric literature, the condition was widely assumed to be rare until very recently. Epidemiological research since 1980 has now identified OCD as the fourth most common psychiatric illness, after phobias, substance use disorders, and major depressive disorders

How do I know I have OCD?

Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects thoughts and actions and is believed to be rooted in a biochemical imbalance of the brain. Its main features are recurrent and disturbing thoughts (called obsessions) and/or repetitive, ritualized behaviors that the person feels driven to perform (called compulsions). Obsessions can also take the form of intrusive images or unwanted impulses. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. While, in most cases compulsions alleviate anxiety, they are often known to trigger a fresh attack.

The most painful part of OCD is that the person recognizes that her thoughts or behaviors are senseless or excessive but caves in to the powerful drive of the compulsions. While an obsession may or may not result into a compulsion, behind every compulsive act is a strong obsessive thought.

What are the different types of OCD?

The most common types of obsessions include concerns with:

-Contamination (e.g., fear of dirt, germs or illness),

-Safety/harm (e.g., being responsible for a fire),

-Unwanted acts of aggression (e.g., unwanted impulse to harm a loved one),

-Unacceptable sexual or religious thoughts (e.g., sacrilegious images of something or somebody venerable)

- And the need for symmetry or exactness.

Common compulsions include:

Excessive cleaning (e.g., ritualized hand washing);

Checking, ordering and arranging rituals; counting; repeating routine activities (e.g., going in/out of a doorway) and

Hoarding (e.g., collecting useless items).

While most compulsions are observable behaviors (e.g., hand washing), some are performed as unobservable mental rituals (e.g., silent recitation of nonsense words to vanquish a horrific image).

How do we know this is OCD and not just temporary symptoms of stress?

The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships. Also OCD should not be confused with Obsessive- Compulsive Personality Disorder which is a lifelong pattern of insistence on control, orderliness, and perfection that begins no later than the early adult years.

Is it a rare mental health condition? Why do people have OCD?

About two-thirds of people with OCD have the first symptoms before they are 25 years old, while only 15% develop symptoms after age 35. There is strong evidence that the illness has a genetic (inherited) basis, since about 35% of people with OCD have a close relative who also has the condition. Although 50% to 70% of patients first develop OCD after a stressful life event such as a pregnancy, a job loss or a death in the family, scientists still do not understand exactly how or why stress seems to trigger the symptoms of this illness.It often takes people a long time to seek out help for OCD, even after they learn it is a treatable illness. When asked why it took so long, the reason given is usually embarrassment. The symptoms of OCD can be so disagreeable and so private that they are very difficult to share with anyone, including loved ones and trained professionals. Most cases of OCD begin inconspicuously and gradually become more apparent over many months or years. It is only in retrospect that one looks back and recognizes some of the early signs of the illness.

Is it true that children can also experience symptoms of OCD?

Yes. According to Tamar Chansky, the author of Freeing Your Child from Obsessive-Compulsive Disorder and the director of the Children’s Center for OCD and Anxiety in Philadelphia, there are more than a million children in the United States today with OCD. Chansky also reports that the condition affects at least one in 100 American children and that the average age of onset is 10.2 years. Children are often too embarrassed to tell their parents or an adult what is going on. Thus parents can watch them carefully for similar warning signs mentioned before they adopt appropriate steps for intervention.

Can OCD be cured?

Behavioral therapy with medications seems to offer the best long term improvement. Although, almost no treatment is curative for OCD most treatment can be expected to reduce symptoms by 50-80% or more. The illness is cyclic, and worsens when the individual is under stress.

Behavior therapy has a lot to offer individuals with this disorder. Two common and popular techniques are systematic desensitization and flooding. Systematic desensitization techniques involve gradually exposing the client to ever-increasing anxiety-provoking stimuli. This is coupled with relaxation techniques involving imagery, breathing skills and muscle relaxation.

Flooding allows the patient to face the most anxiety-provoking situation, while using the relaxation skills learned.

Saturation, response prevention and thought – stopping techniques have also found to be useful in varying degrees.

Research has shown that one of the most difficult problems in OCD is in getting family members to understand that the patient is unable to simply stop the behavior. Many times relatives become angry and upset when they are forced to deal with the time-consuming and unrealistic repetitive behaviors.

What can I do to help myself?

Based on the various behaviour therapies mentioned above some techniques can be followed at home:

1. Practice relaxation techniques and do this daily for 20 minutes in a secluded area of your house.
2. Jot down your ‘irrational’ or obsessional thoughts in a diary and talk to yourself about it trying to use rational thinking to analyze them e.g. “I feel as if germs are there in my hands but I know it is not there.”
3. Delay your compulsions for a time period e.g. 30 seconds or a minute and do some deep breathing in that time. Keep track of the delay and increase that gap every day.
4. You can also tell yourself “ no, stop it” when you experience mild urges to indulge in your thoughts or actions.
5. Redirect your compulsions to an opposite activities like calling up a friend, drawing, writing, knitting as opposed to hand washing.

Do not feel anxious or dejected if you do not succeed in curbing your symptoms. You probably need a professional’s advice to help you achieve your goals.

Some useful websites on mental health issues :

1. www.nimh.nih.gov
2. www.mentalhealth.com
3. www.aap.org/mentalhealth
4. www.bbc.co.uk/health/mental