Obsessive Compulsive Disorder- How to Deal with It?

"OCD is not something that just a handful of people in the world have. It is quite common these days. One in 40 adults in the US are affected: among children, the ratio is 1 in 100. Taking the case of India, especially post-pandemic, the situation has gone worse. India reports more than one million cases every year affected by this disorder."

OCD or Obsessive-compulsive disorder is a phenomenon where cyclic thoughts of no practical value constantly hamper the mind. It's like a disease growing on the individual, making them a slave… Slaves of their thoughts, visions and dreams.

The individual may be aware that the thoughts and dreams they are addicted to not yield benefits or help in any way in day-to-day life still, submitting to such patterns give a feeling of some relief to their anxiety.

You might consider this as escapism.

What causes OCD and what are the symptoms?

Obsessions and compulsions are the hallmarks of all types of OCD. Obsessions are unwanted thoughts, feelings, urges, and doubts, while compulsions are repetitive actions carried out to reduce anxiety and distress.

Obsessions and Compulsions

It is common for an obsession to be motivated by a feared outcome, such as their responsibility for harming themselves or others or being deemed unethical, moral, or imperfect.

An OCD person, for example, maybe obsessed with the fear that they will unintentionally cause a fire in their house by being careless. In some cases, the fear can become so intense that it drives them to perform compulsions to reduce the perception of harm and minimize distress.

As opposed to obsessions, compulsions consist of repetitive behaviours or mental acts that a person with OCD is motivated to perform because of an obsession or because of rigid rules that must be followed.

Compulsions are excessive or not connected in a realistic way to the problem they are intended to address. It is clear that compulsive acts are excessive or that they are not related to the problem they are intended to resolve.

People with OCD also experience compulsions that can vary from person to person.

Types of Obsessions

The common misconception about OCD is that being "obsessed" doesn't mean loving or cherishing something or someone or enjoying the thoughts. Instead, obsessions in OCD are distressing, time-consuming, and fear-based.

Characteristics of OCD Obsessions

1. Internal experiences can be unpleasant, recurring, and feel out of one's control at times.

2. They induce extreme pain, such as anxiety, contempt, and fear, and can sometimes be unbearable.

3. As long as these ideas persist, the person is incapable of focusing on other things that matter to them.

Although the exact content and nature of OCD obsessions may differ from person to person, there are a certain number of common themes.

Contamination

There are many obsessions with contamination, including dirt, germs, bodily fluids, diseases, environmental toxins, or chemicals.

Harm

People who are obsessed with harm may fear harming themselves or other people, be concerned about being responsible for a bad result or unintentionally harm others.

When people with OCD have harm-related obsessions, they do not necessarily fear that they will intentionally harm. Rather, they might be worried about unintentionally harming people out of carelessness, which could lead to checking compulsions (like needing to check all the outlets in their home before leaving).

Unwanted sexual thoughts

OCD can result in intrusive, unwanted, perverse, or forbidden thoughts related to sexuality. These obsessive thoughts can take the form of images or urges about homosexuality, sexual thoughts about children, incest, or rape.

Losing Control

People with OCD may have an excessive fear of losing control. They are worried about causing harm to themselves or others through impulsive and abusive verbal acts, such as insults or words that are taboo or forbidden, or harmful physical acts such as stealing or violence. Often, these obsessions are associated with aggressive or even horrifying mental images.

Perfectionism

Obsessions "just right" are about symmetry, evenness, exactness, a need to remember, following rigid rituals or expectations, and an overall need for something to feel "just right."

Physical Illness

The obsession with illness and disease can be distinct from the obsessions with germs. People with OCD may be preoccupied with worries that they have or will get a disease.

OCD patients tend to be hyperaware of bodily processes like swallowing or breathing which can lead to obsessions related to illnesses, pain, and disease.

But why?

The answer is stress! Stress is the undercurrent of Obsessive-Compulsive Disorder.

Concurrent stress generates anxiety symptoms— flaring OCD behaviours.

Stress interferes with the treatment of this disorder, disabling the patient from getting any benefits… making it worse. Stress does tamper with required coping skills during the treatment. The patient rather develops ‘poor coping mechanisms’ like avoiding instructions prescribed by the psychologist. Running away from real-life situations, Drinking too much coffee or engaging in binging and smoking profusely.

Aggravation of stress laced with anxiety might lead to promiscuous behaviour in certain cases.

Short and long term effects of OCD

Obsessive-Compulsive Disorder strain relationships within the family and outside. It becomes a problem at work or school and also in social life. Such individuals hardly contribute to their families or society. Over a long length of time, if this disorder is left untreated may cause severe depression and anxiety issues.

Untreated OCD can diminish grey matter in the brain making people lose control over impulses. The low grey matter might twitch the way the brain processes information. This might lead to such people being more obsessed with bad and sexually aroused thoughts.

Patients must keep a tab on their stress levels by learning more about it. Recognising stress is a significant step: only then they can regulate it using appropriate stress management procedures.

How to treat an OCD patient?

Anything that is repeated is not an indication of OCD; brushing teeth, taking bath or having breakfast are among many things that we do every day. Caring for personal hygiene isn't a disorder as well but when this gets finicky like sanitising the doorknob and one's hands every time the door is opened or closed qualifies for an abnormality.

So how does one diagnose this anomaly?

A three-step mechanism helps diagnose and understand this disorder.

■ Psychological evaluation

It involves discussing your thoughts, feelings, symptoms, and behaviour patterns with a mental health professional to find out if you have any obsessions or compulsive behaviours that negatively affect your quality of life. Your family or friends may also be asked to participate in this discussion.

■ Diagnostic criteria for OCD

Your doctor may use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

■ Physical examination

A diagnostic test may be performed to identify other problems that could be causing your symptoms and to check for any complications.

Treatment techniques for patients with OCD

OCD can be treated in several proven ways. One of them is Cognitive Behavioral Therapy (CBT).

Cognitive Behavioural Therapy (CBT) teaches people how to identify and change destructive or disturbing thoughts that affect their emotions and behaviour.

The purpose of cognitive behavioural therapy is to change the automatic negative thoughts that are associated with depression, anxiety, and emotional difficulties. These negative thoughts negatively influence mood and can contribute to emotional problems.

CBT replaces these unrealistic, problematic thoughts with more realistic, objective ones.

Exposure and Response Prevention (ERP) is another mechanism that is effectively dealing with treating psychological disorders.

Experiencing thoughts, images, objects, and situations that provoke anxiety and/or obsession is called exposure in ERP.

The Response Prevention part of ERP focuses on making a choice not to do compulsive behaviour once anxiety or obsessions are triggered.

The exercises are performed under the guidance of a therapist at first - but you'll eventually learn how to do them on your own to manage your symptoms.

What makes ERP different from traditional talk therapy (psychotherapy)?

As a traditional method of treatment, talk therapy helps patients gain insight into their problems. It can be very helpful for treating depression or anxiety, but not for treating OCD symptoms that worsen over time.

It's important to try ERP or medication first before talking therapy to treat OCD, as these are the types of treatments that have been demonstrated to best treat OCD through extensive research.

Summary

• Understanding what OCD is all about is the first step to recovering from it. Accept that OCD is a treatable mental health condition.

• Compulsive behaviours can be reinforced by helping a person with their habits. However, the involvement of family and friends in rituals must be reduced gradually as part of a treatment plan agreed upon with the person.

• Help the person find a professional experienced in treating OCD

■ Compiled by Saurabh Sengupta (Editor Zoom Delhi)

■ isaurabh@live.in