Could I have Obsessive Compulsive Disorder (OCD)?

Do I have Obsessive Compulsive Disorder (OCD) ?

What are obsessions?

Reference: (Diagnostic and Statistical Manual of Mental Disorders, 2013)

Obsessions are thoughts or images that:

• repeat themselves,
• are intrusive (they come when you don’t want them to),
• and cause intense anxiety.

Common obsession themes:

Reference: (Frost, Steketee, Krause, & Trepanier, 1995)

• Cleanliness
  • Very bothered by urine or faeces or other bodily secretions
  • Cannot stand dirt or germs
  • Fear of “toxins” in the food or household items or environment
  • Fear of being dirtied by an animal: like cats or dogs
  • Scared of sticky things
  • Scared of falling ill due to these “dirty things”
• Religion
  • Worried that certain things are “against the religion”
  • Excessive worry about what is correct or wrong thing to do
• Aggressive thoughts
  • Harming self or others
  • Violent imagery
  • Fear of shouting vulgarities or insults
  • Fear of doing something embarrassing
  • Fear of stealing things
• Sexual thoughts
  • Sexual thoughts about strangers, friends or family
  • Content involving children, incest or homosexuality
• Symmetry
  • Require things to be arranged in a certain order
  • Needs all the household items to be “perfect”
• Hoarding: Worry about throwing away anything “because it might be useful in the future”.
• Rigid rules
  • Fear that you will harm others because you are “not careful enough”
  • Fear that you are responsible for something terrible happening in other people’s life
• Bodily
  • Worries about being sick
  • Concerned about a particular part of the body
• Miscellaneous
  • Lucky/unlucky thing/colour/number/word
  • Superstitious fears that you know are irrational

Even if you have just one of these above obsessions that can affect your life, you might already have OCD.

Compulsions are:

• Repeated physical or mental acts carried out to try to reduce anxiety caused by the above obsessions.

Common compulsions:

• Cleaning and washing: due to cleanliness obsessions, need to have certain ritualised ways to “clean up”
• Checking of
  • locks, windows, doors, screws, nuts, hob, kettle, CCTV, phones, chats etc
  • other people or self to see if they were harmed
  • mistakes
  • certain body parts to ally the somatic obsessions as above
• Repeating
  • certain routines: like walk from specific place, in a particular direction, etc
  • redoing, re-writing, re-reading, etc
  • counting and recounting
  • ordering and rearranging
  • mental rituals: such as a prayer to undo a “bad” thought
• Hoarding or keeping things as above, just in case “some day you might need them”
• Miscellaneous
  • keep asking friends for reassurance that you “didn’t do something wrong”
  • need to touch, rub or do certain actions
  • eating rituals: like arranging everything in a certain way
  • hair pulling

Some examples of OCD

One of our psychologists knows of a student who had to button her school uniform from the last button up, and repeat the same action two more times among other rituals. It was to neutralise her obsessions that something bad would befall her. She had to wake up extremely early to perform her rituals or risk being late for school.

Our psychologist once encountered a young mother who dared not carry her infant because she had intrusive images of throwing the child off the balcony.

Our team treated a middle-aged man who had to check and re-check emails before and after he sent it out to make sure there were no mistakes. It slowed down his productivity significantly and affected his performance badly.

We also frequently encounter people with obsessive thoughts that their hands are dirty after touching a daily object (e.g. a door handle). They need to repeatedly wash their hands to neutralise these thoughts.

Oh no, I have some of the above symptoms, do I have OCD?

“If you don’t want it, you have it.”

A simple rule to test if you have OCD is to follow this mantra. That means if you don’t like the thought you are having, it could be an obsession.

Two different people can have the exact same thought but the one who does not want that particular thought would develop an OCD.

People with obsessions usually feel ashamed about their thoughts and often avoid telling another person about their obsessions.

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Could I have another similar condition but not OCD?

Ref: (“Obsessive-Compulsive Disorder Differential Diagnoses,” medscape)

Yes! These are the similar conditions but they are not OCD:

• Body Dysmorphic Disorder: Cannot stop thinking about flaws in your body.
• Compulsive Skin Picking: Frequently picking the skin till it hurts.
• Tourette Syndrome: A brain disorder where the patient has involuntary, repetitive, sterotyped movements or shouting.
• Trichotillomania: Frequent hair pulling till it drops.

OCD is known to co-occur with the following conditions as well:

• Major depressive disorder: read this article.
• Panic disorder
• Generalised anxiety disorder
• Social phobia and simple phobia
• ADHD
• Idiopathic torticollis
• Substance abuse
• Eating disorders

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How does it affect your life?

Unfortunately, this is a poorly studied subject. From experience, these are the broad areas in which lives are affected:

Guilt about thoughts

People with OCD do not have control over what thoughts they have. Moreover, many mistakenly believe that they are morally wrong for having these thoughts.

Attempts to control and distract themselves from the thoughts just make the thoughts more prominent. Guilt constantly gnaws at them for having obsessions.

Slowness in daily tasks

Compulsions result in slowness.

A student who compulsively checks and re-checks to make sure he has all the books in his bag would be late for school or have to wake up very early. Repeatedly washing hands for hours takes away precious time that could be spent on performing other meaningful activities.

Struggles in close relationships

Obsessional thoughts can stop a person from doing valuable activities.

A mother might suffer from aggressive obsession thoughts that involve her children whom she loves dearly. She would be busy “fighting” her thoughts while she is with her children.

As a result, she might not be sensitive to her child’s needs. In some cases, a mother might even avoid situations where she would be alone with her children.

Limitations at work

A person who repeatedly checks her emails and documents for mistakes might not be able to perform her work effectively. We once encountered a university student who had to check for more than 20 times if she has submitted a document online.

Thoughts that one has unknowingly knocked someone down might stop a taxi driver from driving for a living.

Someone who has compulsive cleaning behaviour might suffer from dry skin and flaking scalp, attracting unpleasant attention from bosses and co-workers.

How does it affect the lives of people around you?

People who suffer from OCD tend to ask people around them to engage in compulsive behaviour. A middle-aged man suffering from cleanliness obsessions would ask his spouse and children to constantly clean up the house.

OCD sufferers seek reassurance from friends and relatives.

A driver with obsessional thoughts that he has accidentally knocked down someone would repeatedly ask another person if it is possible that he has done the act. A reassurance usually relieves the anxiety only for a brief moment. Such reassurance-seeking acts repeat several times a day, much to the dismay of people close to the OCD sufferer.

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Can OCD be prevented?

There are no known ways to prevent OCD at the point of writing this article.

What is the typical age of OCD?

Typically they start at late teens, with a study (Minichiello, Baer, Jenike, & Holland, 1990) that found the mean age to be 22 years old.

There are some patients who start much younger at about 11 years old. OCD tends to run in their families or they have Tourette Syndrome (Delorme et al., 2005).

Who gets OCD?

1 in 50 people will get diagnosed with OCD in their lifetime (Ruscio, Stein, Chiu, & Kessler, 2010). Equal number of men and women get OCD.

You are more likely to get OCD if you have the following (“NIMH » Obsessive-Compulsive Disorder,”) :

• A first degree relative (father, mother, son) with OCD
• Experienced physical or sexual or other abuse during childhood
• Stressful events

What is the cause of OCD?

Nobody knows. We guess that you could try to blame the following:

• Bad genes
  • If you have a parent, sibling, or child who has OCD, you are 3 to 12 times more likely to get it (Butcher, Hooley, & Mineka, 2013).
  • The younger the OCD starts, the more likely it is related to the genes (Monteiro & Feng, 2016).
• Bad environment
  • OCD can be a learned behaviour. The patient learns to associate a neutral object with negative thoughts or experiences (Butcher, Hooley, & Mineka, 2013).
  • For example, touching a doorknob or shaking hands might become associated with the negative idea of contamination. The person may discover that anxiety produced by shaking hands or touching a doorknob can be reduced by hand washing. Washing his or her hands extensively reduces the anxiety, and so the washing response is reinforced, which makes it more likely to occur again in the future when other situations evoke anxiety about contamination.
• Bad way of thinking
  • The following ways of thinking are thought to lead to OCD:
    • Trying to suppress obsessive thoughts instead of being able to accept those thoughts.
    • Thinking that one is highly responsible for any harmful consequences and the personal responsibility to prevent those negative consequences.
    • Being overly sensitive to negative irrelevant information.

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How can it be treated?

Psychoeducation

What exactly does this mean?

This is the first step to any treatment. Psychoeducation means to understand.

If you have reached this part of the article, it is probably a great achievement already. You should give yourself a pat on the back.

If you can fully understand your own illness, half the battle is won already.

Otherwise, if you come to see any health professional trained sufficiently in mental health, we would cover the following topics with you in brief:

• Anxiety, the causes and its nature
• OCD, the causes and its nature
• How to get in control of your OCD
• How to get people around you to help you get better

Pills or medications

When your symptoms are severe enough to start to impair your life, we will consider medications.

Common FAQs

Ok, we’ve been there, done that, answered many questions from patients. And we’ve curated some of the most common questions for you.

Do I really need medications? 

Early on in our training, we have tried to treat patients without medications. The conclusion was that patients recovered faster and they felt much better while they are on it. No doctor wants to start medications for patients. But if I didn’t offer this option to you, I would be blatantly negligent. It has been found to be very effective in most patients (Abramowitz, 1997).

Would I become dependent on medications?

These medications have not been shown to cause you to become reliant or dependent, unless you have been given tranquilisers or sleeping pills. You will still have your own free will to stop the medications anytime you like. From experience though, most patients get a different life after treatment. They fear stopping the medications, because they don’t want to go back to their “previous self” again.

What are some of the side effects of medications?

The doctor should explain this to you when prescribing these medications and I would leave him/her to do so face-to-face. However, most side effects are short-lived and will go away after continued use or stopping the medications. Possible side effects do not mean that you will definitely get them, in fact most of the side effects happen in <20% of the patients.

Can the medications really help me?

Medications and therapy have been shown consistently to help in about 80% of the patients (Foa et al., 2005).

What do the medications do to my thoughts?

Nothing. Absolutely nothing. You will continue to have the OCD thoughts. So that’s why therapy might come in handy.

So how does the medications actually help?

Good question. The short answer is we don’t know. What we hear from other patients are that they feel calmer, and are more able to get in control of these thoughts. Even when they “hear” the obsessions, they are more able to ignore them.

Would I suffer from a personality change?

Unlikely in a negative way. You are more likely to be the person you actually want to be, rather than let your life be consumed by all these OCD thoughts and actions.

What are the types of medications available?

• Tricyclic Antidepressants
  • Clomipramide was the first to be discovered to be useful, and it remains to be the most effective still (Greist, Jefferson, Kobak, Katzelnick, & Serlin, 1995).
  • Its use however could be limited by its side effects like:
    • Sleepiness
    • Mouth and eye dryness
    • Urinary problems
    • Constipation
    • Sexual dysfunction
• Selective Serotonin Reuptake Inhibitors
  • They are commonly known as antidepressants.
  • There are many brands such as fluoxetine (prozac), escitalopram (lexapro), fluvoxamine (faverin), sertraline (zoloft), etc.
  • Modern doctors are more likely to prescribe these drugs due to lesser side effects.
  • But still can have possible side effects like:
    • Diarrhoea
    • Stomach cramps or bloatedness or nausea
    • Giddiness
    • Sleeplessness or sleepiness
    • Headache
    • Sexual dysfunction
• Antipsychotics
  • These are medications that doctors reach for when your OCD appears to be difficult to treat.
  • Unfortunately, this lies outside of the expertise of a clinical psychologist and a family physician with special interest in mental health.
  • The implications and possible side effects should be further discussed with your own psychiatrists.

Therapy or psychotherapy

Taking the first step to explore this treatment is a good start. Finding a proper psychologist with post graduate qualifications in psychology is the next step.

The psychologist will first build an affirming therapy relationship.

The treatment should involve response prevention like taking all soap and towels away from a handwasher, etc. This is combined with constant exposure to the eliciting stimuli like the doorknob or handshake, etc.

The purpose is not to torture the patient but to get the patient’s brain to learn a new behaviour to overwrite the previous OCD behaviour (Meyer & Weaver, 2009).

Another aspect of treatment involves patients learning to relabel their obsessive urges instead of giving in to them.

For example, they say, “I’m having an obsessive urge or a compulsion again.” They then intentionally engage in 15 minutes of an activity they could be absorbed in and find enjoyable. They might listen to music, or exercise. This shifts their attention away from the compulsion and over time, the urges themselves diminish.

Interesting? Or interested in long-term control of your OCD? You can leave us a request for therapy by leaving your details in the form below. We will contact you to book an appointment.