Curb your obsessions:how to tackle your OCD

-Dr Eli Pradhan Ranjitkar, Consultant, Ophthalmologist, Tilganga Institute of Ophthalmology

Do you feel the urge sometimes to do things that, on hindsight, may not seem entirely rational? Well, if you do, you may be suffering from obsessive compulsive behavior (OCD). But, don’t worry, you are in good company. JK Rowling and David Beckham suffer from the same problem and it is believed that Churchill, Darwin, and Michelangelo were also OCD sufferers.

Do you ever have strange thoughts coming in front of you again and again? Have you ever had the urge to do something repeatedly without being conscious of it? Don’t worry, everyone has thoughts that are upsetting or do not make any sense from time to time; this is normal. Just having an unpleasant thought does not mean you have an obsession. Similarly, it is not uncommon for people to repeat certain actions, such as double-checking whether the door is locked. However, if such behaviors are repeated often, it could be a disorder.

Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by irresistible thoughts or images (obsessions) and/or rigid rituals/behaviors that may be driven by obsessions (compulsions). The diagnosis of OCD has been described in medicine for at least the past 100 years. Statistics on the number of people in the United States who have OCD range from 1% to 2%, or more than 2-3 million adults. Many famous personalities like JK Rowling and David Beckham suffer from OCD. It is also believed that Winston Churchill, Charles Darwin, and Michelangelo suffered from a similar problem. The average age of onset of the disorder is 19 years, although it often begins during childhood or the teenage years and usually develops by 30 years of age. It tends to afflict males more than females.
Recognizing OCD: Do I have it?

I have known a lady whose hand is red, swollen, and cracked due to repeated hand washing. Sometimes it becomes painful and starts to bleed from the crack. She understands it is due to her habit. However, she is unable to stop herself from doing so as she feels that she might get germs by touching anything. She has always been careful about being clean. She frequently disinfects all of her kid’s toys with boiling water and washes their cloths and sheets with bleach.

Dev’s story
Dev is a 45-year-old accountant who repeats everything he does (e.g., reading, writing, locking doors) at least three to four times to ensure that he has done every task perfectly. He knows that he has done something perfectly when it feels “just right”. Dev says that since he was a child he has always been concerned about doing things perfectly and correctly, including school homework.

At work, he repeatedly checks everything he does to make sure that he has done it correctly and perfectly. If he makes a mistake, he needs to redo the whole document. Dev also has a strong need to know and remember things, repeatedly asking for clarification if he does not fully understand something that is said to him.

He is divorced and lives alone. His marriage ended because of his ways of doing things. He worries that if he does not strive to do everything perfectly, he will end up making mistakes all the time and become jobless and then homeless. He sometimes feels confused and depressed; he is not sure what he should do about his condition and is not confident that he can change.

What is the treatment?
The vicious cycle of obsession and compulsion needs to be broken slowly. It includes behavioral therapies and medications. Behavioral therapies for OCD include ritual prevention and exposure therapy. Prevention of rituals involves a mental-health professional helping the OCD sufferer to endure longer and longer periods of resisting the urge to engage in compulsive behaviors. Exposure therapy is a form of behavior modification that involves the individual with OCD getting in touch with situations that tend to increase the OCD sufferer’s urge to engage in compulsions, then helping him or her resist that urge. The therapists help patients change the negative styles of thinking and behaving that are often associated with the anxiety.

How is OCD prevented?
OCD is best prevented through early recognition and treatment. Specifically, recognizing warning signs that a child may be at risk for developing OCD can be a place to start. Examples of such early warning signs include excessive complaints by the child that certain clothes or food textures are intolerable, as well as a child who engages in rigid patterns of behavior.

Everyone has unwanted or unpleasant thoughts sometimes; it’s normal. Just thinking about something won’t make it happen. For example, if you think about winning a million-dollar lottery, it won’t necessarily happen. Thinking a bad thought does not mean you are a bad person. It also does not mean that you want to do anything bad. However, if it becomes a ritual then we need to change the way we think and act before it is too late.

Common examples of obsession are

Fear of contamination
This obsession involves a fear of coming into contact with germs, getting sick, or making others sick from touching “dirty” or “contaminated” items, sticky substances, or chemicals.
Thoughts of doubt
This obsession involves constant doubt about whether you’ve done something wrong or made a mistake. For example, “Did I turn off the stove?”; “Did I keep the knife in the proper place?”
Fear of accidentally harming self or others
Adults with these obsessions are afraid of harming themselves or others through carelessness. For example, “If I don’t make sure that the door is locked at night, the apartment might get broken into and I might be robbed and murdered along with my family members.”
Need for symmetry/exactness
Adults with this obsession feel a need to have objects placed in a certain order or position, or tasks or events to be completed in a set way. For example, “I need to keep all the books in the shelf properly aligned. Otherwise, it just does not feel right!”

Common examples of compulsions
Washing/cleaning compulsions
Washing hands excessively
Cleaning the bathroom or kitchen, washing laundry religiously
Checking compulsions
Checking to make sure doors are locked, stoves are turned off, electrical outlets are unplugged, knives are kept properly
Ordering/arranging compulsions
This category of compulsion involves arranging items in specific ways, such as clothes, books, shoes, etc.
Individuals with OCD are more likely to also develop chronic hair pulling, muscle or vocal tics, or an eating disorder like anorexia or bulimia. OCD sufferers can also develop very low mood, anxiety disorder, and panic disorder. OCD puts its sufferers at a higher risk of having excessive concerns about their bodies causing excessive worry about having a serious illness.

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