Have you noticed someone use a hand sanitiser to clean their work table and computer keyboard again and again before sitting down to work?
Does your friend have this unusual habit of washing hands frequently even though the hands may not be dirty?
Have you ever wondered why some people indulge in needlessly repetitive actions that seem to make great sense only to them?
A common condition with many people, this chronic need to repeat some actions is due to what is known as the Obsessive Compulsive Disorder (OCD). People afflicted with this condition feel the need to perform some tasks with a frequency that is as mystifying as it is disturbing to watch. It is almost as if they need to do this to stave off some impending danger or calamity. And if they miss even one attempt at doing so, it may be too late.
According to Clare Smart, personal development consultant at LifeWorks in Dubai, OCD affects around one in 50 people. It affects an equal number of men and women, she says. But the true nature of OCD is more than just the most commonly described repetitive acts of people “checking light switches to see if they are on or off” or hand washing or locking the front door again and again, says Clare. “OCD is a debilitating and distressing condition for people that suffer from it. The main features of OCD are thoughts that make you deeply anxious and what you do to alleviate the anxiety.”
There are no official statistics on how many people in the UAE suffer from this disorder, but doctors say about two percent of people in the Western nations suffer from it, and that it could be the same percentage here.
Why does OCD occur?
Why this disorder occurs is not yet known, but it is believed that certain brain pathways change in some people, specially those who have undergone certain stresses in life such as a pregnancy, for example. It is not known why the stress triggers this behaviour.
The disorder could also be due to upbringing, or other influences that contribute to such a behaviour. OCD may also be due to an individual’s genetic profile and could be inherited. If you are a very clean and orderly person, sometimes, these habits can become extreme.
At some time or the other, most of us have anxious thoughts but we do not linger on them. But OCD sufferers believe these thoughts are immoral and so they keep getting worried about these thoughts not returning and in the process, obsess about them all the time. They begin to perpetuate the very thing they want to banish from their minds.
People with OCD, says Clare, realise that their obsessional thoughts are irrational, but they believe the only way to relieve the anxiety is to perform compulsive behaviours to prevent perceived harm happening to themselves or to a loved one.
The repetitive physical behaviours or mental thought rituals are performed over and over again in an attempt to relieve the anxiety caused by the obsessional thoughts. “Avoidance of places or situations to prevent triggering these obsessive thoughts is also considered to be a compulsion,” she says.
She cannot, she says, provide a case study even under the guise of anonymity due to the strict confidentially clause in the treatment, as the symptoms are very specific to an individual and the person would easily know that his case is being discussed. But she provides an overview of how OCD works.
In OCD, thoughts pop into your head that are triggered by random things. “The content can vary a lot. One example is a thought that serious harm may come to themselves or to somebody else — that they are a bad person and that they may have offended God in some way, or offended someone they care about every much.”
This feeling of anxiety and discomfort starts to build up over time in these individuals.
The cruelty of compulsion
“The ‘C’ part of OCD is ‘Compulsive’ actions,” says Smart, “which you are compelled to do to rid of that anxiety.” The belief in the minds of these people is that the repetitive action is some way linked to the resolution of that problem.
So if you believe washing your hands repeatedly will make that lurking danger recede, you will do that believing it to be a preventive measure. Or you could want to keep things in a certain way on a table or in a cupboard and if the order is disturbed, you fear that whatever awaits you in the shadows will come to pass.
So you constantly check to see that the order and placement of things are just so.
This is the reason why people repeat certain phrase or prayers, because it helps them believe that the anxious feeling will go away.
The key difference that separates little quirks, often referred to by people as being “a bit OCD”, from the actual full-blown disorder, is the distressing and unwanted experience of obsessions and compulsions impacting in a significant way upon a person’s everyday functioning.
“OCD is very time-consuming,” says Clare. “In extreme cases, you will not be able to leave the home from the front door ever. You will not be able to keep a job as you cannot do things on time.”
Treatment options
If not treated, this anxiety becomes overwhelming, the person feels isolated and is not able to concentrate on other things as he is preoccupied with the obsessive behaviours that gradually get worse over time.
Medication, such as an anti-depressant, is an option for treatment of this disorder.
Along with medication, there is ERP (Exposure and Response Prevention) therapy that helps change the negative and unhelpful thinking and behaviour. ERP involves the person with OCD to face his fears and stop the compulsive behaviour. It is anxiety producing at first, but the anxiety starts to wane and then disappear.
Clare says, “It may sound odd, but if you expose yourself to your troubling thoughts, it is a way of getting more control of them. You record them and listen back to them, or write them down and re-read them.”
This has to be done regularly until the anxiety reduces.
“Resist the compulsive behaviour, but not the obsessional thought and do not use alcohol to control your anxiety,” she says.
“Counselling provides a safe space to talk about your thoughts, worries and feelings and your counsellor will help you to find the best way forward to breaking the cycle of OCD.”
In the normalisation of the individual, Clare believes family members have a big role to play. But, despite their good intentions, if they do not put forth the correct responses, they could make matters worse for the individual with OCD. “Family members start getting indulgent out of concern for the person, reassuring them and that pushes the individual to keep repeating his behaviour.”
Never play along with the rituals when dealing with a person with OCD, says Clare. Instead, encourage the person to tackle what he or she perceives as a fearful situation. On the other hand, do not criticise the person or rebuke them as it will make matters worse. Provide a supportive environment, says Clare, but not in a way that indulges them to continue with their destructive thought pattern.
As a caregiver, you should learn and educate yourself on what you are dealing with. So read as much as you can about the disorder. Family members should also encourage the person to read up on their own condition and encourage them to seek professional help.
OCD can also occur in children. Parents of OCD children and teens are given specific things to work on with the professional, says Clare.
The main thing is to recognise, she says, is that the problem exists and to look for help in treating it. “It is a complex disorder and does require proper treatment.”
