What you need to know about Obsessive-Compulsive Disorder, its symptoms and treatment

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When was the last time you heard someone say, “He/she/they are so OCD with cleaning/putting things in order”? The label OCD is often misused in our everyday conversation for things people are particular about. However, obsessive compulsive disorder (OCD) is a serious mental health condition and can't just be reduced to a single adjective.

While OCD is a common mental health disorder, it is not nearly as rampant as you would think. According to a national survey by Harvard Medical School, an estimated 2.3% of adults in the US are affected by obsessive compulsive disorder. Awareness about the condition can potentially reduce the misuse of the term, so let's clear some misconceptions.

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Symptoms of OCD

According to the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-V), OCD symptoms are characterised by “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.” The recurrent, intrusive thoughts make up the obsessions and the repetitive behaviours or rituals that are carried out in the hope of neutralising the unwanted obsessions are called compulsions.

In my case, I tap my pockets almost every single time I leave a restaurant. Before I go out, I check the kitchen stove to ensure that it's turned off. What distinguishes these daily rituals from those of a person with OCD is that for the latter, it consumes several hours of their time every day. Even if they are aware that it is irrational, they can't help but be controlled by these rituals which get in the way of normal daily functioning.

Types of OCD

There are as many types of OCD as there are subjective experiences of obsessions and compulsions. Clinicians and researchers divide them into subtypes based on the kind of obsessions and the resulting compulsions. Take note that the following types of OCD are not distinct and by no means all-encompassing. One may have symptoms from two or more subtypes at the same time, and on occasion, one that does not fit snugly into any of these subtypes.

1. Contamination

 This is one of the most common types of OCD. This subtype has a tendency to fear physical/contact contamination. The obsessional worry is that if they don't clean or avoid a specific contaminant, it would cause harm to themselves or others. The resultant compulsive behaviour, aside from the obvious cleaning or washing, can also include avoiding surfaces like door handles, bannisters and wet surfaces; public spaces like toilets, hospitals, crowds and eateries; and acts like teeth brushing, handshakes and sex.

Contamination OCD can also be mental in nature and lead to emotional distress. This stems from the belief that they must avoid certain people who can contaminate their sense of self. For instance, staying away from people who had affairs due to the fear that they would be influenced to commit infidelity. Unlike physical contamination, no contact is required and the source of contamination is always another human being.

2. Checking

Remember how I mentioned my personal ritual of checking the kitchen stove before I leave the house? Imagine if I came back to my house every hour to check for the same, fearing that my house is burning down each time. Then I would be exhibiting symptoms of the checking subtype. The obsessional worry and compulsive behaviours are caused by fear of harm or damage, and the compulsion is repetitive acts to relieve that worry.

3. Symmetry

Things have to be perfect or it's ruined. For example, my father has an obsession with the number 10. He has to turn the doorknob exactly ten times before he feels safe to leave the house. It feels just right when it's the tenth time. This is a counting compulsion in response to a symmetry obsession. Other kinds of compulsions in this subtype include arranging and ordering things. For example, all the red shirts need to go first in the wardrobe, and then the blues. Any discrepancy in this order is a source of distress.

As mentioned earlier, some people do not fit clearly into these major types of OCD. There are obsessions that do not have a subsequent compulsion, or at least one which is visible. Hoarding disorder is one such example. Obsessions surrounding religion or sex are often only marked by intrusive thoughts but no resulting compulsive behaviours. Other types of OCD include hair pulling disorder, skin picking disorder, relationship OCD and sexual orientation OCD.

What causes OCD?

The jury is still out on what actually causes OCD. While it has a tendency to run in families, it's not purely genetic as studies on identical twins have shown one twin can have OCD while the other one does not. What we do know is that stress is a strong contributory cause and the condition may appear or worsen during stressful transitions in one's life. It is no wonder that the onset of OCD is common during adolescence.

What is the best treatment for OCD?

To date, the meta-analyses (compilations of multiple peer-reviewed research projects) on the best OCD treatment all point to the best interventions as being those that combine psychotherapy and medication. In psychotherapy, the most common intervention used is Cognitive Behavioral Therapy (CBT). It is often considered the gold standard for OCD as the condition is mediated by irrational beliefs. CBT addresses these beliefs by challenging them and the consequent compulsive behaviours. Controlled exposure and other forms of behavioural therapy that take baby steps towards approaching the fear instead of avoiding it altogether are quite effective too.

What kind of medication is used for OCD treatment?

Since OCD is an anxiety disorder, patients can find relief through anti-anxiety medications/ anxiolytics. It's important to note that the symptoms don't disappear with medication, rather they are easier to manage. The treating physician or psychiatrist can also prescribe antidepressants and Selective Serotonin Reuptake Inhibitors (SSRIs), in addition to anxiolytics.

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Tips for living with OCD

If you are someone living with obsessive compulsive disorder, these tips can be helpful:

1. Explore self-care 

You can be your worst enemy or best ally. A salient feature of OCD is predictability. You are aware of your OCD obsessions and intrusive thoughts, how they make you feel, and what they compel you to do. This gives you the opportunity to try and equip yourself with different tools and techniques to address them. 

Wysa is one such personalised mental health app that you can use. In the Wysa app, you will find numerous calming and anxiety reduction tools that you can try, such as Jacobson's Progressive Muscular Relaxation and Mindfulness Based Stress Reduction (MBSR) techniques. Additionally, journaling about anxiety when it occurs has been shown to reduce its intensity. If you have subscribed to a Wysa coach/therapist, you can message them in real time, and use that space as an interactive journal. You can check out the services provided by Wysa by downloading the app.  

2. Manage stress 

Stress can exacerbate the symptoms of OCD. Granted that one cannot eliminate stress from daily life, we can aim to manage it better. If you list down all your daily activities and classify them into stress-inducing ones and stress-relieving ones, what do you think the ratio between the two would look like? If you find that the number of stress-inducing activities far exceeds the number of stress-relieving ones (a ratio of 2:1 or higher), then perhaps it's time to eliminate some stressors and add some relaxation to your life.

3. Practice self-compassion

Stay long enough with something, and it starts to define you. A guest becomes a roommate, a roommate becomes a best friend, a best friend becomes a partner, and soon enough you are somebody's spouse. Living in close quarters with OCD means you pick up some of its traits — the harshness, too much self-blame, and thinking in black and white. What's often missing is tenderness and self-love. If we can incorporate small acts of self-compassion into our daily lives, we can help remind ourselves that we are more than the mental health condition that we have. Practice self-compassion by taking self-compassion breaks in which you dedicate time to meditate on being kind to yourself. Practices like affirmations, metta (or loving kindness meditation) and self-soothing techniques can also be quite apt for nurturing compassion within ourselves.

Frequently Asked Questions

Is OCD a form of anxiety?

Yes, OCD is classified as one of the five major anxiety disorders, the other four being generalised anxiety disorder, panic disorder, social anxiety disorder and post-traumatic stress disorder (PTSD).

Can OCD go away?

Think of the moon. It waxes and wanes. A new moon doesn't mean the moon ceased to exist and a full moon doesn't mean that it will stay that way in the coming nights. Stress doesn't go away, but it can be managed. The same applies to OCD.

How do they test you for OCD?

While you may find a litany of quizzes and screening tests online, there is no official test for OCD. The diagnosis is performed by a mental health practitioner based on the criteria outlined in the DSM-V.

When should you see a mental health professional?

Most of us know that a fracture to the limb requires medical attention. Psychological fractures, however, are less apparent. Here are two indicators that can tell you it's probably a good time to go see an expert:

• The obsessions and/or compulsions are time-consuming (i.e. they take more than an hour per day).
• When obsessions and/or compulsions are a source of distress and disrupt your social, occupational or other important areas of functioning.

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