Understanding
obsessive-compulsive
disorder
As we go through the hustle and bustle of our daily lives, we are met with a fair share of challenges and issues. While some may learn to cope and overcome the new stressors, others may find these stressors overwhelming.
We may start having irrational thoughts and fears (obsessions) and develop behaviours such as repeating actions that come from those thoughts (compulsions). These obsessions and compulsions can be so immense that they affect our day-to-day activities.
The good news is, the obsessions and compulsions can be managed.
What is obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD) is one of the top three most common mental health disorders.
Obsessions cause distress and anxiety to the person. These obsessions typically intrude into our thoughts and actions. In Singapore, it affects 1 in every 28 Singaporeans in their lifetime.
Common misconceptions:
Learn more
about OCD here
Learn more
about OCD here
Perfectionism vs OCD
There is a difference between being a perfectionist and having OCD. While we may sometimes find a need to keep the floors sparkly clean or have our knickknacks arranged in a certain manner, that does not necessarily mean that we have OCD.
With OCD, our quality of life decreases dramatically as we become consumed in carrying out compulsive behaviours and rituals.
Signs and symptoms
Obsessions Obsessions
Obsessions are repeated, persistent, unwanted ideas, thoughts, images, or impulses that are experienced involuntarily at some time. They typically intrude into our thoughts and actions.
Common obsessions include:
Common obsessions include:
Fear of hurting someone.
Need for symmetry and exactness.
Irrational fears of contamination from dirt or germs.
Distressing religious thoughts.
Examples of these kinds of thoughts include obscenities related to religious figures or making themselves excessively accountable for breaking religious codes of conduct.
Distressing sexually intrusive thoughts. This includes sexual thoughts about friends, family, children, or animals.
These thoughts are unwanted, intrusive and cause extreme anxiety and distress. They do not bring pleasure to the person.
Compulsions Compulsions
Compulsions can be behavioural (actions) or mental (thoughts). They are repetitive actions that are often carried out in a special pattern or according to specific rules. Compulsions are usually performed to try and prevent an obsessive fear from happening, to reduce the anxiety the obsessive thought creates, or to make things feel “just right”.
Common compulsions include:
Common compulsions include:
Excessive checking
Excessive cleaning and washing
Continuously thinking the same thought
Mentally repeating words or numbers a certain number of times
These symptoms may not actually mean OCD as they may also be present in people with other medical and neurological conditions, such as:
Tourette’s syndrome
characterised by sudden, repetitive, rapid, and unwanted movements or vocal sounds
Autism spectrum disorder
where one experiences difficulties with social interaction and communication
Epilepsy
which causes seizures or unusual sensations and behaviours
Brain injury
caused by head traumas
The signs and symptoms can be managed with early treatment.
Diagnosis
To diagnose OCD, a healthcare professional would conduct a detailed clinical interview in which he/she would ask about the individual’s past medical and psychiatric history, family history, current symptoms, and the impact on his/her functioning.
With the patient’s consent, the healthcare professional may also request to speak with a family member to gather more information. A standardised questionnaire may be administered to assess for the presence and severity of OCD. A physical examination and some blood tests may also be done.
Treatment
A combination of medication and cognitive behavioural therapy (a form of therapy to identify and change unhealthy behaviours) has been found to be effective in significantly reducing the symptoms of OCD.
The treatment may not result in a cure, but it can help bring symptoms under control so that they don’t rule over our daily life. Depending on the severity of OCD, some may need long-term, ongoing, or more intensive treatment.
Medication has been found to be an effective way to reduce OCD symptoms. A common medication prescribed is a class of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs).
SSRIs work by increasing the serotonin levels (our body’s chemical messengers that help stabilise our mood) in our brain. This, in turn, helps to decrease OCD symptoms.
Most people will have no or only mild side effects. It will take a few weeks before one sees an improvement in the symptoms. Medication may be prescribed or recommended at the clinical judgment of the healthcare professional.
CBT is a treatment approach that helps us recognise negative or unhelpful thoughts and behaviour patterns. It aims to help develop alternative ways of thinking and behaving to reduce psychological distress.
A specific form of CBT used for clients is Exposure and Response Prevention therapy in which the individual is deliberately exposed to the obsessional trigger, and then prevented from engaging in the associated repetitive behaviour.
With repeated and prolonged exposure to triggers, habituation eventually takes place. In addition, it is also useful to learn how to cope with our anxiety and stress. The combination of medication and CBT often increases the chance of achieving the intended results.
Coping with OCD
Anyone can have a medical condition - some people have hypertension, others are diabetic. It is important to understand that these conditions don’t define who they are. OCD doesn’t define a person, and it doesn’t make them who they are.
To complement the treatment for OCD, here are some coping strategies to help us through this period.
What people may think:
OCD is all about cleanliness
But did you know:
OCD manifests differently in different people. Common behaviours include counting, repeating certain movements, handwashing, arranging things in a specific way etc. These behaviours vary among individuals and can even change over the course of a person’s lifetime.
What people may think:
We’re all ‘a little OCD’
But did you know:
OCD is a complex and serious mental health condition that affects quality of life. It is a diagnosable condition and not a personality or character trait.
What people may think:
People with OCD just need to relax
But did you know:
OCD is a mental health condition, making people with OCD experience persistent and unpleasant thoughts that are difficult to dismiss — hence resulting in them feeling anxious and having difficulty relaxing.
Accept our thoughts without judgement
We may find that holding back our thoughts may have the opposite effect, and conversely, we may find ourselves thinking even more about them. Accept those thoughts as they come, without judgement.
Understand how OCD works
When engaging in the compulsions of OCD, we may find ourselves feeling less worried in the short term, making us think that these compulsions are useful and necessary.In doing this, we are unable to properly discover that these OCD fears/beliefs will not happen and that they will fade away with time even if we do not act on them. We can learn to cope with OCD by first understanding how it works, and give ourselves a chance not to give in to everything it tells us to do.
Recognise that OCD is not us and is separate from who we are
OCD tricks us into thinking that our fears are real and need to be acted upon. For starters, know that OCD is separate from us and it is something that worms its way into our brain as if it belongs there.Recognising that it is separate from us makes the fight against OCD much easier!
Accept mistakes if they happen, and avoid being too harsh with ourselves over it
Remind ourselves that a single mistake does not make us a failure.
In fact, mistakes are bound to happen because managing OCD is not a straightforward journey.Instead, accept the mistake and think about how we can minimise the chances of it happening in the future.
Practise relaxation techniques
These relaxation and guided imagery audio exercises may be helpful in managing OCD.
Access them here:
Relaxation audio exercises
Mindfulness
Other strategies that can improve our mental well-being include making time for the things we enjoy or being in the company of people who bring us joy and laughter. Find out more details about these strategies and other helpful tips here.
