Obsessive Compulsive Disorder
What is OCD?
People afflicted by an Obsessive-Compulsive Disorder (OCD) suffer intensely from obsessions that they cannot control. Surveys show that at least one-third of the cases of adult OCD begin in childhood and can affect both men and women. This can manifest itself in various forms. It may be in the form of persistent, unwelcome thoughts (even thoughts of violence) or repugnant thoughts of sexual acts. They may be thoughts of certain rituals that are against the person’s religious beliefs. The persons may have an excessive repulsion for germs and dirt so they wash their hands over and over again. They may be abnormally particular about order and symmetry.
These disturbing thoughts, impulses or images are called obsessions, and the resultant rituals which are performed to dispel these thoughts are called compulsions. Children may not realize they are afflicted by OCD but most adults with this condition recognize that what they’re doing is senseless although they cannot stop themselves.
Symptoms of OCD
OCD lasts for many years because the patients usually try to hide the fact that they have the problem. They do not seek treatment in the early stages. There may be long intervals when the symptoms are mild but generally OCD is considered a chronic disease. The symptoms vary depending on the kind of disorder:
1) Dirt/Dust: The OCD patient would worry about being contaminated by touching doorknobs, windows, latches and other objects. Their hands are red and raw due to frequent washing of hands to remove the so-called dirt.
2) Order and Symmetry: This manifestation of OCD is very peculiar. The patient would be constantly rearranging furniture and showpieces at home, would be unreasonably angered if objects at home or workplace are not kept in the proper order. Their passion for order and symmetry would go beyond reasonable limits.
3) Fear of injuring others: A woman afflicted by this type of OCD believes she may harm others by her carelessness. Before leaving the house she will go through a whole ritual of checking whether she has put off gas jets/cooking range knobs and water faucets in case these may cause harm to anyone else. She would spend at least an hour a day for this and it would interfere with daily life.
4) Injuring ones child: Similarly, a young mother might be obsessed with thoughts that she is going to harm her own child. She is unable to get rid of this worrisome idea. She even refuses to touch the kitchen knives and other sharp objects because she is afraid that she may use them as weapons on the child.
5) Worry about ‘blasphemy’: A patient with this type of OCD would always worry that his or her thoughts, rituals or activities are against their religion. The person would also have sexual thoughts about deities and ascetics/priests. The fact that they cannot stop or prevent these thoughts would be distressing for the person.
Diagnosis of OCD
1) When diagnosing obsessions the psychiatrists usually look for the following:
Recurrent and persistent thoughts, visions or sudden impulses that are experienced which interfere with the daily life of the person and cause very obvious signs of anxiety or distress. These thoughts, visions or impulses are usually about problems relating to their own lives. Although the person recognizes that these thoughts are really unreasonable, they are unable to ignore or suppress them so they would try to neutralize them with some other thoughts or actions.
2) When diagnosing compulsions the psychiatrists usually look for the following:
Repetitive behaviors and rituals like hand washing, rearranging objects, rechecking things already acted upon or repetitive acts of praying, counting possessions, repeating words silently, etc. In this case the person is driven to perform these activities in response to a particular obsession and they usually rigidly adhere to this ritual. This behavior is aimed at preventing some event or occurrence that they dread.
The psychiatrists check to see if these obsessions or compulsions cause obvious distress and take up more than an hour a day; or if they significantly interfere with the person’s personal or professional routine or adversely affect their social activities or relationships. Constant obsessions and compulsions can further lead to Panic and Anxiety Disorders if not treated in time. The constant worry about rituals and actions would lead to attacks of palpitations, perspiration, stress, poor appetite, etc.
Causes of OCD
Heredity is the main cause of OCD. Evidence shows that a family history of OCD in one of the parents or a close family member predisposes one to OCD. It would also mean that persons who are fussy about punctuality, cleanliness, religious rituals, order and method, symmetry, etc are predisposed to developing OCD.
For example, a school boy may show falling grades. On counseling you may find that he is distracted by thoughts of sex, of being violent and hurting someone, wishing that his parents or siblings were dead, have continuous craving for food, etc. Usually the child will not speak of his thoughts. He hides these from his family members because he thinks that it is something shameful and within his control.
Types of OCD
Obsessive Compulsive Disorder can be categorized by the different symptoms:
1) Body Dysmorphic Disorder: An abnormal concern with ones appearance is a sign of Body Dysmorphic Disorder (fear of dirt and dust).
2) Hypochondriasis: Preoccupation with having a serious or life-threatening illness shows sings of Hypochondriasis.
3) Paraphilia: This is a case of abnormal sexual urges or fantasies.
4) Depression Disorder: An unjustified and uncontrollable feeling of guilt shows that the person suffers from Major Depression Disorder.
5) Eating disorder: Obsessive preoccupation with food would indicate a case of Eating Disorder.
6) Trichotillomania: This refers to an obsession for pulling hair.
7) Substance Use Disorder: Obsessive use of a drug or preoccupation with drugs would be an indication of Substance Use Disorder.
Fears: Fears of hurting another person, fear of blasphemy, etc is another type of OCD.
Treatment of OCD
There are two ways in which OCD is treated depending on the type and severity:
Purely psychiatric treatment is undertaken to remove obsessions, anxieties, fears, obsessive images and visions, etc if the case is not too severe and not been neglected for too long.
But sometimes, when the symptoms have begun to interfere with the 
person’s daily life, some medication along with Cognitive-Behavioral Therapy or CBT is prescribed. CBT is a psychiatric treatment which helps in identifying and changing dysfunctional thinking, behavior, and emotional responses of a person. Medications containing Fluvoxamine, Sertraline, Paroxetine, Fluoxetine, Citlopram and Clomipramine are used to treat OCD patients. They can be used for children as well as adults, but cannot be prescribed during pregnancy and for lactating mothers.
Living with OCD
OCD by itself is an extremely distressing and disabling illness in its severe form. Even simple tasks can be a source of worry for patients with OCD. A patient suffering from OCD may worry, “Have I shut the gas jets or should I go back home and check?” This worry may cause distress to the patient for more than an hour and interfere with his or her routine. It would lead to excessive anxiety.
Symptoms like abnormally frequent washing of hands; rechecking, recounting, obsession with order and symmetry, etc can interfere with the patient’s relationships, be it personal or professional. Also, it would be a waste of time that could have been spent more fruitfully.
Most people with OCD can control the symptoms when at school or work. But over the months and years their resistance weakens. Then OCD becomes so severe that time-consuming rituals take over the person’s life and they do not have time for social activities.
Prevention of OCD
There is very little doctors can do to prevent the onset of this disease. Most times people with OCD are fully aware that their obsessions and compulsions are severe but they are very successful in concealing their condition from family, friends and co-workers. Awareness of their problem is not sufficient to enable them to break free from the illness nor do they seek help in the early stages of the disease. Statistics show that OCD strikes men and women equally and affects one in every fifty people over the world. On an average it first shows up in the teens or early adulthood.
Since 1994, the Obsessive Compulsive Foundation (OCF) and its subgroups are committed to promoting research for the development of more effective treatment for OCD. Working towards this aim, they study the brain, anatomical chemistry, neurobiology and genetics. Members include Clinical Psychologists, Researchers and Academics, Educational Psychologists, Occupational Therapists, Psychiatrists, Social Workers, Speech Therapists, General Practitioners, Nurses, Counselors, Teachers and Students.
