obsessions, intrusive thoughts, repetitive behaviours, compulsions, handwashing, checking, symmetry, orderliness
Obsessive-Compulsive Disorder (OCD)
Obsessive Compulsive Disorder (OCD) is a prevalent psychiatric disorder in Singapore, affecting 3% of the population. The condition is characterized by persistent, recurring, and intrusive thoughts, which lead to anxiety. These obsessive thoughts are often recognized as excessive, and individuals may find it challenging to suppress them.
Common obsessions include i) a fear of contamination by germs or dirt, ii) the need to maintain a certain level of neatness and order, and iii) repeated doubts such as “Did I lock the door?”
Some obsessions can be very distressing for individuals, such as thoughts of relatives or religious figures engaging in sexual acts. These thoughts can cause extreme distress and discomfort for patients as they do not wish to have them.
Compulsions are acts that one performs to try to reduce the anxiety created by the obsessions. For those people who have a fear of dirt, they will wash their hands and bathe in a particular way for hours every day. Other compulsions include checking and rechecking, arranging things in a particular way and doing things in a particular set of order. If any of the steps are not done in order, the patient with OCD will feel the compulsion to redo the whole sequence.
OCD can start at a very young age and as early as late primary school. Oftentimes, patients see a doctor 5 to 10 years after the onset of symptoms. Most patients live with the symptoms and do not seek help even though their obsessions and compulsions consume a significant amount of time every day.
OCD is usually a chronic and long-term disorder. Also, the nature and type of obsessions and compulsions may change.
Scientists have also discovered that the part of the brain associated with OCD is the part just above the eyes called the orbital frontal cortex. OCD-like symptoms can also occur when a person is very depressed or if they have suffered psychological trauma. A brain chemical called serotonin responsible for transmitting information in the brain is also thought to be functioning abnormally in patients with OCD.
In some, OCD occurs with tics. Tics are repeated sudden involuntary muscle movements, for example, excessive blinking, or jerking of a part of the face.
OCD may also be associated with other types of anxiety disorders such as social phobia and may lead to difficulty in sexual function due to their need for hygiene and order. In severe cases, OCD can result in Depression and in rare cases, it is associated with Schizophrenia.
Illustrative Example of OCD
D is a 20-year-old man who is a student in a tertiary institution. Since about 10 years old, he felt that he needed to write in a neat way and he drew the lines in his exercise book very precisely. He would even check with a ruler that the lines were perfectly drawn. If a line he drew was not parallel to the page, he would erase it and redo his work. He often ended up erasing through the page and tearing it.
After primary school, he started to feel that his fingers were dirty when he used the school toilet and he would wash his hands frequently. He avoided going to the school toilet unless he had no choice. He would wonder if other student’s urine got onto the taps or the door handles and that made him feel uncomfortable. It distracted him in class and his grades started to deteriorate.
Eventually, his school teacher noticed his poor performance and he was asked to see the school counselor. He was subsequently referred to see a child psychiatrist and treatment was started. With a combination of medications and psychotherapy, D’s symptoms improved by about 80% and he was able to study. He could control his compulsion to wash and his need for perfection better.
Barriers to Seeking Treatment
Many sufferers are worried about seeking help. They think that they may be stigmatized and their career or studies will be affected. However, without treatment, OCD in itself can cause difficulties. Sufferers may spend hours with their obsessions and compulsions and may not be able to attend to their responsibilities like their work or their family.
Treatment of OCD in Singapore
OCD can be treated by medications, psychotherapy, or a combination of both. Antidepressants, specifically those that act on the serotonergic neuroreceptors are effective for the treatment of OCD. Sometimes when the obsessions are bizarre and bordering on psychosis, an antipsychotic medication may be added.
Cognitive behavioural therapy is hugely effective with OCD and the main approach is that of Exposure and Response Prevention (ERP). It involves the deliberate exposure of the patient to the anxiety-provoking object eg. touching the taps and door handles and getting the patient to refrain from responding ie. not washing his hands. The accuracy and validity of his fears are also challenged in therapy as overestimation of risks and catastrophic thinking patterns are commonly present in OCD patients.
We Can Help!
Fortunately, effective treatment is available for OCD! Antidepressants have been shown in many studies to improve OCD symptoms. Patients can also choose from various types of psychological therapy. You have a right and can choose your preferred modality of treatment when you see our psychiatrist.
You deserve wellness, call +65 64796456 now, to make an appointment.