Again, again & again

Those who suffer from obsessive-compulsive disorder (OCD) could probably identify with Shakespeare’s infamous Lady Macbeth–the ambitious noble lady immortalised in English literature–who repetitively cleaned her hands of imaginary blood while sleepwalking after her role in the king’s death.

OCD is characterised by recurrent, unwanted thoughts (obsessions) and repetitive behaviours (compulsions). According to the National Institute of Mental Health (NIMH) in the US, OCD has a yearly prevalence rate of 2.3% in adults aged between 18 and 54. In Singapore, OCD is classified as a minor psychiatric or mental illness.

The disorder is disturbing and disruptive. In serious cases, sufferers can be prevented from carrying out normal responsibilities at work and at home.

What’s it like?

Most people have obsessive quirks, but OCD is several times more severe compared to normal behaviour. The two components of OCD–obsessions and compulsions–are related. Sufferers typically do not have control over their obsessions and find them disturbing.

For example, they may have overwhelming fears of having knocked down a pedestrian while reversing from the driveway, or be obsessed with sexual thoughts and images. Obsessions are accompanied by feelings such as fear, disgust, and doubt.

To minimise these negative feelings and discomfort, people with OCD perform certain compulsions. The man fearful of knocking down a pedestrian may retrace his car route often to ensure there is no lifeless body. The housewife who left for the market might rush home 10 times to ensure she has locked the door.

Compulsions do not give pleasure; rather, they are performed to relieve discomfort.

Treating OCD

The most effective treatment often involves a combination of cognitive behavioural therapy and medication, says Daniel Koh, psychologist/therapist with Mount Elizabeth-Charter Behavioural Health Services.

Several medicines, belonging to the group called selective serotonin reuptake inhibitors (SSRIs), are prescribed for treating OCD. They include fluoxetine, fluvoxamine, sertraline, and paroxetine. They work by regulating the amounts of serotonin in the brain. Clomipramine is an antidepressant that is also used to treat OCD, as it has anti-obsessional properties.

However, these drugs may cause side-effects like dry mouth, nausea, drowsiness, and affect sexual performance. They should only be taken on professional advice. It is also recommended that each course of medicine be tried consistently for several weeks for a fair evaluation of its effectiveness.

Behavioural therapy to treat OCD includes a procedure known as “exposure and response prevention”–exposure to the obsession stimulus and practice in inhibiting the compulsive response.

For example, a person compulsive about hand-washing may be urged to touch an object believed to be contaminated, and subsequently denied the opportunity to clean up for several hours.

Successful treatment results in the OCD patient experiencing less anxiety and being able to better keep compulsive actions in check.

A person may find it hard to admit he has OCD but it’s even harder to deal with the problem alone. So don’t let obsessive worries zap away your zest for life and get your worries under control with some help •

The expert says

At Mount Elizabeth-Charter, we have seen many forms of obsessive-compulsive disorder (OCD). The most extreme involved a 12-year-old girl who had a fear of germs and avoided touching things for fear of contamination.

She would wash her hands for hours after she touched something. Gradually, she isolated herself from school, friends, family, and sank into depression.

It is believed that insufficient levels of serotonin in the brain contribute to the development of OCD and certain environmental stressors can worsen the symptoms. They include any form of abuse, changes in living situation, illness, relationship concerns, school-related problems, and occupational worries.

If you suspect anyone of exhibiting OCD symptoms, bring them for a Free Needs Assessment at Mount Elizabeth-Charter. A trained psychologist will assess the patient’s emotional and psychological state, after which the psychologist will recommend an appropriate treatment course.