“OCD is not a disease that just bothers, it is a disease that tortures.”
Crippling anxiety. An avalanche of fear.
Stop. Check the door again. Repeat. Stop. Check the door again. Repeat. You know this does not make sense, this heavy compulsion to check the door 20 times already, but somehow fear continues to take over. Then exhaustion strikes. The weariness of checking the door over the course of four hours today and ultimately the inability to leave to do the grocery shopping leaves sadness, frustration and depression in its wake. But there is hope. It is not your fault! These feelings of fear that appear so real and intense are full of untruths. The brain system is not working correctly. It is repeating a message of danger when there is none. This is an example of life with OCD.
OCD stands for Obsessive Compulsive Disorder: a disorder of the brain causing severe anxiety in those who suffer from the disorder and helplessness in those watching loved ones go through it. OCD involves both obsessions and compulsions that cause anxiety, anguish and frustration, robbing the sufferer of joy and impacting the individual’s ability to function in everyday life. Obsessions are unwanted, intrusive and disturbing thoughts or images that play repeatedly in one’s mind. They cause such strong fears that sufferers feel an overwhelming and uncontrollable urge to perform compulsions (also known as rituals). Compulsions are time consuming, repetitive behaviours or thoughts that a person uses with the intention of neutralising, counteracting or making the obsession(s) go away. The level of anxiety is reduced temporarily when the rituals are performed. Sufferers often believe that there will be a negative outcome if they don’t engage in ritualistic behaviour.
Common obsessions include contamination, loss of control, harm, unwanted sexual thoughts, religious obsessions, superstition and perfectionism. For example, if one struggles with fear of contamination, the person may avoid touching objects in a shared environment such as door knobs. For the sake of self-protection and safety, an individual may use a paper towel to open the door, wait for someone to open the door, avoid contact or wash hands straight after contact with the contaminated object. In severe cases of fear of contamination, sufferers may avoid going out all together as it provokes so much anxiety and ritualisation. Common compulsions in response to contamination obsession includes washing and cleaning, ordering and arranging, checking, repeating, counting, protection or prayer and mental rituals.
OCD is a serious psychiatric condition requiring diagnoses from a trained clinical psychologist or psychiatrist. Approximately 1 in 100 adults, as well as 1 in 200 children suffer from OCD. According to the World Health Organisation, OCD is considered to be one of the most disabling illnesses in terms of loss of income and quality of life. For many people, OCD symptoms start during childhood or teenage years.
Obstacles to treatment such as stigma, lack of education and lack of awareness can seriously affect a person’s ability to recover and manage OCD. OCD affects children and adults of both genders, all races and all ethnicities and occurs at every socioeconomic level and all over the world. Research has shown that OCD has strong genetic links. However, OCD only surfaces when individuals with this predisposition are confronted with a highly triggering and overly stressful situational event. On average it can take up to 14 years to receive a proper diagnosis.
Cognitive Behavioural Therapy (CBT) and Exposure Response Prevention (ERP) are two scientifically proven, first line treatment methods for OCD. Studies have shown that engaging in CBT is as equally or more effective than medication for mental health disorders. Individuals who respond to CBT often report a 50-80% reduction in OCD symptoms. CBT involves teaching individuals how to restructure thinking patterns and how to identify negative or unhelpful thinking styles. CBT has three main parts:
- Identifying the fearful thought/image
- Coming up with evidence to support their fear
- Finding evidence to challenge the fear using facts.
CBT allows for a shift in the way an individual with OCD views the fear and consequences of not engaging in compulsions. It highlights how rituals reinforce obsessions, keeping the individual stuck in a cycle of obsessions and compulsions.
In addition to CBT, individuals need to confront the fear causing the compulsions, as beliefs and feelings only change through modification of behaviour. This is done through ERP – a repeated gradual exposure to the feared stimulus. For example, if an individual with OCD had an obsession with planes and the fear of death via plane crash, the individual would be exposed to this fear in gradual steps including looking at a picture of a plane, having a model of a plane in a room, watching video clips of planes crashing, walking into the airport terminal, going to the check in counter, booking a flight online and ultimately getting on a plane. For each exposure, the level of anxiety is monitored using an anxiety rating scale and individuals conduct the exposure until the anxiety rating drops by at least half. CBT and ERP require commitment and is hard work. It takes a lot of courage and energy to face fears and willingness to change thinking patterns.
If you suspect that you or a loved one is struggling with OCD, seek professional help in addition to checking out community support group meetings for OCD and anxiety disorders.
Minal Mahtani has a BSc (hons) Psychology and is the CEO and Founder of OCD and Anxiety Support Hong Kong. Her personal experience with anxiety and passion for psychology is the driving force behind her work with adults who struggle with mental health issues such as Obsessive Compulsive Disorder and Anxiety Disorders. She is committed to creating change in the perception of mental health issues viewed by others, breaking stigma and sharing the tools that she has learnt to others.
Minal currently runs monthly support group meetings for individuals with Anxiety Disorders and OCD, delivers educational workshops, organises and promotes Mental Health and OCD Awareness week activities and offers one to one OCD and Anxiety coaching. Minal’s other training includes:
- Cognitive Behaviour Practitioner and coach for anxiety disorders
- Mental Health First Aid Certification (University of HK)
- Stress management yoga instructor and workshop leader
- National Association Special Educational Needs training in diagnosing and assessment of children with special needs