19 December 2013

Get to grips with OCD

Like TV detective Monk and footballer David Beckham, one million South Africans suffer from obsessive compulsive disorder (OCD). Do you also live in this irrational, secret world?

He worries himself almost to death over germs. He refuses to walk barefoot, dusts his jacket constantly, won't touch anything unless he's wearing gloves, is repelled by anything that seems dirty and is completely maniacal about symmetry. He'll count and rearrange objects endlessly until they're exactly the way he wants them. His behaviour is so exaggerated it borders on paranoia.

No, we're not talking about detective Monk in the series of the same name. Or Jack Nicholson's character in the movie As Good As It Gets. The man in question is John*, and his behaviour is more extreme than any fictional TV or film character.

“Monk's obsessions weren't just invented or exaggerated for the sake of good viewing," says Dr Christine Lochner, clinical psychologist.

OCD is one of the most debilitating psychiatric conditions and the fourth most common after depression, substance abuse and phobias, she says. Two to three percent of people suffer from OCD – which means one in every 30 people who read this article or among your acquaintances show symptoms of this anxiety disorder.

It's characterised by obsessions and compulsions that take up a certain amount of time and cause an overdose of anxiety.


OCD test 1
Do you identify with any of these behaviour patterns?
You might recognise yourself in more than one of these descriptions or your behaviour may contain elements of each one.

Are you obsessive about cleaning or washing your hands?
If you wash your hands to an extreme degree or clean even when there's no dust or dirt in sight you might be suffering from the most common form of OCD: fear of germs.

Susan* (38) is a good example. When she goes to the hairdresser she first cleans the chair with surgical spirits; then wipes down the entire counter. She insists on new, clean brushes and towels, washes her hands and asks her stylist and the assistants to wash theirs too. The process can take up to half an hour – and it's repeated at virtually every place she goes: work, home, even in her car.

”l realise it's irrational but it if l don't live this cleanly, it’s as though I can feel the germs crawling all over me,” she says.

Are you a checker?
Checkers are obsessive ditherers and are often afraid they’ll hurt others or be hurt themselves if they’re not careful enough. A checker will feel like this about driving, for example, and will keep turning back to make sure he hasn’t hit someone. He may also be worried about causing a fire and will check and recheck to make sure the stove or iron has been turned off. The checking is often followed by further doubt and so by more checking.

Magda* (50) says: “Some mornings I’ve turned back in the middle of the Gauteng traffic and gone home to make sure I’ve switched off the iron. I would never have been able to concentrate on my day if I hadn’t checked.  
Are you a dawdler?
Obsessions about symmetry, neatness or the need to check can prolong the simplest of tasks such as brushing your teeth, for hours. This is called obsessive slowness.

Are you morally obsessed?
Some OCD patients suffer from moral and religious obsessions and compulsions. Take David* (42) for example. He dwells on past events to such an extent that he becomes extremely anxious. He feels he was wrong in some situations and might have hurt someone. He feels guilty and prays endlessly for forgiveness for the same things.

Although rationally he knows he's overreacting he just can't suppress the emotions or his behaviour. He's constantly looking for reassurance and his obsession about forgiveness exhausts the people around him. The whole process is so draining that he avoids talking to friends and colleagues and his work is starting to suffer. All this has been going on for months – years, in fact – and some periods are worse than others.

Are you obsessive about symmetry or tidiness?
Some people with OCD need things to be symmetrical, precise and extremely neat. They also often have obsessions about numbers or counting and will spend hours rearranging or tweaking things that are already perfectly tidy and orderly. "I catch myself arranging books on my coffee table when a guest has just put them down,” Magda says.

OCD test 2
Answer “yes” or “no” to these questions regarding your behaviour and thoughts over the past month:

- Have you constantly washed your hands, counted everything in sight, repeatedly checked whether the stove or lights were off or done anything else over and over after being unable to suppress the impulse even though you’ve tried?  
- Do these repetitive thoughts or acts take up more than an hour of your day? Do they interfere with your normal routine, your job, your functioning, social life or behaviour?
- Have repeated or unwelcome thoughts made you excessively anxious? 
- Do these obsessive thoughts recur even though you try to repress or ignore them?
- Do you think your compulsive behaviour or obsessive thoughts are indeed excessive?
- Do you think your obsessions stem from your mind?

Answer: If you answered “yes” to more than two of the questions – and if one of the descriptions in Test 1 also applies to you – you could be an OCD sufferer. People with OCD also tend to be depressed or anxious because they realise their behaviour and thoughts are irrational.

What does OCD involve?
OCD can be divided into two components: obsessive and compulsive, Dr Lochner says:

- The obsessive component: Obsessions are unwelcome thoughts, images or impulses that occur repeatedly and involuntarily and cause extreme anxiety. You can't stop these thoughts from occurring again and again. Sufferers realise they're irrational but can't suppress, ignore or control them.
- The compulsive component: Compulsions are the repeated, ritualistic actions that spring from the obsessions. In effect they're the sufferer's attempt to decrease the anxiety caused by his obsession. Common compulsions include excessive hand washing, constantly checking whether doors are locked or appliances are turned off and repeatedly ordering things into neat rows.

What causes OCD?
There's no single proven cause. The main culprit is probably the interaction between a number of factors, including genetics.

It's now known the brain activity of people with OCD differs from that of other people, even those with other anxiety disorders. Research also suggests OCD involves communication problems between the front part of the brain and the deeper structures.

Furthermore there's growing evidence that specific brain circuits, including the serotonin and dopamine systems, mediate OCD.

There’s increasing evidence OCD may be inherited. Research shows 35% of people with OCD have a relative who shows obsessive-compulsive symptoms.

A number of patients associate the onset of their OCD with a throat infection, possibly a bacterial infection. Hormonal influences may play a part. Pregnancy, menopause and the few days preceding menstruation may be related to the onset or relapse of OCD. Childhood trauma may also be a factor. More than half of those with OCD also suffer from depression.

Who gets OCD?
OCD often starts during childhood, particularly in boys. In women hormonal interactions during pregnancy, menstruation or menopause can play a role.

The treatment
Seeking an accurate diagnosis and treatment for mental health problems such as OCD is a necessity, not a luxury.

"OCD responds to a class of antidepressant medications known as serotonin reuptake inhibitors such as fluoxetine and sertraline,” says Professor Soraya Seedat. “These antidepressants are effective in about 60% of people with OCD. Much higher doses are used to treat OCD than depression or other anxiety disorders as there's some evidence to show the response is better at higher doses.

"Response to treatment isn't usually as fast as it is for depression. It may take at least eight to 12 weeks to experience improvement.

"Cognitive behavioural therapy by a clinical psychologist is often used as a first option, especially in people who have mild to moderate OCD, and is probably as effective as anti-depressants. Psychology is especially effective if the psychologist can help the patient come to terms with the underlying trigger."

When obsession becomes paranoia
It’s rare but in some cases OCD can become so extreme it verges on paranoia and delusions. If you refuse to shake hands because you're obsessive about germs but know you're overreacting, then you most likely have OCD. But if you think people want to shake your hand in order to infect you, you're deluded and suffering from paranoia.

*Not their real names
(Health24, December 2013)


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