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12 March 2004

OCD: Too much of a good thing

"4:30 am. The bedside alarm breaks the stillness of the night. Phillip lunges to shut it off before it wakes his girlfriend. He slides out of bed and gazes at her motionless form. Thankfully, she seems to have slept through it. Maybe they won’t fight this morning. Things are bad enough, he thinks, as he shuffles off to the bathroom, rubbing the sleep from his eyes.

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"4:30 am. The bedside alarm breaks the stillness of the night. Phillip lunges to shut it off before it wakes his girlfriend. He slides out of bed and gazes at her motionless form. Thankfully, she seems to have slept through it. Maybe they won’t fight this morning. Things are bad enough, he thinks, as he shuffles off to the bathroom, rubbing the sleep from his eyes.

“He stares at the mirror. He carefully thinks out every step of the elaborate ritual he has devised for shaving. He lays out his razor and the shaving cream, puts them back, and then lays them out again. With painstaking diligence he turns the razor so it is exactly parallel to the sink. Finally he turns on the water and silently counts, hoping to make it to 100 before the water gets hot."

It takes Phillip two hours to get ready in the morning, longer if anything, such as a fight with his girlfriend, interrupts the ritual. On his way to work it often takes him twice the usual time to get there as he has to cover the route again to be sure he didn’t run anyone over.

Being cautious, careful and orderly are positive traits, but in Obsessive-Compulsive disorder at some point they become maladaptive.

What is OCD?
OCD is characterised by recurrent obsessions and compulsions that occupy a significant amount of time and that cause significant distress. Obsessions are defined as unwelcome and distressing ideas, thoughts, images, or impulses that repeatedly enter the person’s mind against his/her will. Compulsions, on the other hand, are actions the patient feels driven to perform despite the recognition that they may be senseless or excessive.

There are various causes of OCD. The disorder tends to run in families and probably has a genetic basis.

Obsessions and compulsions are among the oldest recognised symptoms. Once ascribed to possession by the devil, many victims of the Inquisition and the Salem witch-hunts were likely suffering from OCD. OCD was once thought to be very rare because so few people sought treatment, confining their rituals to their homes, due to shame. However, recent surveys have found that up to 2 to 3% of the population is suffering from this disorder. OCD is the fourth most common psychological disorder (behind alcohol and drug dependence, depression and phobias) affecting about 7 to 10 million people.

Nowadays a lot more is known about the disorder. Recent studies have identified OCD as a malfunction in the neural pathways that link the frontal lobes with the basal ganglia in the brain. The frontal lobes have been described as the seat of deliberation and judgement, and the basal ganglia serve as a relay station in the planning and execution of movements. In people with OCD the caudate nucleus does not seem to be performing its usual function and this neural circuit is hyperactive. As a result, obsessional thinking persists until a compulsive ritual stops it.

Where to go for help
If you feel you or someone you know may be suffering from OCD, contact the Depression and Anxiety Support Group, Monday to Friday, between 8am and 7pm, and on Saturdays, between 8am and 5pm, on (011) 783-1474/6. Trained counsellors are standing by. Referrals to appropriate mental health professionals are also available.

* Taken from OCD: Too much of a Good Thing

Information supplied by the Depression and Anxiety Support Group

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