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Get to grips with OCD

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.

What does OCD involve? 
OCD can be divided into two components: obsessive and compulsive:

 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



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