Obsessive Compulsive Disorder: Not a quirky disease!

However, when taken casually and left untreated, it can wreck a person’s life. Patriot tries to understand the ABCs of OCD in this brief interaction with psychiatrist Dr Nikhil Raheja.

“I started getting intrusive thoughts when I heard a cat screaming on my terrace after a cat fight. It started feeling very negative. While going back, I started to count the stairs. I thought it was just a normal fear and would go away. Even after a few days, I was counting without any reason. The more I wanted to stop doing it, the more I was doing it.

After one year, I found out that this is a symptom of OCD. I was relieved as well as shocked at the same time. My parents didn’t understand what I was going through, they used to ask me why am I counting things. Through social media platform Cromunity, I found other sufferers like me. One of them suggested Cognitive Behavioural Therapy (CBT) and Exposure and Response Prevention therapy (ERPTwhich helped me control 70% of my OCD. India still needs more awareness regarding the treatment and help people come out of the stigma”, said Divya, while talking about her struggle with the mental disease.

OCD consists of obsessions and compulsions, and comes from a spectrum of disorders that can be generalised under anxiety. When some adverse life event occurs, either acutely or over time, like grief due to the loss of a loved one, major accident, childhood trauma or sexual exploitation, it leads to the formation of bad memories. 

When these memories get bottled inside with no proper way to verbalise the underlying issue, feel the emotions and release them, these thoughts get converted into what we call an Obsessive Compulsive Disorder. Dr Nikhil Raheja, a Delhi-based psychiatrist, explains the causes of the illness, types and methods to take care of people with the condition.

What are the triggers and different types of OCD?

The roots of OCD can be categorised into three degrees: the higher side is the family history along with adverse life events; second, a major life event; third is when there is neither any family history nor any environmental issues directly impacting the individual. 

People who had a troubled family history, and people who’ve not had a very strong personality until sudden shocking events occur in their work or personal life form a homogeneous mixture of average OCD patients.
An unexpected death of a family member, especially a young child, has triggered OCD in people in the age group of 45-50 without any prior history. In 50 % of the cases, there has been a family history of anxiety or depression, a very dysfunctional family atmosphere – like separated family, alcohol addiction, substance abuse, or violence.

Commonly expressed OCD trait is the obsession with contamination, cleanliness and organising. The common patterns seen in clinical practice are when the person is taking a long time in the washroom, or is washing their hands for a long period. In case of contamination, the person fears illness. They don’t like to go to hospitals due to the fear of contamination. If they read about any disease, they’ll start relating to the symptoms.

Assurance and confirmation are two common traits seen in OCD patients. Another trend observed is repeatedly performing actions like counting money, checking if the doors are closed, checking for gas leaks etc.

There are also people who tend to be very organised at their desk. They want their things to be arranged in a particular way. There are cases where people cannot tolerate their own familiar member sitting next to them, or sharing a bed. 

The most common and least expressed form of OCD is the sexual aspect. These repetitive sexual thoughts are gender-neutral. For example, when you meet someone you’ll start having sexual thoughts about that person. This type of OCD is least expressed because of the stigma and the social issues involved.

When a person starts to have negative and intrusive thoughts,  ideas of God, or even abusive thoughts with idols of gods, it is also considered a form of OCD.

OCD in children is more severe as they are not able to vocalise their compulsions. A kid will be afraid to act out their compulsion due to fear of getting scolded by parents or ridiculed by peers. When they are not able to act on these behaviours, it keeps bothering their mind. In the case of adults, they are more vocal and are able to express their obsessions and compulsions. 

There will be a little bit of OCD in one form or the other in everybody. But if it is not disrupting your normal life, it is not considered an illness. However, when these behavioural patterns affect social, professional and cultural aspects of a person’s life then professional aid should be sought.

The biggest myth about OCD is that it’s normal and it is part of the personality. People have to come out of this denial and understand that OCD is a mental illness that has to be treated by a medical professional.

What are the medical methods to treat the illness?

OCD can be treated with pharmacology medicines, psychotherapy, and psychosocial intervention. In severe cases, hospitalisation with behaviour modification techniques is applied. The treatment intervention can be divided into 50% medication, 25% psychosocial activities like meditation, sports, relaxation, breathing exercises, and 25% psychotherapy like CBT or behaviour modification techniques. 

When is the right time to seek help?

When a person takes more time than normally they would devote to doing the task – whether it be bathing, washing hands, organising the cupboard, reading or any ordinary activity. If a person turns into an obsessive cleaner, reads any symptoms of a disease and starts an investigation, checks the treatment methods for such diseases, creates patterns of number plates of vehicles while travelling – then these can be seen as the basic signs when a person should seek help from a medical professional.

How should a primary caretaker deal with these behavioural patterns?

As a family member, friend, counsellor or mental health care worker, don’t be judgemental. The evaluation, assessment and psychiatry interviews will take time with OCD patients because they don’t feel satisfied until they are repetitive. At first, one has to let the person say the same thing a few times or a couple of times so that the person is satisfied. 

Then, you have to set a limit and reiterate to them that you have understood the issue by giving them the pocket words to assure them. Confirmation and comfort are two things people with OCD crave for. But these confirmations have to be blocked when it gets out of hand.

In relationships and married life, the partner needs to understand the situation the patient is going through. They should maintain a safe distance by not involving too much but providing adequate support. The partner or family members should also undergo therapies to understand the needs and how to react to certain situations. When the patient is under treatment, the partner has to check and supervise behavioural patterns.

How do you think the media can help in creating awareness?

At times, the media often glamorises the illness. It has to be represented with its underlying seriousness.

Media can be a platform where awareness can be increased. For example, there are suicidal helpline numbers streaming in certain shows. Similarly, an OCD helpline can also be used to help people in need. 

Social media has become a platform to address these issues while being anonymous. It can connect you with professionals, caregivers, recovered survivors and people going through the same condition.

How curable is OCD?

OCD is a difficult illness to treat. For a certain percentage of patients, the OCD completely goes away and they can lead a normal life. In other cases, the intensity declines with periodic ups and downs. There can be fluctuations in the patterns from person to person. 

With proper medication and other therapies, the intensity of OCD and the stimulus that triggers the behaviour can be controlled. Panic attacks and anxieties, if left untreated, can get converted into OCD.

*Names have been changed to protect identity

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