What Is OCD?
Obsessive compulsive disorder (OCD) is a treatable neurological mental health disorder that is characterized by recurrent, unwanted intrusive thoughts (obsessions) and repetitive behaviors (compulsions/rituals).
These compulsions are behaviors an individual engages in in his/her attempt to get rid of the obsessions and/or decrease his or her distress. OCD obsessions and compulsions can be extremely time consuming, causes significant emotional distress and may interfere with day-to-day functioning and interpersonal relationships.
How Common Is OCD
The worldwide lifetime prevalence rates of OCD is estimated to be 1.5% for women and 1% for men.
The Singapore Mental Health Study done in 2016 found that the prevalence of lifetime and 12-month OCD in Singapore was 3.6% and 2.9%, respectively. This means that 1 in 28 people will have had OCD at some point in their lifetime. In fact, OCD is one of the top three most common mental health conditions in Singapore, just behind Alcohol Abuse and Major Depressive Disorder (MDD).
Although OCD can occur at any age, it typically starts (a) between the ages 8 and 12, or (b) between adolescence and early adulthood and often persists throughout a person’s life.
Causes Of OCD
There are a number of factors that can contribute to the development of OCD
Family studies have shown that the risk of developing OCD is greater for first-degree relatives of affected individuals as compared to the general population. Studies have also shown that the concordance rates in monozygotic and izygotic twin pairs are 80% and 50% respectively.
Brain imaging studies in individuals with OCD have shown increased activity and blood flow in specific parts of the brain
Serotonin is a chemical found in our brain cells that helps to transmit information from one brain cell to another. Studies have shown that there is an imbalance of serotonin in the brains of people with OCD
Stress/ Life Events
Important life events such as bereavement or stress may trigger OCD symptoms in individuals who may be susceptible to develop the condition. Other triggers, including positive events (e.g., childbirth) may also be potential contributors to the eruption of the underlying condition.
Some rare cases of OCD in children and young people have started after severe streptococcal or other infections. These infections may trigger OCD symptoms in children and young people who have a genetic predisposition to develop the condition.
Types Of OCD
Counting & Checking
Counting and checking are performed in an effort to address obsessive and fearful thoughts or to prevent something bad from happening. Counting can be associated both with the need to avoid danger and the obsession for symmetry and exactness. Checking rituals often involve an impulse to check items such as door locks, light switches,taps, and stoves.
Checking rituals often involve an impulse to check items such as door locks, light switches,taps, and stoves. These rituals may be geared toward preventing an error that could seriously impact their or another’s well-being. People with checking compulsions are plagued by feelings of irresponsibility and carelessness and constant doubt about whether or not they completed the task.
Treatment For OCD
Medications with selective serotonin reuptake inhibitors (SSRIs) have been proven to be effective in the treatment of OCD. They can be given to individuals either together with psychological treatment, or alone, depending on the severity of the OCD.
Exposure Response Prevention (ERP) therapy
Exposure and response prevention (ERP) is the gold standard treatment for OCD. Exposures are opportunities to confront feared thoughts, situations, and beliefs without engaging in compulsions or avoidance behaviors. Based on the inhibitory learning model, exposures provide the opportunity to engage in new learning, such as creating a discrepancy between what one predicts before the exposure and the actual outcome. Exposures also offer the opportunity to learn about triggering situations in multiple environments. Thus, this allows people to gain confidence in completing exposures in their real life, and not just in the therapy office. Response prevention is the reduction and, ultimately, elimination of rituals and avoidance behaviors. This breaks the link between the believed fear and consequence, ultimately freeing one from their compulsions. One of the key factors to success in treatment is willingness to participate in treatment both in therapy sessions and using treatment as a new lifestyle.
Barriers to treatment
In the recent Singapore Mental Health Study done in 2016, it was found that amongst those who sought help for mental health conditions, treatment delay was longest for those with OCD at 11 years. This can be attributed to the lack of knowledge and awareness of the OCD symptoms and the stigma surrounding the condition. Shame and guilt about their obsessions could be another possible reason why individuals take a long time to seek help.
Where to Seek Treatment
Block 854 Yishun Ring Road, #01-3511 Singapore 760854/ 7A Lorong 8 Toa Payoh, #04-01 Singapore 319264
Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747
Many other restructured hospitals and clinics within the community also offer treatment for OCD.
What Families Should Know
Your loved one’s OCD isn’t anyone’s fault. OCD is a neurological problem. The obsessions are involuntary and the person experiencing them cannot simply control or get rid of them by an effort of will. Family members, caregivers and friends often feel helpless, not knowing how to reach out or what to do to help their loved one. They often respond to OCD with antagonistic or accommodating behaviours, both of which may cause OCD symptoms to flare up. People with OCD often feel even more distress when they are subjected to criticism or blame.
Here's what you can do to help your loved one suffering from OCD:
The more you know about OCD, the better equipped you will be to avoid pitfalls, cope with challenges and, most importantly, help your loved one.
Help them to get treatment
Erosion of a person’s motivation through OCD can be a barrier to their seeking treatment. To manage OCD in a supportive way, share with your loved one what you know about the disorder, and provide information about both the medications and Exposure and Response Prevention Therapy (ERP). Help your loved one to access these treatments.
Don’t blame yourself
Parents often feel they are responsible for their child’s OCD, when it is something over which they truly have no control. Once you accept that OCD is nobody’s fault, you will be able to take action that is honest and helpful, and not clouded by ideas of what you could or should have done.
Recovery is not a competition
Remember that everyone progresses at their own pace, and your loved one is not weaker or stronger than another OCD patient based on the speed of his or her recovery. Some may have more setbacks than others, even in treatment. When you stop making comparisons, you can truly be happy for your loved one when they accomplish their goals. It is important to be patient, encouraging and supportive.
Avoid criticizing or mocking your loved one’s symptoms. Do not suddenly spring a situation on them in which they are bound to feel anxious. Learn how you can be supportive without accommodating your loved one’s compulsions.
Be a team
Work closely with the psychiatrist, psychologist and other mental health professionals to help your loved one fight OCD.
Recognise victories, even small ones
However successful or unsuccessful the efforts made have been, praise your loved one for standing up to his or her OCD. Acknowledging their efforts and recognizing improvements (even when the wins seem small), will encourage your loved one to keep trying.
Keep communication simple, and avoid complicated explanations.
Motivate your loved one
OCD treatment is hard work, often exhausting for your loved ones. Remind them of their motivation and their recovery goals, as this may encourage them to continue the treatment progress so that they can get their life back.
Support taking medication as prescribed
Be sure to follow the medication instructions that have been prescribed. Do not try to reduce or increase the dosage of the medication without consulting the doctor. All medications have side effects that range in severity. If you have any concerns, you could periodically (if your loved one agrees to this) attend the doctor’s appointment with him/her, so that you can ask questions, learn about side effects and report any behavioural changes that you have noticed.
Set realistic boundaries
Do not change your family routine to accommodate your loved one’s OCD behaviours. Discuss your expectations ahead of time and do not engage in boundary discussions during stressful events. Remember that it is in the individual’s best interests to tolerate exposure to their fears and be reminded of others’ needs. As they begin to return to normal functioning, their wish to do more will increase.
Join a support group
Share and listen to other caregivers how they handle their loved ones’ OCD behaviours. Get feedback about how you can better manage your family member’s OCD demands and/or support them in their recovery journey.
Take care of yourself
Living with someone with OCD is stressful for the entire family. Don’t become so preoccupied with your loved one’s OCD that you neglect your own needs. It is important to engage in activities that are important to you. Self-care is an essential part of caring for others. Make sure you have your own support, so that you can be emotionally recharged.
Myths about OCD
All neat and clean freaks have OCD.
One common sign of OCD is an obsession with cleanliness – such as constantly washing your hands or excessively cleaning household items. But a preoccupation with cleanliness could also be a personality trait. If it is a personality trait, you have control – you can choose whether or not to do it. If you have OCD, you are doing it out of unrelenting, debilitating anxiety or distress.