​OBSESSIVE COMPULSIVE DISORDER

 
OCD means Obsessive Compulsive Disorder, which affects roughly around 12/1000 and if you take India as a whole it affects around roughly 1.5 crores. Very huge number indeed and it is called different names  and in Kannada it is called "giluroga".
 
Usually you may come across people and also they talk about like " very obsessed with cleaning", "she is obsessed with washing hands", and sometimes "he is obsessed with reading" etc or very " compulsive about rituals",  etc.
 
Here are some cases vignettes which can help you to understand
 
“Mr. Mithun, is a pharmacy graduate. He likes to study further however he cannot fully control his thoughts and to progress as he finds tough to study for his entrance examination. He is very obsessed with his reading habits and want to know each and minute details of what he reads. If he cannot comprehend fully of that page he will repeat and repeat to such an extent he takes more than an hour just to finish a page and later gets so frustrated and anxious will shut his books to make himself feel less anxious. He remains tense all the time worry about the details of what he read  on and on and many times goes back to same page. This obsessive belief can make him so crippled that he cannot read hardly few pages in a day and miss his schedule. He was a clever boy in his adolescence and always stood first in school and in his graduate days”.
 
“Mrs. Sheila is a housewife with 2 kids. She developed OCD symptoms during here adolescence and continues to this day. She gets anxious frequently and her routine chores   looks never ending. She believes dirt is around her house and keep washing her utensils all  the time. She maintains this ritual and takes ages to complete which affect her children. She no longer able to help her child in her studies due to her obsession regarding dirt. She also maintains strict vigil with her children and also her husband and they are getting irritable with her. She keeps all things in specific fashion which if disturbed by her husband or her children will lead to severe anxiety in her and becomes irritable. Recently her children are getting      affected and their performance has dropped. Even her husband is fed up with her ritualistic  attitude to everything and so finding problems in their relationship. Mrs. Sheila knows that     she is overdoing things but she feels helpless and also feels she is becoming irrational but couldn’t help it.”
 
Main component of OCD
1)    Thoughts, which make you anxious  ( also called Obsession)
2)    Anxious feeling ( the way you feel after those thoughts)
3)    Behaviour, the things you do to reduce the feeling of anxiety (Compulsion)


Obsessive Thoughts

·         These are thoughts like some phrases or unpleasant thoughts or blasphemous thoughts which causes anxiety like “excessive worry about contamination of germs, HIV, or cancer  and can harm them or family”.
·         Sometimes visual pictures (day dreaming) of seeing loved ones dead or violent thoughts of harming others etc.
·         Sometimes Doubts about harming others or causing accidents or causing accidents or doing things wrongly and leading to failure etc.
·         Thought Ruminations lot of thinking and unable to take decision
·         Perfectionist attitude believing things needs to be done in exact the same way and very rigid towards others
These thoughts leads to anxious feeling or becoming emotional
You become tense, anxious, fearful, guilty, disgusted or depressed  and you feel better if you carry out your compulsive acts  or ritual - but it doesn't last long

Compulsion Behavior

·         These are Correcting thoughts or Behavior you do to reduce the obsessive thoughts like praying or saying special word or chanting some words or doing certain rituals to neutralize the unpleasant thoughts.
·         Sometimes you do Rituals like arranging things or activities in a particular way and these rituals are time consuming and repetitive.
·         Common ones are Checking Behavior,” like checking for contamination, checking doors to see whether its locked, switching off electrical units, etc”
·         Some keep useless or worn out things and find difficult to throw anything away also called as Hoarding
·         Avoiding certain thoughts or places which cause anxious thoughts (Obsessive thoughts) this leads to avoiding taking risks or taking up jobs or responsibility.
 
Famous people who thought to have OCDs

 Charles Darwin,  Florence Nightingale, the actress Cameron Diaz, soccer player David Beckham.
 

What happens to untreated OCD?

It can vary from person to person and many manage to live a productive life, however for some it can worsen and can lead to severe OCD symptoms and these people find difficulty in maintain job or can worsen their performance and find difficulty to achieve even small goals. Some develop severe depression and can become suicidal and some unfortunately attempt suicide as they do not see any hope in continuing like this.

Other conditions similar to OCD

• Body dysmorphic disorder, or 'the distress of imagined ugliness'. You become convinced that part of your face or body is the wrong shape, and spend hours in front of a mirror checking and trying to cover it up. You may even stop going out in public.
• An urge to pull out your hair or eyebrows (Trichotillomania).
• A fear of suffering from a serious physical illness, such as cancer (Health anxiety or hypochondriasis).
• People with Tourette's syndrome (where a sufferer may shout out suddenly, or jerk uncontrollably) often have OCD as well.
• Children and adults with some forms of autism, like Asperger's syndrome, can appear to have OCD because they like things to be the same, and may like to do the same thing over and over again.

When does OCD begin?
This can start as early as in childhood. However majority you find symptoms starting around adolescence and in early twenties. For some, symptoms appear when they are stressed and can disappear when they are stress free.
 

What causes OCD?

·        Genetic: many a times you see similar pattern of behavior running in families and it is inherited disorder in many of them.
·        Brain Changes: it is been noted following research certain brain changes and nerves carrying Serotonin receptors are found to be affected in person suffering from OCDs.
·        Stress: sometimes stressful life event can trigger OCD
·        Obsessive personality:  for some who are meticulous and methodical can suffer from OCD when under stress.
·        Certain types of thinking such as introvert and anxious personality may suffer from OCDs more commonly.
Helping yourself

• Remember - it's not your fault and you are not going 'mad'.
• Expose yourself to your troubling thoughts. This sounds odd, but it's a way of getting more control of them. You record them and listen back to them, or write them down and re-read them. You need to do this regularly for around half an hour every day until your anxiety reduces.
• Resist the compulsive behavior, but not the obsessional thought.
• Don't use alcohol or street drugs to control your anxiety.
• If your thoughts involve worries about your faith or religion, then it can sometimes be helpful to speak to a religious leader to help you work out if this is an OCD problem.
• Contact your Doctor for further information.

 
What you expect from your Doctor?
1)    Psychological therapy: Usual therapy is called Cognitive Behavioral Therapy (CBT) and this consists of  Exposure and response prevention (ERP) and Cognitive Therapy (CT)


 
2)    Antidepressant medication
Clinicians usually prescribe a group of medications called SSRI like Fluoxetine, Sertraline etc. It takes a while to show its effect and only 6 out of 10 responds to these medications and other needs change of medications in 3 months. As with all medications these medications also come with side effects and the common ones are Gastritis, bit of giddiness, and for some it may cause sedation and to these individuals it is advisable to take the meds at night to reduce the drowsiness. The medications works best if it is combined with CBT. it is advised to continue the mediations as long as Doctors advised usually from one to 3 years depending on each individual.


 
3)    rTMS Transcranial Magnetic Stimulation:
 
This is the most recent advanced treatment for OCDs usually offered to clients who are resistant to usual treatment Here powerful electric magnet is used to stimulate and inhibit certain areas of the brain depending upon the type of illness. The idea behind it is if the excited area of the brain is inhibited using repetitive stimuli long enough then the cycle of thoughts reduces and in turn helps in improving OCDs. There are very few centers who offers this form of treatment. Please ask your doctor for more information regarding this form of treatment.