WHAT IS OCD?

Obsessive Compulsive Disorder (OCD) has been listed as one of the 20 most disabling of all medical disorders. Its impact on quality of life has been judged more severe than diabetes.

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But the term OCD is often used lightly. People use it to describe how they value neatness, grammar or orderliness. The mental picture it conjures up is of a comically uptight perfectionist, or someone who feels the need to check that the stove is off several times before leaving the house, or walks in a circle three times if such and such happens… An OCD person may have these ‘compulsions’, but there’s so much more to it.

‘The persistent and common belief that OCD is simply an exaggerated desire for hygiene and order is not the fault of doctors and scientists, who have been telling people it is wrong for decades,’ says author and OCD patient David Adam. Today we are much more open and understanding about anxiety disorders and depressions, and the terrible stigma around mental illness is starting to fade. Yet OCD is more serious, says David, as fewer people regard it as a serious illness (and often confuse it with Obsessive Compulsive Personality Disorder (OCPD).

The result? A widespread misunderstanding of the disorder and its sufferers, who often don’t recognise their condition, and go untreated for years, even decades.

THE ‘WHAT-IF’ SYNDROME
While anxiety is a response to a clear and present danger, OCD is usually about threats that may occur in the future, the ‘what-ifs’. OCD is characterised by the presence of obsessions, or compulsions, or both. What is crucial is that the obsessive thoughts are recurrent, and are intrusive or unwanted, causing obvious anxiety or distress.

Another important factor, according to David, is that the obsessive thoughts of OCD are different to other kinds of thoughts that cause mental anguish; for example, fearing for the safety of your child riding a bicycle for the first time. This is ego-syntonic (in harmony with your drives and motivations you want your child to be safe). It is the content of the thought, not the thought itself, that makes you unhappy. These worries are not permanent, they leave your mind when a new thought enters, and on goes your stream of thoughts.

‘Unwanted and intrusive thoughts the raw materials of obsession are different. They are irrational, ego-dystonic and they clash with how we see ourselves, and how we want others to see us,’ says David. And they don’t go away. These thoughts tend to cluster around a limited number of themes.

COMMON THEMES

• Obsessions of contamination with dirt and disease (the most frequent, occurring in about a third of cases)
• Irrational fears of harm
• An obsessive need for patterns or symmetry (about one in 10)
• Less frequent themes
• Obsessions with the body and physical symptoms
• Religious/blasphemous thoughts
• Unwanted sexual thoughts
• Thoughts of carrying out acts of violence

"Unwanted and intrusive thoughts are the raw materials of obsession. They are irrational and ego-dystonic"

‘Because obsessive thoughts are so often within taboo territory, many OCD sufferers choose to hide them,’ says David. Because of this, mental health professionals refer to OCD as ‘a secret disease and silent epidemic’.

Most OCD sufferers are aware that their obsessions and thoughts are irrational and have no base in reality. But that doesn’t mean they can stop them. They try to suppress the thoughts or alleviate the anxiety with compulsions, which ironically increase the anxiety.

Compulsions include repetitive behaviours or avoidance tactics; and/or repetitive praying or counting. They take up a lot of time, and cause ‘clinically significant distress or impairment socially and in other important areas of functioning.’

OCD is the fourth most common mental disorder – after depression, substance abuse and anxiety. It prevents people from living a ‘normal life’ being employed, moving away from home, raising a family. It can cause damage to relationships as the sufferer becomes inward focused and often feels increasingly misunderstood.

‘HUMOUR AND LEVITY’: OCD IN POPULAR CULTURE
As an English professor put it: ‘What distinguishes representations of OCD from depictions of other mental disorders is the frequency with which OCD is treated with humour and levity.’ Popular culture enforces OCD stereotypes; for example, Jack Nicholson won an Oscar for his quirky and humorous portrayal of an obsessive-compulsive in the film As Good as it Gets.’ Welsh actor and writer Ian Puleston-Davies tried for a more realistic portrayal in a film called Dirty Filthy Love, in which Michael Sheen played an architect with OCD and Tourette Syndrome. After it was screened on TV, OCD-UK received 2 000 phone calls. The film clearly did some good.

HOW DO YOU RECOGNISE OCD?
Joseph Zohar, an OCD expert in Israel, lists five questions that can help doctors and nurses screen for clinical obsessions:

• Do you wash or clean a lot?
• Do you check things a lot?
• Is there any thought that keeps bothering you that you would like to get rid of but can’t?
• Do your daily activities take a long time to finish?
• Are you concerned about orderliness or symmetry?

Note: To answer yes to any of these questions does not mean that someone has OCD, but it should prompt further questions along similar lines to these – but with a range of possible answers to indicate the severity of symptoms, says David.

WHAT CAUSES OCD?
It is believed to be genetic. ‘Cases can be due to environmental stressors, or inherited, or both,’ says Professor Christine Lochner, who is currently conducting long-term research into OCD at Stellenbosch University. ‘An example of environmental cause may be adverse childhood experiences. In a recent study by our group, we found that childhood trauma, specifically emotional abuse and neglect, increased the odds of OCD significantly, and that this, combined with some genetic variables, increased it even more.’

HOPE FOR HEALING
‘OCD is usually a chronic illness,’ says Christine. ‘But treatment can significantly alleviate the symptoms and impairment associated with it.’ Standard treatments are selective serotonin reuptake inhibitor medications (antidepressants) and Cognitive Behavioural Therapy (CBT) which uses techniques of exposure and response prevention (the patient is exposed to their fear, and tries to resist the urge to perform compulsions). Patients can use one or a combination of the treatments, depending on what works best. David states these are only 60-70% effective, and researchers are still looking for better treatments.



OCD VERSUS OCPD
When people refer to OCD, they’re actually describing Obsessive Compulsive Personality Disorder (OCPD) which describes ‘an exceedingly systematic and methodical person, who pays much attention to detail and has a strong dislike of dirt.’ The two phenomena are linked and the symptoms can overlap. People who have OCPD can later develop OCD. The bottom line, though, is that they are very different from each other.

OCD’S NEW CLASSIFICATION
OCD is no longer listed under the broad group of anxiety disorders but now stands on its own – signalling a more accurate grasp on what has been called one of the most elusive and disabling mental illnesses.In the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – the authority for psychiatric diagnosis in the US the broad category of anxiety disorders are now in three sequential chapters:

• Anxiety
• Obsessive-Compulsive and Related
• Trauma-and Stressor-Related.

GREAT BOOK TO READ
The Man Who Couldn’t Stop. OCD, And The True Story of a Life Lost In Thought by David Adam. This eye-opening book contains explicit details of David’s personal struggle with OCD (his obsessions circulated around fears of acquiring HIV/Aids and harming his newborn daughter). There are also some extreme examples of OCD patients, like Kurt Gödel, a friend and colleague of Albert Einstein who ‘suffered from the irrational and obsessive idea that he’d accidentally be poisoned from tainted food, or gas that escaped from his refrigerator.’ He’d only eat food his wife had tasted first. David writes, ‘When she fell ill and could not do this for him, the obsessive siege on his mind made him starve himself to death.’ Two-thirds of sufferers never see a mental health professional. They are burdened with the disorder their entire lives, possibly not even knowing that it requires medical attention.

‘I WENT SIX YEARS UNDIAGNOSED’ – SANDY
‘In 2004 I had a bad car accident. No one was hurt, but it rattled me. I’d always felt so infallible behind the wheel. After about three months, I started becoming anxious while driving and was unusually emotional. My GP diagnosed depression, and I was also diagnosed with an overactive thyroid. I was anxious and paranoid about driving, I kept thinking, “What if I knock someone down?” I couldn’t switch off my thoughts. so I started to avoid driving at all costs. When I did drive, I’d obsess that I’d hit someone, and would go back and check. Half the time I was retracing my route to check there wasn’t a person lying in the road. I tried to hide it from my family; I’d suggest we go out for dinner and would strategically choose a restaurant so we had to drive along the route I’d taken earlier, to check again! But hiding it was impossible, and even people at work knew something was wrong. I carried on for six years. Then I read an article and immediately contacted Christine Lochner. I’ve since gone on antidepressants and I attend CBT every two months. Everything has worked well for me and I feel normal again. The average person doesn’t understand, they just think you’re crazy.’ ‘I thought God would punish me if I didn’t read my Bible’

GAVIN
‘My symptoms started at age seven. The food inside our school bags was attracting ants. My teacher used ant poison in chalk form on our bags. I didn’t want to touch my bag. I had to wash my hands if I touched it or the door handle, because the other children had been touching their bags and the door handle. My main fear was getting sick; I was convinced my mom was poisoning me. I saw lots of doctors, and was diagnosed with OCD at age eight. In grade 11 I thought I’d be okay to stop my medication, but my symptoms came back. I’d think myself sick. I also thought God would punish me if I didn’t read my Bible enough. I went back on antidepressants and now understand that my OCD is a chemical imbalance. Some of the thoughts are still there, but with the medication I am able to repress them. I’ve also learnt how to handle the obsessive thoughts when they emerge. It’s been such a help to have so much support from my parents. OCD sufferers really need support and encouragement.’

GET HELP OR MORE INFORMATION
Prof Christine Lochner (MRC Unit on Anxiety & Stress Disorders at the Universities of Stellenbosch & Cape Town):
Tel: +2721 938 9179

The Mental Health Information Centre of Southern Africa:
Tel: +2721 938 9229
Email: mhic@sun.ac.za
www.mentalhealthsa.org.za


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