You’re obsessed and compulsive…

PETALING JAYA: Obsessive-compulsive disorder (OCD) has become associated with fussiness or being a stickler, but it doesn’t mean that if you do have such characteristics, you are obsessive-compulsive.

Malaysian Mental Health Association deputy president Assoc Prof Datuk Dr Andrew Mohanraj said many individuals have some innate obsessions and compulsions, which are all part of their character.

“Sometimes, these traits can help us succeed as meticulous accountants or good report writers and thorough planners. It does not mean we have OCD,” he said.

He said OCD can also involve other obsessive behaviours and not just preoccupation with contamination or counting, as portrayed in the media.

“The obsessions in OCD can also involve hoarding, saving, meticulous accounting, swearing and arranging things to comply with a certain pattern or symmetry,” he said.

He explained that for one to be diagnosed as having OCD, the condition must be debilitating to the point of causing social and occupational dysfunction and personal distress.

“A diagnosis of OCD is only made if the obsessions and compulsions cause marked distress and are time consuming and significantly interfere with one’s social and occupational functioning,” he said, adding that the distress can be severe to the point that it could ruin personal relationships and lead to suicide.

“In short, simply because you keep checking if you have turned off your gas stove or if you have locked all your doors before you go to sleep does not mean you have OCD,” he stressed.

He added that it is possible for one to have mild symptoms of OCD that do not cause undue impairment in social and occupational functioning.

“However, this can worsen and become more severe when there is additional stress, like from a traumatic life event.

“A significant life event like death in the family or a break-up with a partner can also activate OCD in those who have a predisposition to the disorder,” he shared.

He added that, to a certain extent, the compulsive behaviour could be the manifestation of a desire for control after experiencing helplessness in situations which were beyond their control in the past.

Dr Andrew said there are differences between obsessions and compulsions, in which the former refer to uncontrollable recurring thoughts and impulses while the latter refer to patterns of repetitive behaviour.

“OCD is an anxiety disorder where one has obsessions (thoughts) which result in compulsions (behaviour) that are carried out to reduce anxiety if these compulsions are resisted,” he said.

Although there is a wide spectrum of what a person’s obsessions and compulsions could be, Dr Andrew said there are a few common symptoms.

“A common symptom of obsession would be the irrational worry or fear of dirt, germs or contamination.

“Another common presentation is uncontrollable thoughts of having things arranged orderly or symmetrically to overcome the nagging feeling of things not being in an exact place or order,” he said.

He added that other lesser known obsessive symptoms could include unwanted sexual or blasphemous thoughts or even preoccupation with throwing away objects that are perceived to be useless.

According to Dr Andrew, common symptoms of compulsion are usually the behaviour resulting from these obsessions, including excessive cleaning or handwashing, arranging things in a precise way or repeated counting and checking, or even hoarding things.

He said people with OCD may recognise that their thoughts and behaviours are excessive, but may not necessarily be able to control them.

“They do not get pleasure from their repetitive behaviour, but they do experience relief from them, or more precisely, a reduction in their anxiety levels.

“Unfortunately, the relief felt will only reinforce the belief that compulsive behaviours are necessary to curb unwanted obsessive thoughts,” he said.

What causes the disorder is not immediately clear, though Dr Andrew said one’s genetic make-up and environmental factors contribute to its development.

“Genetics do play a part as evidenced by the fact that a person with OCD is more likely to have a family member with the same condition.

“On the other hand, it is also possible that some can ‘learn’ OCD as a result of modelling after other family members who have OCD.

However, Dr Andrew said OCD is a common disorder that affects people across the board, with the World Health Organisation listing OCD as one of the top 10 leading causes of disability in the working-age group.

“We do not have absolute statistics for OCD in Malaysia, but it is safe to say that the prevalence of OCD is 1-2% of the population, cutting across all ethnic groups and affecting both males and females,” he said, though he added that it is very rare that OCD occurs in children.

He said most people are diagnosed by about age 19, typically with an earlier age of onset in boys than in girls.

“The onset of the disorder is usually gradual, but it can be sudden too, especially after a stressful life event like pregnancy, death of a spouse or loss of livelihood,” he said, adding that onset after age 35 does happen as well.

Dr Andrew stressed that people with OCD should not lose hope, as recovery is possible if the disorder is treated appropriately,

“The two main modalities of treatment are pharmacotherapy and psychotherapy, and they complement each other.

“Pharmacotherapy involves using antidepressant medications like the newer selective serotonin reuptake inhibitors (SSRIs), which increase the levels of serotonin in the brain,” he said, adding that patients with OCD tend to have lower levels of serotonin.

“Psychotherapy can also be effective for patients with OCD. Certain types of psychotherapy, including cognitive behaviour therapy (CBT), can be as effective as medication for many individuals,” he said.