CHENNAI: Obsessive compulsive disorder (OCD) is a behavioural disorder where a person has repeated compelling thoughts that force them to behave or do things in a certain manner. An inability to conform to this behaviour often leaves them distressed, ill-tempered and incapable of functioning normally. OCD affects adults, adolescents and children all over the world. Most people are diagnosed by about 19 years of age, typically with an earlier age of onset in boys than in girls. However, onset after 35 years can also occur.
Obsessions are repeated thoughts, images or impulses that cause distress and cannot be controlled by the patient. Common examples being — fear of contamination, having things symmetrical, unwanted taboo thoughts involving religion and harm. Compulsions are repetitive behaviours that a patient with OCD does, to relieve the anxiety caused by the obsession like fastidious attention to details, checking that a door is locked, extreme cleanliness, extreme organising and counting things.
OCD is often misunderstood as a desire to keep things tidy, but in actuality, this couldn’t be further from the truth. For instance, in most people, the need to expect things to be tidy is just a desire. An untidy cabinet might worry them, but it will not disturb their other important priorities in life. They’d like to organise it because it looks nicer, but it’s not vital to their mental and physical wellbeing. They can easily ignore the cabinet and carry on with other important work. But in people with OCD, the cleaning of the cabinet is more a compulsion, a desperate need to keep it tidy, even at the expense of other important work. They do it because there is an uncontrollable need to have things in a certain order.
OCDs can have many forms; it might be something as trivial as double checking if the car doors are locked or more serious obsessions like excessively locking down a house as they fear not doing this will harm them or their loved ones.
Most of us double check our work, check again if we have locked the doors, or if we have turned off the stove. However not all habits are compulsions. Here is the difference — patients with OCD cannot control their thoughts, though they recognise them as excessive. Thus, they experience severe dysfunction in their daily life. The patients derive no pleasure in doing these acts. Although these acts may seem like rational behaviours, they are in fact irrational because of the time taken to complete these rituals. An individual with OCD may spend hours of their day ensuring that every single window and door in their house is locked, this then becomes a routine — which if not completed makes them extremely anxious. People with OCD generally try to avoid situations that trigger their obsession or are a hindrance for their compulsion thereby causing social isolation.
The difference between OCD and perfectionism is the level of rationale applied to the activity or situation. For example, a rational response to getting dirt on your hands would be to wash them until. An irrational response would be continuously washing your hands long after the stain is gone. Most of us aspire for perfection in our lives; a personality trait that originates from childhood where a reward would be given for good work in school. Many of us carry this into our adult lives and apply it to our work, education, and personal growth. Perfectionism is a personality trait where one strives for flawlessness; it becomes OCD when those strives cause literal disorder in one’s life.
Today, there are many modalities of treatment available to manage the disorder. Pharmacological — medications are available to reduce excessive thoughts and also to manage the distress that it causes. Psychological — many therapies are available which, when done under the guidance of experts can reduce the anxiety that is triggered by these thoughts.
The writer is a consultant psychiatrist at Fortis Malar Hospital, Chennai