Obsessive Compulsive Disorder (OCD)

What is OCD?

OCD is a very common illness and includes having repeated thoughts or images (Obsessive Thoughts) which in most cases is followed by activities to get rid of these thoughts/ images (Compulsion).

All of us are obsessional about some things but it is a disorder when it starts impacting on day to day life.

Symptoms of OCD are very distressing to the patient as they know that these thoughts are wrong or silly but they can’t do anything to stop them from coming into their mind.

Different Types of OCD –

  1. Fear of Contamination (being dirty)- This is probably the most common of the symptoms that the person feels that they have become ‘dirty’ in some way and repeatedly wash hands or take bath. They avoid touching things that they may consider dirty like doors, computers, shaking hands or touching dustbin. Patient’s life usually gets more and more restricted and they avoid leaving their home or even room. They would clean everything again and again.
  2. Repeat Checkers– These are people who repeatedly check whether doors/ windows and light switches are closed or not. They may have to come back from long journeys to rest their mind that all is switched off or locked.
  3. Obsessive Symmetry– These are usually perfectionist people who like things in a particular order and become unhappy/ uncomfortable if they are slightly changed.
  4. Obsessive Rumination– These are people who keep on thinking the same unpleasant things again and again and can not get rid of these thoughts. These thoughts may be that they feel they have caused some harm or accident despite no evidence of it what-so-ever.
  5. Obsessive Images– These are people who repeatedly see unpleasant things/images like for example murder, molestation and cause them an incredible level of distress. They may develop a routine of going and lying down on the bed to avoid such unpleasant images and therefore restricting their daily activities.

Why does it happen?

Most of the time there is no reason for this, usually people are perfectionist in nature and the illness seems to run in families. Having parents with OCD, increases your chance of OCD by several folds. Usually the precipitant of the illness may be trauma, illness or tragic event (Stressful circumstances).

What can be done about it?

90-95% patients respond very well to commonly available treatments.

You will normally need to see a Psychiatrist who will do a complete assessment of your symptoms and restriction on life and suggest treatment accordingly. He/ She may undertake physical examination and conduct few blood tests to rule out other illnesses.

Normally the treatment is combined Medicines and Psychotherapy/ Counseling. Unfortunately, psychotherapy is not widely available in most cities in India, so medication and behavioural changes become the mainstay of treatment for most patients.

The choice of medication is largely dependent on your symptoms, disability and side effect profile of medicines. Commonly prescribed medicines are antidepressants which also help with anxiety and OCD but for select few sometimes addition of small dose of antipsychotic type medication will be appropriate.

Unfortunately, for the small number of patients who do not respond to medication or are unable to tolerate larger doses, there is very little available except going for surgical treatments.

Historically, a small surgery is done in the brain which helps the symptoms but if completed can not be reversed. A newer technique called Deep Brain Stimulation (DBS) is available now which is very similar to a pacemaker which can ease symptoms and is potentially reversible.

Management of Stress (see leaflet) and Self Help books are available which can help with the symptoms to some extent. Leading a healthy life with settled day to day activities will also go a long way in easing your symptoms.