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Compelled by an obsession


08/27/2009 11:06 PM | By Biju Mathew, Staff Report

Imagine constantly being hit by deviant thoughts; imagine doing the same action again and again; imagine being caught in a web and unable to shake out of it. Welcome to the little known world of an anxiety problem: Obsessive Compulsive Disorder (OCD).

People suffering from OCD get recurrent, unwanted thoughts about sex, death, murder or fall for repetitive behaviours like cleaning hands, checking whether the door is locked umpteen times.

Though there have been many studies and much progress in treatment, the real trigger for the distressing disorder is shrouded in mystery.

What is Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterised by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviours (compulsions). Repetitive behaviours such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away.

Signs and symptoms

People with OCD may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals.

Cause

There has been a good deal of research carried out over the past few years regarding the causes of OCD. But there have been no conclusive theories so far.

Treatment

Effective treatments for obsessive-compulsive disorder are available, and research is yielding new, improved therapies that can help most people with OCD and other anxiety disorders lead productive, fulfilling lives.

When in doubt

Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. If you think you have an anxiety disorder, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.

Source: National Institute of Mental Health, US, and other medical journals

Four Case studies by Dr Balan Vijay Kumar MBBS, DPM, MD (Psychiatry), Psychiatrist, Al Lulu Medical Centre, Sharjah

Images of private parts kept 7-year-old girl on edge

*M.N., a 7-year-old girl, was brought in by her parents in a distressed state. She had recurring thoughts about sex and private parts, which worsened over a period of six months. Her thoughts were mostly about exposing her private parts, visualising the genitals of people around her, and an impulse to touch the private parts of people, especially her parents, teachers and neighbours. She couldn’t watch TV, as certain scenes would set off her obsessive thoughts. The thoughts were severe when at school and she would cry all the time.

M.N. is an intelligent girl, with good social skills and is the class topper. She explained her symptoms with great clarity. After her psychiatric evaluation, she stated that nobody else seemed to understand what she was going through.

She was started on medications and cognitive behaviour therapy. M.N. has made significant progress. But, the obsessions continue in a very mild form, but she is able to keep it aside and concentrate on other activities. She has become playful, can watch TV and has attained her earlier levels of academic excellence.

Observations

1. OCD usually starts at a young age; often during childhood.
2. Symptoms are such that patients and parents can be quite ashamed, confused and guilty.
3. Currently, there is a greater awareness in the society.
5. Many times OCD does not resolve completely, but despite that patients continue to do well.
6. Most of medications used to manage OCD are relatively free from long-term side effects.
7. Untreated mental illness can increase the risk of suicide.

Thoughts of death, cleanliness keep plaguing 43-uear-old man

*G.S., a 43-year-old man, has been suffering from OCD for six years. It started suddenly after he saw the body of a colleague in a mortuary. Since then, incessant thoughts about his death have been troubling him. He knew that these thoughts were unreasonable, but these recurring thoughts were beyond his control. When he tried to pray or do any other activity, he felt that was his last prayer or activity. He was forced to visualise himself lying in a coffin. The condition was so severe that he had to give up his job.

Unlike many other OCD sufferers who have a single obsession, G.S. had multiple obsessions: he used to clean the television set, office monitor and mouse repeatedly. He also used to imagine about his parents inside a coffin.

His family took him to a psychiatrist, but G.S. was so anxious and confused that he did not take proper treatment. Since then, he has visited many doctors and was in and out of jobs. His wife looked after the family. Initially, his wife tried her best to ensure proper treatment, but later the patient was abusive and unmanageable, bringing rift in his marital life.

Finally, on his own, he decided to take help. He has been started on medication and marital counselling has been initiated.

Observations

1. In many cases OCD can be a very severe and debilitating disease.
2. Many people are unable to cope and it has a severe impact on their productivity and quality of life.
3. Treatment compliance is a very important factor in deciding outcome.
4. Long-term treatment is necessary.
5. Patient and family education is a very important part of treatment.

Recurring sexual images distress 32-year-old mother of three
*M.K., a 32-year-old housewife and mother of three, had intense, recurring sexual images and thoughts for more than 10 years. The problem compounded when she tried to pray. Despite her best efforts, the thoughts kept coming back. M.K. is a very religious person and tried to find succour in prayer. But multiple obsessions drove her to distress. She had to wash her hands often and while near a window she felt like jumping out. She was scared to go near a knife, for thoughts about using it in a destructive way petrified her.

To top it all, while praying she would feel as if gas escaped from her bowels, adding to her guilt. The intensity of her obsessions varied, at times becoming severe; but somehow she managed to complete her household chores.

Her sexual thoughts also kept recurring. M.K., initially, could not go in for regular treatment since her husband didn’t understand the problem and blamed her for having a “dirty mind”. This intensified her guilt pangs.

Soon after psychiatric treatment was kicked off, M.K. became pregnant and medications were discontinued in the first trimester, but the obsessions became severe and unmanageable and medications had to be restarted after the risks were explained to the couple. Childbirth was uneventful and the baby was healthy.

Following delivery, the obsessions became worse, but M.K. gradually responded to treatment.

She continues to have obsessions, but they are milder compared to the past. Over time, and with regular counselling, the husband was able to accept the medical nature of the problem.

Observations

1. Relatives, at times, can be confused and misunderstand the nature of the illness.
2. Some people have severe obsessions, but despite that manage to complete all their responsibilities with a lot of effort.
3. Obsessions can cause intense feelings of guilt.
4. In women with severe OCD, pregnancy can be a challenge.
5. The focus is to keep the symptoms in check so quality of life can be maximised.

60-year-old man spent hours in bathroom washing hands

*S.K., a retired 60-year-old man, used to constantly worry about cleanliness. The thoughts kept recurring, worsening over a period of six months.

He knew the thoughts were meaningless and described them as silly; but the thoughts never ceased, they were consistent and powerful. The anxiety was considerable if he didn’t wash, especially his hands. He felt that he had no control over these thoughts.

The washing rituals were so severe that he lost interest in all activities, became tired and developed crying spells. He had such an episode about 40 years back, which had lasted for a couple of years, but it had been mild and he did not take any treatment at that time, and it had spontaneously passed.

The present episode was much more severe. He had started spending long hours in the bathroom. The washing had to be done in a certain manner, like a ritual, and this ritual had to be repeated six times every time he felt unclean. Any doubt about the ritual or the count and the whole procedure had to be repeated all over.

He was started on medications and behaviour therapy. He made gradual progress over four months and recovered completely. Since then he has been on regular follow-up and has been symptom free for more than two years.

Observations

1. S.K. had a single obsession, limited to cleanliness of the hand. However, most cases present with multiple obsessions.
2. OCD is mostly a chronic disease, but many cases recover completely.
3. There can be long gaps of normalcy after a complete recovery.
4. Many mild cases improve without any treatment.
5. There is usually a long gap between onset of OCD and the patient taking treatment.
6. S.K. had an excellent response to treatment, with complete recovery.
7. Depression is common with OCD.

Two case studies by Dr Saliha Afridi, Psy.D, Clinical Psychologist, Human Relations Institute, Knowledge Village, Dubai

20-year-old washed his hands so often they bled

*S, a 20-year-old freshman in college, used to be constantly conscious about cleanliness.

The tall and attractive male grew up in a middle class family. Though he was shy and reserved, he had many friends and was part of many social clubs.

His academic and athletic skills got him to a good college, which eventually led him to move away from his family and into the new campus environment.

As time passed by, he started to engage in compulsive hand washing. It had got to the point where his hands used to be dry and the skin flaked off leading to bleeding because he washed them so often. He missed many of his classes and sport practices because if he touched something that he thought was dirty a gym bag, football or a door knob then he would run to the bathroom and wash his hands. Though he knew that his thoughts and behaviour were senseless, he felt compelled to complete his hand-washing rituals.

He didn’t have any history of mental disorders. He was diagnosed with OCD and treatment was initiated: psychotherapy, using cognitive behaviour therapy exposure and response prevention technique.

He was referred to a psychiatrist for a medication evaluation. Because his onset of OCD was most likely stress induced, he had to learn and practice stress-management skills. With medication and psychotherapy, he showed marked improvement and decrease in his compulsive behaviours. He has regained control of his life and has not engaged in the hand-washing ritual for three years now.

Obsession about numbers drives 39-year-old mother 'crazy'

*L., a 39-year-old married female, used to be obsessed about numbers and leading life according to the numbers.

The slightly overweight mother of two girls was encouraged by her “supportive husband” to seek treatment. The female, who has been married for 19 years and leads a “normal” marital life, had signs and symptoms of OCD for more than three months.

When she was 20 years old, she had three separate episodes that brought on a panic-like anxiety with associated obsessive and compulsive behaviours about contamination, about dying or getting very sick, and about people not liking her.

In the recent episode, she believed that everything she did for herself and her husband had to be done in odd numbers, and everything she did for her daughters had to be done according to their ages.

If she did not do the actions according to the associated numbers, she believed that something terrible would happen to that family member.

All her actions like checking the door, making sure the stove was off, packing children’s lunch, watching television programmes, and the types of food served – had an associated number.

And it continued all day long. She knew it was “crazy” to count and go by numbers, but that was the “only thing” that relieved her anxiety.

And it seems she has a genetic predisposition towards anxiety disorders, for her mother was diagnosed with anxiety and depression.

Her paternal grandmother committed suicide after being hit by depression.

L. was started on cognitive behavioural therapy, mostly response prevention and was referred to a psychiatrist for medication.
Since L. had serious issues,her husband’s help was also elicited in her therapy.

L. showed marked improvement by the end of therapy. She was not ‘cured’ of OCD, but she learned to cope with it.

 
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