OCD, short for obsessive-compulsive disorder, is a term that we might use loosely when anyone gets extra-finicky or is ultra-careful about things around. It could be someone who goes on a cleanliness overdrive over a speck of dirt on their laptop screen, or a personal space.
Truth be told, the matter is much more complex than our superficial and light-hearted understanding of such actions.
Sujaur Rehman, 32, resident of Hapur in Uttar Pradesh, talks about his life’s journey with OCD since he was a teenager.
A class topper through his early years, Rehman presumed that high school was also going to be a breeze. Then he started getting anxious and irritable when trying to solve the same question on loop. The same drill continued during his high school exams where he ended up wasting answer sheets trying to solve the same question. When the results came out, the once bright Rehman had flunked exams for the first time in his life.
Then, one day in 2013, Rehman had to catch a bus. While waiting for the bus, he suddenly turned back home for them to wear his shoes. To his shock, he was already wearing them very much. That day, he went back and forth home thrice for the shoes that he was already wearing, according to his elder brother Jiyaur Rehman.
Rehman was diagnosed with OCD. He has been on a combination of therapies curated for him by his doctor.
“OCD is a multifactorial disorder which can be caused due to environmental and genetic factors, or one’s habits developed over the years,” says Dr Karthik Jois, OCD Clinic, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru.
A study from Stanford School of Medicine, Stanford University, USA, says the causes for OCD can be many. However, it pins much of the blame on the unusual serotonin relay in the brain.
Serotonin is a hormone in the brain that regulates several bodily functions, including mood, behaviour, sleep-wake cycle, and emotions.
Early warning signs
Dr Anish V. Cherian, Professor of Psychiatric Social Work, NIMHANS, Bengaluru, explains that obsessions are specific thoughts that may push a person to engage in repetitive behaviour. The obsessions typically make it difficult for people to go about their daily lives. And compulsions are the repetitive behaviours people engage in because of their obsessive and often illogical thoughts.
When Rehman began exhibiting these symptoms at the age of 12, his family played it down believing it to be because of his playful age. He grew up with intrusive or, more accurately — obsessive thoughts.
Not all repetitive behaviours are indicative of OCD. It is not possible to label an activity as obsessive or OCD if the person engages in it voluntarily and finds enjoyment in it.
But if one’s obsessions start to interfere with one’s day-to-day life and consume a lot of time, or one’s thoughts become distressing and intolerable, it is time to seek a specialist’s help.
A few examples of obsession:
- Fear of getting dirty
- Blasphemous thoughts
- Recurring thoughts or doubts about not doing tasks correctly.
- Urge to re-arrange or have objects arranged in a certain order or position.
A few examples of compulsions:
- Repeatedly washing one’s hands;
- Repeatedly checking locks
- Counting over and over to a certain number
- Repeating and checking certain actions
Therapies and strategies
“Accepting the disorder and learning to live with it is the first step towards improving the quality of life,” says Bhavesh Rathod, 38, who is an India representative of international support group OCD Together.
Medications also work well in lowering the episodes of OCD in the initial few years. But as time progresses there is a saturation of the medicinal effect and the person starts experiencing episodes on and off.
Magnetic therapy and behavioural therapy are among medication-free approaches that effectively delay OCD from turning chronic.
- Magnetic therapy helps to reduce the frequency of episodes and brings down the dependency, dose, and frequency of medication.
Rehman receives magnetic therapy at the All India Institute of Medical Sciences, New Delhi. He says it has controlled his recurrent episodes of anxiety.
A magnetic therapy session – which involves sending electric pulses to the head – improves the brain’s functioning, which helps in controlling irrational activities of OCD.
- Behavioural treatment improves the quality of life. Exposure and Response Prevention (ERP) is given to reduce compulsions and obsessions, thereby reducing people’s anxiety and misery.
“ERP has been shown to be beneficial to more than 60 per cent of individuals taking the treatment,” claims Dr Jois.
The problem as a solution
The principle behind ERP is to repeatedly expose the individual to the event that triggers the anxiety episodes. Over time, it nullifies the twin problems.
Let us say a person is overly concerned about a cleanliness issue. ERP makes them clean the troubling object or area repeatedly. In due course the action reduces the cleanliness concern in the individual, says Dr Jois of the OCD clinic.
Dr Cherian of NIMHANS emphasises that along with practising ERP daily, one should also take certain measures to enhance the outcome of the ERP exercise. He lists them:
- Not avoiding things that cause obsession and anxiety;
- Not substituting compulsion;
- Avoiding use of any anxiety-reducing techniques; and
- And keeping realistic expectations.
The NIMHANS 4R rule
The 4R rule suggests that whenever one experiences an episode, one should start thinking – `it is not me but something else that is controlling my thoughts’. This rule should make one realise that all obsessions and compulsions are illogical and can be easily ignored.
Re-label. Recognise the intrusive thoughts and urges.
Re-attribute. Remember that these thoughts are false brain messages and `it is not me, it is OCD that is causing this obsession or thought’.
Refocus and Revalue. This comes as a result of the previous steps.
Role of family and caregivers
Experts suggest that family and caregivers are the first point of contact for such individuals. They play a significant role in early diagnosis and good outcomes of the therapy..
However, the stress that OCD brings upon families frequently results in marital issues, divorce, and separation. Ample family understanding and support can reverse the disorder.
“Family members must be included in the treatment of OCD, especially in the implementation of behaviour therapy and to oversee the administration of medication,” says Dr Jois.
Overcoming the odds
As for Rehman, he now is an M.Com and B.Ed thanks to the support of his family. He tutors matriculation students. Diligent therapy sessions and a supportive family have helped him to regain societal acceptance.
Rathod designs software for stock market analysis. He says he overcame OCD through the acceptance, care, and mental support of his wife Archana.
For people with OCD to lead a better life, it is essential that they receive constant affection from their family and friends and are not neglected or abandoned by them. This support and acceptance will equip them to succeed in life, as Rehman and Rathod have.