Eh, you have OCD is it?
by Wan Ting Koh
HAVE you ever accused a fussy person of being “OCD”? To most of us, the term “Obsessive-compulsive disorder” (OCD) is one that we simply throw at that friend who straightens his books obsessively or the colleague who scrubs at her table religiously everyday. You might want to be more judicious about the term because OCD can actually be a serious psychiatry condition that requires treatment.
It’s an anxiety disorder characterized by uncontrollable, unwanted thoughts which may sometimes result in repetitive, ritualized behaviors the person feels compelled to perform. Plagued by distressing images, the person might create “rituals”, such as counting backwards, to distract them from the images. Somehow, the rituals make them feel calmer.
According to a 2010 study done by the Institute of Mental Health (IMH), OCD emerged as one of the top three most common disorders in Singapore together with major depressive disorder and alcohol abuse. The Singapore Mental Health Study showed that one in 32 people suffered from OCD at some point in their lifetime.
However, a more recent study done on 3,000 people and released by the IMH in October this year showed that OCD was relatively less well-recognised as compared to other mental illnesses in Singapore. The study, called The Mind Matters: A Study of Mental Health Literacy, obtained information on people’s recognition and beliefs about five common mental disorders – alcohol abuse, dementia, major depressive disorder, OCD and schizophrenia – and found that across the five disorders, recognition was relatively poorer for OCD, at 28.7 per cent. Recognition was highest for dementia (66.3 per cent), followed by alcohol abuse (57.1 per cent) and major depressive disorder (55.2 per cent). Schizophrenia was at the bottom of the list at 11.5 per cent.
In the recent case of the allegedly mistreated maid, Ms Thelma Oyasan Gawidan, 40, the court was told that her employer Chong Sui Foon was suffering from OCD, hence Thelma would be asked to shower in a public toilet since it would take ages for Chong to clean the toilet every time she showered.
Such cases are the more common forms of OCD, according to three psychiatrists we spoke to. In addition to obsessive cleaning, checking and re-checking and collecting or hoarding are two of the other most common symptoms of OCD encountered.
So how do you differentiate a true sufferer from one who is merely a perfectionist at heart?
According to psychiatrist Lim Boon Leng, who owns a private practice Dr BL Lim Centre for Psychological Wellness, the line between a perfectionist and a person suffering from OCD is “not difficult to draw”. OCD is a condition acquired over time and is “episodic in nature” as it affects patients who were originally fine. On the other hand, perfectionists are born.
A perfectionist might even enjoy washing his hands or tidying his room everyday as the ritual would award him satisfaction, whereas the same behaviour would be distressing to an OCD patient. “A person suffering from OCD finds his thoughts intrusive and feels distressed by them,” said Dr Lim.
OCD could be caused by multiple factors, he added. There could be a combination of biological causes – a lack of seratonin in the brain or a dysfunctional neuro-transmitter – and external factors such as stress from the environment. In some cases, OCD is also hereditary.
Many of the patients he has encountered developed the condition when they were around nine or 10 years old. And though the condition could be a passing phase, more often than not, it would last for years, becoming a chronic condition that worsens without treatment.
Unlike Dr Lim, Dr Brian Yeo, a consultant psychiatrist at Brian Yeo Clinic Psychiatric Consultancy, doesn’t think it is as easy to draw the line between a perfectionist and someone with OCD. In fact, Dr Yeo thinks that perfectionists are more prone to tipping over to OCD behaviour. The main difference: For someone to suffer from OCD, there “must be a disturbance in his everyday life”.
He described the recurring images in an OCD patient’s mind as akin to a “brain full of spam messages”. “It interferes with daily functions and thoughts to the extent that they cannot meet appointments, they lose out in their jobs, and their families are affected,” he said.
One of the more serious cases Dr Lim Boon Leng has encountered was a patient who became mostly bed-bound due to his fear of contamination. Getting out of bed was a problem as he could only climb out in a particular manner, so he would just remain in bed. But even in bed, the patient refused to turn left or right for fear of coming into contact with contaminated areas. Showering was also a painful process for the patient who would scrub his skin raw and use a copious amount of soap.
Dr Lionel Lim, a psychiatrist at his own practice L.P. Clinic, said that one way to identify whether an action is compulsive is through social norms. For example, a “normal” person would take less than a minute to wash their hands after going to the toilet. So if you take up to 10 minutes to wash your hands each time, there’s a likelier chance that you’re suffering from OCD. One patient he treated even chalked up a monthly water bill of $100 to $200 in a household of two, simply because he washed so much.
“People do not recognise the importance of getting help…your marital, interpersonal and familial relationships can all be affected. I have known those that have their marriages broken up or their family structures destroyed,” he said.
He recalled meeting a man whose wife had OCD just two days ago. Working from 9am to 9pm daily, his wife would be “the first to arrive and last to leave office” due to her compulsion to check through her work multiple times. Apart from making her inefficient at her work, it took away precious time that could have been spent with the family. Even upon reaching home, the wife would start cleaning the house till the moment she fell asleep, leaving no time for her husband and child – and the cycle would be repeated the following day.
“I’ve met a young lady who doesn’t want to go home because of her mother’s OCD. The moment she steps into the house, her mother would ask her to change clothes and bathe. Once she enters her room, she cannot come out anymore, as her mother would keep cleaning after her. Now she just stays out until night after her mother is in bed or one, two hours before her mother goes back to sleep so as to minimize contact.” – Dr Lionel Lim.
Because OCD is a biological as well as a behavioral condition, psychiatrists said that it can be treated by a combination of medication, such as anti-depressants, and cognitive behavioral therapy or exposure therapy, where the patient is gradually exposed to his object of fear, in order to desensitize him.
So next time, when you feel compelled to level the OCD label on someone, don’t.
*Coming up next on The Middle Ground – How much does a mental illness help your case in court?