I was interacting with a friend about a year who claimed she had OCD, because her friends kept insisting she had a particularly weird way of doing her things. Arranging her clothes in a particular way, with white clothes on the top and the dark ones at the bottom; invariable way of telling us how angels conquer demons. She had a preference for the same kind of white socks, and could eat the same food every day for a month without any complaints. Basically, the same everything. Did she have OCD? Let’s find out!
Healthy individuals experience occasional intrusive thoughts, some of which are concerned with sexual, aggressive and other themes similar to those of obsessive patients but that does not mean the diagnosis of OCD has to be thrown down their throats. Familial studies have reached a similar conclusion, and indicate that the risk of OCD in first degree relatives is increased approximately fourfold compared with control rates in individuals.
Obsessive Compulsive Disorder is characterized by
1. Obsessional Thinking
2. Compulsive Behaviour
3. Varying degrees of anxiety, depression and depersonalization.
Obsessions defined by Oxford Advanced Learners Dictionary are the state in which a person’s mind is filled with thoughts of one particular thing, or person in a way that is not normal. The same dictionary defines compulsions as that strong pressure that makes a person do something he/she does not want to do. Depersonalization is a psychiatric terminology defined as consisting of a detachment within the self, regarding one’s mind or body, or being a detached observer of oneself. These people feel they have changed and that the world has become vague, dreamlike, less real and lacking in significance, or being outside reality while looking in.
Putting these together, we have a fair idea of what OCD is. Don’t we? But the outstanding symptom is a subjective feeling which must be resisted to carry out some action, dwell on an idea, to recall an experience, or ruminate on an abstract topic. To ruminate means to think deeply about a topic or idea.
Unwanted thoughts which include the insistency of words or ideas, ruminations or trains of thought are perceived by the person to be inappropriate or nonsensical in OCD.
Obsessional actions may be quasi ritual performance designed to relieve anxiety. Symptoms of anxiety include fearful anticipation, irritability, sensitivity to noise, restlessness, poor concentration, worrying thoughts, dry mouth, chest discomfort and sensation of your own heartbeat. Irritability is a state where you are easily provoked to anger. Washing the hands to deal with contamination? Attempts to dispel these ultimate thoughts may lead to a severe inner struggle with intense anxiety.
Now the different forms of obsessions in details? Drum Rolllllllll………
Obsessional thoughts: They are words, ideas and beliefs that are recognized by patients as their own, and intrude forcibly into the mind. Their mind serves as a yardstick for these uncontrollable ideas. They are usually unpleasant and attempts are usually made to exclude them but to no avail.
It is the combination of an inner sense of compulsion and of efforts at resistance that characterizes obsessional symptoms, but the efforts at resistance is the more variable of the two. Obsessional thoughts may take the form of single words, phrases or rhymes, which are usually unpleasant or shocking to the person, and may be obscene or blasphemous.
Obsessional images: These are vividly imagined scenes, often of a violent or disgusting kind (e.g. involving sexual practices that the person finds abhorrent.
Obsessional ruminations: These are internal debates in which arguments for and against even the simplest everyday actions are reviewed endlessly. Some obsessional doubts concern actions that may not have been completed adequately (e.g. turning off a gas tap or securing a door), while other doubts concern actions that might have harmed other people (e.g. that driving a car past a cyclist might have caused him to fall off his bicycle). Sometimes doubts are related to religious convictions or observances (‘scruples’)—a phenomenon well known to those who hear confession.
Obsessional impulses: are urges to perform acts, usually of a violent or embarrassing kind (e.g. leaping in front of a car or injuring a child)
Obsessional rituals: include both mental activities (e.g. counting repeatedly in a special way or repeating a certain form of word) and repeated but senseless behaviour (e.g. washing the hands 20 or more times a day). Some rituals have an understandable connection with the obsessional thoughts that precede them (e.g. repeated hand washing following thoughts about contamination). Other rituals have no such connection (e.g. arranging objects in a particular way). The person may feel compelled to repeat such actions a certain number of times, and if this sequence is interrupted it has to be repeated from the beginning. People who use rituals are usually aware that these are illogical, and usually try to hide them. Some people fear that their symptoms are a sign of incipient madness, and are greatly helped by reassurance that this is not so.
Obsessional slowness: Although obsessional thoughts and rituals lead to slow performance, a few obsessional patients are afflicted by extreme slowness that is out of proportion to other symptoms.
And now my all- time favorite
Obsessional phobias: Obsessional thoughts and compulsive rituals may worsen in certain situations—for example, obsessional thoughts about harming other people may increase in a kitchen or other place where knives are kept. The person may avoid such situations because they cause distress, just as people with phobic disorders avoid specific situations. Because of this resemblance, the condition is called an obsessional phobia.
When you see a psychiatrist, he/she would use a diagnostic criteria to ascertain the diagnosis of Obsessive – Compulsive Disorder impinged on you by your friends.
1. This requires you either have obsessions, or compulsions or both.
2. These obsessions and compulsions have to be time- consuming and cause clinically significant distress and impairment in social or occupational function.
3. Necessary that the symptoms you are experiencing are not attributable to the effects of a narcotic substance or another medical condition.
4. Disturbance is not better explained by the symptoms of another mental disorder.
Another diagnostic criteria known as ICD-10 (International Classification of Diseases 10) recognizes that these obsessional symptoms or compulsive acts must be present on most days for at least 2 successive weeks and be a source of distress or interference with usual activities.
ICD-10 also classifies OCD as predominantly taking the form of obsessional thoughts and ruminations, or predominantly compulsive acts or mixed obsessional thoughts and acts when both are equally prominent. This distinction may be useful because behaviour therapy, for example, is more effective for the treatment of compulsions than it is for disorders characterized chiefly by obsessional thoughts.
Once you recognize these symptoms, it is advisable you contact a mental health professional for optimal resolution of these symptoms for which you might, or might not need medication for treatment. Because the world needs you in it, to be a better place!
Thanks for reading. Enjoy your Friday!
Reference: Shorter Oxford Textbook of Psychiatry