OCD

Overcompulsive disorder sufferers are haunted by constant DARK and ALL CONSUMING thoughts that can’t be simply switched off.

“In 2004 I had a bad car accident. No one was hurt, but it really rattled me – I had always felt so untouchable behind the wheel. After about three months, I started getting anxious when driving. I was also very emotional, which was unusual for me. My GP diagnosed depression, and later that year I was diagnosed with an overactive thyroid. By this point I was anxious and paranoid about driving. I couldn’t switch off my thoughts. So I would avoid driving at all costs. When I did drive, I’d obsess that I’d hit someone. Half the driving I did during this time was retracing my route, just to check that I hadn’t left a person lying in the road,” says Sandy, 32.

There’s more to overcompulsive disorder (OCD) than these traits. “The persistent and common belief that OCD is simply an exaggerated desire for hygiene and order is not the fault of doctors and scientists, who have been telling people otherwise for decades,’” says author and OCD patient David Adam. Today we’re much more understanding of anxiety disorders and depression, and the terrible stigma around mental illness is starting to fade. Yet OCD is a challenge, says Adam, as fewer people regard it as a serious mental illness. The result?

A widespread misunderstanding of both the disorder and its sufferers, who often don’t recognise that they have the condition, and go untreated for years – even decades.

WHAT IT REALLY IS

OCD is the fourth most common mental disorder, after depression, substance abuse and anxiety. Because it prevents people from living their lives normally, it ends up being a social handicap and a societal burden, says Adam. It can damage relationships, as the sufferer becomes inward-focused and often feels increasingly misunderstood. OCD can also be masked by other mental disorders, like depression, anxiety and eating disorders, which frequently co-exist in the same person.

While anxiety is a response to a clear and present danger, OCD is usually about threats that may occur in the future – the what-ifs. OCD is characterised by the presence of obsessions or compulsions, or both. What’s crucial is that the obsessive thoughts are recurrent, and are intrusive or unwanted, causing

obvious anxiety or distress. Another important factor, according to Adam, is that the obsessive thoughts of OCD are different to other kinds of thoughts that cause mental anguish. For example, fearing for the safety of your child when they ride a bicycle for the first time. This is ‘ego-syntonic’, meaning it’s in harmony with your drives and motivations. It’s the content of the thought, not the thought itself, that makes you unhappy. These worries are not permanent; they leave your mind when a new thought enters, and on goes your stream of thoughts.

“Unwanted and intrusive thoughts, the raw materials of obsession, are different. They’re irrational and ego-dystonic. They clash with how we see ourselves, and how we want others to see us,” says Adam. “It’s because obsessive thoughts are so often within taboo or embarrassing subjects that so many people with OCD choose to hide them,” he adds. Because of this, mental health professionals refer to OCD as “a secret disease and silent epidemic”. Importantly, most people with OCD are aware that their obsessions and thoughts are irrational. But that doesn’t mean they can stop them. Most sufferers try to suppress their thoughts or alleviate the anxiety with compulsions – which, ironically, often only serve to increase it.

Compulsions can include repetitive behaviours or avoidance tactics used to evade the thing that seems to cause the distress. Compulsions can also be mental, like repetitive praying or counting. The obsessions and compulsions take up a lot of time, or cause “clinically significant distress or impairment socially and in other important areas of functioning.”

THE CAUSES

“Cases can be due to environmental stressors, or inherited, or both – an interaction of these variables,” says Professor Christine Lochner, who’s currently conducting long-term research into OCD at Stellenbosch University. “An example of an environmental cause may be adverse childhood experiences. In a recent study by our group, we found that childhood trauma, specifically emotional abuse and neglect, increased the odds of OCD significantly, and that this, combined with some genetic variables, increased it even more.” So, while we may already have the genetic makeup for OCD, it’s the events in our lives that can trigger the dormant OCD threat, such as physical or emotional trauma. The only known risk factor for OCD is having a family member with the disease. Dr Gerald Nestadt, professor of psychiatry and behavioural sciences at Johns Hopkins University School of Medicine, found its occurrence was six times greater if the person had a relative with the condition. Some scientists believe there could be a specific gene responsible, but the jury is still out on that one.

HOPE FOR HEALING

OCD is usually a chronic illness, says Lochner. “But treatment is available that can significantly alleviate the symptoms and impairment associated with it.” Standard treatments are antidepressants and cognitive behavioural therapy, which uses techniques of exposure and response prevention (the patient is exposed to their fear, and tries to resist the urge to perform compulsions). But Adam says these are only 60% effective. Researchers are still looking for better treatments.