OCD

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

True Love - - Health - By SAN­DRA PARMEE

“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.

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