Obsessive-Compulsive Disorder – The unceasing thoughts and behaviours

Everyone from time to time may have some obsessive thoughts or compulsive behaviours, such as the thought of jumping out of the window when standing by one, or the restlessness of not having a door secured which can only be eased by returning to check. Nevertheless, if these thoughts or worries appear once in a while will not affect one’s life. However, when the time spent on obsessions or acting on compulsions become long enough to affect one’s life, it may develop into Obsessive-Compulsive Disorder (OCD), a kind of anxiety disorders. OCD can be further classified into two types. One type of OCD patients is deeply troubled by obsessions. For example, an overstressed mother has imaginations of stabbing her new born baby whenever she holds a knife, pouring hot water over it when making milk with formulas, or to throw it out of the window when stand next to it. Although the aforesaid are only ideas not executed, and some patients do not have them often, these intrusive thoughts are already enough to distress the patients. The scepticism to one’s morality will create a downward spiral and continue to haunt the patients.

Another type of patients has compulsions. A commonly known compulsive behaviour is mysophobia, meaning intensive fears of contamination and cleaning rituals. Initially, mysophobic patients know it is irrational (i.e. resistance), but later the resistance towards the ritual diminishes.  For example, an OCD patient would spend three hours just for a shower. He will start the ritual by cleaning the entrance of bathroom, then the wall, the floor, the bathtub… and finally the shower. If by accident there is a drop of water on the floor, the whole process has to start all over again.

In the US, there are 1.2% of diagnosed OCD. Half of the patients have their onset in their adulthood, while one-fourth to nearly half of the patients already had atypical symptoms during their childhood and adolescence. The childhood-onset symptoms usually wax and wane and are sometimes atypical, such as the unconscious hair-grabbing, nail-picking, skin-peeling, and finger-biting.

Whether it is an obsessive thought or a compulsive behaviour, OCD will cause great disturbance to the patients’ mind, life, work, and even their relationship with people around. Hence, they must receive professional treatment for recovery. The treatment approach is usually a combination of medication and cognitive behavioural therapy (CBT).

Medication can directly relieve the anxiety of patients so that the reappearing thoughts are reduced. Selective serotonin reuptake inhibitors (SSRIs) and minor tranquilizers are most commonly used. For the best results, patients cannot rely solely on the help of medicine. They should also be treated by cognitive behavioural therapy (CBT) for synergistic effect with medication.

There are many skills in CBT, graded exposure being one of the commonest techniques adopted in this illness. The principle of this therapy based on the fact that the compulsive person will exercise irrational behaviours in order to reduce their anxiety. These rituals are called “safety measures”, and it is these safety measures which maintain the disease. Despite refraining the patient from executing these rituals will trigger anxiety, he will gradually habitualise the anxiety and  fears will subside with time.

All in all, CBT should be complemented with medication if it is to be effective in helping patients to overcome the hurdles. In addition, usually there are some persisting stressors  which overwhelmed a patient. Therefore, it will be easier and quicker to first tackle and alleviate the stress and subsequently the nervousness will be further mellowed.

“Standard”  27/6/17