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Obsessive compulsive disorder
15 December, 2004
Expert(s):
Dr. Sumant Khanna
Psychiatrist
Delhi Psychiatric Clinic, New Delhi
Dr. Y.C. Janardhan Reddy
Associate professor of Psychiatry
NIMHANS, Bangalore
DrNDTV: What is an obsessive compulsive disorder (OCD)?
Dr. Khanna: Obsessions and compulsions are repetitive and intrusive thoughts and actions. The thoughts need not be unusual; they may be daily thoughts. But the fact that they come into awareness against one's will makes it an obsession. That is what characterises it as a disease. Repetitive, intrusive thoughts and actions, which interfere with normal day-to-day functions that can cripple a person are a part of OCD.
DrNDTV: Is a psychiatric problem equivalent to a disease?
Dr. Khanna: Many people, especially sufferers of OCD believe that obsessions are psychological experiences and thoughts, which can be controlled by them. They don’t consider it as a psychiatric disorder and come to us at the last stage when they cannot control it anymore. Actually the gap between the onset of the problem and seeking psychiatric help is seven years. For seven years they suffer thinking that I will control the disease.
DrNDTV: What does OCD really mean?
Dr. Reddy: The chief complaint in this illness is that the person gets both obsessions and compulsions. Obsessions are repetitive thoughts, ideas or images, which one gets against his wish. It could be feeling of hands being contaminated or individual sexual thoughts about a family member, which you don't want otherwise. They keep coming again and again. They are repugnant and irrational. You know them but you can't control them. The more you try to resist them the more prominent they become. When you get these obsessions you try to resist them and when you fail to resist, then you have repetitive actions. For example, you feel that your hands are dirty when they are actually clean. You feel like washing them again and again, there are patients who wash their hands for hours. There are patients, who have doubts that they haven't locked the door properly so they go and check the door again and again.
So there are compulsions, which are secondary to this thought; therefore, it is called obsessive compulsive disorder. The common component of both an obsession and a compulsion is the need to repeat things repeatedly. Whenever these obsessions come to the mind, one gets extremely anxious because they are unwanted thoughts. How can you get sexual thoughts about your family members; so when you get these kinds of thoughts then you get extremely anxious to control these obsessions. Compulsion need not always be realistically concerned obsessions, for example, when you feel that your hands are dirty you wash them but you won't want to wash for hours that means that you wash them more than necessary. If you get a sexual thought which you don't want, you start counting or you start praying repeatedly. Sometimes you get horrifying thoughts that something terrible is going to happen to your family member. Then you start praying or start counting in a particular way. It could be counting even number of times, odd number of times so in a realistic way counting doesn't prevent an accident from occurring. So you have an irrational thought coming to your mind and you have an even more irrational solution to your problem.
DrNDTV: Can OCD occur at any age or people are born with this problem?
Dr. Reddy: The most common age when OCD starts is the teenage. Teenagers who are in the eighth or ninth class get this problem. The earliest age at which OCD has been reported, goes back to 3 or 4 years of age. Diagnosing OCD at that age requires a great degree of skill, because many children go through a phase where they hold their stool and being obsessive is a part of the normal development of the child. So to mark or clear rituals requires a greater degree of clinical precession in young age. This disease affects women more than men, especially around the time of pregnancy. The single most important factor associated with the onset of OCD is pregnancy. Very often women develop shocking rituals about contamination involving their children and various such themes, which develop after delivery.
Caller: Is drinking alcohol an obsessive compulsive disorder?
Dr. Khanna: There is a difference between obsession and obsessive compulsive disorder in terms of what the layman talk and what we talk in medical terminology. Obsession may be preoccupation in the lay terminology. For us, it is a repetitive, intrusive thought, which is recognised as being irrational. Although alcoholism is on an extreme of so called obsessive behaviour, it would not in itself independently come under OCD spectra.
DrNDTV: Are particular people more predisposed to getting OCD?
Dr. Khanna: Perhaps a familial predisposition history of OCD in one of your parents or your immediate family predisposes you to OCD. To some extent it would also mean people who are slightly more punctual, more obsessive by nature, are more likely to develop OCD. Very often you find a child in school with falling grades and you find that he is getting repeated thoughts on direct questions. Often the child doesn't tell you his experience. He hides this from his parents because he thinks that its something he has to control. Sometimes the thoughts are too bad, they involve death of their parents. They involve god or sex. Very often we don’t want to talk about this.
Caller: What happens when a person comes to know that he has OCD? What should be done to overcome this?
Dr. Reddy: If someone feels that he has OCD, then he should consult a psychiatrist and not try to take treatment on their own. It requires medical and psychiatric evaluation. The psychiatrist would decide whether you require behavioural or drug therapy and most of the time you end up getting both drug and behaviour therapy.
Caller: I am an old patient of depression and OCD. I have gulped Alprax on my own and I have phobias of situations. I can't travel, I can't fly and I have problem of claustrophobia. It affects my business and my family life. Is it curable?
Dr. Khanna: You have a classical case where I would prescribe behavioural and drug therapy. Cognitive therapy helps answering obsessions, phobias and depression. Single therapy, which would help you along with medication, is cognitive behavioural therapy.
DrNDTV: Would one therapy solve all his issues or he needs separate counselling sessions for each problem?
Dr. Khanna: It would be a holistic approach where all issues are tackled simultaneously and all are attached with the same mental framework of treating a person. Every OCD patient is different and everyone requires his own package.
Caller: My 3-year-old grand daughter doesn’t come out of the bathtub for hours when she sits in it. She keeps on washing her hand and putting more soap for half hour. If somebody comes to our house, she won't let them go. Is this obsessive behaviour?
Dr. Reddy: OCD does occur in children, but OCD occurring in a 3-year-old child seems unusual. Children love playing with soap and water. I don't think it is an obsessive behaviour. Most of these childhood behaviours disappear after sometime. We have seen patients who report that their obsession started as early as five, six and seven years, but I think right now you need not pay much attention to this, unless it persists till the child is six or seven years old.
Caller: I have developed a tendency of praying to different photographs of the same god thinking that each one is for the well being of each family member. If I don't do that I feel terribly depressed.
Dr. Khanna: This is suggestive of an obsessive compulsive disorder with a predominant religious and repetitive theme, which he doesn't want to come. It means that he has to do something ritual, a compulsion, which is irrational. He recognises the irrationality of it and is probably getting distress. He needs to go and see a psychiatrist. He should not try and handle it on his own, and he needs a combination of both pharmacotherapy and behaviour therapy to get over this problem.
Caller: I have been pulling my hair for the last 14 years. I am 24 years old now. How do I stop? I have tried several times but failed. There is no psychiatrist in the town where I live.
Dr. Khanna: What you suffer from is a condition called trichotillomania, which comes under the obsessive compulsive spectrum. It is a fairly complicated problem and you need medication, so you have to meet a psychiatrist.
Caller: I start getting bad thoughts and I have been getting them since I was 14 years old. Now I am 22 years old. I try to control these thoughts sometimes but I can't get them out of my mind. What should I do?
Dr. Khanna: This is very typical OCD to feel that you get thoughts, which you do not want and which come again and again against your wish and have a bad outcome. You need to go to a psychiatrist and rule out obsessive compulsive disorder.
Caller: Can OCD be due to mental trauma or is it due to brain infection?
Dr. Khanna: All these possibilities are there. There is work, which suggests that there are autoimmune causes. We have done some work, which talks of some specific infections but we would accept a multifaceted approach including stressors, psychological events and infections. All of these can contribute to the onset of OCD.
Caller: What happens if OCD is not treated properly?
Dr. Reddy: OCD by itself is an extremely distressing and disabling illness in its severe form. There are lot of patients who actually have a very mild form of illness and who often do not seek treatment. If it is not treated it tends to persist for a very long time.
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