MindSG
Explore our suite of self-care tools and resources to help you better understand and manage your mental health.
Understanding
obsessive-compulsive
disorder
Life may now move at a slower pace for some of us, giving us more time for rest and
relaxation. However, some may find themselves experiencing recurrent unpleasant
thoughts and worries called obsessions.
To reduce the distress associated with these obsessions, we may perform
compensatory mental acts or behaviours called compulsions.
What is obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD) is one of the top three most common mental
health
disorders.
Obsessions cause distress and anxiety to the person. These obsessions
typically intrude into our thoughts and actions. It affects about 1 in every 111
Singaporeans aged 65 and above in their
lifetime.
Common misconceptions:
Perfectionism vs OCD
There is a difference between being a perfectionist and having
OCD. While we may sometimes find a need to keep the floors sparkly clean or have our
knickknacks arranged in a certain manner, that does not necessarily mean
that we have OCD.
With OCD, our quality of life decreases dramatically as we become consumed in
carrying out compulsive behaviours and rituals.
Signs and symptoms
Obsessions Obsessions
Obsessions are repeated, persistent, unwanted ideas, thoughts, images, or impulses that we experience unwillingly at some time. They typically occur when we are trying to think of or do other things.
Common obsessions include:
Common obsessions include:
Fear of hurting someone.
Need for symmetry and exactness.
Irrational fears of contamination from dirt or germs.
Distressing religious thoughts.
Examples of these thoughts include obscenities related to
religious figures or making ourselves excessively accountable for
breaking religious codes
of
conduct.
Distressing sexual intrusive thoughts. This includes sexual thoughts
about friends, family, children, or animals.
These thoughts are unwanted, intrusive and cause extreme
anxiety and distress. They do not bring pleasure to the person.
Compulsions Compulsions
Compulsions can be behavioural (actions) or mental (thoughts). They are repetitive actions often carried out in a special pattern or according to specific rules. Compulsions are usually performed to try and prevent an obsessive fear from happening, to reduce the anxiety the obsessive thought creates, or to make things feel “just right”.
Common compulsions include:
Common compulsions include:
Excessive checking
Excessive cleaning and washing
Continuously thinking the same thought
Mentally repeating words or numbers a certain number of times
Having such symptoms may not mean that one has OCD as these symptoms are also present in people with other medical and neurological conditions, such as:
Tourette’s syndrome
which is characterised by sudden, repetitive, rapid, and unwanted movements or vocal sounds
Autism spectrum disorder
where one experiences difficulties with social interaction and communication
Epilepsy
which causes seizures or unusual sensations and behaviours
Brain injury
caused by head traumas
The signs and symptoms can be managed with early treatment.
Diagnosis
To diagnose OCD, a healthcare professional would conduct a detailed
clinical interview in which he/she would ask about the individual’s past medical
and psychiatric history, family history, current symptoms, and the
impact on
his/her
functioning.
With the patient’s consent, the healthcare professional may also request
to speak with a family member to gather more information. A standardised
questionnaire may be administered to assess whether OCD is present,
and how severe it is. A physical examination and some blood tests may be done.
Treatment
A combination of medication and cognitive behavioural therapy
(a form of therapy to identify and change unhealthy behaviour) has been found to be
effective in significantly reducing the symptoms of OCD.
The treatment may not result in a cure, but it can help bring symptoms under
control
so that they don’t rule over our daily life.
Depending on how serious the OCD is, some people may need long-term,
ongoing, or more intensive treatment.
Medication has been found to be an effective way to
reduce OCD symptoms. A common medication prescribed is a
class of drugs called Selective Serotonin Reuptake
Inhibitors (SSRIs). SSRIs work by increasing the
serotonin levels (our body’s chemical messengers
that help stabilise our mood) in our brain. This, in
turn, helps to decrease OCD symptoms.
Most people will have no or only mild side
effects. It will take a few weeks before one sees an
improvement in the symptoms. Medication may be
prescribed or recommended at the clinical judgement
of the healthcare professional.
CBT is a treatment approach that helps us recognise
negative or unhelpful thoughts and behaviour patterns.
It aims to help develop alternative ways of thinking and
behaving to reduce psychological distress.
A specific form of CBT used for clients is the
Exposure and Response Prevention therapy in which the
individual is deliberately exposed to the obsessional
trigger (the thing or situation that triggers
the obsessional behaviour), and then prevented from
engaging in the associated repetitive behaviour.
With repeated and prolonged exposure to triggers,
the individual eventually gets used to not engaging in
the obsessional behaviour. This process is known as
“habituation”.
In addition, it is also useful to learn how to
cope with our anxiety and stress. The combination of
medication and CBT often increases the chances of
achieving the intended results.
Coping with OCD
Anyone can have a medical condition - some people have hypertension, others are
diabetic. It is important to understand that these conditions don’t define who
they are. OCD doesn’t define a person, and it doesn’t make them who they are.
To complement the treatment for OCD, here are some coping strategies to
help us through this
period.
What people may think:
OCD is all about cleanliness
But did you know:
OCD manifests differently in different people. Common behaviours include counting, repeating certain movements, handwashing, arranging things in a specific way etc. These behaviours vary among individuals and can even change over the course of a person’s lifetime.
What people may think:
We’re all ‘a little OCD’
But did you know:
OCD is a complex and serious mental health condition that affects quality of life.It is a diagnosable condition and not a personality or character trait.
What people may think:
People with OCD just need to relax
But did you know:
OCD is a mental health condition, making people with OCD experience persistent and unpleasant thoughts that are difficult to dismiss — hence resulting in them feeling anxious and having difficulty relaxing.
Accept our thoughts without judgement
We may find that holding back our thoughts may have the opposite effect, and conversely, we may find ourselves thinking even more about them. Accept those thoughts as they come, without judgement.
Understand how OCD works
When engaging in the compulsions of OCD, we may find ourselves feeling less worried in the short term, making us think that these compulsions are useful and necessary. In doing this, we are unable to properly discover that these OCD fears/beliefs will not happen and that they will fade away with time even if we do not act on them. We can learn to cope with OCD by first understanding how it works, and give ourselves a chance not to give in to everything it tells us to do.
Recognise that OCD is not us and is separate from who we are
OCD tricks us into thinking that our fears are real and need to be acted upon. For starters, know that OCD is separate from us and it is something that worms its way into our brain as if it belongs there.Recognising that it is separate from us makes the fight against OCD much easier!
Accept mistakes if they happen, and avoid being too harsh with ourselves over it
Remind ourselves that a single mistake does not make us a failure.
In fact, mistakes are bound to happen because managing OCD is not
a straightforward journey.
Instead, accept the mistake and think
about how we can minimise the chances of it happening in the future.
Practise relaxation techniques
These relaxation and guided imagery audio exercises may be helpful in
managing OCD.
Access them here:
Relaxation audio exercises
Mindfulness
Other strategies that can improve our mental well-being include making time for the things we enjoy or being in the company of people who bring us joy and laughter. Find out more details about these strategies and other helpful tips here.
