Obsessive Compulsive Behaviour: What It Really Looks Like and When to Seek Help

 "I Just Like Things Clean" — And Other Things OCD Is Not

Imagine this. It's 7 o'clock in the morning. A 28-year-old school teacher from Pune, is already running behind schedule to get to their job. However, they can't leave the house yet. Not just yet. They have checked the gas knob eleven times. They know that there is no way they could have left it on; they watched as they turned it off. The doubt, however, returns; a cold and persistent thought - what if you did miss it? what if your home catches fire? what if something happens to someone else because of you? Therefore, they go check the gas knob once again.
At this point, before they leave for school, they are exhausted, embarrassed, and running 40 minutes late. And no one close to them understands why.

 
The way we speak about OCD (Obsessive Compulsive Disorder) today is an example of how many casual terms exist. People use it as a synonym for things such as liking your bookshelves organised by colour or having everything perfect in your kitchen. For countless numbers of individuals experiencing genuine obsessive-compulsive behaviour, however, there is little similarity. In fact, this behaviour will be all consuming of a person's daily existence and could ruin their entire life. 

This article is for everyone who may recognise some part of themselves -- or loved ones -- in that story. You are not crazy. You are not weak. And you are not alone.

What OCD actually is

A disorder referred to as Obsessive Compulsive Disorder (OCD), is a recognised mental illness, consisting of two related aspects of an individual's experience; obsessions,  and compulsions.
An obsession can be defined as unwanted, intrusive ideas, or images that keep on appearing in one’s mind. These obsessive thoughts or feelings seem to occur over and over again with no clear reason for their occurrence. Typically, these obsessive thoughts go against an individual's beliefs, or desires. They can be described as uncomfortable, unyielding, and not easily dismissed. 

A compulsion can be described as actions, or thought processes carried out by an individual to counteract the obsessive thoughts, which cause distressing anxiety. The compulsion provides temporary comfort and reduces an individual's level of discomfort caused by their obsession. However, the key term here is temporary. The compulsion will not eliminate the underlying source of the obsessive thought(s). It will only serve to continue feeding the anxiety associated with those thoughts. Therefore, when this process continues long enough, the intensity of the obsessions increases and so do the number and complexity of compulsions. This represents the OCD cycle and if left untreated will generally increase in severity.

Obsessions and compulsions don't always appear as shown in movies or humour. Below are the ways people usually experience them, along with examples that might seem strangely relatable.

• Contamination OCD

Contamination is probably the most recognised type. People with contamination fear germs, sickness, dirt, or the idea of "transmitting" something harmful to another individual. This may lead individuals to continually wash their hands, to the point of cracking and bleeding; to never shake hands again; or to spend an excessive amount of time washing surfaces which are already clean.

Example: “A 35 yr. old banker in Mumbai will not touch money unless they are wearing rubber gloves. They have also ceased from shaking hands with their co-workers due to the anxiety caused by the above behaviour.”

• Checking OCD

The opening example had shown checking OCD. It occurs when individuals constantly verify if things are okay -- locks, appliances, texts, etc. -- to prevent perceived disasters.

• Harm OCD

Harm OCD is quite possibly the most disturbing of all types. An individual has intrusive thoughts about physically hurting someone they care for (a child, partner, family member); however, the individual wants nothing to do with such thoughts. Thoughts of this nature are ego-dystonic, meaning they represent feelings that are totally against what the individual believes about themselves. The thoughts are not desires. The thoughts are fears. Shame and terror are common consequences.

This is one of the most common reasons people with OCD never speak up: they are afraid of what others — or even doctors — will think of them.

• Order and Symmetry OCD

People with order and symmetry OCD are compelled to arrange objects in an exact manner. If something is off, they will feel intense anxiety until it is restored to its “correct” position.

• Purely Obsessional ("Pure O") OCD

There are also people who suffer from OCD, but whose obsessive thinking does not translate into observable compulsive behaviours. These rituals exist solely within their minds as obsessive thoughts; mentally repeating questions to themselves to confirm if everything is okay, silently praying or counting in an attempt to make the intrusive thoughts stop.

Because of the lack of observable behaviour, it's often difficult for these individuals to receive a diagnosis.

The Differences Between OCD & Regular Routines & Perfectionism 

One of the biggest differences we need to know about (because it can lead to so many misunderstandings, and doubts about oneself) is how OCD differs from just regular routines or perfectionism. 

We all normally check if we closed the backdoor. We all normally want our desk organised before we begin working. We all normally become slightly uneasy for a moment with an unusual thought. 

The difference between OCD obsessions/compulsions and the usual habits are: 

- Time: Obsessions/Compulsions take up a lot of time -- usually more than an hour each day; sometimes far longer. 
- Disturbance: The obsessions cause true anxiety -- not mild annoyance. 
- Control: There is no control over the obsession/ compulsion -- he/she wants to be able to do something but cannot. 
- Interference: The OCD interferes with daily routine, social relationships, job/work, etc.

A person that likes colour coding their planner is not displaying symptoms of obsessive-compulsive behaviour. A person that will not leave their bedroom unless they repeat a particular phrase seventeen times and then still doesn't feel right – that is a completely different experience.

The Unseen Expense: What OCD Does to Day-to-Day Life

OCD doesn’t stay in the confines of just one aspect of lives. 
Its scope is quite broad, and the weight of OCD is also quite heavy.

• At work or in school, OCD symptoms can hinder focus, completing tasks by deadline, and overall performance. For example; A student may read the same paragraph over forty times due to their inability to be confident that they really “get” it. An employee could check email repeatedly prior to sending the email.

• Within relationships, OCD creates space, tension and loneliness. Family members and partners often become entangled within compulsions – being requested multiple times to reassure them, to move furniture/objects to satisfy OCD demands or to accommodate avoidant behaviours. As time goes on, this can lead to erosion of even the strongest relationship ties.

• Inside oneself, the sense of shame can often be the heaviest burden. People who suffer from OCD generally recognise, on some level, that their fears are irrational. Recognising one’s irrationality does nothing to alleviate suffering. Instead, it adds additional layers of anguish. “Why can’t I stop?” is a question people with OCD pose to themselves on a daily basis. Answering as such, is not a matter of lacking will power; it is a matter of brain biology.

The good news is that OCD is one of the most treatable mental health disorders. Most people experience significant relief with the right support. 

Cognitive Behavioural Therapy (CBT)

CBT is a very helpful way of learning how to view your obsessive thoughts and behaviours. CBT is designed to help you realise the way you are thinking about your intrusive thoughts; that simply because you had an idea, you did not act upon it, want it or let it define you.

Exposure & Response Prevention (ERP)

ERP is the accepted treatment for OCD. ERP is designed to provide individuals with exposure to their feared objects/thoughts — but without providing them with the opportunity to perform the compulsive behaviour. While this may seem counterproductive or even scary, if used properly with a licensed clinician, ERP provides the best possible method for breaking the anxiety/compulsive cycle and reducing the obsessions that cause these cycles. As such, the individual's level of fear should decrease and become less of a driving force behind his/her OCD.

Medication

Specifically, certain classes of medications referred to as SSRIs (Selective Serotonin Reuptake Inhibitors), have demonstrated effectiveness in decreasing levels of OCD symptomatology. However, as noted earlier, medication appears to work more effectively when used in conjunction with psychotherapy. A psychiatrist would need to evaluate each individual case to determine if medication might be useful and then assist him/her in determining which type of medication would be best suited to address those symptoms.

rTMS (Repetitive Transcranial Magnetic Stimulation)

rTMS gives an alternative treatment option to those with limited response to both treatment and/or medication. rTMS is a non-invasive method to treat OCD, which is done through the delivery of low-intensity, targeted magnetic pulses to portions of the brain associated with OCD, thus assisting in regulating the hyperactive pathways causing obsessive thoughts/behavioural compulsions. This procedure is pain-free; no anaesthesia is required. Typically, this treatment can be completed in several visits. rTMS has become more readily available in India in specialized psychiatric centres. It is considered a safe and evidenced-based tool for treating resistant OCD patients.

When is intensive help necessary?

Most individuals can successfully recover using out-patient therapy and medication. However, there will be times when OCD becomes extreme enough that an individual needs more than just therapy and/or medication. That is okay.

Hospitalisation for psychiatric issues may be necessary if:

• a person's OCD is so bad they cannot perform the most basic tasks (such as eating) to take care of themselves.
• most of an individual's waking time is spent doing compulsions (rituals).
• an individual has other serious mental health conditions (i.e. depression, anxiety etc.) which require hospitalisation.
• previous out-patient treatments were unsuccessful at reducing OCD symptoms.
• self-care/ neglect or self-injury is occurring due to severity of OCD.

What hospitalisation provides:

Hospitalisation offers an opportunity to receive a more comprehensive level of support. Inpatient care provides what outpatient treatment often cannot -- a safe, structured, and nurturing environment; no access to triggers; a team of highly trained professionals who work together to develop a treatment plan specific to an individual's needs; and an opportunity to fully concentrate on recovery.

A growing number of families in India recognise and acknowledge that inpatient psychiatric care for OCD is an option. This service is evidence-based and non-judgmental. Families should understand that inpatient psychiatric care for OCD is not "the final option." It may be the start of a new and much better quality of life for many individuals.

The Team at Adayu, work with an experienced and multidisciplinary team of mental health professionals including psychiatrists and psychologists to deliver evidence-based care and support to people diagnosed with complex mental health conditions such as OCD. We offer a structured inpatient psychiatric program with a focus on providing dignity and discretion to those requiring intensive support.

We would encourage anyone affected by these issues (either personally or through supporting others) to contact us. While there is no cost associated with having a conversation, this may lead to significant positive outcomes in your life.

Because everyone deserves to feel free in their own mind.