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Stopping the obsession

Find out why it is so difficult for people with obsessive compulsive disorder (OCD) to break out of the vicious cycle of obsessions and compulsions.

The obsessions and compulsions happen in a loop that can be difficult to break.

Evangeline’s parents first started noticing that she had been spending longer amounts of time in the shower over the past few months, resulting in a steady increase in the water bill. They also observed that she spent an unusually long time washing her hands, and seemed frustrated at times while performing a very specific ritual during handwashing. Things got to the point where Evangeline’s prolonged showering caused her to start showing up late at work, and she was eventually let go from her job.

After much persuasion by her parents, the 23-year-old agreed to seek help and sought medical attention at Changi General Hospital (CGH). During the assessment by a psychiatrist, Evangeline shared that she experienced persistent thoughts of being infected with germs, which she found hard to ignore. Whenever these thoughts came to mind, she felt dirty and anxious. Even though she knew that her handwashing was excessive, she felt compelled to repeat the washing until her hands felt “clean”.

After taking a thorough clinical history, the psychiatrist diagnosed Evangeline with OCD. This marked the beginning of her recovery journey. With treatment, she managed to return to work — and significantly reduce the length of her showers.

* Evangeline’s story is based on generalisations from commonly experienced accounts of patients with OCD.

"It is common for people to experience obsessive thoughts or compulsive behaviours at some point in their lives. However, this does not necessarily constitute OCD. The extent of obsessions and compulsions must be severe enough to consume a significant amount of time (more than an hour every day), cause intense distress, or interfere with important activities.”

Characteristics of OCD

OCD is characterised by obsessive thoughts and compulsive behaviours that can take over a person’s life. These obsessive thoughts could be about germs, numbers, or a fear of something bad happening, and they can make a person feel anxious and scared. To cope with these thoughts, a person might start performing certain rituals or compulsions, like repeatedly washing their hands or checking the locks on a door. While these compulsions offer temporary relief, they also take up a lot of time and interfere with daily life.

There is no single cause for OCD. Research indicates that individuals with a family history of OCD are more likely to develop the condition themselves. Certain personality traits — such as perfectionism or a need for control — also increase one’s susceptibility to developing OCD. Additionally, people with OCD often struggle with feelings of shame, which may be linked to earlier life experiences.

Over the years, awareness of OCD has grown, and more people in Singapore are seeking treatment for the condition. However, many people wait a long time — often years — before seeking help.

Curbing the obsession

At CGH, a person diagnosed with OCD may be referred to a psychologist for talk therapy, which has been shown to be highly effective in treating this condition. Talk therapy helps individuals with OCD identify and challenge their obsessive thoughts and compulsive behaviours. Persons with OCD could also work with a psychologist to gradually expose themselves to situations that trigger their anxiety. Patients would learn how to manage the resulting anxiety instead of performing their usual compulsions. This process is known as Exposure and Response Prevention (ERP). Although this form of therapy can be challenging, the resulting benefits can be significant and life-changing.

In more severe cases of OCD, a psychiatrist may prescribe medication, which can be helpful in reducing the obsessive thoughts. For comprehensive care, medication is often used in combination with psychotherapy. An emerging area of global research involves using virtual reality (VR) therapy for OCD patients to help them learn coping strategies and reduce their anxiety.

Stepping forward

If you or someone you know is struggling with OCD, it is best to seek professional help. Individuals with this disorder often feel ashamed and try to conceal their compulsions from others, which can prevent them from getting the help they need.

The rituals performed by individuals with OCD can be frustrating for their family members. It does not help the individual’s condition if their family members explicitly express annoyance, or excessively accommodate these elaborate rituals. It is important to have a joint discussion with a healthcare provider to determine a suitable approach for the specific situation.

Stopping the obsession