OBSESSIVE COMPULSIVE DISORDER

My third child was about 2 months old when I started having this recurrent disturbing thought to harm him. The thought was so intense I started avoiding knives in the house because I feared I might carry out my thought. I also couldn’t share this problem with my husband or any one else least they would think I was either loosing my mind or that I was a witch.
Pat, Nigeria.

What Pat was experiencing is called an Obsessive-Compulsive disorder (OCD). It is an abnormal anxiety state. Obsessions are recurrent, persistent, repulsive thoughts, images or impulses that come up in the mind of an individual despite efforts to ignore or suppress them. They are usually alleged to be personal, but, inappropriate thoughts and are associated with fear that the thoughts may likely be carried out. They are not just excessive worries over life problems. Compulsions are repetitive behavior carried out in response to obsessions. The obsessions and/or compulsion are time-consuming (takes more than 1 hour in a day) or significantly interfere with the individual’s normal life; their academic, occupational or social functioning.
It is the 4th commonest psychiatric illness after phobias, drug abuse and depression and it cuts across various cultures. The incidence (new cases seen) is same for both sexes and is said to occur in about 0.5-2% of general population. A larger percentage of those with this condition develop the problem before 25years but it could occur after 35years. This condition could also occur in children and adolescents. Though most patients have both obsessions and compulsions, some could have just obsessions without compulsions.

THE FEATURES [SYMPTOM PATTERNS]
The pattern could overlap in an individual and may also change over time. There are four major patterns:

· Recurrent thoughts about dirt and contamination: this is the most common pattern. The person has the idea of harm to self or to others through the spread of disease. The person may go ahead and repeatedly wash their hands or may be scared of leaving home because they believe that contamination is spread by the slightest contact.

· Recurrent thoughts of doubts for example, “did I forget to turn off the gas”? This is followed by a repetitive checking and cross checking behavior. This checking behavior would normally last longer than is reasonable. This ranks second.

· The third most common pattern is the type that Pat had it referred to as intrusive obsessional thoughts and they occur without compulsions. It is characterized by repetitive repulsive thoughts usually bordered on sex or aggression.

· Recurrent thoughts about orderliness: maybe about the way objects are to be arranged or work is to be organized. The individual is overwhelmed with the thought of doing things in a particular way which could lead to being slow. Patients could literally spend hours shaving or eating meals.

All these various disturbing thoughts could normally occur occasionally in healthy people but when it becomes recurrent, intense, disturbing and associated with anxiety, and sometimes avoidance of certain situation for fear that you will be compelled to carry out the act, it is then a disorder.

THE CAUSE
Like most psychiatric illness it results from several factors: There are proofs it runs in families, it also could occur due to some physical illness and some have said it is due to some inner psychological conflicts which started from childhood. There are also proofs supporting that there may be slight malfunctioning in the brain of individuals with OCD. It is also known to have started following stressful events like loss of a loved one or child birth.

TREATMENT
This condition usually occurs with depression hence if depression is properly treated the condition improves. Certain antidepressant medications like clomipramine and the SSRI’s have been found to be effective in reducing these symptoms. Some forms of psychotherapy and behavioral therapy have also helped and some argue that this is the most effective form of treatment. In severe persistent cases, where both medications and psychotherapy have failed, a form of brain surgery may have to be carried out.

PROGNOSIS [OUTCOME]
A large number of those with this condition, about two-thirds, resolve within a year but few may suffer from this condition for years with some having these symptoms come and go with varying intensity whereas others will experience their symptoms persistently with the symptoms possibly getting worse. The chance of it recurring after medication is stopped is high. Those who had good social and occupational functioning before they developed the illness, who have the illness waxing and waning and who had stressful events which led to the illness tend to do better in the long term.

Just in case you have this condition or know someone who does, be rest assured that the fear that these recurrent, repulsive thoughts, impulses, images or actions point to an early sign of madness is not true. Also know that help is available if the condition has been persistent, just talk to a psychiatrist.