Are you a compulsive counter? Do germs terrorise you? Do you spend so much time fussing over precision and symmetry that it worries you?
If you answered an overwhelming yes to any of those questions, or know someone who would, then you may be looking at a case of Obsessive Compulsive Disorder (OCD), and that can be more serious than you think.
Once considered an anxiety disorder, OCD is now being increasingly regarded as a unique condition because of its spectrum of bizarre symptoms and their impact on the patient. With children displaying strangely compulsive behaviour patterns too, doctors now warn against taking early signs of OCD lightly.
“See a psychologist or psychiatrist the minute you feel you’re succumbing to an uncontrollable urge or recurring thoughts to repeatedly do strange, weird or dangerous things that affect your daily life,” says Dr Sameer Malhotra, director of mental health and behavioural sciences at Delhi’s Max Hospitals. “OCD is a chronic condition that needs timely treatment. Otherwise it can lead to depression and in worst cases, even suicide.”
Eighty per cent of the time, patients seek help for OCD only when the symptoms become too alarming to ignore, says psychiatrist Dr Gaurav Kulkarni. “Early treatment is crucial, because counselling and medication can help.”
Mumbai software engineer Kirti*, 22, for instance, began facing a strange problem at her traditional Tamilian family’s daily prayer session a year ago. She had a sudden urge to spit at the deity. “I ignored the thought but it kept coming and got stronger,” she remembers. “It made me feel very guilty and disgusted.”
Her family became concerned that these thoughts were the result of her new-age atheist friends. “I couldn’t get rid of those thoughts even after I stopped socialising with them,” Kirti says. “An aunt eventually helped me seek medical help and it turned out to be OCD. After nine months of counselling, the thoughts have gone away.”
The first step we take after the diagnosis is done is to counsel the family, says her neuro-psychiatrist, Dr Sundeep Jadhav. “In this case, it involved the family moving beyond the conventional right thoughts and wrong thoughts and understand the psychology of their daughter.”
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The challenge is even greater when the patients are children. Mumbai homemaker Nirmala*, 27, was forced to alter her daughter’s route to school after her little one began counting her steps and crying occasionally. The problem turned out to be a small bridge over a stormwater drain.
“Every time we walked on it, Kaya would begin counting. If she couldn’t get from one to fifty, she started crying and saying that the bridge would now collapse,” says Nirmala.
After six months of counselling, she is now being treated with medication. Treatment will probably continue for at least two years.
In Delhi, Nina*, 32, who delivered twin boys last month, says she felt so depressed sitting alone all day with the babies that thoughts of throttling them started occupying her mind.
“I would curse myself for harbouring such negative thoughts. Still, I could not get rid of them,” says Nina. “I finally discussed my dilemma with my husband and we decided to see a psychiatrist.”
Dr Malhotra says she came to him with significant guilt and disturbed sleep as well. After being treated for a year, Nina is now fine and off medicines.
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Another of Dr Malhotra’s patients was a 35-year-old motivational speaker who had an urge to mouth obscenities during publicly addresses.
“He would end up biting his tongue to refrain from doing so,” says Dr Malhotra. “When the urge continued for a few months, he slipped into depression, started drinking. He eventually confided in a friend who brought him to me a year ago.”
With a mix of medication and therapy, he has shown improvement. He still comes in for counselling every two weeks.
The cause usually lies in a serotonin imbalance. Serotonin is a chemical that the body produces for the nerve cells and the brain to function at their optimum.
“The medicines given to OCD patients is to overcome a serotonin deficit, and they need to be taken for a long time. If discontinued midway, disturbing urges might resurface,” says Dr Malhotra.
“Cognitive behavioural therapy (CBT) is an important part of treatment,” adds Noopur Singh, research scholar in psychiatric social work at NIMHANS. “The most effective therapy technique is exposure and response prevention, which is used in about 70% of the cases successfully.”
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The most crucial thing to remember, say doctors, is that you should seek help as soon as symptoms become visible.
The second most crucial thing to remember is that most OCD patients respond to treatment.
“Treatment usually takes a couple of years. In some cases it may take longer. But it is very rare for a person to not respond to treatment as desired,” says Dr Malhotra
(* Names changed on request)