Obsessive Compulsive Disorder (OCD)

“Picture standing in a room filled with flies and pouring a bottle of syrup over yourself. The flies constantly swarm about you, buzzing around your head and in your face. You swat and swat, but they keep coming. The flies are like obsessional thoughts — you can’t stop them, you just have to fend them off. The swatting is like compulsions — you can’t resist the urge to do it, even though you know it won’t really keep the flies at bay for more than a brief moment.” - Unknown

For many, obsessive compulsive disorder is synonymous with handwashing, organizing, colour-coding and cleaning. And while associating OCD with these habits isn’t exactly wrong, it leaves out an important part of the picture. It’s easy to look at these behaviours and think, “Oh, that’s not so bad. I would love to keep my room so clean. I hate when my room is a mess. I’m so OCD too.”

But what you don’t see, and what puts the “D” in OCD, are the thought processes behind the compulsive actions. People with OCD don’t organize because it brings them joy. They don’t clean because it’s one of their hobbies. And sometimes, people with OCD don’t clean or organize at all. OCD manifests itself in so many different ways and likening it to a quirk can be hurtful and reductive for those who live with it every day.

Introduction:

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by distressing, intrusive, obsessive thoughts and repetitive, compulsive physical or mental acts. It is a distinct condition but falls within the category of “obsessive-compulsive and related disorders. OCD is a mental health condition that centers around a debilitating obsession or compulsion, distressing actions, and repetitive thoughts. A 2001 World Health Organization (WHO) mental health report estimated that OCD was among the top 20 causes of illness-related disability worldwide for people aged 15 to 44 years.

The report also suggested that OCD was the fourth most common mental illness after phobias and anxiety disorders, substance abuse, and major depression. OCD is associated with a wide range of functional impairments and has a significant impact on social and working life. OCD is separated from other mental health conditions by the presence of obsessions, compulsions, or both. The obsessions or compulsions cause marked distress, are time-consuming, and interfere with a person’s normal function.

There are indications that OCD can occur in children and teenagers, with the disease usually beginning gradually and worsening with age. Symptoms of OCD can be mild or severe. Some people experience obsessive thoughts only, without engaging in compulsive behavior. Some people who experience OCD successfully hide their symptoms for fear of embarrassment or stigma. Friends and family may, however, notice some of the more physical signs.

Obsessions are more than the everyday worries experienced by most healthy people when thinking about real-life problems. Instead, people with OCD experience excessive thoughts and worries that prompt them to engage in particular actions or thoughts in an attempt to relieve or suppress the fear and anxiety.

A person with OCD typically:

• has repetitive thoughts, images, or urges that they do not feel able to control

• is aware of these intrusive thoughts and feelings and does not want to have these ideas

• finds these thoughts disturbing, unwanted, and, in the case of older children and adults, is aware that they do not make sense

• has uncomfortable feelings, such as fear, disgust, doubt, or a feeling that things have to be done in a way that is “just right”

• spends an unwarranted amount of time on these obsessions, which interferes with personal, social, and professional activities

Common OCD obsessions include:

• contamination, including body fluids, germs, and dirt

• losing control, including a fear of acting on an urge to harm one’s self or others

• perfectionism, including concerns about exactness, needing to remember things, and fear of losing things

• ruminations, as is evident in Bayo’s case. Constantly having many thoughts going through your mind.

• magical thoughts, including a fear of being responsible for something terrible happening to others

• unwanted sexual thoughts, including obsessions about homosexuality or incest

• religious obsessions, including concerns about offending God and having blasphemous thoughts about God.

• Visual images of danger like the way Bayo would constantly visualize his house going up in flames.

Compulsions

Not all “rituals” or forms of repetitive behavior are compulsions. Normal repetitive behaviors that feature in everyday life may include bedtime routines, religious practices, and learning a new skill. Behavior also depends on the context. For example, a person who works in a video store arranging DVDs for 8 hours a day is probably not acting out of compulsion.

Common OCD compulsions include:

• washing and cleaning, including constant hand-washing

• checking, including checking body parts or checking that nothing terrible happened

• repeating, including rereading and repeating routine activities like getting up from a chair.

• mental compulsions, including praying to prevent harm and mentally reviewing events

Causes

Despite a wealth of research, the exact causes of OCD have not been identified. OCD is thought to have a neurobiological basis, with neuroimaging studies showing that the brain functions differently in people with the disorder. An abnormality, or an imbalance in neurotransmitters, is thought to be involved in OCD. The disorder is equally common among adult men and women.

Prevalence of OCD

The prevalence is below 40% in Africa, with a study conducted more than a decade ago reporting a prevalence of 28.3% in Nigeria. However, despite the high prevalence and negative impact of OCD, there is a dearth of studies in Africa and Nigeria in particular.

Is OCD treatable?

There’s no cure for OCD. But you may be able to manage how your symptoms affect your life.

Treatments include:

• Psychotherapy. Cognitive behavioral therapy can help change your thinking patterns. In a form called exposure and response prevention, your doctor will put you in a situation designed to create anxiety or set off compulsions. You’ll learn to lessen and then stop your OCD thoughts or actions.

• Relaxation. Simple things like meditation, yoga, and massage can help with stressful OCD symptoms.

• Medication. Certain drugs called selective serotonin reuptake inhibitors help many people control obsessions and compulsions. They might take 2 to 4 months to start working. Common ones include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine, paroxetine (Paxil), and sertraline (Zoloft). If you still have symptoms, your doctor might give you antipsychotic drugs like