Having An Obsession...

By KASMIAH MUSTAPHA
kasmiah@nstp.com.my

People with obsessive compulsive disorder require medication to help them cope, writes KASMIAH MUSTAPHA

IN the movie As Good As It Gets, Jack Nicholson’s character would meticulously arrange M&M’s chocolates in different jars according to their colours.

Suffering from obsessive compulsive disorder (OCD), he avoids stepping on sidewalk cracks and touching other people, wears gloves all the time, wipes off door handles and eats at the same restaurant every day. While OCD may not be common in Malaysia, experts believe that two per cent of the population suffer from the mental illness. According to Sunway Medical Centre consultant psychiatrist Dr Ting Joe Hang, about two to three per cent of the world population suffer from OCD. “The problem with OCD is that it is not as common as other mental illnesses such as depression.

The awareness level is still low in Malaysia.

“Most patients with mild symptoms also hide their condition. It’s only when they can no longer hide it that they seek help.” Two people, Lee and Farah (not their real names and not patients), share their stories. Much like the character in the film, Lee is obsessed about the arrangement of money in his wallet, making sure that they are placed neatly, starting from the biggest to the smallest denominations with each facing forward. Even when Lee is in a hurry, he would ensure the notes are arranged as he likes it.

Repeatedly washing hands is one of the symptoms of OCD

He does not mix the receipts, ATM slips or other pieces of paper with the notes.

“I will also put my wallet face-down in my back pocket.

And I check my pocket often to feel my wallet.

I know it does not make sense, but I feel anxious if I cannot feel it.” “I know people find it weird but it is something that I need to do.

I will not be able to do my work if I feel that things are in a mess.

I have to have everything in order, otherwise I would not be able to think clearly.” As for Farah, she would always check that all electrical switches are turned off before she leaves the house.

She also constantly checks that the gas stove is turned off and the tube connecting to the gas tank is secure and that she does not leave matches or candles lying around the house. The fear of fire, she reveals, was triggered by an experience when she was 15. “I was at a wedding and was walking past the prayer candles.

I soon felt my back was hot but I thought it was because there were too many people around or that the fan was not working.

My brother then screamed, saying that my dress was on fire.
He lunged at me and quickly put the fire out.

People with OCD would only wear clothes of the same size and colour

Luckily, I did not suffer any burns. Ever since that incident, Farah feared that that she would die in a burning house. “I know it is irrational but the need to check everything is so overwhelming that sometimes I cannot concentrate on my work.” While Farah and Lee acknowledge that their behaviour is odd, they don’t think that it is serious. According to Dr Ting, when someone’s obsessive and compulsive behaviour reaches a point that their actions interfere with their lives, then it is time to seek medical treatment. “All of us have an obsession about something.

Some people are meticulous and want everything done properly, such as arranging books alphabetically.

“But when they need to arrange it repeatedly, then they need help.” Dr Ting said people with severe OCD symptoms are unable to live normally as they are consumed with obsessive thoughts. It could be something as simple as cleaning their hands.

They would do it repeatedly until they are satisfied that their hands are clean.

This “ritual” could take hours. “For others, it could be a certain magic number to follow.

Maybe they need to turn the lock three times to ensure it is secured or washing their hands 50 times.

If they do not keep up with the same numbers, they would start all over again,” he says. Dr Ting related one case in which his patient would shower for more than five hours because he was obsessed with cleanliness. He would wake up at 3am every morning to take a bath before leaving for work at 8am. “He follows certain steps while in the shower.

And if he misses one step or thinks he did it wrongly, he would do everything all over again.

Even then he would still doubt whether he is really clean. “The obsession has affected his work as he is often tired and anxious.

Eventually he stopped taking his baths in the morning and did it after coming home from work.

So he would be in the bathroom from 7pm until midnight. “However, the change of time did not help, because he would still feel tired from lack of sleep.” Dr Ting said people with OCD know their behaviour is irrational.

They feel anxious and have doubts all the time.

They feel uneasy and are often stressed out. OCD is believed to be caused by neurotransmitter defects in the brain that lead to an increased level of anxiety and doubt in the patient. Medication can help regulate the condition and ensure symptoms are under control.”But there is no magic bullet,” said Dr Ting. “Most times, however, the symptoms can be controlled.” The treatment period will depend on the severity of the cases.

“Some could be on medication for months, even years.

There are those who suffer a relapse, due to some events occurring in their lives.” “Usually they are already full of anxiety and doubts.

When they face a traumatic experience, they become more anxious and OCD symptoms can surface. “In Malaysia, there is the stigma that seeing a psychiatrist means you are crazy.

That is why many OCD patients do not seek treatment and hide their illness from others.

They should realise that with medication, they can get better.” Common obsessions: • Fear of dirt or contamination by germs.

• Fear of causing harm to another.

• Fear of making a mistake.

• Fear of being embarrassed or behaving in a socially unacceptable manner.

• Fear of thinking evil or sinful thoughts.

• Need for order, symmetry, or exactness.

• Excessive doubt and the need for constant reassurance. Common compulsions: • Repeatedly bathing, showering, or washing hands.

• Refusing to shake hands or touch doorknobs.

• Repeatedly checking things, such as locks or stoves.

• Constant counting, mentally or aloud, while performing routine tasks.

• Constantly arranging things in a certain way.

• Eating foods in a specific order.

• Being stuck on words, images or thoughts, usually disturbing, that won’t go away and interferes with sleep.

• Repeating specific words, phrases, or prayers.

• Need to perform tasks a certain number of times.

• Collecting or hoarding items with no apparent value. The causes: Although the exact cause of OCD is not fully understood, studies have shown that a combination of biological and environmental factors may be involved. • Biological Factors: The brain is a complex structure.

It contains billions of nerve cells called neurons that must communicate and work together for the body to function normally.

The neurons communicate via electrical signals.

Special chemicals, called neurotransmitters, help move these electrical messages from neuron to neuron.

Research has found a link between low levels of one neurotransmitter called serotonin and the development of OCD.

In addition, there is evidence that a serotonin imbalance may be passed on from parents to children.

This means the tendency to develop OCD may be inherited. In addition, certain areas of the brain appear to be affected by the serotonin imbalance that leads to OCD.

This involve the pathways of the brain that link the area that deals with judgment and planning, and the area that filters messages involving body movements. Studies also have found a link between a certain type of infection caused by the Streptococcus bacteria and OCD.

This infection, if recurrent and untreated, may lead to the development of OCD and other disorders in children. • Environmental Factors: • Abuse • Changes in living situation • Illness • Death of a loved one • Work- or school-related changes or problems.

Source : www.webmd.com

"Published in NST March 23, 2010