Understanding OCD

Obsessive-Compulsive Disorder

Are you an individual who has a system for your wardrobe and table? Are you generally neat and insist on having your items being returned to their assigned places? Chances are you have been called “OCD” by your friends or family for being insistent or tidy. However just being tidy and neat does not mean an individual has obsessive-compulsive disorder (OCD). In fact, not everyone diagnosed with OCD are exceptionally clean or organized!

Singapore Mental Health Study conducted by IMH in 2010 found that one in 33 adults in Singapore had OCD at some point in their life. OCD also emerged as one of the top three most common disorders in Singapore. To qualify for a diagnosis of OCD, an individual must have obsessions, compulsions or both.

What are obsessions and compulsions?

Obsessions can be repeated persistent thoughts, urges or impulses that are unwanted and causes anxiety in the individual. The individual may try to suppress or ignore these urges/images.

Compulsions are repetitive behaviours or mental acts that provide temporary relief from anxiety caused by the intrusive thoughts. The individual feels compelled or forced to engage in the behaviours with no particular reason. The behaviours or acts may not be realistically related to the intrusive thoughts experienced and could be excessive.

These obsessions and compulsions consume an excessive amount of time in the person’s day (i.e. an hour or more). They cause significant distress, interfere with daily functioning and may also affect relationships.

Obsessions usually follow themes such as fear of germs/contamination, fear of death or being harmed, urges related to maintaining symmetry or order, excessive fear of violating moral/religious rules.

Some examples of compulsion related to the obsessions:

• Repeated washing of hands
• Avoiding touching “dirty” surfaces that others may have touched (i.e. doorknobs, lift buttons, desks, soaps, tables)
• Refusing to share items or supplies with others
• Avoiding use of public washrooms
• Avoiding leaving a “safe” zone
• Repeated and excessive “checking” behaviour (i.e. making sure doors/windows are locked, checking oven/stove are turned off, checking on child while sleeping to see if s/he is still breathing)
• Rearranging items to be in certain order
• Aligning items or edges to be “just right” or “even”
• Constant seeking of reassurance that task is done perfectly and seeking affirmation that no mistake was made

OCD in Children

Unlike adults, children may not be able to verbalise their intrusive thoughts or realise that their actions are excessive or do not make sense. Older children or teenagers may not express themselves as they feel ashamed or confused of their behaviour. Other times, parents/caregivers may not notice these symptoms or brush them off as part of growing up. OCD is not something that a child or teenager outgrows or “snaps out of”. According to statistics provided by IMH Child Guidance Clinics, in a year they see between 100 and 200 children and adolescents with OCD.

Common obsessions in children and teenagers can be similar to that in adults (i.e. worries about contamination/germs, fear of death/illness or something wrong happening, feeling that things have to be “just right”, disturbing thoughts or images about hurting others or that of a sexual nature).

Some difficulties that parents may notice in their children could be:

• Trouble concentrating on schoolwork, or enjoying activities
• Acting irritable, upset, sad or anxious
• Seeming unsure of whether things are ok
• Having trouble choosing or deciding
• Taking too much time to complete daily tasks or routine (i.e. showering, getting dressed, completing homework, organizing a backpack)
• Getting upset if they are unable to make something perfect or if something is out of place
• Insisting that things have to be said or done in a certain way

To help assess if child’s or teenager’s behaviours are excessive or concerning, parents can noted the frequency and intensity of the behaviours (i.e. number of times, how long they engage in behaviours, amount of products used if any). Parents can check if their peers/classmates do these behaviours in the same frequency or duration. When in doubt, seek guidance and help from a trained mental health professional.

What are the risk factors leading to OCD?

• Having family history of OCD or anxiety disorders could mean a higher chance of an individual developing OCD
• Neurobiological research has found that differences in brain circuits (frontal cortex and subcortical structures) that depend on neurotransmitter serotonin.
• Exposure to trauma or abuse seems to have a correlation with individuals developing symptoms of OCD
• Some children may develop symptoms of OCD due to Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Treatment for OCD

1. Our trained psychologists choose an appropriate therapy for the individual based on their needs. Types of cognitive behavioural therapies could be employed in treating OCD.
2. When treating children or adolescents, parents would be coached on how they can support their children better.