Obsessive-compulsive disorder

Gloria Ogunbadejo |

Obsessive-compulsive disorder is a topic I have written about in past edition. But then I am sure there are many topics I will revisit when appropriate. I have returned to it today after talking to a friend recently who told me about a particular problem she was facing.

Interestingly, she was totally unaware that she had told me the same story several years ago.

This young lady in her late thirties described a recurrent dream (I call it a recurrent intrusive thought), where her husband die in a car crash. She also described vivid visual imagery accompanying this thought: she would ‘see’ the scene of the accident, the two cars, the broken glass, the blood and the injured. I asked her what she did when she had the ‘dream’ she said she resisted and tried to dismiss it.

I asked if it worked and she said it did at times but it almost always came back within a short period of time.

Her conclusion she said according to church members was that it was the ‘devil’ and she should go for ‘anointing.’

I came away thinking just how many variations of mental illness are misdiagnosed and ascribed to the devil due to a lack of awareness, ignorance, fear and misguided religious beliefs or fervour. I am in no way casting aspersions on religious beliefs or faith but I have met countless people in the course of my career that have overlooked very clear signs of depression, stress and other mental health signals that have led to more serious problems.

Obsessive-compulsive disorder is traditionally regarded as a neurotic disorder, like phobias and anxiety states. People with this problem can suffer considerable distress and often feel that they are helpless victims. Although neurotic disorders are generally considered to be less handicapping and disabling than psychotic illnesses such as schizophrenia and severe obsessive-compulsive disorder sometimes causes major incapacitation and drastically affects people’s lives.

Broadly speaking, neurotic disorders or neuroses, are relatively minor psychiatric illnesses. The neurotic patient is aware that he has a problem, in other words, they have insight about their condition. Their contact with the outside world is relatively intact. In contrast, psychotic disorders, or psychosis are more serious mental illnesses where the patient has broken with reality.

An obsession is an unwanted, intrusive, recurrent, and persistent thought, image or impulse. Obsessions are not voluntarily produced, but are experienced as events that invade a person’s consciousness. They can be worrying, repugnant, blasphemous, obscene, nonsensical or all of these. I have had clients who had recurrent thoughts that they had one major illness or another and they were consumed by the thoughts (some might describe this as a hypochondriac).

Other clients have had recurrent thoughts of hurting a member of their family in the most brutal way. Others have had main features of obsession around cleanliness, with an unbearable and all consuming fear of being contaminated with germs. The most common themes of obsession include: contamination and dirt; disease and illness, death, violence and aggression; harm and danger, moral and religious topics. There are also sex-related obsessions.

A compulsion is a repetitive and seemingly purposeful behaviour that is performed according to certain rules or rituals. It may be wholly unacceptable or more often, partly acceptable. The behaviour is not an end in itself, but is usually intended to produce, or to prevent, some event or situation. The activity however, is not connected in a logistical or realistic way with what it is intended to achieve. For instance, touching the picture of a loved one a certain number of times, in order to ensure that no harm comes to them; or it may be something excessive such as washing hands for half an hour or more at a time to get rid of germs.

There are also times when a person engages in the compulsive act simply to ward off great anxiety, or even panic. The person usually recognises the senselessness or irrationality of the behaviour and does not derive any pleasure in carrying it out, although it provides a release of tension or a feeling of relief in the short term.

As a society that thrives on superstitions, it might be useful to point out the similarities between superstitious ideas and some obsessions and between superstitious acts and compulsive behaviour. Superstitions and certain obsessions are similar in that the person recognises the irrationality of the idea or its associated activity, but prefers to err on the side of caution. Like compulsions, many superstitious acts are carried out in order to prevent a misfortune from happening.

When an obsessive-compulsive person engages in his or her compulsion, he or she needs to carry it out precisely as they feel it ought to be done. If the behaviour is disrupted, then for many the compulsive ritual is invalidated and needs to be restarted. For long and complicated rituals, this can be extremely time-consuming and exhausting.

There is a relationship between obsessive-compulsive disorder and ‘obsessional’ personality (also known as compulsive personality). ‘Obsessional’ personality characterised in a person includes orderliness, meticulousness, obstinacy, neatness and perfectionism. Many clinicians believe obsessive-compulsive disorder is only an exaggerated stage or version of an ‘obsessional’ personality. However, from my own personal practice and other colleagues, it is my observation that people with the personality traits are comfortable with them, they seldom cause them distress or are they accompanied by a sense of compulsion and equally rarely provoke resistance.

As with many mental illnesses, there tends not to be unequivocal explanation for why people are affected with the condition. However, there is a consensus that the problems generally begin and develop gradually. The problem gets worse when a person is under stress (that word again!) The onset of the condition can also be sudden and dramatic, following on the heels of a traumatic event. I had a client who developed severe case of the condition related to the fear of illness after undergoing surgery for the removal of a growth. As always, there might be some genetic predispositions.

The contents in this column are strictly meant for information purposes. It is not meant in any way to be used to diagnose or to treat any condition. Please seek medical attention if you feel you are affected by anything you have read.