UNDERSTANDING OBSESSIVE – COMPULSIVE DISORDER (OCD)

It’s normal, on occasion, to go back and double check that the iron is unplugged or worry that you might be contaminated by germs, or even have an occasional unpleasant, violent thoughts. But if you have OCD , these behaviours are difficult to resist and interfere with your daily life.

OCD causes the brain to get stuck on a particular thought or urge. For example, you may check the stove 20 times to make sure it’s really turned off because you’re terrified of burning down your house, or wash your hands until they are scrubbed raw for fear of germs. While you don’t derive any sense of pleasure from performing these repetitive behaviors, they may offer some passing relief for the anxiety generated by the obsessive thoughts.

What is OCD?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent obsessions or compulsions that are inordinately time-consuming re that cause significant distress or impairment. Basically, OCD has two main parts : obsessions and compulsions.

Obsessions are persistent thoughts, pictures, urges or doubts that appear in your mind again and again. They interrupt your thoughts against your control, and can be really frightening and disturbing. They make you feel anxious, disgusted or uncomfortable.

You might feel you can’t share them with others or that there is something wrong with you that you have to hide. Many people with OCD recognize that the thoughts, impulses, or images are a product of their mind and are excessive or unreasonable. Yet these intrusive thoughts cannot be settled by logic or reasoning. Most people with OCD try to ignore or suppress such obsessions or offset them with some other thought or action.

Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession. The behaviors are aimed at preventing or reducing distress or a feared situation. In the most severe cases, a constant repetition of rituals may fill the day, making a normal routine impossible. Although the compulsion may bring some relief to the worry, the obsession returns and the cycle repeats over and over.

The typical onset of obsessive-compulsive disorder is before the age of twenty. It is very uncommon for obsessive-compulsive behavior to begin after the age of thirty-five, though it can occur. Obsessions and compulsions are prevalent among children and occur about equally in men and women. 

What are the symptoms?

Some of the more common obsession signs and symptoms include :

  • Fear of being contaminated with germs or dirt by shaking hands with another person or touching objects that are not yours
  • Feeling intensely stressed out when certain belonging are not facing in the same direction (need for order and symmetry)
  • Avoiding situations that could cause obsessive thoughts (e.g., avoiding shaking another person’s hand for fear of getting germs or dirt on your own hands)
  • Constant doubt that you locked the door to your house/car and/or turned your stove off
  • Thoughts about horrifically hurting yourself or hurting others
  • Obsessive thoughts about shouting inappropriate things or obscenities
  • Feeling stressed out when you replay unwanted sexual images in your head repeatedly
  • Fear of being embarrassed
  • Excessive doubt and need for reassurance

Common compulsion signs and symptoms include:

  • Excessive hand washing, often causing your hands to become raw and sometimes bleed
  • Patterned counting behaviors
  • Repeated checking that the stove is turned off
  • Repeated checking of door locks
  • Refusing to shake hands or touch door knobs
  • Eating foods in a specific order and/or not allowing foods to touch
  • Collecting or hoarding items
  • Repeating a prayer or phrase to yourself
  • Ordering and arranging things in a precise, symmetrical way

If you are suffering from obsessive-compulsive disorder, your symptoms may come and go over time and also vary in intensity.

What causes OCD ?

Although it is not clear as to what causes OCD, some known factors are:

  • Genetic factors: OCD can sometimes be inherited from the parent.
  • Biological/neurological factors: Some research links the development of OCD to a chemical imbalance of serotonin in the brain.
  • Life changes: Sometimes, major life changes such as a new job or the birth of a child thrust more responsibility on a person. This can trigger OCD.
  • Behavioral factors: People who are extremely organized, neat, meticulous and those who like to be in charge from a young age, sometimes run the risk of developing OCD.
  • Personal experience: A person who has experienced severe trauma is likely to be affected with OCD. For instance, contracting a severe rash by touching rat poison in the house, can lead to hand-washing compulsions.

Treatment of OCD

The most common treatment options for obsessive-compulsive disorder are medication and psychotherapy, or a combination of both.

Medication

If you are suffering from OCD, you may be prescribed serotonin reuptake inhibitors (SRIs) or selective serotonin reuptake inhibitors (SSRIs) to control symptoms. Antidepressants are normally tried first to control OCD symptoms. The most commonly prescribed medications include:

  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Clomipramine (Anafranil)
  • Fluvoxamine (Luvox, CR)
  • Paroxetine (Paxil, Pexeva)

In extreme cases in which no other treatments provide symptom relief, people with OCD may be treated with psychiatric neurosurgery. For example, deep brain stimulation to areas of the brain involved in motor control can help reduce the frequency of obsessive compulsive thoughts.

If you have been prescribed a medication for treatment of OCD, it is important to note that many of these medications may take a number of weeks or months to have a full effect on your symptoms.

Psychotherapy

Your doctor might also suggest psychotherapy as a treatment option for obsessive-compulsive disorder. Psychotherapy is meant to change your negative thought patterns to related to obsessions and resultant compulsions. With OCD, exposure and response prevention (ERP) has been found to be the most effective treatment option. A form of cognitive behavioral therapy, this method of exposure therapy gradually exposes you to your obsession (e.g., dirt) to allow you to cope with your anxiety in a healthier way. Many times, doctors will prescribe ERP therapy in conjunction with medications when SRIs and SSRIs are not effective enough on their own. Another treatment option is satiation therapy, in which clients confront their obsessional thoughts for so long that they lose their meaning.

Obsessive-compulsive disorder is a chronic condition, meaning if you are suffering from this disorder, you may cope with it for your entire life. However, as our understanding of this condition grows, our treatment options and success rates of treatment evolve. Educate yourself about your condition, follow your doctor’s advice, and learn the warning signs and symptoms. Doing so keeps you proactive and informed of your disorder and enables you to live a healthy and productive life.

SUICIDE : What to do when someone is suicidal ?

Suicide prevention starts with recognizing the warning signs and taking them seriously. If you think a friend or family member is considering suicide, there’s plenty you can do to help save a life.

Suicide is a serious and growing problem. It is a desperate attempt to escape suffering that has become unbearable. Blinded by feelings of self-loathing, hopelessness, and isolation, a suicidal person can’t see any way of finding relief except through death. 

If someone says he or she is thinking of suicide or behaves in a way that makes you think the person may be suicidal, don’t ignore the situation. Many people who kill themselves have expressed the intention at some point. You may worry that you’re overreacting, but the safety of your friend or loved one is most important. The best way to prevent suicide is to recognize these warning signs and know how to respond if you spot them.

Suicide warning signs include

Talking about suicide – Any talk about suicide, dying, or self-harm, such as “I wish I hadn’t been born,” “If I see you again…” and “I’d be better off dead.”

Seeking out lethal means Seeking access to guns, pills, knives, or other objects that could be used in a suicide attempt.

Preoccupation with death Unusual focus on death, dying, or violence. Writing poems or stories about death.

No hope for the future Feelings of helplessness, hopelessness, and being trapped (“There’s no way out”). Belief that things will never get better or change.

Self-loathing, self-hatred – Feelings of worthlessness, guilt, shame, and self-hatred. Feeling like a burden (“Everyone would be better off without me”).

Getting affairs in order – Making out a will. Giving away prized possessions. Making arrangements for family members.

Saying goodbye Unusual or unexpected visits or calls to family and friends. Saying goodbye to people as if they won’t be seen again

Withdrawing from others Withdrawing from friends and family. Increasing social isolation. Desire to be left alone.

Self-destructive behavior  Increased alcohol or drug use, reckless driving, unsafe sex. Taking unnecessary risks as if they have a “death wish.”

Sudden sense of calm A sudden sense of calm and happiness after being extremely depressed can mean that the person has made a decision to attempt suicide.

Suicide Prevention

Start by asking questions

If you think someone might be suicidal, ask the question. And be direct. There’s a misconception that discussing suicide might plant the idea, but it just doesn’t work like this. If someone is contemplating suicide, the idea will already be there. If they aren’t, talking about it won’t put the idea into their mind. Suicide isn’t caused by asking the question. Never has been. In fact, giving a suicidal person the opportunity to express his or her feelings can provide relief from loneliness and pent-up negative feelings, and may prevent a suicide attempt.

Ways to start a conversation about suicide:

I have been feeling concerned about you lately

“Recently, I have noticed some differences in you and wondered how you are doing.”

“I wanted to check in with you because you haven’t seemed yourself lately.”

Questions you can ask:

“When did you begin feeling like this?”

“Did something happen to make you start feeling this way?”

“Are you thinking about dying?”

“Are you thinking about hurting yourself?”

“Are you thinking about suicide?”

“Have you ever thought about suicide before, or tried to harm yourself before?”

“Have you thought about how or when you’d do it?”

“Do you have access to weapons or things that can be used as weapons to harm yourself?”

“How can I best support you right now?”

“Have you thought about getting help?”

What you can say that helps?

“You are not alone in this. I’m here for you.”

“You may not believe it now, but the way you’re feeling will change.”

“I may not be able to understand exactly how you feel, but I care about you and want to help.”

“When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.”

When talking to a suicidal person

Do:

Be yourself. Let the person know you care, that they are not alone.

Listen. Let your friend or loved one vent and unload their feelings. No matter how negative the conversation seems, the fact that it is taking place is a positive sign.

Be sympathetic and non-judgmental. The suicidal person is doing the right thing by talking about their feelings, no matter how difficult it may be to hear.

Offer hope. Reassure your loved one that help is available and that the suicidal feelings are temporary. Let the person know that their life is important to you.

Take the person seriously. If a suicidal person says things like, “I’m so depressed, I can’t go on,” ask if they’re having thoughts of suicide. You’re allowing them to share their pain with you, not putting ideas in their head.

But don’t:

Argue with the suicidal person. Avoid saying things like: “You have so much to live for,” “Your suicide will hurt your family,” or “Just snap out of it.”

Act shocked, lecture on the value of life, or argue that suicide is wrong.

Promise confidentiality or be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.

Offer ways to fix your loved one’s problems, give advice, or make them feel like they have to justify their suicidal feelings.

Offer help and support

Get professional help.  Encourage the person to see a mental health professional, help locate a treatment facility, or take them to a doctor’s appointment.

Follow-up on treatment. If the doctor prescribes medication, make sure your friend or loved one takes it as directed. Be aware of possible side effects and be sure to notify the physician if the person seems to be getting worse.

Be proactive. Those contemplating suicide often don’t believe they can be helped, so you may have to be more proactive at offering assistance. Saying, “Call me if you need anything” is too vague. Don’t wait for the person to call you or even to return your calls. Drop by, call again, invite the person out.

Encourage positive lifestyle changes, such as a healthy diet, plenty of sleep, and getting out in the sun or into nature for at least 30 minutes each day.

Remove potential means of suicide, such as pills, knives, razors, or firearms. If the person is likely to take an overdose, keep medications locked away or give them out only as the person needs them.

Continue your support over the long haul. Even after the immediate suicidal crisis has passed, stay in touch with the person, periodically checking in or dropping by. Your support is vital to ensure your friend or loved one remains on the recovery track.

Take any suicidal talk or behavior seriously. It’s not just a warning sign that the person is thinking about suicide—it’s a cry for help.

WHAT DOES DEPRESSION LOOK AND FEEL LIKE ?

So what’s the difference between feeling a bit low or sad and having depression? what do you think depression look like?

To get a better sense of what its like to have depression, it can be helpful to hear from those who’ve actually experienced depression. Look at the following accounts, by people who have experienced depression.

Depression is like going through life like you’re trying to wade through water. Everything is an effort. I just feel so sluggish and slow. And I’ve stopped doing all the things that I used to do – nothing feels good anymore.”

It‘s like stepping into quicksand. Slowly it takes you in, until you are submerged. Can’t breath, can’t think. After you pass through the sand, you find yourself in a dark, never ending abyss. ”

Depression to me is like drowning while everyone else is breathing. It’s also kind of like life is in slow motion. It’s feels like being shackled and having no power or sense of existence. Depression is like being on the outside of eveything.”

“It feels incredibly lonely. And the frustrating thing is that things that could help make things better (such as being physically active, talking to someone, going out with friends) are so much difficult to do when you feel depressed.”

The World Health Organisation has produced a short animation about what its like to live with depression which is available to view on Youtube-https://www.youtube.com/watch?v=XiCrniLQGYc

It’s hopefully clear by now that when we refer to depression, we’re talking about something that is more serious than just feeling sad or low for a day or so. Depression occurs when an individual feels so low or sad that this interferes with their everyday life, and causes a number of different symptoms. Depression is also different from feeling sad in terms of duration; as a general rule, if an individual feels sad or low for two weeks or more (nearly all of the time), this may be indicative of a more serious difficulty than a normal fluctuations in mood.

Criteria for depression (symptoms)

For most of the time during a two-week period, a person experiences at least five of the following criteria. He or she must experience a change from previous and at least one of the first two symptoms must be present.

  • Depressed mood most of the day
  • Markedly diminished interest or pleasure in all or most daily activities
  • Significant unintended weight loss or unusual increase or decrease in appetite
  • Insomania or hypersomania
  • Psychomotor agitation or retardation observable by others
  • Fatigue or loss of energy
  • Feeling of worthlessness or excessive or inappropriate guilt
  • Difficulty maintaining concentration or making decisions
  • Recurrent thoughts of death or having suicidal thoughts, plans, or attempts
  • The symptoms are not attributable to a medical condition or use of a substance
  • The symptoms cause significant distress or impairment

It’s important to remember that symptoms may vary from individual to individual (eg increased versus decreased appetite, sleeping all day versus difficulties sleeping at all) and must represent a change from what is ‘normal’ for that individual.

You may also like to watch the short Ted-Ed video, on Youtube: ‘What is depression?’, which further explains the symptoms of depression.( https://www.youtube.com/watch?v=z-IR48Mb3W0)

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