'It's not a cute way of saying you don't like mess': why OCD needs to be treated more seriously

The condition, which can manifest itself in the form of cleanliness, orderliness and hoarding, is oft-mocked despite ranking among the 10 most serious diseases

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Common OCD symptoms and how they manifest

Checking: the obsession or thoughts focus on some harm coming from things not being as they should, which usually centre around the theme of safety. For example, the obsession is “the building will burn down”, therefore the compulsion is checking that the oven is switched off.

Contamination: the obsession is focused on the presence of germs, dirt or harmful bacteria and how this will impact the person and/or their loved ones. For example, the obsession is “the floor is dirty; me and my family will get sick and die”, the compulsion is repetitive cleaning.

Orderliness: the obsession is a fear of sitting with uncomfortable feelings, or to prevent harm coming to oneself or others. Objectively there appears to be no logical link between the obsession and compulsion. For example,” I won’t feel right if the jars aren’t lined up” or “harm will come to my family if I don’t line up all the jars”, so the compulsion is therefore lining up the jars.

Intrusive thoughts: the intrusive thought is usually highly distressing and repetitive. Common examples may include thoughts of perpetrating violence towards others, harming others, or questions over one’s character or deeds, usually in conflict with the person’s true values. An example would be: “I think I might hurt my family”, which in turn leads to the compulsion of avoiding social gatherings.

Hoarding: the intrusive thought is the overvaluing of objects or possessions, while the compulsion is stashing or hoarding these items and refusing to let them go. For example, “this newspaper may come in useful one day”, therefore, the compulsion is hoarding newspapers instead of discarding them the next day.

Source: Dr Robert Chandler, clinical psychologist at Lighthouse Arabia

Colloquially, the term OCD has come to refer to people who like things done "just so", but experts say obsessive-compulsive disorder is misunderstood. They believe it's often mocked and not taken seriously enough, given that in the World Health Organisation's 2017 report Depression and Other Common Mental Disorders, anxiety disorders, of which OCD is one, are listed as "the sixth largest contributor to non-fatal health-loss globally".

Meanwhile, Healthyplace.com, a consumer mental health platform, notes that only about 10 per cent of those living with OCD seek help, even though about two thirds experience severe symptoms that cause major dysfunction in their lives.

OCD can pass down generations

Dr Thoraiya Kanafani, clinical psychologist at the Human Relations Institute and Clinics, says the condition can appear in children as young as five years old, but on average, manifests between the ages of eight and 12. As with many mental disorders, family history can play a role, meaning one is predisposed to OCD if a family member has it.

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People talk about the condition casually and flippantly. It's not a cute way of saying that you don't like mess or like to organise your shoe collection

Emily (name changed upon request) is a third-generation sufferer, following her father and paternal grandmother. “As a child, I wasn't aware of it, but I could definitely sense that something was wrong. For them, it manifested in excessive cleaning. The house I grew up in could never be clean enough, and we were late for everything because my father had to clean the house before we could leave,” she says.

Emily experienced OCD as a child and had a constant fear that she was never clean enough, which led to excessive handwashing and showering. She thinks this stemmed from being bullied at school, when she was once told she was dirty, so she began showering three times a day.

Her OCD started to change as she undertook a high-pressure law course. “At university, I developed a different sort of obsessive behaviour – eating the same foods every day and repeatedly checking things. Around exam time, in particular, I found myself repeating patterns and being unable to leave my room until I’d checked that all the plugs were off and that the door was shut, but multiple times.”

Kanafani explains that the bullying Emily experienced can be a trigger for OCD.

Personality traits and the pandemic as triggers

Some other factors include abuse or neglect, bereavement and even childbirth. Environment also plays a role. Children in very controlling households, for example, are more prone to developing OCD. In other cases, personality traits can be a risk factor, whether in a child or adult. Ghania Kabbara, Clinical Psychologist at Priory Wellbeing Centre, Dubai, explains: “These traits include indecisiveness, perfectionism, impulsiveness and orderliness.”

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As a joke, my friends would move my things around. At the time, I didn't understand why it annoyed me, but I couldn't laugh with them

Worryingly, Kabbara says since the current pandemic plays on many of these concerns, those with OCD may feel that it validates their behaviour. This can especially manifest in a fear of the virus and germs at large. “Covid-19 is likely to exacerbate symptoms in those already living with OCD and could also encourage the re-emergence of symptoms in others,” she says.

When it comes to neurology, Kanafani says people with OCD have differences in brain functioning, as in "they either have areas of unusually high activity or low levels of serotonin", which may explain why OCD often appears alongside disorders such as anxiety, attention deficit hyperactivity disorder, depression and substance use.

Can OCD be cured?

Sara (name changed upon request) self-diagnosed when she was 19, but knew little of the condition. Now 30, it took the Emirati until she was 23 to see a professional, who diagnosed her with OCD and ADHD. She says it began slowly. "In my room, I liked things to be set in a certain way. If they were moved, I got irritated. In senior year, I left my [school] desk a certain way and, as a joke, my friends would move things around to see my reaction when I got back. At the time, I didn't understand why it annoyed me, but I couldn't laugh with them," she recalls.

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Therapy can help manage compulsions and even obsessions, but it is important to work on underlying anxiety and understand the source

While Sarah has found treatment in the UAE, she admits the cost is prohibitive to many. “It isn’t ‘resolved’ from just one session, either, so when I do go to therapy, I talk about bigger issues that have been affecting my life, rather than just the OCD, which so far hasn’t stopped me from living my everyday life,” she says.

The term OCD is used “haphazardly”, says Kanafani, and the experience and difficulty that those with a diagnosable disorder go through are often invalidated.

Speaking first-hand, Emily agrees. “I don't feel like it's taken seriously. OCD is not about being clean or tidy, and I hate hearing people say that the ideal housemate is ‘someone with OCD’. People talk about the condition casually and flippantly. It's not a cute way of saying that you don't like mess or like to organise your shoe collection. I think it's also viewed as a ‘weird’ condition, like someone who has OCD isn't normal.”

Mandeep Jassal, a behavioural therapist at Priory Wellbeing Centre, Dubai, says while there is greater openness to speaking about mental health, it must be done with more care. “In one respect, talking about OCD by the general public has become more normalised and can make it somewhat easier for those struggling with it to talk about their concerns with less fear of being judged. However, for other individuals with OCD, they can feel their illness is being downplayed and ultimately lead to further guilt and shame.”

Many people still hide their OCD behaviour from others, Kanafani says. There is hope for those living with the condition, however. "Usually, about seven out of 10 individuals will benefit from either medication or therapeutic treatments, and those who benefit from medication usually have reduced symptoms by 40 per cent to 60 per cent," she says. The best results, she adds, come from a combined therapeutic approach, with both medication and psychotherapy.

Masa Valkanou, a family psychotherapist at Thrive Wellbeing Centre in Dubai, says understanding the root cause is critical. "Although behavioural therapy can help a client manage compulsions and even obsessions, it is important to work on underlying anxiety in a psychodynamic way and understand the source."

The therapy needs dedication and patience, and can, in extreme cases where the condition affects daily functioning, take years to resolve.

What is key is finding help, says Sara. “If these conditions tend to affect your day-to-day life and activities, causing you to lose touch with friends, family members, or even lose interest in work, hobbies and going out, that is when it needs to be dealt with professionally.

“Research, converse, shine a light on it, do anything … just don’t close the door on it and expect it to go away.”

Common OCD symptoms and how they manifest

Checking: the obsession or thoughts focus on some harm coming from things not being as they should, which usually centre around the theme of safety. For example, the obsession is “the building will burn down”, therefore the compulsion is checking that the oven is switched off.

Contamination: the obsession is focused on the presence of germs, dirt or harmful bacteria and how this will impact the person and/or their loved ones. For example, the obsession is “the floor is dirty; me and my family will get sick and die”, the compulsion is repetitive cleaning.

Orderliness: the obsession is a fear of sitting with uncomfortable feelings, or to prevent harm coming to oneself or others. Objectively there appears to be no logical link between the obsession and compulsion. For example,” I won’t feel right if the jars aren’t lined up” or “harm will come to my family if I don’t line up all the jars”, so the compulsion is therefore lining up the jars.

Intrusive thoughts: the intrusive thought is usually highly distressing and repetitive. Common examples may include thoughts of perpetrating violence towards others, harming others, or questions over one’s character or deeds, usually in conflict with the person’s true values. An example would be: “I think I might hurt my family”, which in turn leads to the compulsion of avoiding social gatherings.

Hoarding: the intrusive thought is the overvaluing of objects or possessions, while the compulsion is stashing or hoarding these items and refusing to let them go. For example, “this newspaper may come in useful one day”, therefore, the compulsion is hoarding newspapers instead of discarding them the next day.

Source: Dr Robert Chandler, clinical psychologist at Lighthouse Arabia