OBSESSIVE-COMPULSIVE AND RELATED DISORDERS

Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) affects 1 in every 28 Singaporeans in their lifetime, and it is considered a common mental health condition in Singapore.

What is OCD? 

OCD, or Obsessive-Compulsive Disorder, is a chronic condition in which a person has uncontrollable, recurring urges or thoughts (i.e., obsessions) and/or the urge to repeat certain behaviours (i.e., compulsions) in an attempt to suppress these urges or thoughts. In reality, these compulsions, developing as unhealthy coping strategies, usually create even more distress and anxiety.

Some common obsessions and compulsions are:

Ψ Fear of germs and/or contamination;
Ψ Desire for things to be symmetrical, or in perfect order;
Ψ Aggressive thoughts towards self or others;
Ψ Excessive cleaning (e.g., repeated handwashing);
Ψ Compulsive counting or arranging items in a particular way; or
Ψ Repeatedly checking on things (e.g., to see if the door is locked)

Indeed, it can be normal for us to double-check, especially if that thing is considered important. So how do we know when our habits or rituals become a compulsion? Consider the following signs:

You recognise that your thoughts and behaviour are irrational and excessive, but have no way of containing them;

You spend at least 1 hour every day on these thoughts or behaviours;

You feel only brief relief when performing compulsive rituals; or

You experience significant problems in your daily life due to these thoughts or behaviours.

Taken together, these obsessions and compulsions can make us extremely anxious, distressed, and exhausted.

Addressing OCD

Typically, OCD is managed with medication, psychological therapy, or a combination of both. The following are two primary forms of psychological therapies with proven efficacy for individuals with OCD.

Ψ Exposure and Response Prevention Therapy (ERP)

ERP is a form of Cognitive Behavioural Therapy (CBT) that has been clinically validated in its efficacy in managing OCD. It involves exposing individuals to the source of their anxiety repeatedly while preventing them from engaging in the associated compulsive behaviours.

So, if someone were to have an obsessive fear of contamination, he might be exposed to dirt and be prevented from cleaning himself. Through gradual exposure, starting from the least anxiety provoking situation, the individual slowly builds a tolerance for distress which eventually enables him or her to resist the compulsions as well as re-evaluate the anxiety that they feel.

Through the collection of scores called Subjective Units of Discomfort (SUDS), the reduction in the severity of obsessions and associated anxiety are tracked to achieve greater functioning.

Ψ Acceptance and Commitment Therapy (ACT)

ACT (which rhymes with THAT) is typically used in conjunction with ERP to help individuals manage their OCD. Incorporating acceptance and mindfulness practices, the goal of ACT is to help individuals increase their awareness and flexibility in how they respond to their obsessive urges and thoughts, and how they choose to act on their compulsions.

Unlike ERP where the primary focus is to eliminate the obsession or compulsion, Acceptance and Commitment Therapy (or ACT) involves accepting those obsessions or compulsions and holding them at a distance from the self, while deliberately engaging in behaviours that are consistent with your personal values. ACT helps us learn how face our fears, as well as take risks, in the service of living and committing the values that are important to us.

In other words, ACT encourages those with OCD to explore ways of leading a meaningful life consistent with our values, in spite of OCD.

Involving your Family in Therapy

A key part of the therapy process is the involvement of your loved ones (e.g., parents, friends, romantic partners). Often, individuals who struggle with OCD would turn to their loved ones seeking reassurance (e.g., “can you confirm for me that I have turned off the stove?”).

Contrary to popular belief, providing reassurance might not always be the best way to provide support

Reassurance often serves only as a reinforcement of those compulsions and provides temporary relief. Instead, consider how you can support them during those difficult moments (i.e. staying by their side as they experience the discomfort) rather than feed into the discomfort.

As with most mental health conditions, therapy plan can differ between individuals. If you think that you, or someone you know, may have OCD, seek professional help to improve your coping and functioning. Feel free to make an appointment with one of our experienced psychologists, like Max, for support with coping with OCD!