OCD is not a joke

In 2013, Malayalam cinema got a whiff of fresh air with the film North 24 Kaatham. Faahid Faazil who brilliantly essays the role of the protagonist Hari in the movie, is a software programmer with obsessive compulsive traits. Without explicitly stating the disorder, the movie attempted to portray what is largely believed to be a classic OCD symptom—being overly clean or neat. Hari carries tissues everywhere so he can wipe seats clean before sitting down. He refuses to leave or enter a restroom until someone opens the door, because well, knobs can be dirty. His morning ritual involves a multi-step cleansing routine. The director has also tried to acknowledge that people with OCD may also have symptoms characteristic of other mental disorders, like for instance, Hari's irrational fear of air travel which is common in people with phobia. The movie ends with Hari on the brink of a positive transformation, after a chance meeting with a veteran politician and a social worker on a train journey.

It's interesting to see movies such as North 24 Kaatham tread the unconventional road to success, in an age where box office hits are usually movies with hackneyed romance or action plots. But what North 24 Kaatham also brings to light is how flippant we are as a society when it comes to mental health, particularly with disorders such as OCD. Our understanding of OCD is full of misconceptions and colored by what we largely see and hear.

Firstly, obsessive-compulsive disorder (OCD) is not just about cleanliness or orderliness, as popular media seems to portray. If you stack clothes in your wardrobe according to color, you do not necessarily have OCD; you are simply saving time on deciding what to wear. As Dr YC Janardhan Reddy, consultant at India's first OCD Clinic that's housed in NIMHANS, says, "The fine line between being organized and having OCD appears when a thought or a routine becomes distressing. We all have bad thoughts but these thoughts are momentary and can be dismissed. That is not the case with OCD patients—the thought becomes intrusive in them." In other words, OCD begins to affect your personal and professional life on a daily basis.

OCD is a disorder characterized by obsessive thoughts that lead to compulsions. Compulsions are repetitive acts that a person is driven to carry out, in spite of knowing that they are meaningless, unnecessary and excessive. OCD ranges from being mild to being a severely debilitating condition. The symptoms of OCD are complex and can manifest in many different ways. While preoccupation with contamination fears and washing and cleaning are the frequent manifestations, other typical symptoms of OCD include doubts about daily activities and excessive checking or repeating, obsessions of harm and aggression, blasphemy, sexual thoughts, superstitious behaviors and excessive concern with symmetry and orderliness.

Some OCD cases are even characterized by counting compulsions—as in the case of 30-year-old Satish*, a bank cashier who suffered from a doubt that he was not counting currency notes properly before handing them over to customers. So Satish ended up counting the notes over and over again and soon irate customers were shouting at him for his slowness, and the bank manager decided to send him a memo for being inefficient. OCD is also characterized by intrusive thoughts, which could range from an irrational fear of contracting a certain disease to constant pondering on what happens after death. The sufferer unendingly looks for a respite from these thoughts and the fact that these thoughts are not produced voluntarily makes it even more distressing for the person.

OCD is more prevalent than schizophrenia or bipolar disorder and afflicts roughly 1–3% of the population¹. Most sufferers have mild forms of OCD, a condition they tend to live with and therefore it goes undiagnosed. However 1% of them have a severe form of OCD which can leave them feeling incapacitated. Also, contrary to popular belief, OCD is common in children as well and according to Dr Reddy, it can affect children as young as four. In a study conducted on juvenile OCD by Dr Jaisoorya TS² of NIMHANS, it was found that 1 in a 100 children have symptoms of OCD.

In children the condition can be particularly difficult because they may be fixated on a thought without realizing that it is unrealistic and therefore not talk about it. The good news is that OCD can be treated and Dr Reddy notes that about 70% of the cases treated at NIMHANS have shown significant improvement, and about half of them had minimal or no symptoms post-treatment and are now leading lives of normalcy. Cognitive Behavioral Therapy (CBT), which is commonly used in treatment, aims to change the way obsessions are perceived, and in so doing facilitates change in behavior. In severe cases, medications are used, and if these medications are prematurely terminated, chances of relapse are higher and the patient may have to continue treatment for several years.

However what is most alarming is that as a society, we tend to use OCD very flippantly in our everyday conversations, to the extent that the illness is now on the brink of losing its real meaning. We describe ourselves as 'a little bit OCD' if we like our desks neatly arranged. In truth, we like our desks neatly arranged because we prefer it that way. When we tidy up our desks, we feel satisfied. It does not impair our life in any way. However an OCD-affected individual's life is dominated by obsessive thoughts and there is a compelling urge to give in to these thoughts. So whether it is checking on locks or arranging things a certain way, an individual with OCD may perform an activity repeatedly, but derives no pleasure or satisfaction out of it.

OCD is a condition so serious that the World Health Organisation ranks it among the top ten handicapping illnesses of the world³, in terms of lost earnings and decreased quality of life. In fact, living with OCD can be so daunting that some sufferers have been reported to even contemplate or attempt suicide.

It is time for us to stop thinking of OCD as just a personality quirk. OCD is a mental disorder that can be severely debilitating and even if we cannot offer our understanding and empathy, we can atleast stop making a mockery of people whose lives are actually impacted by it.

Self-help books for OCD:

1. Brain Lock by Jeffrey M. Schwartz

2. The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder, 3rd Edition Paperback by Bruce M. Hyman

3. Break Free from OCD: Overcoming Obsessive Compulsive Disorder with CBT by Fiona Challacombe, Victoria Oldfield & Paul M. Salkovskis

4. OCD in Children and Adolescents: A Cognitive-Behavioral Treatment by John S.March, Karen Mulle

5. Treating your OCD with Exposure and Response (Ritual) Prevention Therapy Workbook (Treatments That Work) Paperback by Elna Yadin , Edna B. Foa , Tracey K. Lichner

References:

1. http://www.bmj.com/content/348/bmj.g2183

2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243905/

3. http://www.ncbi.nlm.nih.gov/pubmed/14689261

*name changed

This article has used information from the OCD Patient Information Brochure, published by the OCD Clinic at NIMHANS.