Shalini ( name changed ), a 33 years old housewife, lives with her husband and son in Delhi. Shalini was fond of cleanliness since childhood and used to keep her room neat and clean, would wear a clean dress, and stay away from dirt. Although family members told her that she’s very fond of cleanliness, they never considered anything abnormal. Shalini was very good in her studies and she did B.Ed and was a teacher in a private school for some time.
Almost, At the age of 26 years, Shalini got married and became a housewife. She used to spend the day Mostly doing household chores. One year after marriage, Shalini thought she was cleaning a lot for the first time. Even after cleaning properly, she believed the house didn’t look clean. However, it used to be clean. But the mind would say otherwise. Shalini thought of some solution. She made a ritual that she would do the cleaning process twice. Even then, the mind Was not satisfied. And she started doing The cleaning process thrice. When her husband noticed, he asked why she was doing so ? She made an excuse that she had an allergy to dust, that is why she Is fond of keeping things neat and clean.
But deep down, Shalini understood that whatever she did was wrong. She was in confusion. Because, whenever she wouldn’t clean it, again and again, she would feel anxious. She decided that on Sundays, when her husband was at home, she would do the cleaning only once and for the rest of the days when her husband would be in the office, she would do the cleaning process thrice before her husband will come home from the office. The exact process continued and Shalini became pregnant and her mother came to her home and started living with her. Her mother would do the household chores and Shalini, because of her pregnancy, started spending less time in the cleaning process.
Things were fine until a few months after delivery, but Shalini started becoming anxious slowly. Along with The cleanliness process, she would even feel that her hands were dirty, and she would wash her hands again and again. Even at the time of Toilet, things worsened. She would feel uneasy and would wash her genital area again and again. After that, she used to wash her hands for 15 to 20 minutes. After some days, after using the toilet, she started taking a bath, because she wouldn’t get satisfaction just by cleaning Her hands. Even that process would take a long time and the water tank used to become empty.
When her husband returned from the office, she thought he might have sat on a dirty chair, and as he would have traveled in Metro, the seat In the Metro train would be very dirty, also, hands would be contaminated. So she asked her husband that he should take a bath, change his clothes, and then sit whenever he returns from the office. The husband became angry, but after seeing that, Shalini is worried , he agreed to whatever she said. But after few days, things worsened, and they started having arguments frequently.
After some time, things worsened. In the morning, when the milk vendor would come to deliver milk, Shalini started thinking that he had knocked on the door and rang the bell, the hands of the milkman, would be dirty. She started cleaning the main entrance of the house along with the doorbell. A few days later, she told the garbage collector that he shouldn’t ring the bell. And she started keeping the garbage outside by herself. She would clean the bed sheets and sofa cover and floor properly whenever some relatives would come to her home, after, they would go.
Shalini was worried, would remain sad most of the time, and would avoid going to the toilet because she knew that if she went to the bathroom, she wouldn’t be able to come back For one or two hours. She was not able to take care of her child. Her relationship with her husband worsened. She was not able to understand anything. Every night before sleeping, she would decide not to do these things the next day but she was not able to control her mind. Sometimes she would think of leaving home and going somewhere far away. After suggestions from some people, she started doing yoga, praying, and even taking some Ayurvedic medications, But they were of no use.
As she was educated, She thought of consulting a doctor. But then, She thought if she would consult a psychiatrist, Then the people would call her mad, and she would be given sleeping pills which she would have to take life long after thinking about all this, Her anxiety again worsened.
Finally, when things went out of control. Shalini googled about a psychiatrist and started treatment. The doctor explained to her that she was suffering from OCD and suggested her medical treatment in the form of medicines and counseling sessions.
Q. What is OCD?
Ans – It means obsessive-compulsive disorder. Let’s try to understand it one by one. Obsession means some thought or some image that comes to mind again and again. The patient is aware that it is illogical and irrational thought. But even after knowing so, the patient is unable to stop these thoughts from coming into the mind, while the action that is done to control or stop these thoughts is called compulsion. For example, as we have explained above, Shalini was having thoughts about dirt and contamination. Even after trying, Shalini was not able to control these thoughts and even she used to think that these were irrational thoughts. So this thought would be called an obsession. The act that she was doing it in the form of cleaning, again and again, would be called a compulsion. Obsession can be in the form of thoughts or sometimes in the form of images. Sometimes few people suffer from obsessive imagery, which basically means that some image would come into their mind again and again. This is called obsessive imagery. To get rid of those images, sometimes, The patient In their mind, do some mental acts like counting backward or saying stop. This act is known as a mental compulsion. There is another entity, called religious OCD. In religious OCD, The patient gets bad ,sexual thoughts regarding God, which are known as blasphemous thoughts. For religious people, this is very troublesome but taking treatment on time anyone can get rid of this issue.
Q. how common is OCD?
Ans – It is fairly common. as per a few studies, the prevalence of OCD is approximately 2 to 3% which means In a set of 100 people, about 2 to 3 people would be suffering from this issue. It is more commonly seen in females and the average age of onset is usually 18 to 19 years.After the age of 30 years, it is generally seen rarely.
Q. Why does OCD happen?
Ans – OCD is caused because of some structural abnormality in the brain. Few of the chemicals which we call neurotransmitters, Their levels when gets altered is the reason behind OCD.Also abnormality in one of the neural circuits, Which we call as corticostriatal Thalamic cortical circuit, is also one of the reasons behind OCD. Alteration in levels of some of the neurotransmitters like serotonin, dopamine, and glutamine, is also considered one of the causative factors. Also if someone in the family is suffering from OCD, Then the chances of having this disease In other family member or the upcoming generations increase.
Q. What is the treatment for OCD?
Ans – OCD is treatable. We have two options, mainly medicine as well as therapy. It has been seen that when medicine and therapy are combined, we get better results. In medicines, we have SSRIs, which are commonly used. Apart from SSRIs, there are various other medications that are also used, the important thing to understand here is that any medication takes approximately few weeks to months to show its good effects. If one molecule doesn’t work, we can change the medication. In therapy, we have cognitive-behavioral therapy. One particular type of CBT is known as exposure and response prevention. It is used commonly in cases of OCD. Let’s understand exposure and response prevention, for example. Suppose a patient is having thoughts regarding dirt and contamination. We, Arrange the thoughts which are distressing to the patient in increasing order of the hierarchy. For example, if a particular thought is less distressing to the patient, we work on that thought first and, subsequently, the more troublesome thoughts. The more troubling thoughts we deal later. In this therapy, usually, the patient is exposed to some dirt and a contaminated environment. And he’s prevented to perform the compulsive act. After that, he is made to understand that even if he don’t wash or clean, No sort of Problem will occur. Slowly, with therapy as well as medications, the patient improves.
Q. Can OCD be cured?
Ans – Absolutely. With the advancement in science today, we have various treatment options for OCD. Above I have explained medicine and therapy. Apart from that, we today have some techniques known as deep brain stimulation, which are used in some problematic cases in which specific areas of the brain are stimulated. After this, the repetitive thoughts start decreasing. In some rare cases, even surgery can be done. But the most important thing to understand here is to take treatment on time. It has been seen in OCD as well as any other mental health issue that if treatment is not taken on time, It becomes a bit difficult to treat and the patient then has to take medicine for a longer duration. But timely intervention if done, Then OCD can be cured.
References –
1.Fawcett EJ, Power H, Fawcett JM. Women are at greater risk of OCD than men: a meta-analytic review of OCD prevalence worldwide. The Journal of clinical psychiatry. 2020 Jun 23;81(4):13075.
2. Clark DA. Cognitive-behavioral therapy for OCD. Guilford Press; 2006.
3. Rapinesi C, Kotzalidis GD, Ferracuti S, Sani G, Girardi P, Del Casale A. Brain stimulation in obsessive-compulsive disorder (OCD): a systematic review. Current Neuropharmacology. 2019 Aug 1;17(8):787-807.