Aastha, a 22-year-old woman sought psychological help after two years of suffering from weird symptoms.Over the last two years she had repetitive thoughts that she may get dirty and contract a disease. As a result she tried her best to avoid physical contact with a number of things. She stopped taking the metro and other means of public transport. She avoided shaking hands with people. At home and work, she avoided touching several objects. If she had to handle some objects against her will, she experienced intense anxiety. In order to get rid of this anxiety, she started washing her hands excessively for long durations. On an average she spent approximately two hours per day in hand washing. Her bathing time increased significantly. Throughout the day, thoughts of dirt and contamination and urges to keep everything clean ruled her mind. She felt scared of losing mental control and becoming insane. Though she recognized that these thoughts were baseless she could not control them. After psychological evaluation, it became apparent that she was suffering from obsessive-compulsive disorder.

What is obsessive-compulsive disorder (OCD)?

It is normal to worry about a few things. All of us have a daily checklist of doubts including- whether we have locked the house before leaving for work, are our surroundings clean and hygienic, have we checked the bills and are we and our close ones safe from dangers. However, for some people this daily checklist becomes never ending and repetitive. Their mind is literally flooded with obsessions that are repetitive thoughts, fears and impulses. In order to deal with it, they perform repetitive mental or physical actions known as compulsions. This condition is a psychological disorder known as obsessive-compulsive disorder or OCD.

What are the various signs and symptoms of obsessive-compulsive disorder (OCD)?

. OCD sign and symptom 1- Obsessions:The most common symptom of OCD is obsession. The person having obsessive-compulsive disorderexperiences thoughts, impulses and images that they find forceful and crazy. The person does not wish to think about them but they keep coming back in a pushy manner against the person's will. The person suffering from obsessive-compulsive disorder cannot stop or distract their mind from these thoughts and feels helpless and anxious. While working as a psychologist in Delhi, I have observed that, the most common obsessive thoughts, impulses and images revolve around one or more following clusters-

Obsessions around dirt and contamination:The person lives in a constantdread of contracting dirt and germs from the environment, other people and their own body. For some OCD sufferers, the list of dangerous and dirty items starts including almost everything.

Obsessions about sex and violence:The individual is troubled by violent thoughts of hitting, injuring, pushing and torturing other people. They get intrusive thoughts of abusing or performing sadistic sexual acts on children, family members and images of God.

Obsessions around doubt:The person has repetitive thoughts that they have committed some huge error despite checking. Common examples include- keeping the door unlocked, misplacing important possessions or documents and forgetting important information.

Obsessions involving perfection:Some OCD patients are troubled by slight imperfections and have a need to keep everything in perfect order. They are the ones who keep their belongings, work and surroundings in an extremely organized manner.

Obsessions of harm and embarrassment: Few people with obsessive compulsive symptoms have repeated thoughts that something bad may happen to them or their close ones.

. OCD sign and symptom 2- Compulsions:A person suffering from obsessive-compulsive disorderindulges one or more compulsions. A compulsion is a mental or physicalact that the patient feels forced to perform in order to decrease the anxiety and helplessness due to obsessions.OCD sufferers usually indulge in compulsions in a repetitive manner. Often, a lot of their productive time may go waste while performing the compulsions. They cannot control themselves from performing the compulsion even if it is has an extremely negative impact on their life.While working as a psychologist in Delhi, I have observed that compulsions usually fall into the following categories-

Compulsions around cleanliness: The person experiencing obsessions around dirt and contamination carries out several compulsive actions to feel secure. The most common cleanliness compulsions include excessive hand washing, bathing for long hours, changing clothes frequently, spending huge amount of time in house cleaning, disinfecting and sterilizing various objects and remaining confined to a certain area of the house.

Compulsions involving magic: OCD sufferers who feel extremely scared of obsessions around sex, violence, doubt and harm perform certain magical rituals to 'cleanse' the impact of obsessive fears from their mind. The rituals that are performed include chanting a prayer or mantra each time the obsessive thought comes up, excessive use of numerology to differentiate between lucky and unlucky numbers, indulging in elaborate counting, touching and moving either objects or one's own body in a special way.

Compulsions around checking and organizing:People suffering from obsessive-compulsive disorderremain preoccupied with doubts, which make them perform repetitive checks. They may check their belongings at home and work repeatedly to make sure everything is in perfect order and nothing is missing. They have a need to obtain more and more information about any aspect to be reassured that they are not missing out on anything. They keep things well organized to deal with fear.

Compulsions involving hoarding: Some people suffering from obsessive-compulsive disorder have a tendency to collect objects and indulge in savings to an extreme. The objects that are collected or saved are usually of little value and excessive in quantity.

. OCD sign and symptom 3- Insight: The people who suffer fromobsessive-compulsive disorder usually acknowledge that their symptoms are irrational or excessive. However, despite having this insight they are unable to dismiss their obsessive thoughts or stop their compulsive behaviours. This happens because the sense of doom associated with the obsessions is very intense. Rather than tolerating the anxiety the person gives in to the vicious cycle of symptoms. However, individuals with a long history of obsessive-compulsive disorder tend to lose their insight.

. OCD sign and symptom 4- Dysfunction: Obsessive-compulsive disorder symptoms are time consuming and cause intense turmoil in the life of the person. OCD patients usually struggle to perform at work or in studies. They experience significant problems at home as almost everyone is fed up of their excessive rituals or reassurance seeking.

What are the causes of obsessive-compulsive disorder (OCD)?

Current psychiatric and psychological research as well as insights from psychotherapeutic case studies of OCD list following factors that may cause obsessive-compulsive disorder in an individual-

. Disturbance in the levels of brain neurotransmitter serotonin
. Injury to central nervous system
. Stressful life events and experience of psychological trauma
. Unconscious conflicts around sexuality and anger
. Fear of losing self-control
. Faulty childhood learning patterns
. Separation anxiety

What are the best available treatments for obsessive-compulsive disorder (OCD)?

Following psychiatric and psychological treatments for obsessive-compulsive disorder are available:

. Psychiatric medication for OCD: SSRIs are a class of medication that can lower the intensity of obsessions and reduce compulsive actions. However, medication alone does not resolve all symptoms. The person feels better till the time they are taking medication and symptoms return back with full intensity and frequency when the medicine is stopped. Therefore, for effective treatment of obsessive-compulsive disorder medication needs to be combined with psychological treatments such as behaviour therapy, cognitive-behavioural therapy or psychoanalytic psychotherapy.

. Cognitive therapy for OCD: In order to treat obsessive-compulsive disorder, cognitive therapy enables the person to revaluate the significance that they attribute to obsessive thoughts and compulsive actions. Once the OCD patient stops thinking catastrophically about the obsessive thoughts, their anxiety comes down and they are able to deal with the symptoms. Further the need for performing compulsions also decreases.

. Behaviour therapy for OCD: In order to treat obsessive-compulsive disorder, methods of exposure and response prevention are used. The patient is exposed to a graded hierarchy of obsessions or discomforting stimuli while preventing the associated compulsion. As the person faces the discomfort, they are habituated to it and the anxiety drops down. This brings a drastic relief in symptoms.

. Psychoanalytical therapy for OCD: From a psychoanalytical perspective, some obsessive-compulsive symptoms serve an unconscious purpose for the person. Once the significance is understood and alternative methods of dealing with conflicts are devised, the intensity and frequency of obsessive-compulsive symptoms declines.

In case you or someone close to you suffers from this stubborn and debilitating condition, the first step is to acknowledge it. It has been my experience that people either lack awareness about this condition or do not acknowledge it due to a feeling of shame. Obsessive-compulsive disorder rarely responds to waiting, self-help and reassurance. The more you delay the treatment, the stronger will be the grip of the disorder. Therefore, it is better to get yourself diagnosed and treated as early as possible.