By September 2003 Despite the fact that obsessive-compulsive disorder (OCD) is more common than schizophrenia, few people are aware of this dreadful disorder that affects both children and adults. Ajay, a medical student, suddenly stopped going out of his hostel room during the day. He developed a fear that others would think he was a homosexual and would laugh at him. He would only go out at night after he had written ‘I am not gay’ 500 times in a notebook. If his roommates dragged him out, he would get severe anxiety attacks. He realised that his fears were irrational because he was only attracted to girls and he also had a healthy relationship with his girlfriend. His friends finally convinced him to consult a psychiatrist. After the treatment he was back to normal within a few weeks. A person suffering from OCD is obsessed with very upsetting thoughts, which create in him a sense of apprehension, threat or guilt. Some examples: ‘‘I might get an infection from the germs on a book or a currency note’’, ‘‘I might kill somebody’’, ‘‘If I don’t pick up that bandage, someone else might get sick and die because of me’’, etc. The person realises that these thoughts are irrational, and they cause a great deal of anxiety. This fear can be torturous and it is this that makes the disorder so frightening. Some people with this disorder may only have obsessions (thoughts), and no abnormal behavioural patterns. However, some persons do develop compulsive actions or rituals emerging from their obsessive thoughts. For example, a person may believe that if he washes his hands 20 times after touching a currency note, he will be able to prevent illness; or that if he prays 10 times he will prevent someone close to him from dying. Patients may spend hours performing these acts to prevent the feared outcome. Some become hyper-religious, spending hours praying and feeding animals, birds, etc. Other people with this disorder frequently consult astrologers, tarot readers and feng shui practitioners. The most common obsessions involve the fear of contamination or disease, which is accompanied by such compulsive acts as hand washing and spraying disinfectant on books, currency notes and doorknobs. The other common obsession with such a person is the fear that some inaction of his will get others into trouble. The person will repeatedly check and ensure that light switches, taps, gas stoves etc have not been left on. And he might do this 10-50 times before he is satisfied. Some people may hoard objects such as papers, notes, books and magazines in case they are useful in the future. People with this disorder often take hours to do simple things and are frequently late for appointments. Offsprings of people with this disorder are more likely to develop it, indicating that genes play some role. In children the disorder often follows a throat infection with the streptococcus bacteria. In most cases the cause is psychological and they respond to psychological therapies. There are a number of medications that can reduce or control the abnormal thoughts but they only work in a certain percentage of cases. Most patients benefit from psychotherapy, which spares them the side effects of medicines. The main aim is to help them learn to live with uncertainty, so that they do not excessively worry as a means to prevent a possible mishap. However, this takes a lot of time and effort on the part of both the therapist and the patient. There are some newer psychotherapies used for the OCD patients these days. For example, some patients respond well to advanced forms of hypnotherapy. A number of other experimental treatments such as brain stimulation have also shown some promise. The most common obsessions involve fear of contamination or disease, which is accompanied by such compulsive acts like hand washing and spraying disinfectants
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