If you find yourself checking and re-checking whether the front door is locked, sweeping and re-sweeping an already clean floor or if you have a strong urge to perform certain rituals repeatedly, then your obsession might be out of control.

Obsession out of hand

Take the case of Raju, a software engineer from Bangalore. He is scrupulous about hygiene. To make sure that his environment is clean, he uses a cleansing swipe each time he touches the elevator button, cleans his keyboard by rubbing alcohol and a micro-fibre cloth every hour, washes his hands every 30 minutes with antiseptic soap and vacuums his seat four times a day. He gets his car washed twice a day with an extra-deep cleaning wash on the weekends at the local car care centre. His parents tried in vain to talk him out of his fixation for hygiene. They thought marriage would change him and so got him married. His wife was shocked on their wedding night when he asked her to bathe thrice in hot water with antiseptic soap. He forced his wife to do the household chores with unrealistic hygiene standards. Predictably, four months into marriage she packed her bags and left.

On the professional front, one unfortunate day he ran out of swipes. In a fit of rage he flung his laptop out of his office window. Regrettably, Raju refuses to get help.

Types of OCD

Do you know someone like Raju? If so, this person might have an anxiety-based disorder called Obsessive Compulsive Disorder [OCD]. People suffering from OCD are preoccupied with a topic, an idea or even a person. ‘Obsessions’ are recurrent and persist in the form of thoughts, impulse, or images at various time intervals. These are triggered by inappropriate stimuli that cause heightened distress. These recurring thoughts, impulses or images are not simply excessive worries about real-life problems, and they will not just go away; besides, they are severe enough to debilitate someone. The person even recognises that these thoughts, impulses or images are a figment of their mind.

OCD can manifest at any age. It usually appears between the ages of eight to 12 or during late teens and early adulthood. The exact cause for OCD is not known.

The most common types of obsessions are:

• Fear of contamination: The worry is that something which is contaminated may cause illness and ultimately death to oneself or a loved one. Such people could brush their teeth excessively due to fear of leaving a minuscule amount of germs and therefore getting mouth disease; or they might clean their kitchen and bathroom repeatedly due to the fear of germs being spread to family.
• Fear of causing harm: The anxiety in this case is of carrying out violent acts against loved ones or others. Obsessive thoughts include violently harming children or loved ones using sharp objects like knives or causing self-harm by jumping in front of a train or a fast-moving bus. While these people might not display ritualistic behaviour, they repeatedly go through the day’s events to check if they have done something to cause harm.
• Excessive concern with symmetry: People with this obsessive fear do anything to ensure everything feels ‘just right’ to prevent discomfort. They have everything neat and in place at all times. For instance, they might have their canned food facing forward or have their clothes hanging in order of colour.
• Unwanted thoughts related to religious beliefs: These people believe that their sins will never be forgiven by God and they will go to hell. To avoid this, they touch or kiss religious objects repeatedly. They also fear becoming a paedophile or a homosexual.
• Excessive accumulation of generic things: Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They might, for example, collect woollen clothes and cartons.

How to treat OCD

Despite the perils of a disorder like obsession, help is available. With treatment and a good support system, you can break free of the unwanted thoughts and irrational urges and take back control of life. The following strategies can be used:

• Psychological intervention or psychotherapy
  Behaviour therapy has a lot to offer to individuals with this disorder. Systematic desensitisation techniques involve gradually exposing the patient to ever-increasing anxiety-provoking stimuli.
  Cognitive-behavioural therapy, which may have some effectiveness for people who suffer from OCD include saturation and thought-stopping. Through saturation, the patient is directed to do nothing but think of one obsessive thought, which worries them. After concentrating on this one thought for a number of days, the obsession can lose some of its strength. Through thought-stopping, the individual learns how to halt obsessive thoughts by identifying the thoughts and then averting it by doing an opposite, incompatible response.
• Medications
  Certain medication has proven to be effective in combating this disorder. However precaution must be taken to prevent an overdose.
• Social support
  Active participation by friends or family in the recovery of an OCD patient is essential. Family members and friends can help by ensuring that medication is taken at the appropriate time, attending follow-up sessions with the patient’s therapist to monitor progress and providing constant motivation at each stage.

Overcoming OCD

In another true story, Radha, a 35-year-old entrepreneur, married with seven-year-old twins was diagnosed with OCD. Prior to being diagnosed, she ran a thriving chain of designer boutiques. Unfortunately her personal and professional life was hanging by a thread.

Radha was obsessed with perfection. She wanted all the clothes in her boutique to be crease free and arranged symmetrically at all times. Employees had to be impeccably dressed and cash in the registers had to arranged denomination-wise. The display lights, carpets and windows had to be cleaned till they shone. She would fire employees instantly if they didn’t comply with her norms. At home, her kids were petrified of her. She would beat them up mercilessly if they left their toys strewn on the floor. She expected them to arrange their school books according to colour or height. She would even hit her husband if he didn’t place his shoes, laptop, clothes and other items in their allocated places.

As things started to get worse, her husband, with the help of her parents, arranged for her to visit a clinical psychologist. But with a lot of support from her family, she met a psychiatrist and a psychologist. Her psychiatrist started her on medication. Her family asked her employees to monitor whether she was taking her medications on time and also requested them to act normal and not to treat her as an ill person. Her siblings made sure she went for her psychotherapy sessions. Her friends would speak to her every week to motivate her on her progress. In a couple of months she began to change; the change was gradual but positive.

Today, Radha is back to being the loving wife, doting mother, happy employer and OCD-free person that she used to be.

All of us have a few harmless obsessions. It’s only when these spin beyond our control and get into endless loops of behaviours that it can be labelled as OCD. Anyone can get OCD irrespective of age, gender, education or socio-economic status.

People who have OCD are suffering and need to be encouraged to seek professional help so that their obsession can be brought under control.

This was first published in the March 2015 issue of Complete Wellbeing.

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How would you know it is anxiety?

Anxiety is what happens when we perceive danger. Anxiety, in and of itself, is not unhealthy or abnormal. It is an adaptive response that helps us survive when faced with threats. The problem occurs when a person misinterprets innocent situations, objects, or people as harmful. Whenever we perceive a threat, the brain’s alarm system responds with a flood of hormones to help us quickly react—via fighting or fleeing. However, this natural response cannot filter the difference between a real danger and a false alarm. It simply reacts to whatever threat you perceive. Anxiety becomes a disorder when we consistently misinterpret these false alarms as real dangers. As a result, the suffering child either perpetually avoids the falsely perceived threats or overreacts with fearful responses. Here are some of the main features of anxiety disorders common to children.

Separation Anxiety Disorder [SAD]

It is normal for toddlers to be clingy and fear unfamiliar people and places. Your child may have separation anxiety disorder if:

• S/he displays excessive fear even though brief separation from the parents is expected at his or her age.
• S/he is very attached to a parent or caregiver, and frequently worries that something bad will happen to him/her or the caregiver, when separated.
• Even the thought of future separation causes intense nervousness that can lead to physical symptoms, such as stomach aches, nausea, and headaches. School refusal is often a result of the child’s fear of separation.

Specific phobias

Most of us have at least one phobia that may have developed in childhood and often continues till late adulthood. Children with a phobia are highly afraid of a specific object or situation, and make attempts to avoid it at all costs. The anxious reaction is so strong that it can result in a panic attack. The thought of being near the dreaded fear triggers intense anxiety. Some common phobias in children include those of insects, animals, blood, injections, doctors, dentists, elevators, planes, moving vehicles, clowns and other odd-looking people or characters, thunder and lightning, natural disasters, night-time, and monsters.

Social phobia

Social phobia also known as Social Anxiety Disorder is not simply extreme shyness. Many children experience some shyness and discomfort, especially in new situations or with unfamiliar people. However, it is generally tolerable for the child, once he or she warms up and relaxes after a while. These same conditions are intolerable for children with social phobia. They find it nearly impossible to relax in social or performance settings, and intensely fear being rejected, criticised, judged, or simply perceived unfavourably when having to perform. Their lack of self-confidence also tends to result in poor assertiveness. Social anxiety often interferes with academic achievement, school attendance, social hobbies, and making friends.

Generalised Anxiety Disorder [GAD]

Worrying every now and again is normal. However, children with GAD are worried almost all of the time about various everyday activities that would be considered insignificant by others. They struggle to control their worries, which may include school, sports and other activities, peers, homework, and the overall wellbeing of themselves and loved ones. When worries are chronic and extensive, they can result in physical symptoms, such as fatigue and body aches.

Panic disorder

A panic attack is a sudden surge of overwhelming fear that comes without warning. It can last a few minutes to several hours, with the first 10 minutes being the most severe. Children often exhibit panic attacks as extreme crying spells or temper tantrums. Agoraphobia is when a child continuously avoids places or situations where escape would be difficult if a panic attack occurs.

Obsessive-Compulsive Disorder [OCD]

There are two parts to OCD: obsessions and compulsions. Obsessions are unwanted, intrusive thoughts or images that occur repeatedly. The content of the obsessions are often frightening, induce the feeling that something bad will happen, and lead to intense anxiety and fear. Compulsions are physical or mental reactions performed to keep the bad things from happening. This becomes a vicious cycle of obsessions and corresponding compulsions that takes up an excessive amount of time, since the relief is only temporary.

Children with OCD tend to demand that family members help them perform compulsions, and have specific rules of what others can and cannot do. Common obsessive fears include contamination, safety, sexual or other inappropriate thoughts, forbidden religious thoughts, morality, imperfection, making mistakes, and needs for symmetry and exactness. Corresponding compulsive behaviours include washing, cleaning, checking, ordering and arranging, repeating, praying, counting, retracing past memories, and seeking reassurance from family members and others.

Signs of anxiety in children

Now that you have a basic understanding of the differences amongst the various anxiety disorders, here are some red flags that may signal excessive anxiety in your child. If these signs are present, it’s a good idea to have your child checked by an anxiety expert to determine whether treatment is needed.

• Constant tantrums, pleading, emotional meltdowns, anger outbursts, and irritability
• Obvious signs of worries and fears
• Refusal to go to school
• Repetitive, ritualistic behaviours
• A continual fear that something terrible will happen to them, their loved ones, or even strangers
• An exceptionally long time spent getting ready for bed, leaving for school, or using the bathroom
• Constant nightmares, bed wetting and difficulty falling asleep
• Requests for family members to repeat specific phrases, behaviours, or keep answering the same questions
• Sudden drop in academic performance or avoiding peers; Excessive, unproductive hours spent doing homework
• Refusal to sleep alone or sleep away from home
• Raw, chapped hands from constant washing
• Difficulty concentrating and easily startled
• Holes erased through test papers and homework
• A persistent fear of illness, or constant checks on the health of family members
• Complaints, such as headaches, and stomach aches

Effective treatment for anxiety disorders

Cognitive-Behavioural Therapy [CBT] is the evidence-based treatment for anxiety disorders. When combined with Family Systems Therapy, it is highly effective for treating childhood anxiety. This type of treatment is usually short-term but has long lasting effects. CBT is not simply the traditional talk therapy or play therapy. It provides the child with tools that need to be practised in order for her to develop the necessary skills to defeat anxiety. In CBT, children learn to identify negative-thinking patterns that aren’t serving them. This allows them to change their perspectives about themselves and the world, so they can engage with the environment in healthier ways.

Exposure therapy is a specific type of CBT that helps children confront fears in a stepwise manner in order to learn that their fears actually are not that threatening. CBT is essentially an exercise for the brain. The more you flex those brain muscles, the stronger you become.

If a child’s symptoms are very severe or the child refuses CBT, then the use of medication may be warranted. However, we have evidence from over two decades of research that CBT actually changes the neurochemistry of the brain. Thus, for children, CBT would be the first route to take, especially when the young brain is still developing and growing. Once the symptoms decrease and the child is able to apply the CBT tools, then the medication can be reduced. The ultimate goal is for children to rely on their own skills, rather than medication, for the rest of their lives.

In Family Systems Therapy, the goal is to teach family members about anxiety and how to be supportive of the child without enabling the condition. The symptoms of anxiety cause havoc on the whole family by interfering with healthy family dynamics and boundaries. When symptoms are chronic, family members wind up inadvertently expressing emotions in ways that are harmful to the relationship with their child. As such, Family Systems Therapy helps to reduce family conflict, re-establish healthy boundaries, and improve effective communication.

This was first published in the August 2013 issue of  Complete Wellbeing.

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