Obsessive compulsive disorder (OCD)
Do you feel the need to check things repeatedly, perform certain routines or have uncontrollable thoughts?
In the US, 2.3% of adults suffer and 1 in 100 children. Obsessive compulsive disorder symptoms tend to develop more frequently in children that are 10–14 years of age, with males displaying symptoms at an earlier age and a more severe level than females.
With a population of 7.3 million, mental health problems are not uncommon in Hong Kong. For a high-tempo, action-packed and densely populated city like Hong Kong, the challenges we are facing are immense and multi-faceted. According to the Hong Kong Mental Morbidity Survey 2010-2013, the prevalence of common mental disorders among Chinese adults aged between 16 and 75 was 13.3%.
OCD involves intrusive, unwanted and distressing thoughts (obsessions), followed by specific behaviours (compulsions) which are used to self-soothe.
Most adults realize that their behaviours, such as compulsive cleaning do not make sense, but they are also almost impossible to stop.
OCD is a response to anxiety or fear. The human response to discomfort is avoidance and an attempt to change the emotion. In OCD, avoidance takes the form of compulsions.
These compulsions may be obvious such as repeated cleaning, or invisible - repeating a phrase in their head. The latter is sometimes known as 'Pure O'.
Compulsions reinforce OCD. If a person reduces anxiety by washing their hands after touching a “contaminated” door knob, the relief sends a false message that the door knob was harmful. The compulsive behaviour is then felt to be the thing that brings relief, and the cycle goes round again.
OCD is recognised by the World Health Organization as being one of the top ten most disabling illnesses.
OCD presents differently for different people. Obsessions may come in the form of an urge, a mental picture, feeling or memory.
We all have unwanted or unpleasant thoughts at times, but in OCD, these thoughts dominate normal thinking patterns.
Common intrusive thoughts experienced in OCD are:
- fear of harming yourself or others - either deliberately or by mistake
- fear of contamination by disease, infection or an unpleasant substance
- need for things to be 'just right' - clean or orderly
- thoughts about sex
- fears about relationships, like infidelity or uncertainty of feelings
Compulsive behaviours might include:
- cleaning and hand washing
- checking – if doors are locked or the gas is off
- counting, ordering and arranging
- asking for reassurance
- repeating words in your head
- thinking "neutralising" thoughts to counter the obsessive thoughts
- avoiding places and situations that trigger obsessive thoughts
- using substances like alcohol or drugs to cope
Despite a lot of research being done, there is no clear answer on the causes of OCD. The respected British mental health charity MIND says that there are three main theories:
- Biological & genetic – A report indicated that a combination of nutritional deficiency and MTHFR mutations (which affect a third of the population, causing methylation issues and making it difficult to absorb B vitamins) can increase OCD behaviours. Methylation governs your ability to create neurotransmitters like serotonin and GABA, low levels of which are associated with OCD.
- Personal experiences like childhood trauma, especially emotional abuse and neglect, may increase the risk of OCD. Traumatic experiences can mean we develop strong thought patterns and behaviours to cope. If our parents or carers used compulsive behaviour to deal with their own anxiety, we may learn it as a normal coping strategy.
- Dysfunctional beliefs – when particular beliefs and thoughts get “locked in” – we can feel like they are completely true and live our lives accordingly. If the belief is frightening, it can trigger excessive anxiety and start the OCD cycle.
If these symptoms sound familiar, we recommend you meet with our clinical psychologists. They can diagnose OCD and offer support to those with the condition.
Diagnosis can seem scary, but can also create more self-compassion and improve your quality of life.
There are two evidence based psychological approaches shown to support those with OCD. These are Cognitive Behavioural therapy and Mindfulness Based therapy. Both will assist you in becoming more aware of unwanted thoughts and compulsive behaviours, and developing coping mechanisms to manage them.
You may want to address the underlying issues and causes that led to the development of OCD. Psychotherapy can help you explore unresolved trauma or difficult experiences in your life that may have created a basic biological patterning, with resulting tendencies towards anxiety and OCD patterns to cope.
Our naturopaths can also help recommend the right tests in order to assess contributing factors like methylation issues, deficiencies, and levels of neurotransmitters.
Exercise can change your brain patterns, triggering neurons to make new connections which can support those with OCD. Exercise releases stress-relieving endorphins.
Eating a healthy diet with foods rich in tryptophan can boost serotonin levels. Having enough sleep is also important as those who lack sleep are more likely to have repetitive negative thoughts.
- NHS, Obsessive compulsive disorder, 2023
- Hong Kong Food and Health Bureau, Mental health review report
- Faravelli C. et al. Childhood stressful events, HPA axis and anxiety disorders. World J. Psychiatry 2, 13–25 (2012)
- Weihua Y et al, Genome-wide DNA methylation analysis in obsessive-compulsive disorder patients, 2016
- International OCD Foundation, New Horizons in OCD Research and the Potential Importance of Glutamate. Can We Develop Treatments That Work Better and Faster?
- Zongfeng Z, Brain Gamma-Aminobutyric Acid (GABA) Concentration of the Prefrontal Lobe in Unmedicated Patients with Obsessive-Compulsive Disorder: A Research of Magnetic Resonance Spectroscopy, 2016
- K Star, The Mental Health Benefits of Physical Exercise, 2023