OCD: When Heart and Mind are not Functioning as One

Have you ever have a feeling that you need to go and check the car, strong urge that it wasn't lock, only to find out later that it already was?

What about waking up in the middle of the night, fearing that you didn't shut the gas stove properly, and the thoughts keep on haunting you until you need to go and check it?

What about having all this symptoms, but en core over and over again, say, 10 times until you exhaust yourself? This is what an Obsessive-Compulsive Disorder person is going through.

Let me share a story:

Mr. Garry, 38 year old gentleman, assistant research personnel in a well known company, married for 15 years with 2 children. Since his teenager years, he started to experience excessive worrying whenever he is stressed out or under pressure. At times, the symptoms worsen until he felt like ' going to die'. With the attack, he heart beats faster, and he feels suffocated, out of breath as well. He tends to avoid crowded places whenever possible and seldom like to adress in front of his colleague. He is afraid of 'losing control of himself'. Generally speaking, his functions deteriorate with the symptoms. He smoked cannabis in the teenagers years but denied sharing habit now.

This persist until 8 years ago, his wife noted he starts to act strange. He would drive his wife to school everyday, but halfway through the journey, he would turn back to go and check the door again. This does not happen only once, but up to 7 to 8 times in a day. Halfway though work, he also can't fight the urge to go back and check on every electrical switch and gas stove. Subsequently, his wife is always late to school; the employer in his company aren't too happy for his absence from work. Despite knowing that the door is lock, there is repeated intrusive thoughts of not locking the door and internal urge to go and check again. This problem has worsen the relationship between he and his wife.

His problem came to medical attention when he went for a general practitioner, who subsequently referred him to a psychiatrist. Proper assessment of his problem was done and a diagnosis of OCD was made. He was given medications and behaviour therapy. His symptoms improved but there is still some degree of checking behaviour. So he device a method: using his phone, he took photos of the lock, the electrical switches and gas stove before he left. Whenever the thoughts came back, he would just check at the photos. Brilliant!

There are a few types of obsessional behaviours.

Obsessional (O.) thoughts is the repeated thoughts that intrudes the patient and patient will try to exclude them, labeling them as unreal. This differs from delusions, where patient entertains the thoughts and believe them as real. Furthermore, you can't change their false beliefs.

O. images are intrusive pictures, usually obscene and related to abnormal sex practices.

O. rumination is the internal debates that keeps on going on and on.

O. doubts is where patient have repeated doubts on locking the door or turning off the tap.

O. impulses is a form of urge to perform a violent act.

O. rituals are repeated senseless activity.

O. phobias is fear that one would loss control and harm someone else.

O. slowness is the recurrent thought that eventually leads to the slowness of the person.

The aetiology is believed to arise from genetic factor, organic factors and early childhood experience. Family members with history of OCD running among the members will have higher risk of getting OCD. Organic factors refers to lesion of the brain, medication or drugs used. and early experience that shape a person's personality is thought to be important to the development of OCD.

Treatment is by avoiding the rituals, medications and behaviour therapy. This disease is usually recurrent and requires long term treatment.