Obsessive Compulsive Disorder (OCD) and its vicious cycle

This blog entry seeks to guide our understanding on Obsessive Compulsive Disorder (OCD), the workings of the OCD vicious cycle and available treatment options for OCD.

OCD is often misperceived by members of community/public as a minor quirk and/or tendency (related to perfectionism or cleanliness) and that everyone can be “alittle OCD” at different points in life. Such misperceptions or unhelpful use of term (as an adjective) can minimise or dismiss the real pain experienced by individuals with OCD, and prevent these individuals from stepping forward for support.

It is however important to note that, in reality, OCD is a mental disorder that can be highly debilitating for the individuals experiencing it as well as their caregivers. For instance, it impairs daily living and functioning as well as adversely affects one's well-being and quality of life.

OCD is a mental health condition characterised by presence of obsessions and/or compulsions. While those diagnosed with OCD can have only obsessions or compulsions, the vast majority have both obsessions and compulsions. Although the OCD tends to be used casually in social contexts, diagnosis for this disorder needs to be done by a qualified mental health professional.

A vicious cycle is a system whereby factors within reinforce each other through a feedback loop, usually resulting in unfavourable outcome(s). And this continues in a non-stop cyclical manner, until an external factor intervenes to break the cycle.

The picture below is an OCD cycle which illustrates how OCD symptoms and factors engage with each other in a vicious loop, exemplifying the never-ending pain the individuals with OCD are typically stuck in.

For a video of this vicious cycle, do check out my reel in Instagram: https://www.instagram.com/jeanice_cheong?igsh=cmsxYXMzcmdhNjNq&utm_source=qr

This shows the OCD vicious cycle in which the factors can result in unfavourable outcomes for individuals plagued with the disorder. The snake in the picture seems to be chasing its own tail, suggesting how resource intensive and unhelpful this process is. With treatment, however, individuals can potentially free themselves from the loop and regain control of their lives.

A given situation can trigger obsessions that include intrusive and unwanted thoughts, images or impulses that come to mind involuntarily. These are accompanied by distress (combination of anxiety, guilt, uncertainty etc) and a strong urge to engage in compulsions that relieves the distress. Compulsions (whether behavioural or mental) are habits/rituals of certain actions or thinking special thoughts which reduce the distress. Compulsive behaviours, along with avoidance, typically do not work beyond short term. In other words, the compulsions do not permanently reduce the distress. While the distress gets temporary relief, they recur again depending on the next trigger, and the cycle goes on. The non-stop nature of vicious cycle effectively translates to one doing more to get rid of the distress over time. In light of significant resources (e.g. time and energy) expended by individuals to the OCD cycle, various aspects of their lives (e.g., relationships, work performance) get compromised.

Untreated OCD causes unfavourable impacts on one’s life. Research has found that on average, individuals with OCD typically wait for approximately 7 years after onset of significant OCD symptoms before they seek help. This meant that many of them suffer silently for years, possibly due to shame and/or fear of judgement associated with the OCD symptoms that plagued them. It may also be related to their sense of uncertainty about whether their OCD is treatable.

The first line of therapy that is effective for OCD is Exposure and Response Prevention (ERP; a form of cognitive behavioural therapy) which involves two components i) exposure to situations that trigger obsessions and ii) refraining oneself from engaging in avoidance and compulsions. Should individuals participate actively and collaboratively with their psychologist in ERP, it can allow them to effectively break the vicious cycle, and regain control over their lives, over time.

Before individuals embark on ERP journey, I often invite them to consider their “WHY” of seeking help/treatment.  The answer to this question can serve as motivation for individuals to sustain in the treatment journey. In addition, the willingness to tolerate distress in the short term is essential, in order to reap longer term results. In light that ERP is not a walk in the park, working with a trained psychologist who can provide close guidance and support during the journey may be essential.

In addition, antidepressant medications are the first-line medications for OCD. In fact, therapy and medication can be considered complementary in the treatment for OCD. Hence, it is common for individuals diagnosed with OCD to receive medication and therapy support, concurrently.

If you or your loved ones wish to embark on treatment for OCD, do reach out for support. And, do forward this to anyone you care about who may benefit from reading this entry.

Rooting for you always,

Jeanice