A mental health literacy series, in collaboration with Ngee Ann Polytechnic, School of Humanities & Social Sciences
Obsessive Compulsive Disorder (OCD) is a term that everyone has heard of at least once in their life, but what is it actually? According to the American Psychiatric Association (2013), OCD is defined as having recurrent and persistent unwanted, distressing thoughts known as obsessions, which cause repetitious, ritualistic behaviors known as compulsions. These compulsions are performed with the aim of reducing the distress and anxiety that comes with obsessions or preventing the consequence of a feared event. However, these compulsions are often not connected to the fears in a realistic way or just excessive. Compulsions take up more than an hour each day and significantly impair social, occupational, and/or other important areas of functioning. For example, an OCD sufferer may have a fear of getting a serious illness from germs and feel compelled to wash their hands every time they touch a doorknob, or anything they deem as dirty. In this scenario, this could lead to skin chafing on the hands and the consumption of a lot of time, which could lead to the impairments in functioning as mentioned.
To many, the issue of OCD may seem trivial. However, the Institute of Mental Health (2018) reported that 1 in 28 people suffer from OCD, making it the third most prevalent mental health condition in Singapore. To put that into perspective, there are approximately 250,000 Singaporeans living with OCD today. With many such people, one might think that this issue is widely understood and that many OCD sufferers are actively seeking help. Unfortunately, this is not the case at all. According to the Singapore Mental Health Study (SMHS) initiated in 2016, the delay between the onset of symptoms and seeking treatment for OCD averaged at 11 years. This means that it takes just about 11 years for an OCD sufferer to successfully seek treatment for their condition. This was the longest delay observed amongst mental health disorders.
There are several reasons for this enormous delay in seeking help. The most common reason is that the patient is not convinced that they have a mental illness (OCD in this case) and of the necessity for treatment (Juckel, Kienast, Mavrogiorgou, & Siebers, 2015). Many people, even those with OCD themselves, are unaware of how serious untreated OCD can be. An interview was conducted with Ms Lynette Tan, a clinical psychologist from The Psychology Practice in Singapore. She explained that the severity of OCD is often downplayed in society. The term ‘OCD’ is frequently used in everyday conversations to describe regular, possibly slightly aberrant behaviour – and hearing this term being used so loosely can in turn diminish the gravity of being afflicted with OCD. This is highly likely one of the reasons why many people in society still do not understand the severity of the condition, and why many OCD patients take such a long time before recognising the seriousness of their issue.
Another reason for the treatment delay, as cited by majority of people with mental illness, is the fear of stigmatization and discrimination. Individuals struggling with mental issues are often afraid that their peers would look at them differently after being diagnosed with a mental condition, and these fears are valid. A survey conducted by the National Council of Social Services revealed that 6 in 10 people held the belief that mental health conditions are caused by a lack of self-discipline and willpower, while half of them believed that persons with mental health conditions should be emancipated from any form of responsibilities (Ng, 2018). This is quite possibly the reason why many with mental conditions delay treatment. The fear of being treated differently from non-mentally ill persons and not being trusted with any responsibilities can be quite demeaning.
As a result of these doubts and fears, many underestimate the effectiveness and importance of seeking therapy for their conditions leading to the long delay. For OCD, the most common type of therapy is known as Exposure and Response Prevention (ERP) therapy. With ERP therapy, OCD sufferers learn that the consequences they fear from their obsessive thoughts will not occur even if they refrain from performing compulsions. They learn how to tolerate the distress and uncertainty that comes with their thoughts, without engaging in compulsions (Hezel & Simpson, 2019). This is very important as it trains them to cope and live a regular life with the condition, which will in turn improve social, work and family functioning, as well as their overall quality of life (Abramowitz, Diefenbach, Norberg, & Tolin, 2007).Recently, Channel News Asia covered a story of a Singaporean student who was afflicted with OCD. Before his diagnosis, he was ranked among the top 10% of his cohort in secondary school. However, when he entered Polytechnic, he was made to leave after only a year due to his poor results which was caused by the onset of his OCD. The student’s severe condition then led to increased hostility and frustration amongst his family members, who were also his caregivers. Eventually, he managed to successfully cope with his symptoms after treatment, and even found a job as a peer support specialist at the Institute of Mental Health (Chandramohan, 2019). With this account, therapy can clearly help someone return to a more normal life.
With all that said, it can be seen how seeking help for OCD is essential to begin the long but worthwhile road to recovery. Even as mental health issues are being discussed more widely in recent years, there is still much stigma around the subject. Perceptions of OCD and other mental illnesses need to change, and that change needs to start now. Change begins with us. Society too needs therapy, and hopefully we can normalize mental health issues in the near future so that people will feel comfortable seeking treatment for their mental health conditions.
Shared with permission. This content was provided by Year Two Ngee Ann Polytechnic students created in consultation with The Psychology Practice. Read their previous article on depression here.