Story by: Tan Yong En, Chia Hui Ying
Obsessive Compulsive Disorder (OCD) is a term that is often used loosely in Singapore, with many stigmatizing certain behaviours as ‘’OCD’’. However, few are aware of the true ordeal that OCD patients go through in their daily lives. To unpack some of the challenges that they face, we speak to * Miss Alice Lim(not her real name) to find out more.
Chances are, you have heard someone cracking a similar joke before: ‘’Oh, I think I may have OCD because I like to organize things in a certain way.’’
This reflects the stigma of what the public understands of this disorder.
To find out more about OCD, we spoke to Mr James Chong, 34, the co-founder cum clinical director, and senior mental health clinician with The Lion Mind. Mr Chong has had many years of experience providing clinical services for people from all walks of life such as (e.g. addiction, elderly, renal health, students, working professionals).
Together with a partner, Mr Chong founded the Lion Mind in 2018 - an organization that provides counselling and psychological services to patients with depression, anxiety and OCD , to name a few.
PUBLIC STIGMA TOWARDS OCD
“Many people are rather dismissive of OCD and certain behaviours that OCD patients exhibit. A client once shared with me that he confided in a friend, telling him that he was suffering due to OCD. In response, his friend jeered and replied that he was also suffering from it too.
This made my client feel that his feelings were trivialized. It made him feel that his OCD was actually a trivial issue, when it was in fact , interfering with his functioning ability to cope with everyday life. This can be distressing for sufferers as they may feel that no one understands the true turmoil they go through due to their mental disorder,” Mr Chong shared.
On a societal level, this can be a problem because it shows the lack of true understanding the public has towards OCD.
A LONELY BATTLE: OCD is a stigmatized mental illness, where few understand the true turmoil sufferers go through on a daily basis (PHOTO: TAN YONG EN)
OCD - ONE OF THE MOST COMMON MENTAL ILLNESSES IN SINGAPORE
Findings from the Second Singapore Mental Health Study also showed that OCD is one of the most common mental disorders in Singapore, and affects one in 28 people in their lifetime. Alice is one in 28 who suffers from OCD.
According to the Institute of Mental Health’s website, Obsessive Compulsive Disorder is categorized as compulsive behaviour that may include physical or mental acts that are repetitive and purposeful, and performed in response to an obsession. Obsessions are defined as recurrent, persistent ideas, images or impulses – while compulsions performed are an attempt to reduce the anxiety caused by the obsession.
OCD sufferers often spend hours agonizing over the smallest details to attain perfection, ruminating over imperfections and repeating certain actions (known as compulsions) over and over again. This is especially true in the case of Miss Lim, who is a graduate from a special needs school.
Miss Lim was first diagnosed with OCD in 2013 when she was 12 years old, with her predominant OCD type being Ordering and Symmetry.
“People with the order and symmetry type often arrange things in a certain order, such as symmetrically arranging shoes in a closet. They often experience extreme anxiety and discomfort that something bad would happen if anything was believed to be asymmetrical, or anything that does not line up evenly.” According to BeyondOCD.org.
Some obsessions that Miss Lim has include: an irrational fear of contamination from dirt or germs. She also performs compulsions such as counting and packing the books on her table repetitively, arranging the clothes in her closet repeatedly and cleaning obsessively.
THE START OF OCD
The first event that triggered her OCD happened in 2013 , when she was 12. At that time, Miss Lim was part of the Wushu Co-Curricular Activity (CCA) in school.
A new teacher had been assigned to become the teacher in charge of Miss Lim’s CCA. She was a very impatient teacher who expected everything to be done promptly, and in order. When Miss Lim was slow , she would repeatedly rush her. This caused Miss Lim to develop anxiety and this incident - eventually, sent her spiralling down to a point of no return.
A vicious cycle started for Miss Lim, where she started to have obsessive thoughts (repeated flashes of her teacher rushing her), which led to the need to perform compulsions(her organising certain objects in her home) to relieve her anxiety.
Mr Chong shares: “Mental issues start from daily life events, that lead up to bigger issues. For example, a non-sufferer may be tasked to do some admin entry. However out of carelessness, data might still be keyed in wrongly and this may lead to them getting scolded by their superior. The next time they are tasked to do the work, they may start to show signs of OCD, by repeatedly checking and ruminating over their work.’’
Similarly in Miss Lim’s case, a negative experience in her life led her to the pathway of developing OCD.
OCD- A VICIOUS CYCLE: OCD Sufferers are often caught in a vicious 4 way cycle, where they experience obsessive thoughts which then leads them to perform compulsions due to their anxiety. This fuels the entire OCD cycle all over again. (PHOTO : https://www.souletherapy.com/post/how-to-tell-if-you-have-ocd-and-what-to-do-about-it)
CONTRIBUTING FACTOR TO OCD
Another factor that contributed to Miss Lim’s OCD is Autism Spectrum Disorder(ASD). When she was in Primary 1 then, she had failed all her subjects in Primary School. Her parents then realized that she was not ‘’normal’’ and her mother brought her to the doctor for a check-up, where she was eventually diagnosed with Autism Spectrum Disorder.
After she was diagnosed with ASD, her parents then sent her to a special needs school for children diagnosed with autism and other developmental and neurological disorders.
According to a study done by the National Center for Biotechnology Information, individuals that were first diagnosed with neurological disorders such as ASD have a 2-fold higher risk of contracting OCD in the future.
RISING TENSION BETWEEN FAMILY MEMBERS
Taking two hours to organize her closet by refolding her clothes again and again has already become a norm for Miss Lim. However, it took some getting used to for her family members, who spent at most 15 minutes folding their laundry. Inevitably, the need to perform her compulsions has caused a rift between Miss Lim and her family.
Miss Lim’s elder sister shared:’’ I think I did feel some tension rising between myself and my sister because of her OCD. Whenever we made plans as a family to go out at a specific time, she would always not be ready by the set timing because she was arranging the clothes in her wardrobe. Sometimes, we would even have to wait two hours for her to finish folding her clothes. It frustrated me so badly.’’
OCD RELATED BEHAVIOURS
Besides the rising tension between herself and her family, Miss Lim also shares that she has had to endure quizzical looks from passersby because of her OCD.
‘’I can’t stand anything being out of place not just when I’m at home but even when I’m outside. When I go to a shop that have things that are out of place, I always make sure to arrange the products so that they are orderly put in place. There was once I got so engrossed that the store assistant actually came up to me once to prevent me from doing it.’’
Besides that, I also like to pluck my hair on my legs and hands repeatedly and sniff them. It gives me a strong sense of release when I do so because it gives me an outlet to release my anxiety.
Miss Lim’s mother, Mrs Lim shares: ‘’I always notice that Alice likes to pluck hair from her legs and hands. Whenever I see her doing that, I try to remind her that she should not do it because it’s hurting her.’’
In addition, Miss Lim is also obsessed with cleanliness, where she shares that she often cleans and scrubs surfaces such as table tops repeatedly.
ILLNESS DOES NOT DEFINE YOU: Ever since developing OCD, Miss Alice Lim has the thought that her hands are always dirty no matter how many times she washes it. This causes her hands to be dry and cracked. (PHOTO: CHIA HUI YING)
Miss Lim’s elder sister shares :’’ My sister has a habit of washing her hands after eating. Even though it might not be necessary, she gets the urge to wash her hands because she thinks that they are dirty.’’
Miss Lim shares:’’ I think that it's dirty because I feel that it might harm me. To put it simply, let’s say I blow a candle at home, and the smoke from the candle is detected by the smoke sensor. This causes the fire alarm in the building to ring. There is no actual danger here, since the cause of the fire alarm was only because of the smoke detected from the candle, and not the start of a massive fire. So, the fire alarm ringing is actually a false alarm that was triggered because of the perceived danger that was detected.
OCD works in a similar way. When intrusive thoughts come, it’s like a false fire alarm that gets triggered. When the thoughts come, it exaggerates the perceived danger that an OCD sufferer is facing, and the possibility of something bad happening if OCD sufferers don’t perform the compulsion. This compels OCD sufferers to perform their compulsions to get rid of the intolerance of anxiety. However, there is actually no genuine threat in the situation that they are facing.’’
SEEKING PROFESSIONAL HELP
To cope with her OCD, Miss Lim sees a specialist in the Child Guidance Clinic at the Health Promotion Board, where she goes through psychotherapy treatment.
She also couples this treatment with fluoxetine, an antidepressant that inhibits the uptake of serotonin by nerve cells, and helps treat patients with anxiety or OCD symptoms. So far, professional treatment has helped to stabilize Miss Lim’s condition.
When asked if psychotherapy or medication was more helpful, Mr Chong shared:’’ For mild to moderate health issues, psychotherapy would work as well as medication. Changing one’s lifestyle habits also creates a great improvement in mental health. However, for chronic mental issues that have been prevalent for a long time, psychotherapy and medication need to go hand in hand to reduce the severity of the sufferer’s condition and allow it to stabilize.’’
SELF-CARE GUIDELINE
SELF-CARE TIPS: Mr Chong recommends 3 balanced meals a day for mental health sufferers. He shares: ‘’When stressed, some clients either neglect their meals or over eat. The key here to self care is to have balanced meals at regular intervals.’’ (PHOTO : CHIA HUI YING)
To cope with problems that sufferers are facing and protect their mental health, Mr Chong recommended basic self care tips such as, eating three balanced meals a day, exercising three times a week for 30 minutes (3x30 mins) to keep the heart rate up, and getting at least eight hours of sleep at night.
He shares: ’’These things may seem very simple but you’ll be surprised. Many of my clients do not even get eight hours of sleep a day. Some of them go to bed around five to six am in the morning, which is extremely alarming. Proper self-care really goes a long way because when people are taking care of themselves, they are less likely to be susceptible to depression or mental illnesses that plague them.‘’
Another strategy that Mr Chong advised patients to do, was to focus on the present. He says: “Focus on the here and now, worrying means that you are focusing on the future. If you feel low, chances are, you are focusing on the past. Learn to appreciate the positive and good in your surroundings.’’
CARING FOR SUFFERERS WITH MENTAL ISSUES
WITHSTANDING OCD TOGETHER: A support network is essential for sufferers of mental illness. Being together doesn’t resolve everything, but at least, it helps them withstand it. (PHOTO: CHIA HUI YING)
When asked about how family members or friends could offer help to sufferers with mental issues, Mr Chong suggests that being there for them and lending a listening ear to them is key. ‘’This is a very difficult period of time and they need your support. Moral support is very essential here because most sufferers need to get through this time with a support network.
You don’t really have to say anything, simply offering them a listening ear is good enough. Instead of telling them what to do, let them tell you what they want to do. Don’t give advice to them but instead, go through with them the options that they have, and let them think for themselves how they best wish to settle an issue.’’
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