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Obsessive Compulsive Disorder: Not Just About Being Neat Or Organised

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  • Balvinder Sandhu

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Obsessive Compulsive Disorder: Not Just About Being Neat Or Organised
It’s not uncommon to jokingly say to someone who’s extremely tidy that “you’re so OCD!”. However, obsessive compulsive disorder (OCD) is no laughing matter.
Evelyn Chng, 55, cares for her son, who is in his mid-20s and living with OCD. She started noticing signs when he was 15 – he became unusually indecisive and would ask her basic questions like what to eat or how to talk to friends. He started moving slower, getting lost in his thoughts and struggling with school.
At first, I brushed it off as anxiety, but after several checks and a visit to a psychiatrist, he was diagnosed with OCD,
she shares.

"His symptoms included obsessive thoughts that made it hard to make decisions and, later, compulsive behaviours like repeatedly switching lights on and off or not bathing for days."

Evelyn reveals that, after his diagnosis, he initially struggled with treatment – he didn’t want to take medication or attend therapy.

"As a family, we were divided. My husband thought we should stop him from performing his compulsions, but my son would beg us to let him continue. His younger sister had a hard time understanding why he got so much attention. I was caught in the middle and it took a toll on me emotionally and physically – I even fell into a depression, suffered panic attacks and was hospitalised."

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The "OCD capital" of the world
Dr Tay Kai Hong, consultant psychiatrist at Private Space Medical, cites the 2016 Singapore Mental Health Study (SMHS), which found that up to 3% of the Singapore resident population has some degree of OCD.
This prompted local newspapers to proclaim Singapore to be the 'OCD Capital' of the world, with rates of OCD considerably higher than other developed countries,
he adds.
Obsessive Compulsive Disorder: Not Just About Being Neat Or Organised - Siew Choo Ting, clinical psychologist, Private Space Medical
Siew Choo Ting, clinical psychologist, Private Space Medical
Credit: Private Space Medical
Siew Choo Ting, clinical psychologist at Private Space Medical, explains that the study also highlighted a significant treatment gap: on average, individuals wait 11 years before seeking professional help. This delay could be due to the stigma surrounding mental health care and a lack of awareness about the disorder.

As its name suggests, OCD is about obsessions and compulsions. Obsessions are recurrent, unwanted and intrusive thoughts that provoke a high level of anxiety in the person, says Dr Tay.

These thoughts intrude upon the sufferer’s mind multiple times a day and cause the person to engage in compulsions to relieve the associated anxiety,
he elaborates.
Compulsions are ritualised repetitive behaviours which the OCD sufferer engages in to neutralise the anxiety caused by the obsessions.
They are often recognised by the sufferer to be senseless and irrational, yet they are not completely under the person's voluntary control,
he adds.
Obsessive Compulsive Disorder: Not Just About Being Neat Or Organised - Dr Tay Kai Hong, consultant psychiatrist , Private Space Medical
Dr Tay Kai Hong, consultant psychiatrist , Private Space Medical
Credit: Private Space Medical

Dr Tay says that OCD symptoms may relate to one or more of the following themes:

  • fear of contamination and washing/cleaning behaviours
  • checking behaviour due to excessive doubt, religious or blasphemous thoughts
  • repetitive mental counting and assurance seeking
  • packing and hoarding behaviours.
There is usually an underlying core fear driving the obsessions and compulsions, such as fear of harming others or fear of being a bad person,
says Dr Tay.
OCD can cause mental distress as the person feels like he or she is compelled to do repetitive, irrational actions, which can waste a lot of time and impact the person’s ability to go about the usual routines, says Dr Tay.
It can affect concentration and work productivity. Sometimes, family members are asked to take part in the compulsive rituals. OCD can lead to strained family ties and caregiver burnout. In severe and chronic cases, it can lead to secondary depression and self-neglect.
Dr Ho Zhen Chong, consultant, Institute of Mental Health (IMH), National Healthcare Group (NHG), says the SMHS 2016 also revealed that people with OCD also had a higher likelihood of having other mental disorders such as generalised anxiety disorder, major depressive disorder, bipolar disorder or alcohol abuse. Persons with OCD also had a higher risk of having suicidality or suicidal ideation.
Treatment options for OCD
Treatment options for OCD include either psychological therapy, medication or a combination of both, depending on the severity of the OCD and the patient’s preference.
Obsessive Compulsive Disorder: Not Just About Being Neat Or Organised - Dr Ho Zhen Chong
Dr Ho Zhen Chong, consultant, Institute of Mental Health (IMH), National Healthcare Group (NHG)
Credit: Institute of Mental Health (IMH)
Psychological therapy – also known as psychotherapy – is in the form of cognitive behavioural therapy (CBT), including exposure and response prevention (ERP),
says Dr Ho.

"The person is encouraged to deliberately expose themselves to the obsessional cues and to refrain from engaging in the associated compulsion or ritual. Extinction of the distress is achieved after consistently learning to approach the triggers (exposure) without performing the rituals (response prevention)."

Medication is usually in the form of selective serotonin reuptake inhibitors (SSRIs) and needs to be taken regularly to be effective. They can also be helpful if a patient also has another mental illness, such as major depressive disorder. Other medications may also be prescribed based on the doctor’s assessment.
In some cases where patients do not respond well to medications or psychotherapy, or who are unable to tolerate medications, brain stimulation techniques in the form of transcranial magnetic stimulation (TMS) may be used as an adjunctive treatment of OCD,
says Dr Ho.

"TMS is a non-invasive medical procedure that relies on the generation of brief magnetic fields to generate a weak electrical current in the brain, that briefly activates neural circuits at the stimulation site."

Showing compassion and setting boundaries
If you’re looking to support a loved one with OCD, Dr Ho recommends encouraging them to seek help and to continue treatment. Also, learn more about the condition so you can better understand what your loved one is experiencing.
You can learn about OCD by reading online articles (such as on HealthHub), reading books, listening to podcasts by mental health experts or attending talks and courses, such as those by Caregivers Alliance Limited (CAL),
he adds.

You should also show compassion to your loved one. Family members of a person with OCD may experience distress, frustration, anger and other emotions because of the person’s behaviours.

Though it can be frustrating, it is important not to have a rejecting attitude towards the patient or to be harsh with them, as the patients are not in full control of their symptoms,
says Dr Ho.

"Even when patients are on treatment, be patient with them, as they can improve at different rates."

Obsessive Compulsive Disorder: Not Just About Being Neat Or Organised - Evelyn Chng
Evelyn Chng, mother of a son with OCD.
Credit: Caregivers Alliance Limited
Evelyn, the caregiver for a son with OCD, is also head of CREST at CAL. She attended CAL’s Caregivers-to-Caregivers (C2C) training programme in 2015, found help, hope and friendship, and decided to volunteer with CAL, first becoming a volunteer trainer and eventually a permanent staff member in 2016. She supports her son by helping him manage his daily routine, making sure he takes his medication and encouraging him to be independent.
In the beginning, I was with him almost all the time, helping with his rituals and guiding him through each day,
she recalls.

"But over time, I realised the importance of setting boundaries – for his growth and my own well-being. Now, I support him emotionally, give him space to manage on his own and step in only when necessary."

Evelyn admits that looking after her son has “been a tough journey” and wants everyone to know that OCD is a serious mental health condition that can deeply affect someone’s ability to function.
People with OCD aren't doing these things for fun or attention,
she says.

"The compulsions come from a place of anxiety, and it takes a lot of strength for them to even get through a day. With the right support and understanding, recovery is possible. Education and empathy make a huge difference."

Being a caregiver taught me that love isn’t about doing everything for someone – it's about giving them the strength to do it themselves,
she adds.
Myths about Obsessive Compulsive Disorder (OCD)
OCD is an often misunderstood condition. Here are some common myths about this invisible disability.
Myth 1: OCD is just about being neat or clean
Reality: While some individuals with OCD may engage in cleaning rituals due to fears of contamination, the disorder is much more complex.
Myth 2: OCD always manifests the same way
Reality: OCD is highly individualised and often evolves over time, adapting to what is significant in an individual’s life at that moment. For example, an adolescent may initially experience OCD through repetitive prayers to protect family members, which could later shift to obsessive cleaning once they become parents, driven by fears of harm befalling their child.
Myth 3: Everyone is a little bit OCD
Reality: Many people mistakenly equate OCD with harmless quirks, like being overly perfectionistic. However, OCD is a serious mental health disorder that can severely disrupt daily life, relationships and work.
Myth 4: People with OCD can just ‘snap out of it’ because they know it’s irrational
Reality: While individuals with OCD often recognise that their obsessions and compulsions are irrational, the anxiety they generate can be overwhelming, making it difficult to stop engaging in these behaviours.
Myth 5: Providing reassurance is helpful to someone with OCD
Reality: While reassurance-seeking is a common human tendency, for those with OCD, it becomes a compulsive behaviour. Though reassurance may provide short-term relief, it only temporarily alleviates the doubts or insecurities associated with obsessive thoughts. Over time, this behaviour becomes a cycle and the obsessions resurface, prompting the individual to seek reassurance again, reinforcing the cycle.
Information provided by Siew Choo Ting, clinical psychologist, Private Space Medical

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Balvinder Sandhu

Balvinder Sandhu

A published author who lives in Melbourne but stays in touch with her Singapore roots and way of life.

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