Obsessive Compulsive Disorder: treatments for an overwhelming condition

Timothy Hillier was only seven years old when he began to obsess about his pillow and its position on his bed. Was it lying in the exact middle from the edges of the mattress? Were its corners aligned at a perfect ninety degrees? Were there creases in the pillowcase or was it totally flat?

Minor matters perhaps, but for poor young Timothy it became all-encompassing. 

He would lie awake for hours, frequently getting out of bed to check that the pillow was still lying in the correct place. He would straighten the pillowcase and measure its distance from the bed’s edge. And when he was finally satisfied he would carefully get back into bed, only to hop out again a few minutes later.

If Hillier’s pillow had been the only thing he obsessed about, his life may have been okay, but as it turned out it was merely the beginning.

“I went to a Catholic school, and I was constantly tormented with obsessive thoughts about whether or not I was sinning,” Hillier told me. “I’d spend most of the day worrying if I was going to heaven or going to go to hell.”

Other obsessions and compulsions plagued him: worrying about how much saliva should be in his mouth before he swallowed; repeating sentences in his head over and over again; as well as persistent social phobia and anxiety around his clothes.

When Hillier was in his second year of university, studying a Bachelor of Business, his life finally reached a crisis point.  

“I’d failed a subject because I couldn’t concentrate with all my distracting thoughts,” he said. “I knew I couldn’t go on like this anymore.”

His parents took him to see a GP who referred Hillier to a psychiatrist, and at the age of 20 Hillier was diagnosed with obsessive compulsive disorder (OCD).

According to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V), OCD is defined as the presence of obsessions – which are recurrent and persistent thoughts, urges or images that are unwanted and cause anxiety – and/or the presence of compulsions – which are repetitive behaviours that the individual feels driven to perform. These behaviours or mental acts are aimed at preventing anxiety; however, they are not connected in a realistic way with what they are trying to prevent, are time consuming, and can cause significant impairment in social and occupational functioning. 

SANE Australia estimates that up to two per cent of the population suffers from OCD. Most people with OCD start to show signs of it in their childhood or teenage years and it is a condition that affects both genders equally.

There are broadly four different categories into which OCD sufferers fall. These include checkers, who will make sure that something, such as locking the door or turning the stove off, is done over and over again; counters and arrangers, who are obsessed with symmetry and spend hours ordering and counting things; and doubters, who are constantly afflicted with intrusive thoughts of a violent, sexual or religious nature.

The most common group, however, are the cleaners, those whose lives are consumed by fears of dirt and germs and the subsequent cleaning rituals.

“Instead of having a shower and thinking, ‘Okay, that’s it, I’ve cleaned my body’, they have to wash their body three times, and then it becomes five times, and then it becomes ten or twenty times,” Cairns-based psychiatrist Professor Carlos Hojaij told me. “I’ve had a patient who would get so exhausted he would even sleep in the shower.”

The cause of OCD is unknown and likely multifactorial. Genetic, environmental and neurological factors may all play a role. Treatment usually involves medication or psychotherapy or a combination of both; and deep brain stimulation neurosurgery is even occasionally used in severe cases.  

Glenn Davis has been utilising psychotherapy in his role as a GP for over forty years. “Early life can be a very anxious time for children, being at the whims of their parents and the environment,” he said. “As they grow older they learn that their compulsive anxious thoughts can be relieved by ritualistic behaviour.”

Surfers Health Practice Principal Dr Mark Jeffery has a special interest in mental health care. “It’s crucial to have psychological intervention,” he said. “There’s numerous studies to support that.”

Hojaij also urges caution with a medication-first, talk-later approach. “We can only talk about treatment if you have a proper diagnosis,” he says. Although, once a diagnosis is made, selective serotonin reuptake inhibitors (SSRIs), a class of medication that helps regulate serotonin levels in the brain, can often help alleviate symptoms.  

In addition to OCD, there are an even greater number of people with obsessive compulsive personality traits that share many features of OCD, however there are also important differences. People with OCD usually have insight that their thoughts and behaviours are unreasonable; they are distressed by their actions; and they waste time on their obsessions and compulsions. Whereas those with obsessive compulsive personality traits believe that their way is the right way to do things; they are usually comforted by adhering to their own rules and routines; and they are often quite time efficient.

Perth OCD Clinic director Dr Gayle Maloney says that of the doctors and lawyers she has seen suffering from OCD, the most frequently occurring obsessions and compulsions relate to perfectionism and associated repetitive checking rituals.

“When symptoms start to impede a person’s day-to-day functioning, they may benefit from an assessment,” she told me. 

For Hillier, both medication as well as regular visits to his psychiatrist has been necessary for his OCD management.

“You’ve just got to keep on top of it,” Hillier said. “Exposing yourself, doing the right things.”

Hillier acknowledges he still has a long way to go. “I have a good job but I don’t really have the capacity to take on anything too stressful because with my OCD it does wear me down,” he said.

Despite these ongoing challenges Hillier remains upbeat. He is a SANE ambassador and runs corporate awareness workshops for companies, teaching managers how to help staff who may be struggling with OCD.

He has important advice for sufferers of OCD. “Never give up,” he said. “There is help if you look for it.”

• March 16 – 22 is Brain Awareness Week, the global campaign to raise awareness for the progress and benefits of brain research.

• The Brain Foundation is a nationally registered charity dedicated to funding much needed research into brain disorders. To celebrate its 50th year the foundation is inviting interested members of the community to hold fundraising events for them during Brain Awareness Week. Phone 1300 886 660 or visit their website for details.

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Suvi Mahonen is a Surfers Paradise-based journalist. Her work appears in The Australian, HuffPost, Mamamia and other health and lifestyle publications. Follow her on Facebook and online art-selling platform Redbubble.

Feature photo credit: Daniel Reche