Beyond quirks: A deep dive into obsessive-compulsive disorder and how to find help

Rajesh (name changed), a 28-year-old software engineer in Bengaluru, awakens to an unrelenting fear that he has left the gas stove on, and checks it multiple times before leaving home. This doubt spirals into hours of repetitive verification, turning back midway to work, calling his neighbour to confirm, and mentally replaying his actions. At the office, intrusive thoughts about contaminating his colleagues with germs compel him to wash his hands excessively, leading to raw, bleeding skin. These rituals consume his day, straining his relationships and diminishing his productivity. Rajesh knows his fears are irrational, yet the anxiety they provoke feels insurmountable. This vignette illustrates the profound disruption caused by Obsessive-Compulsive Disorder (OCD), a condition that affects millions worldwide, including in India.

Obsessive-Compulsive Disorder is a chronic mental health condition characterised by persistent, unwanted thoughts or images (obsessions) and repetitive behaviours or mental acts (compulsions) that individuals feel driven to perform in response to these obsessions. These symptoms often interfere significantly with daily functioning, causing distress and impairment in social, occupational, or other areas of life. 

OCD is not merely a quirk or a preference for orderliness; it is a clinical disorder rooted in the brain's circuitry, particularly involving areas responsible for habit formation and fear response. While the exact cause remains multifaceted, involving genetic, environmental, and neurochemical factors, OCD is a treatable illness. Obsessions are recurrent and intrusive, while compulsions aim to neutralise the anxiety they generate, though they provide only temporary relief.

Prevalence

Globally, OCD affects approximately 2-3% of the population over a lifetime, making it one of the more common anxiety-related disorders. However, in India, the data suggest a somewhat lower prevalence, though underreporting and diagnostic challenges may influence these figures. 

A study conducted in the early 2000s found a lifetime prevalence of 0.6% in the general Indian population, which is notably lower than Western estimates. More recent insights from the National Mental Health Survey (NMHS) of 2015-2016 corroborate this, indicating that about 0.6% of Indians experience some form of OCD. However, 0.6% of India's population translates to approximately 88 lakh people having experienced or living with OCD. 

Among adolescents, a prevalence of 0.8% has been reported in school-going populations. Higher rates are observed in specific groups, such as medical students, where prevalence is much higher, likely due to heightened stress and academic pressures.

These statistics underscore the need for greater awareness in India, where cultural stigma and limited access to mental health services often delay diagnosis.

Clinical features

The hallmark of OCD lies in its dual components: obsessions and compulsions. Obsessions are recurrent, distressing, intrusive thoughts, images, or urges that recur despite efforts to suppress them. Common themes include fears of contamination (e.g., germs or dirt), doubts about safety (e.g., whether doors are locked), aggressive or taboo impulses (e.g., harming others), and a need for symmetry or exactness.

These are not mere worries but provoke intense anxiety, often leading to a sense of impending doom. Compulsions, in turn, are ritualistic behaviours or mental acts performed to alleviate this anxiety. Examples include excessive handwashing, repeated checking (e.g., appliances or locks), counting, arranging objects in a specific order, or silently repeating phrases.

While these actions provide fleeting relief, they reinforce the cycle, consuming hours daily and exacerbating isolation. Symptoms typically emerge in adolescence or early adulthood, though they can appear in childhood. In India, cultural factors may shape manifestations, such as religious obsessions involving purity rituals, which can be mistaken for devout practices.

Dignostic assessment 

Accurate diagnosis is crucial for effective intervention. Psychiatrists employ structured tools to evaluate OCD severity and differentiate it from other similar conditions. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is the gold standard, a clinician-administered questionnaire that rates the time spent on obsessions and compulsions, their interference, distress, resistance, and control.

Co-morbidities

OCD rarely occurs in isolation; many individuals experience co-occurring conditions, complicating diagnosis and treatment. Major depressive disorder is the most prevalent, often arising from the chronic stress of OCD symptoms. Anxiety disorders, such as generalised anxiety disorder and social phobia, are also common. Other common comorbidities include attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, substance use disorders, and eating disorders.

In children, neurodevelopmental issues like autism spectrum disorder may overlap. These comorbidities can amplify OCD's impact, increasing suicide risk and functional impairment. In the Indian context, cultural pressures may heighten depression or anxiety, necessitating holistic assessments.

Solutions 

Effective management of OCD adopts a bio-psycho-social framework, addressing biological underpinnings, psychological patterns, and social contexts. Medications are used to reduce symptom severity. In resistant cases, augmentation with dopamine-receptor blockers (DRBs) or neuromodulation techniques like transcranial magnetic stimulation (TMS) may be considered. Intravenous ketamine infusion is emerging as a novel treatment modality for resistant OCD.

Psychologically, cognitive-behavioural therapy (CBT), particularly exposure and response prevention (ERP), is the cornerstone. ERP involves gradual exposure to feared stimuli while refraining from compulsions, helping patients habituate to anxiety. These therapies empower individuals to challenge dysfunctional beliefs.

Socially, family education and support groups play vital roles. In India, involving families can mitigate stigma, while community resources provide peer support.

Lifestyle interventions, including exercise and stress management, serve as useful adjuncts to medication and therapy. A multidisciplinary approach integrating psychiatrists, psychologists, and social workers ensures comprehensive care, but it may not be feasible in resource-limited settings.

While OCD presents formidable challenges, advances in understanding and treatment offer substantial hope. Studies indicate significant symptomatic remission rates, with many achieving full recovery or effective management through evidence-based interventions.

For individuals like Rajesh, timely help can restore autonomy and joy. With growing awareness in India, de-stigmatisation efforts, and accessible therapies, the future holds promise: with science and evidence-based interventions, it is possible to overcome OCD. 

Dr Alok Kulkarni, Senior Consultant Psychiatrist, Manas Institute of Mental Health and Neurosciences  

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.