The irrational urge to repeat an action could be a condition called Obsessive Compulsive Disorder, says Anima Balakrishnan

OCD cases don't come to us until they hamper the routine of daily life V. Ponni Muralidharan Lady Macbeth would have been a classic case. The ambitious wife of Shakespeare's Macbeth, who wrung the guilt off by perpetually washing her hands, must have had Obsessive Compulsive Disorder or OCD. OCD, rated by the WHO as one of the top ten debilitating diseases and prevalent in 2.5 per cent of the Indian population, is beginning to shake off its "laughing matter" tag. Of course, I poked fun at the uncle who compulsively washed his hands every time he touched the gate "some beggars might have handled." But then, the other day when I scanned my plate for unseen dirt, I too was branded an OCD case!But, what the heck! David Beckham has it. They say even Dickens and Darwin had it. Jack Nicholson tapped his feet to an Oscar with his portrayal of a writer with OCD in As Good As It Gets. And Tony Shalhoub in the tele-series The Monk combats unsolved cases as well as his obsession for order and cleanliness.

Misconceptions galore

But despite the representation in the media, that mostly draws chuckles, OCD to a large extent remains undetected as it is still shrouded in misconceptions."The OCD cases don't come to us until they hamper the routine of daily life," says V. Ponni Muralidharan, consultant psychiatrist, KG Hospital.P. N. Suresh Kumar, Director, Institute of Mental Health and Neuro Sciences, Kozhikode, is of the opinion that OCD remains an undetected problem as it is often mistaken to be a character trait.He says "OCD is the recurrent, intrusive, disturbing thought, impulse or images occurring in the patient's mind in clear consciousness without any control."The impulse could be anything. From the urge to tap the table thrice after every sentence, to placing your foot dead centre of the floor tiles, the feeling that clothes are dirty even after washing them repeatedly, the compulsive urge to check if the cooking gas is turned off or the door locked and so on and so forth to more serious obsessions."The commonest fear today is being infected by HIV," says N.S Mony, psychiatrist and points out that OCD is the fourth most common mental disorder in India.According to the doctors, OCD is caused by a chemical imbalance in the brain - the deficiency of serotonin. However, everyone with serotonin deficiency need not have OCD. But those with the deficiency are susceptible to it in the event of stress. Dr. Ponni observes that most people who create this intricate web of actions believe something may actually go wrong when this pattern is broken."Especially in children, who grow up in an overtly critical or judgemental atmosphere, these repetitive actions become a way for them to be in control," she says. Most kids tend to believe that a tragedy may befall their parents if the pattern - which may be jumping twice even as they walk or placing their foot in the middle of the square of the floor - is broken.According to Dr. Mony, while OCD traits are seen from childhood, puberty or even during the teens, it is only when the disorder has peaked five to ten years later, that the doctor is consulted."And when they come it is often the tip of the iceberg," points out Dr. Suresh. "In these cases, adjustment is a problem. Celibacy rate is high among these people as they believe the spouse will not be able to adjust to their ways," he adds.Psychiatrists have come across all kinds of cases, some of which may appear weird to lot of us. On a lighter vein Dr. Ponni notes "There was a surge in OCD cases when there was water shortage in the city. Husbands brought along wives who wasted water washing clothes all day." Then, there are those who believe their body is dirty and cannot make do even with a tank of water, or for whom a soap wouldn't last even a couple of days. These actions of cleaning or washing are often done at the cost of ignoring other important chores. OCD is also culture induced. Like the Suchibai syndrome said to be prevalent among Bengalis relating to their obsession with cleanliness.

Guilt trip

OCD also comes in the form of obsessive images or thoughts. For example, "There are patients who have the urge to use abusive words when visiting holy places," says Dr. Suresh. "And, this obsessive desire to use obscene words puts them in a position where they have to deal with the guilt," he explains. Often, the recurring thought or the images transgress into the realm of the inappropriate thereby creating guilt once again. "Since, these people are not perverts, the guilt makes it difficult for them to face people," explains Dr. Ponni.The treatment for OCD is multi-pronged. Quelling the prevalent misconception that OCD is a kind of madness, Dr. Ponni clarifies "These are neurotic people who are not mad." The treatment will involve both pharmacotherapy as well as behavioural therapy. The pharmacotherapy therapy is called Selective Serotonin Reuptake Inhibitors (SSRI) aimed at increasing the serotonin levels. And usually family therapy is also advised. "In rare cases a neuro-surgical intervention is also done," says Dr. Mony."OCD is 100 per cent controllable and the behaviour therapy has to continued," concludes Dr. Suresh.