Obsessive compulsive disorder (OCD)
Do you feel the need to check things repeatedly, perform certain routines or have uncontrollable thoughts?
In the US, 2.3% of adults suffer and 1 in 100 children. Obsessive compulsive disorder symptoms tend to develop more frequently in children that are 10–14 years of age, with males displaying symptoms at an earlier age and a more severe level than females.
With a population of 7.3 million, mental health problems are not uncommon in Hong Kong. For a high-tempo, action-packed and densely populated city like Hong Kong, the challenges we are facing are immense and multi-faceted. According to the Hong Kong Mental Morbidity Survey 2010-2013, the prevalence of common mental disorders among Chinese adults aged between 16 and 75 was 13.3%.
OCD can be distressing and significantly interfere with your life, but we can help you keep it under control. IMI offers an integrative approach, so that you can get help and advice with a range of treatments and therapies without the need for more traditional medical intervention.
OCD is a mental disorder which results in intrusive or unwanted thoughts (obsessions), along with related feelings and sensations. If you suffer from OCD, you’ll struggle to control OCD symptoms for more than a short period of time, often with compulsive behaviours. These behaviours become a disorder when the anxious obsessive thoughts and subsequent compulsive activities occur to such a degree that the person's daily life is negatively affected i.e. taking up more than an hour a day. Most adults realize that the behaviours, such as compulsive cleaning do not make sense, but to a sufferer are almost impossible to stop. Even though they give temporary relief from the obsessive thoughts, the compulsive behaviours are very distressing. Indeed, this disorder is recognised by the World Health Organization (WHO) as being one of the top ten most disabling illnesses.
OCD is often the response to a feeling of anxiety or fear. The general response humans have when something is uncomfortable is avoidance and an attempt to change the uncomfortable experience. As OCD develops, this avoidance takes the form of behaviours called compulsions, i.e. behaviours that the person feels compelled to do. These compulsions may be obvious such as repeated cleaning, or may be invisible to the human eye, e.g. repeating a phrase in their head.
Performing compulsions are thought to be a means of getting rid of these uncomfortable feelings and so OCD becomes reinforced. If a person reduces their anxiety by washing their hands after touching a “contaminated” door knob, the relief sends a false message that the door knob was harmful. The compulsive behaviour is then felt to be the thing that brings relief, and so the cycle goes round again.
OCD may show itself differently for different people. Some people may only experience obsessive thoughts, and some may then follow this with compulsive behaviours.
We all have unwanted or unpleasant thoughts at times, but in OCD sufferers these thoughts become very persistent and start to dominate our normal thinking patterns.
Some of the more common obsessive thinking in OCD are:
- fear of deliberately harming yourself or others deliberately
- fear of harming yourself or others by mistake
- fear of contamination by disease, infection or an unpleasant substance
- a need for symmetry or orderliness
Compulsive behaviour can develop as a way to try and cope with these thoughts:
- cleaning and hand washing
- checking – such as checking doors are locked or that the gas is off
- ordering and arranging
- asking for reassurance
- repeating words in your head
- thinking "neutralising" thoughts to counter the obsessive thoughts
- avoiding places and situations that could trigger obsessive thoughts
Despite a lot of research being done, there is no clear answer on the causes of OCD. The respected British mental health charity MIND says that there are three main theories:
- Biological & Genetic – A report called “Genome-wide DNA Methylation Analysis in Obsessive-Compulsive Disorder Patients” indicated Methylation issues related to genetics as well as deficiencies in methylating vitamins such as B12, folate and Inositol make a difference to the anxiety and attenuate the severity of OCD behaviours. Genetics play a role in predisposing individuals to OCD and that Methylation governing the brains neurotransmitter production can be an amplifying effect to the psychological factors. These DNA influences can be identified in a test and shortages in the methylating B vitamins can be corrected as well to create a stabilizing effect. Supporting Serotonin and GABA neurotransmitters with herbs and supplements as well as managing down the stimulating glutamate with NAC are all shown as successful strategies to stabilize the brain in an overdrive situation such as OCD.
- Personal experiences such as childhood trauma, especially emotional abuse and neglect, may also increase the risk of mood disorders. If traumatic experiences in the past mean that we often feel fear and anxiety, then we may develop strong thought patterns and behaviours to try and cope. If our parents or carers used compulsive behaviour to deal with their own anxiety, then we may learn it as a normal coping strategy.
- Dysfunctional beliefs – when particular beliefs and thoughts get “locked in” – we can feel like they are completely true and we live our lives accordingly. If the belief is frightening, it can trigger excessive anxiety and start the OCD cycle.
Our naturopaths will look to the body’s methylating capacity, ideally by assessing your DNA for understanding special methylation and nutritional needs. Brain neurotransmitter levels can be tested in a urine test, called the Organic Acids Test. Once detected any low serotonin, dopamine, or GABA can corrected with nutrition and/or herbal therapies. Also high Glutamate is another neurotransmitter finding in OCD, and again a nutritional approach is available with NAC. The goal will be to reduce the levels of anxiety so that cognitive behavioural therapy and the psychological approach can be more successful.
Exercise can change your brain patterns, it may cause the release of “growth factors,” which trigger neurons to make new connections. These new connections may help to reduce symptoms of OCD. Exercise also promotes the release of endorphins, “feel good” neurochemicals, boosting mood and fending off stress.
There are two main evidence based psychological approaches that have been shown to help. These are Cognitive Behavioural therapy and Mindfulness Based therapy. Both of these will assist you to develop a toolkit of strategies so that you feel you can become more aware of the unwanted thoughts and compulsive behaviours and develop coping mechanisms and ways to manage them.
You may also want to address the underlying issues and causes that led to the development of OCD. For this, more in-depth psychotherapy can help you to explore unresolved trauma or difficult experiences in your life that may have created a basic biological patterning, with resulting tendencies towards anxiety and OCD patterns to cope. By establishing a trusting relationship for therapeutic purposes, creates the possibility for depth healing – both for past events and present time experiences. Positive changes occur in fundamental biology, such as the creation of new neural pathways in the brain, regulation of cortisol and other hormones in response to stress, and a more resilient nervous system.
Eating foods rich in tryptophan, or the use of certain supplements and herbs can help boost serotonin levels in the body which is a mood enhancer as well as eating a nutritional balanced diet avoiding overly processed and sugared food which affect healthy neurotransmitter levels.
Having enough sleep is also important as those who lack sleep are more likely to have repetitive negative thoughts.
Homeopathy is a natural medicine approach which has many positive case reports in OCD. One of the great aspects of homeopathy is that is has some psychological benefits without the need for a talk-therapy based approach, which may be helpful for some children and adults. Homeopathy considers both the key diagnostic characteristics of the illness, and other physical symptoms that you may have, to find the “constitutional remedy” most appropriate for you.
- Faravelli C. et al. Childhood stressful events, HPA axis and anxiety disorders. World J. Psychiatry 2, 13–25 (2012).
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985637/ (about methylation)
- https://iocdf.org/expert-opinions/expert-opinion-glutamate/ (about glutamate)
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434282/ (about GABA)