Again and again and again;Mind amp; body

3rd April 1998 at 01:00
Do you keep checking that you've remembered your keys? Worry that you left the oven on?

Fret over whether those homework marks add up? Well, that's normal. But anything worse, and you could be among the one million UK sufferers of Obsessive Compulsive Disorder. Lynne Wallis discovers how to fight it

Most of us have at some time carried out tasks in an obsessive or compulsive way -shifting ornaments or ceaselessly plumping up cushions.

That doesn't mean we suffer from Obsessive Compulsive Disorder (OCD), yet it is the fourth most common psychological problem in Britain - after depression, addictions and simple phobias. More than one million people are thought to suffer OCD in the form of recurrent thoughts or ideas that are senseless or repugnant but which the sufferer is unable to suppress or ignore, and repetitive actions he or she is driven to perform.

In As Good As It Gets, Jack Nicholson plays a vitriolic, inflexible novelist who suffers contamination phobia, the commonest form of OCD among adults. The part won him an Oscar last week and the film is helping raise awareness about this little-understood condition in much the same way Rain Man did autism.

There is no consensus on what causes OCD, although it is generally classified as an anxiety disorder. Recent research suggests it may be caused by a chemical imbalance in the brain, or even brain injury or infection. It has also been linked to stress, and teachers who suffer are often forced to change their jobs. OCD specialist Dr Frank Tallis says:

"Although there is nothing to suggest OCD is more common among teachers, it's certainly linked to anxiety and having an elevated sense of responsibility. Two-thirds of sufferers can identify a precipitant - for example, a period of depression or stress, and those with perfectionist tendencies are the most likely candidates."

Yet the biggest problems surrounding the disorder are ignorance and misunderstanding. Dr Tallis says: "It has nothing to do with insanity. The majority of sufferers retain an insight, although they feel simultaneously that they have to do these things. It's a bit like having an internal dictator."

Charlie Singh was a physics teacher during the 1970s and 80s. He was forced to resign from two posts because of OCD. When he first started teaching he had a fear of contamination and his complex morning cleaning rituals often made him late. "I wore a turban then and had long hair, so it took me ages to get ready because I was so fastidious. There were other problems - marking that should have taken an hour or so took seven hours because I'd have to keep going back to check the additions and percentages. One thing that was guaranteed was that everyone got a fair mark! But I had no social life and was permanently tired, and doing the end-of-year reports were awful."

Charlie took another job at a multicultural centre where there was no formal marking. Although his work had suffered from OCD, there were occasional benefits. "Sufferers usually have a good eye for detail, which means organising conferences and seminars is a doddle. But it's small recompense. OCD uses up so much energy. It's exhausting."

Although Charlie was informally offered a deputy headship, he chose to retire early to work from home and is now using cognitive therapy to control his OCD.

Margaret Kane left teaching to become the co-ordinator of a local group called Triumph Over Phobia, helping those with OCD to understand it and cope better. She first sought help at London's Maudsley Hospital 10 years ago after 30 years of taking continual baths and obsessive washing of clothes, furniture and even money. Eventually her therapist told her to "contaminate" herself by touching something she considered dirty. It worked. Now she can shower in five minutes instead of the three baths she used to convince herself were needed to get really clean.

Margaret's former colleagues were unaware of her disorder and saw her as a lively person without a care in the world, while her terror of germs raged on. She says: "You have to learn to live with the anxiety - learn to realise it will gradually subside, giving you control."

There is still very little awareness of OCD and many sufferers don't know they have it until, like Margaret, they are spurred into seeking help after seeing a television programme on OCD or reading an article in a newspaper.

Other common forms include obsessive checking, where it can take hours to leave home because of repeated checking of locks, ovens, plugs and sockets. This is also known as "pathological doubting". Others, including Woody Allen, suffer from "ruminating thoughts", where a fearful or anxious thought enters the head and goes round and round, creating inner torment.

Some sufferers have a fear of causing accidents and constantly retrace their steps to ensure they have not left anything behind that can cause damage. Others hoard to the point where they cannot even throw out old newspapers. Actor Harrison Ford has reported OCD symptons related to order and symmetry, and actress Jodie Foster allegedly has contamination fear.

One sufferer, a former maths teacher, left teaching in the late 1980s. Alongside obsessive checking rituals, she also has trichtillomania, which means she pulls her hair out in clumps. She was taunted in the classroom for her baldness, and her checking rituals often made her late. "All of this meant my esteem was terribly low and parents' evening used to put the fear of God in me. I used to have ruminating thoughts about the headmaster, who was rather aggressive."

She also had a fear of instructions and was often unable to understand them. When GCSEs replaced O-levels, her life became unbearable. "I got heart palpitations and tremors but I didn't dare tell anyone."

She claims to have cured herself of OCD by exploring the damage she feels she suffered as a child when she went to a convent run by cruel and overly-strict nuns. "I'm sure my fear of instructions links back to my past," she says.

Today she can leave the house in under 10 minutes instead of two hours.

Triumph Over Phobia's helpline: 01225 330353

Confronting your fears

A combination of cognitive behavioural therapy and medication is generally accepted as the most effective way to treat OCD

* Cognitive behavioural therapy encourages the sufferer to confront the fear behind the behaviour- for example, by throwing away something they previously hoarded. Gradually the anxiety connected to the rumination behaviour decreases.

* The medications used for OCD are well-known anti-depressants although they have a specific anti-obsessional effect. They are mainly SSRIs (Selective Serotonin Reuptake Inhibitors) and are effective in short and long-term treatments.

* A registered charity called Obsessive Action publishes a newsletter four times a year, and provides other information about Obsessive Compulsive Disorder, including lists of help groups around the country. Tel: 0181 991 9585 * Books and self-help manuals include: Understanding Obsessions and Compulsions by Frank Tallis Sheldon Press, 1992 Obsessive Compulsive Disorder: The Facts by Pedmal de Silva and Stanley Rachman OUP, 1992 How to Stop Worrying by Frank Tallis Sheldon Press The Boy Who Couldn't Stop Washing by Judith Rapaport, Collins Living With Fear by Isaac Marks, McGraw Hill

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