by Shaikh Shahriyar Wahab | September 3, 2008 12:30 am
SARAH is eighteen. She has had a six-month fear of contamination by dirt and ‘germs’. It all started after she watched a television programme about hepatitis and became worried that she might catch the disease. She realized that her fear was ‘over the top’, but felt unable to stop herself from taking elaborate precautions to prevent ‘contamination’.
These precautions included washing her hands at least forty times a day, bathing for three hours a night, not touching doorknobs or other objects which had been handled by other people, or only touching these items using plastic gloves or paper tissues. Any clothes that she wore were placed in a plastic bag immediately after she undressed and were not allowed to come into contact with ‘clean’ clothes.
Following assessment, and review by a Psychiatrist and after proper explanation to Sonia and her mother about behavioral treatment, Sonia agreed to start an ‘exposure programme’ at home with her mother’s assistance.
Her targets for the first week were that, with the help of her mother, she was to touch her ‘dirty clothes, systematically ‘contaminate’ all her clean clothes by touching them, and then sleep in her bed even if she did not feel perfectly clean.
The following week, Sonia returned with her mother to report on her success. To start with she had been tearful and very anxious when attempting the tasks. Her mother had firmly but kindly reminded her of the purpose of the treatment. Eventually she calmed down and agreed to touch her outside clothes, and then the outside of the wardrobe where her clean clothes were kept.
While she did this she was very shaky and tearful, but she succeeded. Once she had finished this ‘contamination’ exercise, she agreed to try to touch all her clean clothes. She was surprised to find that her anxiety reduced as she continued, although she remained concerned that her fear might escalate later. Before completing the session, Sonia volunteered to ‘contaminate’ the bedclothes of her clean bed.
She continued to make progress and reported that once she had ‘taken the plunge’ her anxiety got better. Over the next six weeks she was able to set herself more difficult targets, and managed to return to ‘normal washing’. Two months after starting treatment she was able to return to work.
Obsessive compulsive disorder:
People often talk about a friend or family member having an ‘obsession’ with football, films or a particular celebrity. In these cases, the individual enjoys the subject and spends many pleasurable hours engaged in their chosen activity. This is very different from what is meant in psychiatry by an obsession or obsessive compulsive disorder (OCD). People with OCD are tortured by worrying and frightening thoughts, and they may become very distressed.
Most of us will experience obsessions and compulsions from time to time, like worrying about whether we have switched the gas cooker off, or going back to check that we have locked the car. If you have OCD, these habits become very strong, so you feel compelled to check things or repeat actions even if that takes over your life.
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