Category Archives: Obsession & Compulsion

心理问题/精神疾病病友互助小组(吉隆坡/巴生)

在国外,不管是什么疾病,互助小组(support group)都是蛮常见的,比如抗癌勇士、强迫症患者等。过去也曾有好一些病人问过我,在马来西亚有这种小组吗… 所以在这里我提出一些意见,有兴趣或有其它看法的人,欢迎联络我…

互助小组类型:

  1. 抑郁症、情绪障碍
  2. 强迫症
  3. 焦虑与焦虑相关障碍
  4. 精神分裂,妄想、幻觉相关障碍
  5. 照护者、患者家属

什么是互助小组?做些什么?

  1. 每个月或每两个星期见一次面,大约一小时
  2. 认识和你面对一样或类似问题的人
  3. 轻松讨论一些主题(由我引导)
  4. 彼此分享、鼓励、支持、学习

语言

  1. 英语
  2. 中文/广东话

地点

  1. 吉隆坡欧阳专科医疗所(Jalan Pudu)
  2. 巴生Manipal Hospital Klang (Bukit Tinggi)
  3. 巴生河流域一代的咖啡馆

必要条件:

  1. 病人的意愿(不是被逼的;愿意出席、参与、讨论、分享、聆听)
  2. 至少三人才能进行
  3. 尊重其他人、尊重隐私权(不泄露其他人的隐私)
  4. 承担费用(行政、材料、场地等)(若有)

目前这只是初始阶段,如果你有什么意见和想法、或者有兴趣参与的话,请留下联络方式,也可以电邮 hello@huibee.com 或致电/whatsapp 017-2757813

英文版本:http://huibee.com/2017/08/support-groups-in-kl-klang/

Support Groups in KL / Klang

I’ve been asked about support groups quite a few times and been thinking how I can start this. It’s definitely something very common in western countries, I’m not sure how it will work here in Malaysia. Now I’m proposing the idea here, and for anyone who reads this and is interested in any of the support groups, please get in touch, let me know what you think and how we can start this and get it going!

Support groups for:

  1. Depression or mood related problems
  2. OCD (Obsessive Compulsive Disorder)
  3. Anxiety or stress related problems
  4. Schizophrenia and psychotic related disorders
  5. Carers (immediate family etc)

What is it? How does it go? What do we do?

  1. Meet monthly or every fortnightly for an hour or so
  2. Getting to know people who share the same or similar problems
  3. Casual discussion following a theme that we set (led by me)
  4. Sharing, supporting and learning among/from each other

Languages:

  1. English
  2. Mandarin / Cantonese

Venues:

  1. Klinik Pakar Au Yong, Jln Pudu, KL
  2. Manipal Hospitals Klang
  3. Some cafes in Klang Valley?

Requirements:

  1. Patient’s willingness! (is not forced by others to join us; willingly attend, participate, share and listen to others)
  2. At least 3 to form a group
  3. To treat others with respect and maintain confidentiality
  4. To share the cost of a small administrations/materials/venue fees (if any)

These are just some ideas for now, if you have some ideas or are interested, please do leave your contacts (email or contact numbers) below or get in touch by emailing hello@huibee.com or calling/whatsapp 017-2757813

Neutral Pure-O

Most people know that Exposure Response Prevention (ERP) is the main intervention used for Obsessive Compulsive Disorder (OCD). So the rationale is pretty simple here, say we have a patient who is afraid of contamination (obsession) and wash his hands excessively (compulsion), we do some preparation work and can then start the ERP by exposing him to dirt without letting him to wash his hands (response prevention). This is normally done on a very gradual manner (with the patient’s consent and enough preparation work beforehand, so it is definitely not forcefully done to him). And of course in reality the OCD cases are barely as straightforward and simple as this, but this is the general principle.

With pure obsession, i.e. those without any compulsive behaviour, it’s all in their minds, things can get a bit harder, but still, it’s possible. Some commonly seen pure-O are (1) relationship obsessions (discussed in my blog else where as “morbid jealousy” which might or might not be the same condition), (2) sexual obsessions, (3) religious obsessions, (4) violent obsessions, (5) neutral obsessions.

So let’s take a recently seen man as an example here. It started once when he drove past a church, and somehow a sexual related thought popped out in his mind, he couldn’t bear himself having such “dirty” thought in a holy place, and since then, whenever he goes passed any holy places, he will suppress his mind from coming out with any “dirty thoughts”. And as we all know that our minds don’t work this way, the more you try to push some thoughts away, the more they bounce back and pop up.

ERP is possible for such pure-O cases. After the initial preparation work including psychoeducation and relaxation training, they are exposed to those thoughts that they have been avoiding, in those places (based on the items in the hierarchy). So it works similarly for all different types of pure obsessions, be it relationship, violent, religious or sexual (in certain cases where direct exposure is not possible, it will have to be done in imagination, and by watching videos etc).

However, how about neutral obsessions? What the patient has could be some really simple, random thoughts, which might be inconsistent, but they might be spending hours and hours thinking about these random stuff. Like a young man I saw couple months ago, who reacts to any thought his mind comes up with, e.g. “why does the universe work this way?”, “how do my ears listen and my brain comprehend what others say?” etc. I couldn’t really carry out typical ERP to him, since those are really random topics and they can be completely different every time. So I needed him to start thought defusion exercises, mindfulness meditation (then he dropped out…). I believe this is the best way for neutral pure-O, though I understand how difficult it’s to increase their motivation to keep practicing until they see the effects (did have patients in the past who were surprised by how quiet their minds can be after such exercises – and this is just a bonus, as it’s not the intention or purpose of such practices).

Do enlighten me if you have better psychological intervention for neutral pure-O. And I hope all the OCD sufferers out there will not give in to the illness!

Obsession or Psychosis?

The girl has been housebound for several months now. Though she managed to come to the clinic, but was seemingly restless and anxious, pacing the floor in the waiting area. She couldn’t see people using smartphones anywhere near her. She would think people are taking her pictures and use them for detrimental purposes. When she is in such situation, she experiences strong urges to grab the phone from others.

She does recognise those intrusive thoughts as irrational and could restrain herself from doing so. But like many other with OCD, she is staying home more and more to avoid such situations. When she first consulted a psychiatrist, it was about two years ago. She was quiet, introverted, sensitive, and repetitive in her speech, but wasn’t diagnosed as having OCD.

To really consider her current presentation, she seems to be having persecutory delusions (a common form of delusion in paranoid schizophrenia, where the person believes that ”he or she is being tormented, followed, tricked, spied on, or ridiculed.”).

So, how do you know or decide the diagnosis? Is it OCD or is it borderline psychotic of sorts?

Looking at the backgrounds, the mother who came with her said that she (the mother) has been “depressed” and taking psychiatric drugs for the past 10 years, it was mainly due to the stress caused by her daughter (only child). Though one of the mother’s symptoms, is compulsive washing(!), fear of contamination. It’s not difficult to imagine some OCD can be so severe and disabling leading to depression (the comorbidity rate is high anyway). But here through the mother at least a family history of OCD is exhibited.

In DSM-5, it is specified that OCD may be seen with: (i) good or fair insight, (ii) poor insight, or (iii) absent insight/delusional beliefs.  In all previous editions of the DSM, the criteria for the diagnosis of obsessive-compulsive disorder included the sufferer’s realization that their obsessions and compulsions are irrational or illogical. Now, absent insight/delusional beliefs can be part of an OCD diagnosis. Though we have all noticed that OCD sufferers’ levels of insight can change quickly, often depending on the circumstances and situations (e.g. the intrusive thought was felt completely real when she’s in the public noticing someone holding the phone VS when she’s at home thinking about that situation).

Some psychiatrists would prescribe both anti-depressants (serving as anti-OCD) and anti-psychotics. However, there were cases where OCD patients were first misdiagnosed as psychotic, and taking anti-psychotic very much worsened their OCD (though once they stopped the anti-psychotics and took anti-depressants at the right dosage, their OCD symptoms alleviated).

So time spent for detailed psychopathology and specific diagnosis would be of greatest importance. The presentation of suspiciousness (paranoia) as the main symptom suggested possibility of psychosis, however, the repetitive nature of the thought, which was stereotyped, causing severe distress, also the family history of OCD, pointed toward a greater possibility of obsessions. What is more difficult with this case is the absence of compulsions and reassurance seeking. And my final point, it’s not necessarily “either or”, it could be both! But still it takes much time and effort to really work that out.

接受不确定性

生活中很多人不太能接受“不确定性”(uncertainty),比如担心孩子老公的安全,担心睡不着,担心明天工作报告的表现等。很多人用担心与忧虑来应付不确定性,感觉上担心的事的不确定性在你担心后就变得比较能够预测,比较可以确定,这往往导致你继续担心与忧虑。

但是事实上,你的担心与忧虑,真的能使事情更确定更能预测吗?

挑战对不确定性的接受程度

  • 生活所有事都能肯定确定吗?有可能吗?
  • 对“确定性”的需要其实有多重要呢?有什么好处与坏处?
  • 你是否常常因为事情的不确定性而总是预测坏事会发生?这样合理吗?坏事以外的事发生的可能性不大吗?
  • 你所预测的事,发生的机率有多高呢?如果发生的机率很低,这样一直担心下去对你好吗?生活会快乐吗?
  • 你能尝试接受“不确定性”吗?能怎样做到船到桥头自然直的态度呢?
  • 问问你周围的人,他们怎么接受“不确定性”呢?

接受与警觉

当你无法忍受“不确定性”时,你都把专注力放在“未来”。现在就要学习如何活在当下,对当下警觉注意,并接受这个“不确定性” -三个步骤:

  • 警觉:清楚自己目前的思维与感受。用呼吸的步伐来让自己感受当下。当你总是想要确定性时,它给你带来了什么感受或问题?
  • 放手:放弃这个对确定性的需要,告诉自己“这不过是个需要确定性的想法,我可以放手让它走”
  • 不批判性:让想法在脑海里走过,不要批判它,或尝试改变它。然后把注意力放回当下,体验现在,注意你周围的声音,身体的感觉,或你的呼吸,或专注于你现在需要做的事。

 

N.B. 在我看来,除了广泛性焦虑症(generalised anxiety disorder, GAD),不能接受“不确定性”(就是凡事都要百分百确定,不能冒一点险)也是强迫症(obsessive compulsive disorder, OCD)的一个明显特征,只是除了在脑中担心、不断思考,强迫症患者会对不确定性做出(反复的)行为反应。

新的一年,不妨把这当成今年的目标之一,学习与练习“接受不确定性”,活得灵活自在些!

You don’t have to see the whole staircase, just take the first step.

- Martin Luther King Jr.

Trichotillomania

She started picking hair since standard 5 in primary school, and the problems got worse over the years, especially when she was under pressure. She had seen a few counsellors, also skin specialist, and was given injection on the scalp and prescribed medicine. Finally her parents decided to take her to consult psychiatrist, and within two months she got better with some SSRIs and anti-anxiety drugs. She then stopped taking the medicine. Her hair was growing again.

Few days ago the mother called up, saying her problem is back. When she was sweeping her room, she could see hair all over her bed, pillows and on the floor. The mother asked if we could provide phone counselling to help her (without using medication, as it was causing drowsiness).

This kind of request is not untypical here. Asian people (including myself) tend not to take so much western medicine, and avoid it as much as possible. I can understand that. But the girl’s trichotillomania (hair pulling) problem has a biological components.

Most mental or psychiatric illnesses have a biological component, whether it’s depression, anxiety, OCD, psychosis (obvious!) etc. Sometimes it depends on the type of illness, sometimes on the individual, sometimes it depends on which episode (which means for the same individual, she could have a biological trigger last year but this time it’s a pure psychological triggered episode), sometimes it’s a mix of both. For a person who suffers from very bad OCD, medication can probably reduce his symptoms of 30-50%, but still leaving symptoms that would still interfere with his life, so for this part he would need psychological interventions.

So I explained to the mother that she needs medication, pure counselling may relieve her symptoms to an extend, but not all of it. Because when something is wrong biologically, she would need medication to help her, whereas psychological interventions can help her to reduce her anxiety and stress, and to learn to cope with stress, mood swing, etc.

The best treatment for her would be both medication and psychological interventions, and a good combination is in fact the best and most effective treatment for a lot of people and for many mental illness and psychological problems, unfortunately nowadays this is not the kind of service provided anywhere.


拔毛癖

她从小学五年级开始拔头发,多年来问题一直恶化,特别是面对很大压力的时候。她看过几个辅导师,也见过皮肤专科,并接受头皮注射和处方药。最后,她的父母决定带她去咨询精神科医生,吃了一些SSRIs(抗抑郁)和抗焦虑药,在两个月内情况就好转了。然后她就自行停止服药,头发也慢慢长出来了。

前几天,母亲打了个电话来诊所,说她的问题又回来了。当她帮女儿打扫房间的时候,看见床上,枕头,地板上都有头发。母亲问我们是否可以提供电话咨询辅导服务来帮助她(不使用药物,因为药物使她很疲累)。

这种要求在这里绝对不是非典型的(意即典型!)。亚洲人(包括我)普遍不爱吃西药,能免则免。这点我可以理解。但这女生的拔毛癖不是简单的心理问题,她的起因含有生物因素。

大多心理和精神疾病的起因都有生物成分,无论是抑郁症,焦虑症,强迫症,精神病(显然!)等。有时它取决于疾病的类型,有时针对个人,有时取决于哪次病发(就算是同一个人,她去年发病可能是因为生物因素,但这次却是心理引起的),更多时候是两者混合。对于严重的强迫症病患,药物也许可以减轻他的症状的30-50%,但剩余的症状仍然会干扰他的生活,所以对于这部分,他需要心理治疗。

于是我向她母亲解释她需要来见医生和吃药,单纯辅导或心理治疗可以缓解她部分的症状,但不是全部。因为当头脑里的传输物质出错了,她需要药物来帮助她,而心理治疗可以减轻她的焦虑和压力,并学会应对压力和生活的变动,情绪波动等。

最好的治疗方法是结合药物+心理治疗,其实对于很多人和大部分精神疾病,结合治疗都是最好最有效的方法,可惜在现今这却不是多少地方找得到的服务。