Category Archives: Obsession & Compulsion

Has OCD started as an Evolutionary Advantage?

It is kind of obvious that it is?

Checking is good, double-checking is good, tidying up is good, washing is good, trying to be perfect is good, counting is good, being attentive is good, thinking thoroughly is good, requiring precision is good, getting reassurance is good … …

From the evoluntionary perspective, are people who are attentive, careful, clean, thoughtful (etc) more likely to survive? Obviously, yes? It’s very much needed in ancient societies, as survival skills.

How if these careful people get married and have children? Do they produce even more “careful” children? And then next generation, and next, and next…

And it’s not just the genes from both lines of the “careful” ancestors, but also the upbringing environments provided by these attentive parents, they certainly continue to reinforce such behaviour… We were taught many of these acts as children, by our parents, older siblings and teachers in the school, weren’t we?

Then as the behaviour continues to be reinforced and developed and advanced… there you go, OCD? (This is just a hypothesis)

It’s just my random thought… But we are surely seeing more and more OCD clients in our clinic these days. Not just that, it’s got harder and harder to treat as well (the illness has got more stubborn and sticky).

Imagine that this theory is somewhat 70% true (another 30% of factors that’s beyond the knowledge of this psychologist in the modern days), OCD is going to get stronger and stronger, right? It can become a real big (detrimental) issue, especially in Asian culture…

What can we do? How do you bring up a child that strive to be better and better, but not aiming to be 100% certain for everything s/he does?

OCD – A Devised Theater Piece

Tap. One two three four five six seven eight nine ten.
Tap. One two three four five six seven eight nine ten.
Goodnight Papa. Papa goodnight. Papa goodnight. Goodnight Papa.
Papa goodnight. Goodnight Papa. Goodnight Papa. Papa goodnight.

No, no, no. Not right! Mama is going to die. Mama is going to die.
Again, Again, Again. From the start.

I went to see a performance on OCD last night. It was great, filled with tears and laughter, anxiety and tension, very much. I can’t help thinking about many OCD clients I have seen in my clinical work, especially those that I’m still seeing this week, and some earlier on. They are living in this every, single, day, and, night.

The actors have done very well, sharply and vividly demonstrated the intense emotion felt by OCD sufferers. I highly recommend anyone who doesn’t really understand OCD to see it, especially those who think “I’m just a bit OCD” to see it. Check if the tickets are available here.

Before I went, I even thought about inviting my clients to see it. Now I’m really wondering for those who have been suffering from it for more than 5-6 years, how they would feel when they see this…

A few things that I want to point out regarding OCD, which are nicely and clearly presented in this performance…

  • It is always about “making sure”. They can’t tolerate uncertainty. Yet in this world, there is no such thing as 100% sure.
  • It’s always about “feeling right”. The comfortable, right feeling is what they are seeking. They can’t tolerate discomfort, that leads to anxiety and fear, so much anxiety and fear that are unbearable.
  • Quite often the sufferers find their own thought (obsession) and behaviour (compulsion) are ridiculous too, but they still can’t help it. It’s not about reasoning on an intellectual level, but it’s the psychological and emotion impacts on them.
  • It can be highly disrupting to the sufferer’s life, and more, to their immediate family.

Things that I want to add…

  • The best psychological intervention is “Exposure Response Prevention” (it’s a very straightforward treatment, refer here)
  • But before the treatment begins, a lot of preparation has to be done, being motivated enough to tolerate the discomfort when one is not allowed to perform the rituals.
  • Seek help as soon as you can. Many patients that we see, came to us around 3-5 years after some initial signs showed. By the time they were here, the disorder is rather aggressive and disabling, and surely, difficult to treat.
  • If you can overcome your longstanding OCD, you can overcome anything. This is what I think. And I sincerely believe it.

Peeping Tom on social medias

No matter how much we study, learn, read, practice (see clients), we barely feel what we learnt is enough. As the world advances, as new technology becomes common, new psychological problems appear too.

They were married last year after being in courtship for 5 years. It all seems fine, their marriage, their relationships, their marriage, their families, their sex lives. Until half a year ago, she realised that her husband was peeping the lady living next door, a married woman with two children. The husband would use every opportunity to peek at her, apparently after understanding her routine, like when she’d be hanging clothes at the balcony, when she’d leave home for work etc. Sometimes they are having meals, the husband notices the timing that the neighbour is coming home, he’d go upstairs to peek. This is his current status.

Previously he has been peeping her on social medias. He searched for her and followed her online, few times a day, he would visit her page just to look at her posts and activities. She is not the only target, according to the wife, he also peeks at a few other women, all beautiful ladies, including the wife’s colleague, a lady that works in the same building with him, . He doesn’t chat with them, but only “watching” them online, few times a day.

Initially he denied it when the wife confronted him. But when all the evidence is showing up, he admitted that he has always had this fetish, for a long time, before they even met each other. But he said he loves her, he only peek at them, he doesn’t and wouldn’t do anything else. He promised to change, but was soon caught by wife to be doing it again, and again.

The wife is confused. What problem does he have? Personality problems? A hidden bad habit? Psychological disorders? OCD? Sexual disorder? She searched through the internet trying to figure it out. But there laid no answer.

Indeed, it surely is an unhealthy behaviour peeping into other’s lives (through social medias) few times a day, every day. So undeniably it’s a psychology disorder, one that’s appearing following technology advancement, as when facebook wasn’t available we can’t peep into one’s life the way we do now on facebook, instagram, twitter etc, right?

The closest I can get to, is Obsessive Compulsive Disorder (OCD). There is certainly compulsive behaviour that he does, though we don’t know the obsessive thought underlying these behaviour/rituals based on the wife’s description. It also does seem that, like many other OCDs, that the problem is worsening.

How does this differ from “traditional” peeping tom / voyeurism? Are they under the same category? Does doing it digitally or online make it less severe and obstructive? Should the treatment differ? How about digital or porn addiction? Aren’t they similar in some ways too?

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, motivation building and mindfulness 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!