What happens when a simple act of handwashing becomes an obsession? One mum tells EVELINE GAN how OCD turned her nine-year-old into a nervous wreck.
<b>PHOTOGRAPHY</b> ZAPHS ZHANG <b>ART DIRECTION & STYLING</b> LOY SZE JIN.
While most parents drill handwashing into their kids as part of their personal-hygiene routine, 41-year-old part-time lecturer Joyce Koh (not her real name) did everything she could to break her kid’s squeaky clean habits.
“As part of basic hygiene, we taught our daughter to wash her hands before eating from a young age. But towards the end of her Primary 3 school year, we noticed she became utterly obsessed about it,” says Joyce.
Later diagnosed with obsessive compulsive disorder (OCD), Cheryl was left with dry, cracked skin due to her elaborate handwashing rituals.
“After visiting the toilet, she would wash her hands very thoroughly about four to five times. It got to the point where her skin was so dry it would flake,” Joyce recalls.
A type of anxiety disorder marked by obsessive and compulsive thoughts and behaviour, OCD was brought into the spotlight last year after a housewife suffering from the condition was convicted of starving her Filipino domestic helper.
It is one of the top three most common mental health disorders in Singapore, according to a Singapore Mental Health Study conducted by Institute of Mental Health (IMH) in 2010.
Only nine years old when she was diagnosed in 2014, Cheryl was one of the youngest patients undergoing treatment for OCD at IMH at the time. She turns 12 this year.
The IMH Child Guidance Clinic runs an OCD programme for children and teens up to 19 years old with moderate to severe forms of the disorder. Each year, it sees between 100 and 200 kids and teens with the condition.
“It feels right”
When OCD strikes in childhood, the symptoms can distressing for both the child and her parents.
Haanusia Prithivi Raj, senior clinical psychologist at IMH’s department of child and adolescent psychiatry, says when children are troubled by OCD, they can experience “very high levels of anxiety and distress”.
Their compulsive rituals may also affect their everyday routines as they take up a lot of their time, she adds.
Yet, such kids cannot understand why they are behaving so compulsively.
“In many cases, their explanation (for their behaviour) is that it just ‘feels right’, which can be frustrating for parents,” says Dr Adrian Loh, visiting consultant at IMH’s department of child and adolescent psychiatry.
When told to stop washing her hands, Cheryl’s hygiene rituals manifested as other quirks. She would check her belongings over and over again. The thought that she might have overlooked something turned her into a nervous wreck.
“Like the handwashing, the checking and re-checking became a ritual. Once, after a friend’s party, she anxiously told me she wasn’t sure if she had brought all her things home and kept going through her belongings.
“Within a span of about half an hour, she asked and repeated the same thing eight times!” Joyce says.
Psychology experts still do not know why some kids develop such obsessive thoughts and compulsive behaviour.
Haanusia says it could be due to genes, stress or even the child’s personality – those with an anxious character run a higher risk of developing anxiety disorders.
Some studies also link OCD to low levels of serotonin, a brain chemical believed to be important in regulating mood, attention and behaviour, she adds.
Fixing the problem, fast As her only child’s anxiety and bizarre behaviour escalated, Joyce knew she had to seek help. A child psychologist confirmed her suspicion that Cheryl had OCD, and the problem had to be tackled promptly before it spiralled out of control.
Studies show the sooner OCD is treated, the better treatment results are likely to be. Haanusia stresses the importance of seeking professional help and following through with treatment.
“While most OCD cases in kids and teens are straightforward, they may sometimes be a harbingers of other mentalhealth conditions, such as schizophrenia and mood disorders,” she explains.
Cheryl underwent cognitive behavioural therapy (CBT), which helped her to recognise and change her distressing thoughts and behaviour. OCD patients on the therapy programme are usually deliberately exposed to triggers that normally upset them.
For instance, during Cheryl’s therapy sessions, she was asked to do things she normally avoided, such as touching a toilet bowl.
The aim was to gradually reduce her level of anxiety towards triggers over time.
Cheryl struggled with the initial weekly therapy sessions, which spanned around four months.
“She was quite resistant to the therapy at first. It took her so much effort to overcome her own irrational feelings but, over time, she realised that touching the toilet bowl doesn’t actually hurt her,” says Joyce.
There are also drugs available for people suffering from moderate to severe OCD, but Joyce was not keen to medicate Cheryl after learning they might cause side effects which affect attention and focus.
Family support To help her daughter, Joyce also involved other family members, including her mother-in-law, in the recovery process.
“Being a doting grandma, she would pick up or clean up after her granddaughter whenever she complained that something was dirty. We explained that those were symptoms of OCD, and taught her how to respond to her appropriately,” says Joyce.
With early treatment and support, the elaborate rituals no longer take centre stage in Cheryl’s life.
“She still checks her things at least once but that is reasonable. Recently, we’ve even managed to trash two big garbage bags full of her old belongings. That is a big achievement for her as she also used to hoard everything, from T-shirt tags to clothes and souvenirs,” Joyce says.
Looking back, she thinks the stress Cheryl went through while preparing for her Primary 3 year-end examinations might have triggered the OCD symptoms.
“Now, we try not to cram her revision so intensively. I think spreading out her revision timetable works because she hasn’t suffered any relapses.”
Having gone through this challenging journey with her daughter, Joyce says parents need to be aware that a child with OCD isn’t behaving badly or being disobedient intentionally.
“Children with OCD can’t control their feelings and behaviour. Most importantly, both the parents and child need to communicate openly with each other instead of sweeping the problem aside,” she says.