I was seized by the stern hand of Compulsion, that dark, unseasonable Urge that impels women to clean house in the middle of the night.  ~James Thurber

The World Health Organisation (WHO) even ranks OCD as the tenth most disabling illness of any kind, in terms of lost earnings and diminished quality of life.

What is it

OCD can take many forms, but, in general, sufferers experience repetitive, intrusive and unwelcome thoughts, images, impulses and doubts which they find hard to ignore. These thoughts form the obsessional part of ‘Obsessive-Compulsive’ and they usually (but not always) cause the person to perform repetitive compulsions in a vain attempt to relieve themselves of the obsessions and neutralise the fear. Some sufferers will have the obsessions but no outward compulsions – a form of OCD often called Pure-O.

What are the Symptoms

Common obsessions include contamination and germs, causing harm to oneself or to others, upsetting sexual, violent or blasphemous thoughts, the ordering or arrangement of objects, and worries about throwing things away.
Sufferers try to fight these thoughts with mental or physical rituals, the compulsions, which involve repeatedly performing actions such as washing, cleaning, checking, counting, hoarding or partaking in endless rumination (e.g. touching a certain item of furniture before going to bed in order to ‘ward off’ a nightmare, or checking several times that the door and windows are locked before leaving the house when going on holiday). Avoidance of feared situations is also common; however, this often results in further worrying and preoccupation with the obsessional thoughts.
Most sufferers know that their thoughts and behaviour are irrational and senseless, but feel incapable of stopping them. This has a significant impact on their confidence and self-esteem and as a result, their careers, relationships and lifestyles.
To sufferers and non-sufferers alike, thoughts and fears related to OCD can seem profoundly shocking. It must be stressed, however, that they are just thoughts – not fantasies or impulses which will be acted upon.

Compulsions or compulsive acts can be defined as repetitious, purposeful actions in which the individual feels compelled to engage according to their own rules or in a stereotyped manner. Typically, the individual experiences a sense of resistance to the act but this is overridden by the strong, subjective drive to perform the action. Most often the principal aim behind the compulsive act is to generate temporary relief froExamples include mental counting, compulsive visualisation and substitution of distressing mental images or ideas with neutralising alternatives. Practical examples would be a sufferer who feels compelled to silently repeat a string of words over and over on experiencing a negative or violent thought or the need of a sufferer to transpose negative words or images which may intrude into consciousness with positive ones e.g. feeling compelled to mentally substitute the word ‘hell’ that pops up, either as a thought or as a mental visual image, with the word ‘well’.
Another obsession considered to be part of the ‘OCD spectrum’ is the inability to discard useless or worn out possessions, commonly referred to as ‘hoarding’.

How Common is it

It affects as many as three in a hundred people – from young children to older adults - regardless of gender and social or cultural background. OCD affects males as frequently as it does females, and on average begins to affect people in late adolescence for men and early twenties for women. However, it may take individuals 10-15 years or even longer to seek professional help.

What is the treatment

The treatments found to be the most effective in successfully treating OCD are anti-depressants belonging to the SSRI class for example paroxetine, fluoxetine, citalopram etc. Another option is the anti depressant Clomipramine.

Apart from medication, Cognitive-Behavioural therapy (CBT) also forms the mainstay for treatment.

Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD) is often called the 'imagined ugliness' disorder. It was formerly known as Dysmorphophobia and is an anxiety disorder whereby a person is abnormally preoccupied with an imagined or slight defect in their physical appearance.
BDD obsessions may manifest themselves as excessive, disproportionate concerns about a minor flaw, or as recurrent, anxiety-provoking thoughts about an entirely imagined defect. The obsessions are most frequently focused on the head and face, but may involve any body part. When others tell them that they look fine or that the flaw they perceive is minimal, people with BDD find it hard to believe this reassurance.The onset of BDD usually begins in adolescence up to early twenties, a time when people are generally most sensitive about their appearance. It is not unique to, although more predominant in, women, although clinic samples tend to have suggested an equal proportion of men and women. It has been noted that BDD has features that are quite similar to those of OCD. Some studies have shown that many of those with BDD also have OCD.
Common BDD obsessions involve concerns about the face, namely the nose, the hair, the skin, the eyes, the chin, or the lips. Flaws on the face or head, such as hair thinning, acne, wrinkles, scars, vascular markings, paleness or redness of the complexion or excessive hair are perceived as major concerns. Sufferers may be concerned about a lack of symmetry, or feel that something is too big or swollen or too small, or that it is out of proportion to the rest of the body. Any part of the body may however be involved in BDD including the breasts, genitals, buttocks, abdomen, hands, feet, legs, hips, overall body size, body build or muscle bulk. These concerns lead most patients to engage in compulsive behaviours, such as mirror checking, excessive grooming, and skin picking.
The behaviour of BDD sufferers will include some or all of the following:
Checking the appearance of the specific body part in mirrors.
Camouflaging the perceived defect with clothing or makeup.
Excessive grooming, by combing, shaving, removing or cutting hair, applying makeup.
Picking their skin to make it smooth.
Picking the skin around the perceived defect.
Comparing the appearance of the perceived defect with that of others.
Dieting and excessive exercise or weight lifting.
Avoiding social situations in which the perceived defect might be exposed.
Possibly seeking surgery or dermatological treatment despite being told that surgery is not required.
Sufferers of BDD may also experience periods of depression, anxiety, and even suicidal thoughts because of their preoccupation with the perceived flaw.
Although some people with this disorder manage to function well despite their distress, most find that their appearance concerns cause problems for them. They may find it hard to concentrate on their job or school work, which may suffer, and relationship problems are common. People with BDD feel very self-conscious in social situations and generally have a very poor quality of life.
There is still not a single clear cause for Body Dysmorphic Disorder, but experts believe that biological, psychological and socio-cultural factors have contributed to its emergence. Neurochemical factors, such as abnormalities in the brain chemical serotonin, may make some people more likely to express the symptoms of BDD than others. However, psychological factors such as teasing about one's appearance during childhood, families' or peers' emphasis on appearance and trauma or sexual abuse might also be risk stimuli for the expression of symptoms. Although no one treatment has been found to be effective for everyone, sometimes a combination of both CBT and medication will be required