What is it like living with OCD?
Singapore has one of the highest obsessive-compulsive disorder (OCD) rates. What is it like to live with this mental disorder?
She was lying in bed casually surfing the Internet at 1am when she saw two ants crawling across her study desk.
Her reaction? Extreme, in the eyes of most people.
Miss Sabrina Teo jumped out of bed and woke her mother up, asking for help to clean her "dirty" table.
The 23-year-old university student then burst into tears and immediately took a taxi to her boyfriend's place to stay for the night. We corroborated this incident with her family members.
Miss Teo said: "The ants were filled with germs, and they were tracking dirt onto the table."
Every time an ant crawled on her table or cupboard, she would remove everything and start cleaning each item with wet wipes and wipe down her table. This would take about an hour.
She has an aversion to "dirtiness", which leads to strong physical reactions.
Miss Teo said: "My heart starts to beat faster, and I will start panicking, trying to clean up. It is the helplessness that makes me cry... Like if I don't get rid of the dirt, I won't know what to do about it."
Miss Teo's reactions are symptomatic of someone with an obsessive-compulsive disorder (OCD), say doctors.
People with this mental disorder feel the need to check things repeatedly, have certain thoughts repeatedly, and/or feel the need to perform certain routines over and over.
She washes her hands about five to 10 times a day to keep herself clean.
Miss Teo's eczema worsened from her frequent hand-washing and from the detergent used to clean her things.
Once, her friend picked up and used her mobile phone.
Miss Teo said: "The whole time, I kept my eyes fixed on my phone and her hands, thinking to myself, 'Please stop, please stop'."
After her friend put the phone down, she said she sneaked off to the toilet to clean her phone and phone case thoroughly with wet wipes.
"When I am outside, I avoid contact with strangers because I don't know how dirty they are.
"Some people might have spilt something on themselves or touched something dirty. I don't want them to dirty me as well.
"If I have no choice and people touch my stuff, I will clean them with wet wipes. But to avoid offending others, I do it discreetly."
Even though her cleaning habits do not bother her as she wants things to be clean and in order, she said it "annoys everyone around me as I can get quite extreme sometimes, so they might feel frustrated when I force them to do what I want".
According to a major study spearheaded by the Institute of Mental Health conducted in 2010, a staggering three per cent of Singaporeans are hit by the illness in their lifetime - one of the highest figures in the world.
That means that about one in 30 people here suffers from OCD, compared to about one in 40 in the United States.
Dr Brian Yeo, 54, consultant psychiatrist at Brian Yeo Clinic Psychiatric Consultancy,agreed that OCD is very common in Singapore.
He said: "Most OCD symptoms are actually traits of a successful person: always checking that things are done, ensuring that things are clean and making sure everything goes according to plan.
"But once it becomes excessive and extreme, it then becomes a disorder."
One of the most common signs he sees is an obsession with cleanliness.
"If you change or affect their ritual in cleaning, they will feel uncomfortable and will need to start over," he said.
One of the worst cases in his experience is a patient who would not use public toilets and refused to travel far from home in case a toilet trip was necessary,
Another patient would make her husband dip his feet in an antiseptic before stepping into the house.
Dr Yeo said most OCD patients cannot control their behaviour and would prefer not to think about it.
He added: "Most (ordinary) people don't see a problem with OCD behaviour as long as they are willing to adjust to their (OCD sufferers') lifestyle. It is only when people are unable to accommodate it, then it becomes a problem and even a danger."
Family and loved ones are often affected.
Dr Lim Boon Leng, psychiatrist at Dr BL Lim Centre for Psychological Wellness, said family members are sometimes bewildered by the behaviour of OCD patients and may be upset with them over the irrationality of their behaviour.
He said: "They may also be roped in to perform the ritualistic compulsions. For example, a child is made to wash and clean himself excessively as the mother has an obsession with contamination. This often leads to quarrels and frequent fights."
One man, who did not want to be named, said his wife insisted that he and his five-year-old son eat at a particular spot in the house. The area is thoroughly cleaned after they eat. Any deviation would create huge arguments. His wife has since sought treatment.
Miss Teo is also looking for treatment. Her family acknowledged that it is hard, but they want to support her.
Said her sister, Joanna, 19: "Sometimes it gets frustrating because we have to stand there and watch her go about her routine. It really puts our patience to the test but we've all got used to it over the years.
"Now we just let her go about doing her thing so long as it makes her comfortable and happy. We'd rather see her happily cleaning every day than seeing her get upset over a dirty table."
Miss Teo said: "I think my family gets annoyed sometimes, but they try not to show it because they love me too much. They try to keep my area clean at least so I won't be too bothered by it."
The whole time I kept my eyes fixed on my phone and her hands, thinking to myself: 'Please stop, please stop'.
- Miss Sabrina Teo, on an incident when her friend used her mobile phone
Q&A ON OCD
WHAT IS OBSESSIVE-COMPULSIVE DISORDER (OCD)?
A mental disorder where the sufferer has thoughts, feelings or fears that drive him to do something repeatedly.
WHAT ARE THE SIGNS?
The common signs are having repeated thoughts or images about many different things and performing the same rituals over and over such as excessive hand-washing, constant checking, counting behaviour and hoarding.
OCD usually begins before the age of 25 and often in childhood or adolescence.
IS IT HARMFUL?
Most people do not see OCD as a problem, as long as everyone else is willing to adjust to his or her lifestyle, said consultant psychiatrist Brian Yeo.
Once other people or family members are unable to accommodate his or her lifestyle, it becomes a problem and the patient might need treatment and professional help.
HOW TO TREAT OCD?
If you or your loved one experiences signs of OCD and it starts to negatively affect daily life, seek professional help from a psychiatrist.
Most of the time, OCD patients will undergo behavioural treatment - exposure and response prevention (ERP) - to reduce the compulsive behaviour, Dr Yeo said.
A typical course of ERP treatment lasts between 14 and 16 weeks.
Doctors may also prescribe medication. The most commonly prescribed medications for OCD are anti-anxiety medications and antidepressants.