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Written By
Li Yuan Sip

OCD in Singapore: Symptoms, diagnosis, and treatment in the “OCD capital” of the world

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Table of Contents

Singapore is renowned for its cultural fusion, dazzling skyline, and relentless pursuit of excellence, but it also holds a lesser-known title: the “OCD capital of the world.” 

In 2016, the Singapore Mental Health Study (SMHS) found that OCD affects approximately 1 in 28 adults in Singapore at some point in their lifetime. This rate continues to rise, making Singapore one of the countries with the highest OCD rates in the world. 

Yet, the term “OCD” is often used casually these days, typically to describe an obsession with orderliness. But what exactly does it mean?

What is OCD?

First things first, Obsessive-Compulsive Disorder (OCD) isn’t just a quirky personality trait of the perfectionists among us. It’s a mental health condition that affects millions around the globe, involving intrusive thoughts (obsessions) and/or repetitive behaviours (compulsions) driven by fear, anxiety, disgust, and a pervasive sense of something feeling “incomplete” or “not right.”

  • Obsessions: These are intrusive and distressing thoughts, images, or urges that repeatedly enter your minds. 
  • Compulsions: Triggered by these obsessions, you engage in repetitive behaviours or mental acts to neutralise or prevent a dreaded event, even if they cannot realistically do so. 

Below is a non-exhaustive list of common themes:

ThemeExample of obsessionsExample of common compulsions
Contamination“This shop is contaminated. If I touch anything, I’ll get sick.”Excessive washing or cleaning
Harm“I know I turned off the stove. I remember it clearly. But what if I didn’t?”
Checking stove repeatedly 
Symmetry and order“If I don’t touch every third crack on the wall as I pass by, my dad will lose his job.”Touching every third crack, and going back to do it again just to be certain
Forbidden or taboo thoughts“What if I look at a child and feel aroused?”Avoiding children or attempting to “check”

Seeking reassurance that one does not feel aroused when seeing a child.
Somatic“What if my doctor missed a spot and I have a tumour after all?”Checking your entire body for lumps multiple times a day to make sure none have appeared.
Religious“What if I miss or forget to confess a sin?”Drafting long lists of potentially “wrong” or sinful behaviours

Making a new confession or praying each time you remember a new one

Do I have OCD?

Because the frequency and intensity of OCD symptoms vary among individuals, a diagnosis can only be reached if symptoms meet specific criteria, such as:

  • Causing marked anxiety or distress
  • Taking up more than an hour a day 
  • Impairing in social, occupational, or other important areas of functioning

OCD is often accompanied by one or more mental health conditions, with anxiety disorders being the most common. In fact, studies have shown that 75.8% of individuals with OCD experience one or more anxiety disorders during their lifetime. 

Mood disorders, particularly Major Depressive Disorder (MDD), also commonly co-occur with OCD. MDD often follows the development of OCD, and can exacerbate OCD symptoms and hinder recovery.

If you’ve read this far and suspect that you might have OCD, consider seeing a registered mental health professional who can assess you for OCD and any other conditions and offer the best possible course of treatment. (In Singapore, only clinical psychologists and psychiatrists can diagnose an individual with OCD, and only the latter can prescribe medication.)

Where can I get diagnosed with OCD in Singapore?

Seeking help can be incredibly empowering, as understanding your mental health is the first step to improving it. In Singapore, you can see a mental health professional within the public or private healthcare systems. 

Under the public healthcare system, you can start by visiting a polyclinic, where a General Practitioner (GP) can refer you to a specialist – a psychiatrist or clinical psychologist, in this case – at a public hospital for further assessment, diagnosis, and treatment.

Generally, seeking help within the public healthcare system is more affordable as treatment fees are subsidised. For this very reason, though, the next available appointment could be weeks or even months down the road.

If that seems too far out, fret not. Private healthcare options are also available, allowing you to bypass a GP consultation and see a specialist directly. Clinical psychologists and psychiatrists can be found in private hospitals or clinics across Singapore, often offering shorter wait times for appointments.

Intellect Clinic is one such avenue. Our clinical psychologists are qualified to evaluate you for OCD and other mental health conditions, make an official diagnosis, and work closely with you to develop a personalised, evidence-based treatment plan. Should you prefer, we can also facilitate connections with our in-house counsellors and psychotherapists, who will be with you every step of the way. Additionally, if medication is required, we can connect you with psychiatrists within our network.

When you’re ready, you can schedule an in-person appointment with us, and there’s a good chance we can see you within the week.

How is OCD diagnosed?

Getting diagnosed with OCD in Singapore typically goes like this:

1. Consultation and clinical interview

Your consultation with a psychologist or psychiatrist specialising in OCD is an opportunity to discuss your symptoms, personal history, and concerns. 

At some private practices, like Intellect Clinic, a thorough clinical interview may be conducted to gather information about the nature and severity of your obsessions and compulsions. Our mental health professionals may also inquire about your family, medical history, and psychosocial stressors (e.g., divorce, the loss of a loved one, retrenchment).

Either way, this should be a safe and supportive space for you to share as much or as little as you feel comfortable with.

2. Diagnostic instruments 

To assess OCD symptoms and how they affect your daily life, your clinician may employ standardised evaluation tools. For instance, widely used tools like the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Y-BOCS Symptom Checklist help gauge the severity of your OCD symptoms and monitor your progress throughout treatment.

Additionally, self-report measures, such as the Obsessional Compulsive Inventory – Revised (OCI-R) and Dimensional Obsessive-Compulsive Scale (DOCS), also help to gather more detailed information about the severity of behavioural and cognitive symptoms. In particular, these self-report measures focus on specific symptom dimensions, like obsessions related to contamination or compulsions involving checking behaviours, 

If you’re comfortable with it, there’s also the option for your clinician to conduct brief interviews with your family members or others close to you. This can provide valuable insight into your behaviours in various settings, ensuring a comprehensive diagnosis and tailored treatment plans.

3. Additional tests or scans 

While OCD is primarily diagnosed through clinical evaluation and the symptom criteria outlined in the DSM-5, additional tests or scans may be necessary to rule out underlying medical or neurological conditions that could be contributing to your symptoms.

For instance, your mental health professional may use neuroimaging techniques like functional magnetic resonance imaging (fMRI) or positron emission tomography (PET) scans to identify brain activity patterns linked to OCD. The insights gathered from these procedures will then be carefully reviewed and incorporated into the diagnostic process.

4. Case formulation

After a diagnostic assessment, your clinician will put together a detailed case formulation to help you understand your condition more deeply. You can think of this as a summary that explains:

  • Why your OCD symptoms might have developed (e.g. genetics, past experiences)
  • What continues to fuel them (e.g. avoidance of specific situations, unhelpful thinking styles)
  • When it is worse (e.g. being in crowded places, feeling stressed before a deadline)

Understanding the “why,” “what,” and “when” also allows your clinician to determine “how” to help you, taking into account your unique needs, strengths, and challenges. In other words, a case formulation guides the creation of a treatment plan to reduce OCD symptoms.  

Types of treatment for OCD in Singapore 

Following diagnosis, you may be prescribed medication, psychotherapy, or a combination of both. 

Medication 

Psychiatrists commonly prescribe Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclic Antidepressants (TCAs). These medications work by increasing and regulating levels of serotonin, a brain chemical that influences mood, to alleviate symptoms of OCD.

SSRIs are considered more effective than TCAs and are regarded as the first-line pharmacological treatment for OCD. Studies by Stanford Medicine have shown that SSRIs can reduce OCD symptoms by 40 to 50% over 10 to 12 weeks. Clinical trials demonstrating the efficacy of fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, and escitalopram. 

Psychotherapy 

Cognitive Behavioural Therapy (CBT) is widely regarded as the gold-standard treatment for OCD, with studies showing remission rates of 59.2% post-treatment and 57% at follow-up. As its name suggests, CBT addresses both your thoughts and actions through these evidence-based treatments:

Exposure and Response Prevention (ERP)

ERP has been shown to reduce symptoms substantially in a majority of cases, with response rates often exceeding 60% and many patients achieving clinically meaningful improvements. 

In ERP, your psychotherapist will guide you towards extended and repeated exposure to obsession cues. This exposure can take either of these forms, or both:

  • In-vivo: Actual confrontation with feared, low-risk situations 
  • Imaginal: Confronting the feared consequences in your head 

(Fun fact: Some modern clinics even use virtual reality in ERP!) 

Suppose you constantly worry about leaving the stove on and causing a fire. In ERP, you might start with a less anxiety-provoking exercise, like leaving the kitchen without checking the stove and returning to your room without checking. When you feel more confident, you might practise leaving the house altogether, or even imagining a fire starting in your kitchen. 

Understandably, some of these exercises may sound insurmountable. As you refrain from responding with compulsive behaviours, it is natural for unpleasant thoughts, emotions, and physical sensations to arise, and that’s what your psychotherapist is here for. Beyond creating a safe environment and facilitating these exercises, they will also equip you with mindfulness techniques, such as breathing and grounding exercises. Over time, ERP aims to not only reduce your levels of distress but also increase your tolerance of anxiety and discomfort.

Cognitive restructuring 

CT can enhance immediate outcomes for individuals with OCD, with studies showing up to a 50% decrease in Y-BOCS scores post-treatment. 

In CT, you will practise identifying, challenging, and testing distorted thoughts and beliefs associated with OCD. Your psychotherapist will work with you on recognising irrational and exaggerated fears, and replacing them with more balanced and realistic thinking. 

They may use techniques and tools such as:

  • Socratic questioning: Asking strategic questions designed to clarify your core beliefs and feelings
  • Thought records: Writing down obsessive thoughts and evaluating their accuracy and reliability 

Imagine you believe that skipping a specific ritual will lead to your father losing his job. In this case, your psychotherapist might prompt you to examine the series of events necessary for your father to be laid off, along with other contributing factors. This examination helps you realise that the actual probability of this happening, as well as your degree of responsibility, may be much lower than you initially thought.

Intellect Clinic – OCD treatment in Singapore

Early detection and intervention can lead to even better outcomes, so if you are struggling with symptoms of OCD, consider reaching out to a mental health professional today. Taking this step, even if it doesn’t result in a diagnosis, brings you closer to the support you need to manage your symptoms.

Our team at Intellect Clinic is here for you whenever you feel ready.

 

  

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