DISEASE CONTROLS EACH DAY

By Sonja Puzic

Every morning, *Kelly takes a deep breath when she enters the subway for her 30-minute commute to Ryerson. While many people dread the thought of using public transit during the morning rush hour, this first-year fashion student thinks it may actually kill her.

Kelly, 20, seeks out the least crowded corner of the car so that she can have a good view of all the other passengers.

“That way, I know exactly who’s coughing, who just sneezed and who looks even slightly ill,” she says. “And I make sure I stay as far away from those people as possible.”

Kelly has an overwhelming fear of getting sick or catching an incurable disease while in public. She suffers from an anxiety disorder called Obsessive-Compulsive Disorder (OCD), and it has been controlling her life for more than six years. While years of therapy and family support have helped her cope with disturbing thoughts and compulsive behaviour, her simple daily routine of classes and social interaction is still a daunting task.

“It’s really hard for me to make new friends because I think that every person is a walking disease,” Kelly says. “So, instead of looking at a girl sitting next to me in class and thinking ‘She seems like a nice person,’ I look at her and think, – She could have Hepatitis C.'”

The main symptoms of OCD are recurrent obsessions or compulsions that significantly interfere with a person’s life. The symptoms must take up more than an hour a day and cause significant impairment and distress. OCD sufferers are usually aware that their thoughts and repetitive actions are excessive and unreasonable but find it almost impossible to function otherwise.

Common obsessions include fear of contamination by dirt or germs, preoccupation with exactness and order, fear of harming oneself or others, unwanted sexual thoughts or urges and preoccupation with religious symbols and worship. It is common for people to carry out a compulsion in order to reduce the anxiety they feel from an obsession. These compulsions range from excessive cleaning and washing to checking and arranging things. Some compulsions take the form of mental rituals, such as repeating a specific sentence or a prayer.

Kelly washes her hands after every class and goes through at least one bottle of hand sanitizer a day. She never uses public washrooms.

“You can’t even begin to imagine what I put my bladder through,” she says.

Kelly rarely touches a doorknob with her bare hand and when that does happen, she jokingly calls it a “breakthrough.” As soon as she comes home from school, she takes off her clothes and puts them in plastic bags. “I give my mom specific instructions on how my clothes need to be washed so I don’t have to worry that there are leftover germs on them,” she says.

Obsessive- Compulsive Disorder is not as rare as some may think. The Centre for Addiction and Mental Health (CAMH) in Toronto estimates that OCD affects about one out of every 40 adults. Approximately two-thirds of sufferers develop OCD in adolescence. The most commonly used treatment for OCD is a combination of cognitive behaviour therapy and medicines. Unfortunately, a typical delay in diagnosis can be anywhere from five to 10 years. One of the reasons why OCD is difficult to detect is its co-existence with other types of mental disorders.

“OCD is a spectrum of disorders,” said Peggy Richter, a mental health professional and one of the speakers at the Obsessive-Compulsive Disorder Network forum held at the CAMH on Nov.4. “It overlaps with other types of anxiety disorders, anorexia nervosa and depression.”

“OCD is not a lone enemy,” she says. “When you have OCD, not only are you obsessing about the most ridiculous things, but you also get severely depressed; you become antisocial and hurt people that love you the most.”

Kelly says she experienced her worst crisis during last year’s SARS outbreak in Toronto. “I literally made myself a prisoner in my home,” she says. “I refused to even step out into the hallway of our apartment building for an entire month. I just sat in front of the TV all day like a lunatic and watched SARS-related programs. I had nightmares about dying from SARS, along with my entire family.”

Kelly says she has grown weary of mental health professionals that have tried to help her deal with OCD over the years. “I think somewhere along the way I got discouraged,” she says. “I take drugs that don’t seem to help me and go home still thinking that AIDS is smeared all over the elevator walls.”

Richter addressed the issue of drug effectiveness at the OCD forum, pointing out that most OCD patients are “only modestly improved by medication” and that the majority of them relapse after they stop taking the prescribed drugs. She stressed the long-term effectiveness of cognitive behaviour therapy, as well as family support. “The biggest first step to improvement is getting information and getting educated,” she said. “People who avoid feared situations make the fear stronger. The patient needs to stay within that fearful situation in order to improve.”

Kelly says she has two childhood friends who know about her condition and try to help her improve. “When I start freaking out about something, they calm me down and then tell me stories of their own fears of dirt and germs so that I don’t feel like an alien,” she says. “It helps to know that even ‘normal’ people have the same anxieties as I do.”

Kelly says while it may seem strange, she enjoys watching regular people perform their mini-compulsions. “It makes me feel like one of them, but only for a brief moment.”

Kelly knows she may never totally conquer OCD. She does, however, hope to have her fears and compulsions under control as she gets older. She believes that as long as she is encouraged by her family and a few loyal friends, she will be able to pursue a career and experience life.

“I’m prepared to live with OCD,” she says, “but that doesn’t mean I won’t fight it.”

* name has been changed