Religious devotion: a risk factor for mental illness

OCD is defined in ICD-10 as obsessional thoughts and/or compulsive actions, of at least two weeks duration, with associated anxiety. The obsessional thoughts of OCD are often distressing and can be in the form of urges, ideas and images (ICD-10). These disturbing thoughts are recognised as the patient’s own regardless of their unpleasant nature. The patient will often try initially to resist these thoughts and this is accompanied by an increase in anxiety levels. As the illness progresses, thoughts will be resisted less and less as the associated anxiety becomes unbearable. The second component of OCD, compulsive actions, are described as ‘stereotyped behaviours’ (ICD-10) which are repeatedly carried out by the patient and are often ritualistic. These may be performed in isolation or may be linked to the patient’s obsessional thoughts. For example, if a patient’s main obsession is that he is unclean; his compulsive action may be handwashing. As with obsessions, an initial attempt to resist carrying out compulsions is usual, but, as above, with illness progression, compulsions are performed more frequently in an attempt to find some relief from symptoms. OCD is often exceptionally distressing for the patient as they become consumed with the demands of their condition to the exclusion of all other commitments.