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Informative article on OCD. I always thought OCD refers to those who like to keep things clean and tidy, but there are so much more to it. I guess I am one of them too. https://www.straitstimes.com/lifestyle/ocd-nation-children-as-young-as-eight-have-been-diagnosed Helplines Mental Health Helpline Tel: 6389-2222 Singapore Association of Mental Health Helpline Tel: 1800-283-7019 TOUCHline (Counselling) Tel: 1800-377-2252 SINGAPORE - Two years ago, when Vera was in her first year of junior college, she had problems taking notes. She would rewrite them repeatedly to ensure that her handwriting was neat and "perfect", using copious amounts of correction tape. She sometimes stayed up till 2am, tearing up sheets of notes that did not meet her expectations. She found it embarrassing to study in groups as it hindered her rewriting obsession, which she wanted to keep to herself. Now a 19-year-old university student, she says: "I was always looking at my handwriting, but I was not absorbing the information. I felt very tired doing my homework because it took so long." "I didn't seek help immediately because the stereotype of OCD behaviour is handwashing. I was doubtful whether mine was an OCD symptom," says Vera, who declined to give her full name. She sought professional help in her second year of junior college and has since learnt to manage her condition. Obsessive-compulsive disorder (OCD) features obsessive and unreasonable thoughts and fears, and compulsive, repetitive behaviours. In Singapore, which has a higher prevalence of OCD than global norms, children as young as eight have been diagnosed with the mental disorder. DIFFICULT TO DIAGNOSE Despite warning signs, the condition is not easy to diagnose in children and youth as they are less able to verbalise what they are going through. Ms Haanusia Prithivi Raj, a senior clinical psychologist at the Institute of Mental Health (IMH), says OCD is usually triggered by an obsession that incites anxiety or discomfort, prompting the sufferer to engage in repetitive actions to alleviate the uncomfortable feelings. Common obsessions include those revolving around "order or symmetry"; religious anxiety with excessive fears of offending a higher being; or worries about contamination and falling ill. Dr Adrian Loh, a visiting consultant at IMH's department of developmental psychiatry, says the national prevalence for OCD is 4 per cent of the population, higher than global figures of 2 to 3 per cent. From 2014 to last year, IMH's Child Guidance Clinics saw an average of about 130 children and adolescents with OCD annually. Figures have remained consistent, with about 50 new cases each year, according to IMH. Dr Loh says OCD can develop from the pre-school years through to adulthood, but there are two peak ages where OCD is more likely to appear. These are "the upper primary school years, just before puberty; and the late teen years, the transition from junior college and polytechnic to university or a corporate environment". The onset of OCD, like other psychiatric conditions, can be triggered by "excessive stress", such as the stress experienced during key transition years, says Dr Loh. Although OCD is the third-most prevalent mental disorder in Singapore - after major depressive disorder in first place and alcohol abuse in second - the condition can be difficult to diagnose. Dr Loh says: "What makes OCD different in children is that they frequently lack insight and awareness into the abnormal nature of their symptoms, and may be more unwilling to seek help or accept the problem. "In some cases, all they can explain is that something just 'feels right', leading to parental frustration." "Some sufferers who are unable to obtain relief from overwhelming anxiety (by engaging in rituals) may end up having rage attacks that can be misunderstood as misconduct. This can lead to disciplinary measures instead of taking the child to seek professional help," Dr Loh says. EVERYTHING HAD TO BE PERFECT At age 15, Mr Wayne Kee was taking part in the National Physical Fitness Award Scheme (Napfa) test in school when he landed "wrong" after doing the standing broad jump. He complained that his neck felt stiff, but all scans and physical checks showed nothing was wrong. After psychological tests, he was diagnosed with OCD and started receiving therapy. His mother, Ms Evelyn Chng, said: "The initial difficulty was that we couldn't see physical rituals (associated with OCD). We only knew he was anxious but we couldn't understand why, because he couldn't relate what was wrong with him." "Neither could he verbalise his thoughts to his psychologist," says Ms Chng, 49, who is married to a 51-year-old financial consultant. They also have a 20-year-old daughter. Ms Chng recalls a profound indecisiveness in her son at that time. "He would call me and ask what he should eat at the school canteen. I had to reassure him that eating caifan (economy rice) or yong tau foo was the right decision," says the counsellor with Caregivers Alliance Limited. But "the monster in his head", as she describes it, surfaced in full force a couple of years later, when he started opening and closing the fridge door, in addition to other hours-long rituals. By age 17, OCD had taken over his life and he had to drop out of polytechnic. Mr Kee, now 23, recalls: "I had mental rituals and a certain way of doing things which I thought was right, but it was OCD. "I had the feeling that something would go wrong. It's like acting, every scene must be exact. If not, my life is not recorded properly and I would have to re-edit the scene and ask people to redo it." TOLL ON THE FAMILY Family meals were agonising, his mother recalls, because everything had to be put in its exact place. A dish of fish had to be passed to and fro, in the same direction. Dragging Mr Kee away from performing his rituals would result in screaming or he would find a way to return later to complete his rituals. The police were called in by neighbours several times when arguments got heated between Mr Kee and his father. Ms Chng was caught in the middle. Sometimes, when Mr Kee engaged in rituals such as opening and closing the fridge door for hours, he got tired and asked his mother to do it for him. His relationship with his sister deteriorated too. "It was crazy. There was shouting and screaming, fights between him and his dad and quarrels between me and my husband," says Ms Chng, who suffered two mental breakdowns. Things got better in 2015 when Ms Chng, then working in retail, and her husband went for a workshop on OCD and started attending classes at Caregivers Alliance which they had come across at IMH. Three years ago, she started working at Caregivers Alliance. She learnt to be a caregiver for a person with mental illness and engaged Mr Kee in chores that he enjoyed, such as cutting and preparing vegetables with precision. Mr Kee, too, felt the need for a change and started to commit to his treatment at IMH, which he previously felt was a waste of time and money. This involved Exposure and Response Prevention (ERP) therapy. In ERP, the person with OCD is exposed to the source of his fear, without acting out any compulsions to ease the fear. Mr Kee says: "I decided I wanted to start afresh. I had just turned 21 and I wanted things to improve." Today, his condition is under control and he works as a peer support specialist at IMH, where he helps and supports clients with OCD. He says he wants to talk about his experiences to combat the stigma associated with the illness. "At the start, I was afraid. But I wanted to stand up because no one else would," he says. COMMON OBSESSIONS IN OCD Here are some common obsessions in OCD, according to Ms Haanusia Prithivi Raj, senior clinical psychologist, department of developmental psychiatry, IMH. • Fear of contamination, such as of places deemed "dirty"; or fear of contagious diseases like Ebola or H1N1 • Intrusive aggressive thoughts, such as the fear of being harmed or of harming family or friends • Intrusive, sexually explicit or violent thoughts or images • Fear of losing important things • Discomfort if things are not symmetrical or evenly numbered • Needing to tell or confess everything Watch our for these common compulsions, which are repetitive actions to reduce anxiety: • Excessive washing of one's hands, body or important items like wallets • Checking doors, locks, phones, bags • Mental rituals such as the repetition of prayers to negate intrusive negative thoughts • Avoiding possible OCD triggers, such as avoiding throwing things into the dustbin, suggesting the child might have intrusive thoughts about dirt • Seeking reassurance by repeatedly asking seemingly mundane questions that the child is worried about • Counting, tapping, repeating certain actions such as rewriting or re-reading, or doing other senseless things to reduce anxiety

When it comes to road safety, Russia roads are far from being the safest as proven by the many in-car camera videos that show road rages and other dangerous driving. To curb this problem, the Russian goverment came up with a list of pretty bizarre and discriminative set of rules which dictate who can hold a driving license. The list a very long one but highlights of how weird it is include not allowing transgenders to drive because they are deemed to have a 'medical condition'. Of course, the gay-rights activists around the world aren't too happy about this, but in 2013, Russia made 'promoting non-traditional lifestyles' illegal so it is doubtful the government will revise their rules. The list also includes banning drivers who have gambling and stealing problems. People with 'mental disorders' like fetishism, exhibitionism and voyeurism are also barred from driving. If you are too short, under 150cm to be exact, you are also not allowed to hold a driver's license too. We are glad we don't live in Russia!