Let’s Talk About Treatment for OCD in Penang & Malaysia

“Yeah, I have OCD, and I want to treat it because it’s gotten pretty bad.”

One good thing about OCD is that patients often already know they have it.

When you have an urge to repeatedly check, wash, or clean — which annoys not only the people around you but also yourself — it’s often very easy for both you and those around you to recognise that this is OCD.

Some OCD symptoms get a lot of attention in the media, such as checking, cleaning, and making things perfectly symmetrical. But others don’t — and some patients come to the clinic thinking they’re just seeking help for anxiety or depression, only for us to discover during consultation that they also have OCD symptoms.

Common symptoms of OCD?

Well-Known OCD Types

Cleanliness: “If I don’t wash my hands [x number of times], I will carry germs around and infect myself and my loved ones.”

Checking: “If I don’t check [x number of times], I might miss something and something very bad will happen.”

Other Examples of OCD:

Violent thought & imagery: “I’m afraid to look at a sharp knife because I automatically imagine stabbing my children or husband.”

Sexual / taboo thoughts: “I’m afraid to look at people of the opposite sex because I automatically think of sexual images of them or sexual acts with them.”

Magical thinking: “If I step on black tiles, one of my family members will die — unless I undo the ‘curse’ by rewinding my steps [or doing another specific action].”

Religious scrupulosity: “I take two hours to solat because I have to go over the steps carefully, otherwise my solat will tidak sah.”

What is OCD?

Obsessive-Compulsive Disorder (OCD) is a mental health condition where a person gets stuck in a cycle of unwanted thoughts and repeated actions.

That word — unwanted — is important. They don’t want to be checking the switch 10 times before leaving the house. They know it’s unnecessary and may even think it’s silly. But they can’t help feeling that something is “wrong” if they don’t do it — a very strong, uncomfortable feeling that’s hard to ignore.

There are 2 key parts to OCD: obsession and compulsion.

• Obsessions are thoughts, images, or urges that keep coming into your mind even though you don’t want them. They can make you feel anxious, uncomfortable, or “not right.”
  Example: Worrying over and over that you forgot to lock the door, or having an image pop into your head that upsets you.
• Compulsions are things you feel you must do — either physically or in your mind — to make the anxiety go away or to stop something bad from happening.
  Example: Checking the lock ten times before you can leave, or silently repeating a prayer to “cancel out” a bad thought.
  Sometimes this means feeling compelled to turn back home to check the lock, even when you’re already 20 minutes into your journey to work.

Everyone has strange thoughts sometimes, and everyone repeats actions now and then — but with OCD, these patterns take up a lot of time (often more than an hour a day), cause a lot of stress, and get in the way of daily life.

OCD isn’t about being “extra neat” or “a perfectionist” — it’s about feeling trapped in a loop that’s very hard to break without the right help.

OCD Can Be a Minor Inconvenience or Completely Life-Destroying

Severe OCD may look like this:

OCD can be extremely disabling, and I’ve seen it destroy lives and families.

Some patients can’t leave the house because getting ready — from leaving the bed, dressing up, packing belongings — may take 2–3 hours due to an exhausting checking routine. Taking a shower can take more than an hour.

They can’t live a normal life, study, or work because OCD takes up all their time.

OCD often affects family members too. I’ve seen mothers and wives constantly scolding children for not following their cleaning routine, or outright refusing to let family members leave the house for fear of bringing germs home. In some cases, they stopped their children from going to school and their husband from going to work. The scare of COVID-19 pandemic particularly, trigger a lot of cases, but many of these OCD stories continues for years afterwards.

Mild OCD may look like this:

Some patients don’t come in for OCD treatment specifically — but during consultations for other issues, we uncover mild OCD symptoms.

They might occasionally have repetitive checking or washing behaviours, especially during stressful periods, but the OCD doesn’t dictate their entire life, and it’s not obvious to those around them.

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Fun Fact – OCD & Anxiety:

Many people with anxiety also have some OCD symptoms, but anxiety isn’t a necessary part of OCD. Some people don’t feel anxious about checking, cleanliness, or symmetry — instead, they experience an uncomfortable urge that compels them to act.

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It’s Not Perfectionism or OCPD

One of the pet peeves for many psychiatrists is how pop culture portrays perfectionist tendencies as “OCD.” It might seem harmless to say “My OCD won’t let me accept that” when something isn’t symmetrical — but for those with real OCD, this comparison can trivialise a deeply distressing condition.

Not liking asymmetry or enjoying neatness doesn’t mean you have OCD. OCD is about unwanted, intrusive thoughts and compulsions that disrupt life.

A different but related condition is OCPD (Obsessive-Compulsive Personality Disorder), also called perfectionist personality or anakastic personality. People with OCPD are excessive and happy to be excessive — they believe their way is correct, and if you don’t share their standard, you’re the one who’s wrong. Unlike having “high standards,” their perfectionism is rigid and often causes conflict or stress for themselves and others.

Most psychiatrists I know rarely come across OCPD patients, because by definition, a person with OCPD doesn’t see their behaviour as a problem and doesn’t think they need help. They usually only seek treatment when their perfectionistic tendencies cause dysfunction in other parts of life and lead to depression or anxiety. Still, we see OCPD show up often in our patients’ stories — usually as a boss, parent, or spouse whose rigid standards make life incredibly difficult for those around them.

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Can OCD Be Treated or Cured?

Yes — but severity affects the outcome, and symptoms often come and go at different times in a person’s life.

It’s better to think about managing OCD so it doesn’t interfere with your life, rather than aiming for absolute elimination of every urge.

Instead of hoping “I don’t want to have the urge to check anymore”, aim for:

“I know I’ll have the urge to check from time to time, but I can live with it without giving in. I won’t check despite the urge, and it won’t take up my time or change my plans for the day.”

Many patients learn to ignore obsessive urges, and over time, the urges weaken. For example, a housewife who resisted the urge to sweep the floor five times noticed those urges became weaker and easier to ignore. Or a person who stopped checking for a week realised nothing bad happened, and became more comfortable resisting.

Medication can also help, sometimes dramatically. Patients who’ve struggled for years find their urges much weaker, allowing them to finish a degree, start working, or simply enjoy life without OCD consuming all their time (and sometimes even saving money on water bills).

Unfortunately, there are severe cases that don’t respond well to high-dose, combination medication plus psychotherapy — but these are rare. Most people do see significant improvement.

Treatment Options for OCD in Malaysia

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1. Medication for OCD

OCD is mainly treated with antidepressants, particularly SSRIs (selective serotonin reuptake inhibitors) — usually at higher doses than what’s used for depression.

Besides antidepressants, sometimes other medications such as antipsychotics, mood stabilisers, or benzodiazepines are added in combination. The choice of medication is tailored to each person’s condition, often considering which side effects we most want to avoid.

Many people are afraid to take antidepressants because they worry about getting addicted or having to take them for life. The truth is, antidepressants are not addictive. Another class of medication — benzodiazepines — can be addictive, but you don’t have to take them for OCD. You can always discuss potential side effects with your doctor and only agree to start a medication when you feel comfortable with it.

How long should you take the medication? That really depends on the individual. Some people choose to stay on medication for the long haul because they find their quality of life much better afterwards. Especially when OCD symptoms still linger in the background, stopping medication often just returns the person to their pre-treatment state (but not worse than before starting treatment).

For patients who have completely recovered from OCD, most doctors recommend staying on antidepressants — particularly SSRIs — for at least 12 months after your symptoms have significantly improved and you’re functioning well. This helps reduce the risk of OCD coming back.

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2. Therapy for OCD — What is ERP?

Medication is often helpful for OCD, but it’s not the only option. One of the most effective psychological treatments is ERP, which stands for Exposure and Response Prevention.

It always helps — which is why I try to work a simplified version of ERP with my OCD patients, or refer them to my clinical psychologist or counsellor for a complete ERP program.

Principles of ERP (Exposure & Response Prevention):

• Exposure means you slowly and safely face the situations, thoughts, or feelings that trigger your OCD anxiety.
• Response Prevention means resisting the urge to do your usual compulsion (like checking, washing, repeating a prayer, or avoiding something).

By doing this in a guided, structured way with a trained therapist, your brain gradually learns that:

• The anxiety will go down on its own, even without doing the compulsion.
• The “bad thing” you fear usually doesn’t happen — and even if it did, you could cope.

Example:
If your OCD fear is that your hands are contaminated, your therapist might first guide you to touch a doorknob for a short time — and then help you delay washing your hands for a few minutes. Over time, the exposure steps become a little more challenging, but always at a pace you can handle.

ERP is not about “forcing” you to do something scary all at once — it’s about training your brain to break the OCD cycle, one step at a time.

When ERP is done well, many people find their anxiety drops much faster than they expected, and they regain a sense of control over their lives.

Thoughts on OCD

I often feel OCD is one of the most distressing psychiatric conditions. Many patients have their lives hijacked by it — they don’t want to spend hours washing or checking, but can’t help it. People around them get frustrated, and patients themselves feel exasperated at their inability to stop. It’s like something hijacks their brain.

OCD brings countless stories of wasted youth, abandoned careers, and strained family relationships.

The longer OCD is left untreated, the harder it becomes to treat — so please, get help from a trusted psychiatrist. Don’t wait.

Read here for more on OCD (Obsessive-Compulsive Disorder) – information by Royal College Of Psychiatrists

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