“I’m terrified of my wedding day because wedding dresses don’t have pockets: I keep my hands in my pockets when I go out to avoid any contamination.

I don’t touch anything while I’m out of the house,” says 25-year-old Sulla, a Kuwaiti citizen, her hands snugly tucked in the pockets of her cardigan. “I genuinely wish I wasn’t like this; I have to count the number of times I turn the bar of soap to make sure each time is consistent. I’m scared to say the number of times I count in case I encourage someone else to become as obsessed with that number as I am,” she adds.

Dr Fatima Ayyad, a Professor of Psychology at Kuwait University, said that guilt plays a key role in the prevalence of Obsessive Compulsive Disorder (OCD) in Kuwait: “It’s common in Kuwait. I think a key factor is rigidity and restriction, which can cause deep feelings of guilt.

Without any flexibility or room for error, people end up being completely guilt-ridden.” She added, “OCD is becoming more prevalent than it was before, possibly due to various pressures and feelings of guilt manifesting. In extreme cases, even thoughts and emotions can be interpreted as sources of guilt.”

According to Dr Ayyad, sexual abuse can also be a catalyst. “Abused women and children can also develop OCD sometimes as a result of feelings of guilt following abuse. They often feel responsible, and this anxiety and guilt can trigger obsessive-compulsive behaviors.”

Whilst there sometimes may be a link between the two, the presence of OCD symptoms cannot be seen as an indicator of abuse. “It all started from an idea that got stuck in my mind,” said Salwa. “I was never abused; I had a very happy, normal childhood.”

OCD has become somewhat of a mainstream issue, with many acknowledging that certain behaviors may be slightly odd, neurotic or different. Sulla even has “OCD obsessed” included in her Twitter bio.

While Sulla described her symptoms as ‘life ruining’, many others use the term more loosely. “The term OCD has lately also become part of the popular vernacular as a synonym for being extremely conscientious about one’s responsibilities and/or very concerned about orderliness in general,” said Dr Vincenza Tiberia a psychologist at Kuwait’s Al Razi Counseling Center in Salmiya.

“In face, on a societal level some degree of obsessive-compulsiveness may be desirable and appropriate, for example in the case of doctoral students and other high achievers who must be goal-oriented and self-disciplined to be able to successfully achieve their goals and deadlines.”

However, the general awareness of OCD certainly doesn’t play down the severity it can reach. “OCD is an anxiety disorder which involves obsessions (intrusive thoughts) and compulsions (ritualized behaviors).

The most common obsessions have to do with germs and contamination, forgetting to do something, and having to do things in a particular order,” said Dr Tiberia. “Associated problems may involve avoidance behavior in the case of contamination obsessions and excessive visits to the physician for reassurance of not having “caught anything”,” she added.

The most common compulsive behaviors involve ritualized hand-washing, ordering, checking, counting and the repetition of certain phrases to oneself, said Dr Tiberia. She added that OCD is just as common in Kuwait as the rest of the world.

“The incidence of obsessive compulsive disorder or OCD in Kuwait is comparable with rates in other countries,” said Dr Tiberia. “Excessive hand-washing is one of the most familiar compulsions here in Kuwait. Individuals afflicted with this disorder may spend hours in the bathroom washing their hands, even up to one hundred times per day,” she said.

Sulla suggested that the trend may be something being passed on through the generations, “Cleanliness is a central issue in homes here, but usually to an extreme – everything must be perfect all the time.”

She added, “It’s easy to become obsessive. My mother would tell me as a child that the devil dwells wherever there is dirt, which really stayed in my mind.” Obsessive cleanliness is something Sulla has been battling for years, “I’ve tried to control it and force myself not to wash my hands for a few hours. But the idea of germs and bacteria makes my stomach turn and makes me feel nauseous.”

Sulla’s predicament is quite common in OCD suffers, said Dr Tiberia. “People with OCD are usually aware that their obsessions and compulsions are unrealistic and dysfunctional, yet they cannot resist performing them.” In fact, Sulla says the more she resists, the worse it gets. “Even if I manage to resist washing my hands for an hour or so, eventually I’ll give in and end up at the sink washing and scrubbing them for an hour to make up for it. It’s relentless.”

Not all sufferers feel that there’s anything wrong or strange about their actions. “Good hygiene is good sense,” said 34-year-old Lebanese expatriate Nahed, every single detail of her appearance as pristine and perfect as her home.

“It’s an embarrassment to have any dirt in your home, so constant cleaning is a necessity, especially here where it’s so dusty.” Despite her insistence that she’s following the usual standards of cleanliness, Nahed matches many of the symptoms listed by Dr Tiberia – she washes her hands with Dettol morning and night, vacuums the curtains and furniture daily at the same time each day and refuses to buy any foodstuff that will leave leftovers.

“I do buy food in certain numbers. There are five of us in the house, so if I buy steak, there must be five steaks, five potatoes and so on. I don’t think it’s sanitary to have leftovers so I get exactly the amount needed.” She counts from one to five, pointing to each setting on the dining table where the food would be.

Whilst her habit may seem admirable in terms of avoiding waste, it comes at a high cost as every single food item is portion sized. “I buy miniature milk cartons, miniature cheeses, and even the tiny packets of bread.

I don’t want anything molding or ageing in my house or my fridge.” Nahed may feel her behaviors are normal, but according to Dr Ayyad, such signs should not be ignored.

“Leaving OCD untreated can make it considerably worse; it can expand from one issue to another, one habit to a second. It will develop.”

There are treatments available to tackle the disorder, said Dr Tiberia, “There can be negative consequences of such compulsions upon one’s personal relationships or work performance. Many people respond well to cognitive behavioral therapy techniques.” She added, “It is not unusual for some people with OCD to suffer silently for years before seeking treatment.” First, said Dr Ayyad, sufferers must try and address the root cause.

“Problems cannot be solved with judgment; we must be realistic. Applying excessive guilt will worsen the situation.”

Despite the impact her OCD is having on her life, Sulla refuses to seek treatment. “I will never change, this is my life now. I have thoughts of awful things happening if I stop my routines.” When asked what she thinks may happen, she replied, “I’m scared to tell you because then maybe it will stay in your mind and you’ll end up with the same obsessions and fears. I’m scared for anyone to know in case I influence them.”