Affective compulsive disorder. Main symptoms of OCD

Obsessive-compulsive disorder is a pathological condition that has a clear onset and is reversible with proper treatment. This syndrome is considered under the heading of borderline mental disorders. Obsessive-compulsive disorder (OCD) is distinguished from pathology at the neurotic level by its greater severity, frequency of occurrence, and intensity of obsessions.

To date, information about the prevalence of the disease cannot be called reliable and accurate. The inconsistency in the data can be explained by the fact that so many people suffering from obsessions do not contact mental health services. Therefore, in clinical practice, in terms of frequency, obsessive-compulsive disorder ranks after anxiety-phobic disorders and conversion disorders. However, anonymous sociological surveys show that over 3% of respondents suffer from obsessions and compulsions to varying degrees of severity.

First episode of obsessive-compulsive disorder most often occurs between 25 and 35 years of age. Neurosis is recorded in people with different levels of education, financial situation and social status. In most cases, the occurrence of obsessions is determined in unmarried women and single men. OCD often affects people with a high IQ whose professional responsibilities involve active mental activity. Residents of large industrial cities are more susceptible to the disease. Among the population of rural areas, the disorder is recorded extremely rarely.

In most patients with OCD, symptoms are chronic: compulsions occur regularly or are constantly present. Manifestations of obsessive-compulsive disorder may be sluggish and perceived by the patient as tolerable. Or, as the disease develops, the symptoms become aggravated at a rapid speed, not giving the person the opportunity to live a normal life. Depending on the severity and rate of development of symptoms, obsessive-compulsive disorder either partially impedes the patient’s full activity or completely prevents interaction in society. In severe cases of OCD, the patient becomes a hostage to the obsessions that overcome him. In some cases, the patient completely loses the ability to control the thinking process and cannot control his behavior.

For obsessive-compulsive disorder Characterized by two leading symptoms - obsessive thoughts and compulsive actions. Obsessions and compulsions arise spontaneously, are obsessive and irresistible in nature, and cannot be independently eliminated either by willpower or conscious personal work. The individual evaluates the obsessions that overcome him as alien, illogical, inexplicable, irrational, absurd phenomena.

Obsessions are usually called intrusive, persistent, oppressive, weary, frightening or threatening thoughts that come to mind involuntarily, in addition to the desire of the subject. Obsessive thinking includes persistent ideas, images, desires, drives, doubts, and fears. A person tries with all his might to resist regularly occurring obsessive thoughts. However, attempts to get distracted and switch the way of thinking do not give the desired result. Intrusive ideas still span the entire spectrum of the subject's thinking. No other ideas, except annoying thoughts, arise in the person’s mind.
Compulsions are debilitating and exhausting actions that are regularly and repeatedly repeated in an unchangeable constant form. Standardly performed processes and manipulations are a kind of protective and protective rituals. Persistent repetition of compulsive actions is intended to prevent the occurrence of any circumstances frightening the object. However, according to an objective assessment, such circumstances simply cannot occur or are unlikely situations.

With obsessive-compulsive disorder, the patient may experience both obsessions and compulsions at the same time. There may also be exclusively obsessive thoughts without subsequent ritual actions. Or the person may suffer from the oppressive feeling of having to carry out compulsive actions and perform them repeatedly.

In the vast majority of cases, obsessive-compulsive disorder has a clear, pronounced start. Only in isolated cases is a gradual slow increase in symptoms possible. The manifestation of pathology almost always coincides with the period when a person is in a severe stressful state. The onset of OCD is possible as a result of sudden exposure to extreme stressful situations. Or the first episode of the disorder is a consequence of prolonged chronic stress. It should be pointed out that the trigger for obsessive-compulsive disorder is not only stress in its understanding as a traumatic situation. The onset of the disease often coincides with stress caused by physical ill health and severe somatic illness.

Obsessive-compulsive disorder: pathogenesis

Most often, a person pays attention to the existence of obsessions and compulsions after he has experienced a serious life drama. It also becomes noticeable to others that after the tragedy the person began to behave differently and seemed to be in his own world of reflection. Despite the fact that the symptoms of obsessive-compulsive disorder become pronounced precisely after extreme circumstances in the subject’s life, it acts only as a trigger for the visible manifestation of pathology. A psychotraumatic situation is not the direct cause of OCD; it only provokes a rapid aggravation of the disease.

Reason 1. Genetic theory

Predisposition to pathological reactions is inherent at the gene level. It has been established that most patients with obsessive-compulsive disorder have defects in the gene responsible for transporting the neurotransmitter serotonin. More than half of the examined individuals had mutations in the seventeenth chromosome in the SLC6A4 gene, the serotonin transporter.

The appearance of obsessions is recorded in people whose parents have a history of episodes of neurotic and psychotic disorders. Obsessions and compulsions can occur in people whose close relatives suffered from alcohol or drug addiction.

Scientists also suggest that excessive anxiety is also passed on from descendants to ancestors. Many cases have been recorded in which grandparents, parents and children had similar or performed similar ritual actions.

Reason 2. Features of higher nervous activity

The development of obsessive-compulsive disorder is also influenced by the individual properties of the nervous system, which are determined by innate qualities and acquired experiences throughout life. Most patients with OCD have a weak nervous system. The nerve cells of such people are not able to fully function under prolonged stress. In many patients, an imbalance in the processes of excitation and inhibition is determined. Another feature identified in such individuals is the inertia of nervous processes. That is why sanguine people are rarely found among patients with obsessive-compulsive disorder.

Reason 3. Constitutional and typological aspects of personality

The risk group includes anankaste individuals. They are characterized by an increased tendency to doubt. These pedantic individuals are absorbed in studying details. These are suspicious and impressionable people. They strive to do everything in the best possible way and suffer from perfectionism. They scrupulously think about the events of their lives every day and endlessly analyze their actions.

Such subjects are unable to make an unambiguous decision even when all the conditions for the correct choice exist. Anancasts are not able to displace obsessive doubts, which provokes the emergence of a strong feeling about the future. They cannot resist the illogical desire to double-check the work done. To avoid failure or mistakes, Anankasts begin to use saving rituals.

Reason 4. The influence of neurotransmitters

Doctors suggest that a disruption in serotonin metabolism plays a role in the development of obsessive-compulsive disorder. In the central nervous system, this neurotransmitter optimizes the interaction of individual neurons. Disturbances in serotonin metabolism do not allow for high-quality exchange of information between nerve cells.

Reason 5. PANDAS syndrome

Nowadays, there is a lot of confirmation of the assumption made about the connection between obsessive-compulsive disorder and infection of the patient’s body with group A beta-hemolytic streptococcus. These cases are designated by the English term

PANDAS. The essence of this autoimmune syndrome is that when there is a streptococcal infection in the body, the immune system is activated and, trying to destroy microbes, mistakenly attacks nerve tissue.

Obsessive-compulsive disorder: clinical picture

The leading symptoms of obsessive-compulsive disorder are obsessive thoughts and compulsive actions. The criteria for making a diagnosis of OCD are the severity and intensity of symptoms. Obsessions and compulsions occur regularly or are constantly present in a person. Symptoms of the disorder make it impossible for the subject to fully function and interact in society.

Despite the diversity and variety of obsessive thoughts and ritual actions, all symptoms of obsessive-compulsive disorder can be divided into several classes.

Group 1. Ineradicable doubts

In this situation, a person is overcome by obsessive doubts about whether some action has been completed or not. He is haunted by the need to conduct a re-inspection, which, from his point of view, can prevent catastrophic consequences. Even repeated checks do not give the subject confidence that the matter has been carried out and completed.

The patient's pathological doubts may relate to traditional everyday activities, which, as a rule, are performed automatically. Such a person will check several times: whether the gas valve is closed, whether the water tap is closed, whether the front door is locked. He returns to the scene of action several times and touches these objects with his hands. However, as soon as he leaves his home, doubts overcome him with greater force.

Painful doubts can also affect professional responsibilities. The patient is confused whether he has completed the required task or not. He is not sure that he drafted the document and sent it by email. He questions whether all the details are included in the weekly report. He re-reads, looks through, double-checks again and again. However, after leaving the workplace, obsessive doubts arise again.

It is worth pointing out that obsessive thoughts and compulsive actions resemble a vicious circle that a person cannot break through the efforts of will. The patient understands that his doubts are unfounded. He knows that he has never made similar mistakes in his life. However, he cannot “talk” his mind into not making repeated checks.

Only a sudden “insight” can break the vicious circle. This is a situation where a person’s mind becomes clearer, the symptoms of obsessive-compulsive disorder subside for a while, and the person experiences relief from obsessions. However, a person cannot bring the moment of “insight” closer by force of will.

Group 2. Immoral obsessions

This group of obsessions is represented by obsessive ideas of indecent, immoral, illegal, blasphemous content. A person begins to be overcome by an indomitable need to commit an indecent act. In this case, the person has a conflict between her existing moral standards and an indomitable desire for antisocial action.

The subject may be overcome by a desire to insult and humiliate someone, to be rude and rude to someone. A respectable individual may be haunted by some absurd undertaking that represents a debauched immoral act. He may begin to blaspheme God and speak unflatteringly about the church. He may be overwhelmed by the idea of engaging in sexual debauchery. He may feel a desire to commit a hooligan act.

However, a patient with obsessive-compulsive disorder fully understands that such an obsessive need is unnatural, indecent, and illegal. He tries to drive away such thoughts from himself, but the more effort he makes, the more intense his obsessions become.

Group 3. Overwhelming worries about pollution

Symptoms of obsessive-compulsive disorder also cover the topic. The patient may be pathologically afraid of contracting some difficult-to-diagnose and incurable disease. In such a situation, he takes protective actions to prevent contact with germs. He takes strange precautions, fearing viruses.

Obsessions are also manifested by an abnormal fear of contamination. People with obsessive-compulsive disorder may fear that they will be covered in dirt. They are terrified of house dust, so they clean for days on end. Such subjects are very careful about what they eat and drink, because they are convinced that they can be poisoned by poor-quality food.

In obsessive-compulsive disorder, common themes of obsession are the patient's thoughts about polluting his own home. Such subjects are not satisfied with standard apartment cleaning methods. They vacuum carpets several times, wash the floor using disinfectants, and wipe furniture surfaces using cleaning products. For some patients, cleaning their home takes up the entire waking period; they take a break only while sleeping at night.

Group 4. Obsessive actions

Compulsions are actions, behaviors and behavior in general that a person with obsessive-compulsive disorder uses to overcome obsessive thoughts. Compulsive acts are committed by the subject as a ritual designed to protect against some potential disasters. Compulsions are performed regularly and frequently, and a person cannot refuse or suspend their implementation.

There are a great many types of compulsions, since they reflect the subject’s obsessive thinking in a particular area. The most common forms of protective and preventive actions are:

activities carried out due to existing superstitions and prejudices, for example: fear of the evil eye and a preventive method - regular washing with “holy” water;
stereotypical, mechanically performed movements, for example: pulling out one's own hair from the head;
execution of any process devoid of common sense and necessity, for example: brushing your hair for five hours;
excessive personal hygiene, for example: taking a shower ten times a day;
uncontrollable need to recalculate all surrounding objects, for example: counting the number of dumplings in a serving;
an uncontrollable desire to place all objects symmetrically to each other, the desire to arrange things in a strictly established sequence, for example: arranging units of shoes in parallel;
craving for collecting, collecting, hoarding, when the hobby goes from the category of hobby to pathology, for example: keeping at home all the newspapers purchased over the past ten years.

Obsessive-compulsive disorder: treatment methods

The treatment regimen for obsessive-compulsive disorder is selected for each patient individually, depending on the severity of symptoms and the severity of existing obsessions. In most cases, it is possible to help a person by providing treatment on an outpatient basis. However, some patients with severe OCD require hospitalization in an inpatient facility because there is a risk that intrusive thoughts will require them to perform actions that could cause real harm to the person and those around them.

The classic method of treating obsessive-compulsive disorder involves the sequential implementation of activities that can be divided into four groups:

pharmacological therapy;
psychotherapeutic influence;
use of hypnosis techniques;
implementation of preventive measures.

Drug treatment

The use of medications has the following goals: to strengthen the patient’s nervous system, minimize feelings and anxiety, help take control of one’s own thinking and behavior, and eliminate existing depression and despair. Treatment for OCD begins with two weeks of benzodiazepines. In parallel with tranquilizers, the patient is recommended to take antidepressants from the SSRI class for six months. To get rid of the symptoms of the disorder, it is advisable to prescribe atypical antipsychotics to the patient. In some cases, the use of mood stabilizers may be required.

Psychotherapeutic treatment

Modern psychotherapy has in its arsenal a variety of proven and effective techniques for getting rid of obsessive-compulsive disorder. Most often, treatment for OCD is carried out using the cognitive-behavioral method. This technique involves helping the client identify destructive components of thinking and subsequently acquiring a functional way of thinking. During psychotherapeutic sessions, the patient gains skills to control his thoughts, which makes it possible to manage his own behavior.

Another psychotherapeutic treatment option that has shown good results in the treatment of obsessive-compulsive disorder is exposure and response prevention techniques. Placing the patient in artificially created frightening conditions, accompanied by clear and understandable step-by-step instructions on how to prevent compulsions, gradually softens and eliminates the symptoms of obsessive-compulsive disorder.

Hypnosis treatment

Many people suffering from obsessive-compulsive disorder report that when they give in to their obsessive ideas and perform compulsive actions, they feel as if they are in a state of trance. That is, they concentrate within themselves, so the fruits of their imagination become more real than the objectively existing reality. That is why it is advisable to influence obsessions precisely in a state of trance, immersion into which occurs during a hypnosis session.

During a hypnosis session, the associative connection between overwhelming obsessions and the need to use a stereotypical model of behavior occurs. Hypnosis techniques help the patient become convinced of the inappropriateness, absurdity and alienness of the obsessive thoughts that arise. As a result of hypnosis, the need to perform certain rituals disappears. He gains free thinking and takes control of his own behavior.

Preventive actions

To prevent relapses of obsessive-compulsive disorder, it is recommended:

take a contrast shower in the morning;
in the evening, take baths with the addition of relaxing natural oils or soothing herbal compositions;
ensuring a good night's sleep;
daily walks before bed;
stay in the fresh air for at least two hours a day;
active physical activity, outdoor sports;
drawing up a healthy menu, excluding foods with stimulating properties from the diet;
refusal of alcoholic beverages;
avoiding smoking;
creating a favorable atmosphere at home, eliminating stressful situations;
normalization of work schedule;
performing breathing exercises.

Despite the persistent course of obsessive-compulsive disorder, the disease is treatable provided the patient fully follows all medical recommendations.

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Obsessive-compulsive disorder is a syndrome whose causes are rarely obvious. It is characterized by the presence of obsessive thoughts (obsessions), to which a person responds with certain actions (compulsions).

Obsession (lat. obsessio - “siege”) is a thought or desire that constantly pops up in the mind. This thought is difficult to control or get rid of, and it causes a lot of stress.

Common obsessions in OCD are:

fear of contamination (from dirt, viruses, germs, body fluids, excrement or chemicals);
concerns about possible dangers (external, such as fear of being robbed, and internal, such as fear of losing control and harming someone close);
excessive concern about precision, order, or symmetry;
sexual thoughts or images.

Almost everyone has experienced these intrusive thoughts. However, for a person with OCD, the level of anxiety from such thoughts is off the charts. And in order to avoid too much anxiety, a person is often forced to resort to some “protective” actions - compulsions (Latin compello - “to force”).

Compulsions in OCD are somewhat reminiscent of rituals. These are actions that a person repeats over and over again in response to an obsession in order to reduce the risk of harm. The compulsion can be physical (like repeatedly checking to see if a door is locked) or mental (like saying a certain phrase in your head). For example, this could be uttering a special phrase to “protect relatives from death” (this is called “neutralization”).

Common in OCD syndrome are compulsions in the form of endless checks (for example, gas taps), mental rituals (special words or prayers repeated in a prescribed order), and counting.

The most common is fear of germs combined with compulsive washing and cleaning. Because of the fear of getting infected, people go to great lengths: they do not touch door handles, toilet seats, and avoid shaking hands. Typically, with OCD syndrome, a person stops washing his hands not when they are clean, but when he finally feels “relief” or “right.”

Avoidance behavior is a central part of OCD and includes:

desire to avoid situations that cause anxiety;
the need to perform compulsive actions.

Obsessive-compulsive disorder can cause many problems and is usually accompanied by shame, guilt and depression. The disease creates chaos in human relationships and affects performance. According to WHO, OCD is one of the ten diseases leading to disability. People with OCD syndrome do not seek professional help because they are embarrassed, afraid or do not know that their illness can be treated, incl. non-medicinal.

What Causes OCD

Despite many studies on OCD, it is still impossible to say for sure what is the main cause of the disorder. Both physiological factors (impaired chemical balance in nerve cells) and psychological factors may be responsible for this condition. Let's look at them in detail.

Genetics

Research has shown that OCD can be passed down through generations to close relatives, in the form of a greater tendency to develop painful obsessive states.

A study of adult twins showed that the disorder is moderately hereditary, but no single gene has been identified as causing the condition. However, genes that could play a role in the development of OCD deserve special attention: hSERT and SLC1A1.

The task of the hSERT gene is to collect “waste” serotonin in nerve fibers. Recall that the neurotransmitter serotonin is necessary for the transmission of impulses in neurons. There are studies that support unusual hSERT mutations in some obsessive-compulsive disorder patients. As a result of these mutations, the gene begins to work too quickly, collecting all the serotonin before the next nerve “hears” the signal.

SLC1A1 is another gene that may be involved in obsessive-compulsive disorder. This gene is similar to hSERT, but its responsibilities include transporting another neurotransmitter - glutamate.

Autoimmune reaction

Some cases of rapid onset of OCD in children can be a consequence of Group A streptococcal infection, which causes inflammation and dysfunction of the basal ganglia. These cases are grouped into clinical conditions called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection).

Another study suggested that the episodic occurrence of OCD is not due to streptococcal infection, but rather to prophylactic antibiotics that are prescribed to treat infections. OCD conditions may also be associated with immunological reactions to other pathogens.

Neurological problems

Brain imaging techniques have allowed researchers to study the activity of specific areas of the brain. Some parts of the brain have been shown to have unusual activity in OCD sufferers. OCD symptoms involved are:

orbitofrontal cortex;
anterior cingulate gyrus;
striatum;
thalamus;
caudate nucleus;
basal ganglia.

The circuit involving the above areas regulates primitive behavioral aspects such as aggression, sexuality and bodily secretions. Activation of the circuit triggers appropriate behavior, such as washing hands thoroughly after touching something unpleasant. Normally, after the necessary act, the desire decreases, that is, the person stops washing his hands and moves on to another activity.

However, in patients diagnosed with OCD, the brain has some difficulty turning off and ignoring the urges from the circuit, which creates communication problems in these areas of the brain. Obsessions and compulsions continue, leading to repetition of certain behaviors.

The nature of this problem is not yet clear, but it is most likely associated with a violation of brain biochemistry, which we talked about earlier (reduced activity of serotonin and glutamate).

Causes of OCD from the point of view of behavioral psychology

According to one of the fundamental laws of behavioral psychology, repetition of a particular behavioral act makes it easier to reproduce it in the future.

All people with OCD do is try to avoid things that can trigger fear, “fight” thoughts, or perform “rituals” to reduce anxiety. Such actions temporarily reduce fear, but paradoxically, according to the law stated above, they increase the likelihood of obsessive behavior occurring in the future.

It turns out that avoidance is the cause of obsessive-compulsive disorder. Avoiding the object of fear instead of enduring it can lead to dire consequences.

People who are most susceptible to pathology are those who are under stress: starting a new job, ending a relationship, or suffering from overwork. For example, a person who has always calmly used public restrooms suddenly, in a state of stress, begins to “wind up” himself, saying that the toilet seat is dirty and there is a danger of contracting an illness... Further, by association, fear can spread to other similar objects: public sinks, showers, etc.

If a person avoids public toilets or begins to perform complex cleansing rituals (cleaning seats, door handles, followed by a thorough hand washing procedure) instead of coping with fear, this may result in the development of a real phobia.

Cognitive Causes of OCD

The behavioral theory described above explains the occurrence of pathology with “wrong” behavior, while the cognitive theory explains the occurrence of OCD with the inability to correctly interpret one’s thoughts.

Most people experience unwanted or intrusive thoughts several times a day, but all sufferers greatly exaggerate the importance of these thoughts.

For example, against the background of fatigue, a woman who is raising a child may periodically have thoughts about harming her baby. The majority, of course, brushes aside such obsessions and ignores them. People suffering from OCD exaggerate the importance of thoughts and react to them as a threat: “What if I’m really capable of this?!”

The woman begins to think that she could become a threat to the child, and this causes her anxiety and other negative emotions, such as disgust, guilt and shame.

Fear of one's own thoughts may lead to attempts to neutralize the negative feelings arising from obsessions, for example, by avoiding situations that trigger the corresponding thoughts, or by participating in "rituals" of excessive self-purification or prayer.

As we noted earlier, repeated avoidance behavior can become “stuck” and tend to repeat itself. It turns out that the cause of obsessive-compulsive disorder is the interpretation of intrusive thoughts as catastrophic and true.

Researchers theorize that OCD sufferers attach exaggerated importance to thoughts due to false beliefs learned in childhood. Among them:

exaggerated responsibility: the belief that a person bears overall responsibility for the safety of others or harm caused to them;
belief in the materiality of thoughts: the belief that negative thoughts can “come true” or influence other people and should be controlled;
exaggerated sense of danger: tendency to overestimate the likelihood of danger;
exaggerated perfectionism: the belief that everything must be perfect and mistakes are unacceptable.

Environment, distress

Stress and psychological trauma can trigger the process of OCD in people who are prone to developing this condition. Studies of adult twins have shown that obsessive-compulsive neurosis in 53-73% of cases arose due to adverse environmental influences.

Statistics confirm the fact that most people with OCD symptoms experienced a stressful or traumatic life event just before the onset of the disease. Such events may also cause existing symptoms of the disorder to worsen. Here is a list of the most traumatic environmental factors:

abuse and violence;
change of housing;
disease;
death of a family member or friend;
changes or problems at school or work;
relationship problems.

What contributes to the progression of OCD?

For effective treatment of obsessive-compulsive disorder, knowledge of the causes of the pathology is not so important. It is much more important to understand the mechanisms that support OCD. This is the key to overcoming the problem.

Avoidance and compulsive rituals

Obsessive-compulsive disorder is perpetuated by a vicious cycle of compulsion, anxiety, and response to the anxiety.

Whenever a person avoids a situation or action, the behavior becomes “hardwired” into a corresponding neural circuit in the brain. The next time in a similar situation, he will act in the same way, which means he will again miss the chance to reduce the intensity of his neurosis.

Compulsions are also reinforced. A person feels less anxious after checking that the lights are off. Therefore, it will act the same way in the future.

Avoidance and impulsive actions “work” at first: the patient thinks that he has prevented harm, and this stops the feeling of anxiety. But in the long run they will create even more anxiety and fear because they feed the obsession.

Exaggerating your capabilities and “magical” thinking

A person with OCD over-exaggerates their capabilities and ability to influence the world. He believes in his power to cause or prevent bad events with the power of thought. “Magical” thinking presupposes the belief that the performance of certain special actions, rituals, will prevent something unwanted (similar to superstition).

This allows a person to feel the illusion of comfort, as if he has more influence over events and control over what is happening. As a rule, the patient, wanting to feel calmer, performs rituals more and more often, which leads to the progression of neurosis.

Excessive concentration on thoughts

This refers to the degree of importance a person places on intrusive thoughts or images. It is important to understand here that obsessive thoughts and doubts - often absurd and opposite to what a person wants or does - appear in everyone! In the 1970s, researchers conducted experiments in which they asked people with and without OCD to list their intrusive thoughts. There was no difference between the thoughts recorded by both groups of subjects - with and without the disease.

The actual content of intrusive thoughts comes from a person's values: the things that matter most to him. Thoughts represent a person's deepest fears. So, for example, any mother always worries about the health of her child, because he is the greatest value in her life, and she will be in despair if something bad happens to him. This is why obsessive thoughts about harming the child are so common among mothers.

The difference is that people with obsessive-compulsive disorder experience distressing thoughts more often than others. But this happens due to too much significance that patients attribute to these thoughts. It's no secret: the more attention you pay to your obsessive thoughts, the worse they seem. Healthy people can simply ignore obsessions and not concentrate their attention on them.

Overestimation of danger and intolerance of uncertainty

Another important aspect is overestimating the danger of the situation and underestimating your ability to cope with it. Many OCD sufferers believe that they need to know for sure that bad things won't happen. For them, OCD is a kind of absolute insurance policy. They think that if they try harder and do more rituals and better insurance, they will get more certainty. In reality, trying harder only leads to more doubt and a greater sense of uncertainty.

Perfectionism

Some forms of OCD involve the belief that there is always a perfect solution, that everything should be done perfectly, and that the slightest mistake will have serious consequences. This is common in people with OCD who seek order, and is especially common in those with anorexia nervosa.

Looping

As they say, fear has big eyes. There are typical ways to “wind up” yourself and increase anxiety with your own hands:

“Everything is terrible!” ‒ means the tendency to describe something as “terrible”, “nightmarish” or “the end of the world”. It only makes the event seem more frightening.
"Catastrophe!" - means expecting a catastrophe as the only possible outcome. The idea that something catastrophic will happen if it is not prevented.
Low tolerance for disappointment - when any excitement is perceived as “unbearable” or “intolerable.”

In OCD, a person first involuntarily plunges himself into a state of extreme anxiety due to his obsessions, then tries to escape from them by suppressing them or performing compulsive actions. As we already know, it is precisely this behavior that increases the frequency of obsessions.

Treatment of OCD

Research shows that psychotherapy significantly helps 75% of patients with obsessive-compulsive disorder. There are two main ways to treat neurosis: medications and psychotherapy. They can also be used together.

However, non-drug treatment is preferable because OCD is highly treatable without medication. Psychotherapy does not have side effects on the body and has a more sustainable effect. Medication may be recommended as treatment if the neurosis is severe, or as a short-term measure to relieve symptoms while you begin psychotherapy.

Cognitive behavioral psychotherapy (CBT), short-term strategic psychotherapy, and also are used to treat obsessive-compulsive disorder.

Exposure—the controlled confrontation with fear—is also used in the treatment of OCD.

The technique of confrontation with parallel suppression of the anxiety reaction was recognized as the first effective psychological method of combating OCD. Its essence lies in a carefully dosed confrontation with fears and obsessive thoughts, but without the usual reaction of avoidance. As a result, the patient gradually gets used to them, and fears begin to fade away.

However, not everyone feels able to undergo such treatment, so the technique has been refined through CBT, which focuses on changing the meaning of intrusive thoughts and urges (the cognitive part), as well as changing the response to the urge (the behavioral part).

Obsessive-compulsive disorder: causes

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Obsessive-compulsive disorder is a human mental illness, otherwise called obsessive-compulsive disorder. For example, a pathological desire to wash your hands two hundred times in one day because of thoughts about countless bacteria, or counting the pages of a book you are reading in an effort to know exactly how much time to spend on one sheet, or returning home many times before work in doubt whether the iron is turned off or gas.

That is, a person suffering from obsessive-compulsive disorder suffers from obsessive thoughts that dictate the need for tedious, repetitive movements, which leads to stress and depression. This condition undoubtedly reduces the quality of life and requires treatment.

Description of the disease

The official medical term “obsessive-compulsive disorder” is based on two Latin roots: “obsession,” which means “being overwhelmed or besieged by an obsessed idea,” and “compulsion,” which means “compulsory action.”

Sometimes local disorders occur:

a purely obsessive disorder, experienced only emotionally and not physically;
separately compulsive disorder, when restless actions are not caused by clear fears.

Obsessive-compulsive disorder occurs in about three out of a hundred cases in adults and about two out of five hundred in children. Mental pathology can manifest itself in different ways:

occur sporadically;
progress from year to year;
be chronic.

The first signs are usually observed no earlier than 10 years and rarely require immediate treatment. Initial obsessive-compulsive neurosis appears in the form of various phobias and strange obsessive states, the irrationality of which a person is able to understand independently.

By the age of 30, the patient may have already developed a pronounced clinical picture, with a refusal to perceive his fears adequately. In advanced cases, a person, as a rule, has to be hospitalized and treated with more effective methods than conventional psychotherapeutic sessions.

Causes

Today, the exact etiological factors for the occurrence of obsessive-compulsive syndrome are unknown. There are only a few theories and assumptions.

Among the biological causes, the following factors are considered possible:

pathologies of the autonomic nervous system;
peculiarity of the transmission of electronic impulses in the brain;
disruption of the metabolism of serotonin or other substances necessary for the normal functioning of neurons;
suffered traumatic brain injuries;
infectious diseases with complications;
genetic inheritance.

In addition to biological factors, obsessive-compulsive disorder can have a lot of psychological or social causes:

psychotraumatic family relationships;
strictly religious upbringing;
work in stressful working conditions;
experienced fear due to a real threat to life.

Panic fear may have roots in personal experience or be imposed by society. For example, watching crime news provokes anxiety about being attacked by robbers on the street or fear of car theft.

The person tries to overcome the obsessions that arise by repeating “control” actions: looking over his shoulder every ten steps, pulling the car door handle several times, etc. But such compulsions do not provide relief for long. If you don’t start fighting them in the form of psychotherapeutic treatment, obsessive-compulsive syndrome threatens to completely overwhelm a person’s psyche and turn into paranoia.

Symptoms in adults

Symptoms of obsessive-compulsive disorder in adults develop approximately the same clinical picture:

1. First of all, neurosis manifests itself in obsessive painful thoughts:

about sexual perversions;
about death, physical harm or violence;
blasphemous or sacrilegious ideas;
fears of diseases, viral infections;
anxiety about the loss of material values, etc.

Such painful thoughts terrify a person with obsessive-compulsive disorder. He understands their groundlessness, but cannot cope with the irrational fear or superstition that all this will one day come true.

2. The syndrome in adults also has external symptoms, expressed in repetitive movements or actions:

recalculation of the number of steps on the stairs;
very frequent hand washing;
rechecking turned off taps and closed doors several times in a row;
putting the table in symmetrical order every half hour;
arranging books on a shelf in a certain order, etc.

All these actions are a kind of ritual to “get rid” of an obsessive state.

3. Obsessive-compulsive disorder tends to worsen in crowded places. In a crowd, the patient may experience periodic panic attacks:

fear of infection due to the slightest sneeze from someone else;
fear of coming into contact with the “dirty” clothes of other passers-by;
nervousness due to “strange” smells, sounds, sights;
fear of losing personal belongings or becoming a victim of pickpockets.

Due to such obsessive-compulsive disorders, a person with obsessive-compulsive neurosis tries to avoid crowded places.

4. Since obsessive-compulsive disorder affects, to a greater extent, people who are suspicious and have the habit of controlling everything in their lives, the syndrome is often accompanied by a very strong decrease in self-esteem. This happens because a person understands the irrationality of the changes happening to him and is powerless in the face of his own fears.

Symptoms in children

Obsessive-compulsive disorder occurs less frequently in children than in adults. But it has a similar obsessive state:

the fear of getting lost in the crowd forces children who are already quite old to hold their parents’ hands and constantly check whether the hoop is tightly clasped together;
the fear of ending up in an orphanage (if adults have at least once threatened such “punishment”) makes the child want to very often ask his mother if he is loved;
panic at school over a lost notebook leads to a frantic counting of all school subjects while folding a briefcase, and at night waking up in a cold sweat and rushing back to this activity;
obsessive complexes, which are intensified by the “persecution” of classmates because of dirty cuffs, can torment so much that the child completely refuses to go to school.

Obsessive-compulsive disorder in children is accompanied by sullenness, unsociability, frequent nightmares and poor appetite. Contacting a child psychologist will help you get rid of the syndrome faster and prevent its development.

What to do

Obsessive-compulsive personality disorder can occur occasionally in any person, even a completely mentally healthy person. It is very important to recognize the beginning symptoms at the very first stages and begin treatment with a psychologist, or at least try to help yourself by analyzing your own behavior and developing a certain defense against the syndrome:

Step 1. Learn what obsessive-compulsive disorder is.

Read the causes, symptoms and treatments several times. Write down on a piece of paper the signs that you observe. Next to each disorder, leave space for a detailed description and a plan describing how to get rid of it.

Step 2. Ask for an outside assessment.

If you suspect obsessive-compulsive disorder, it is best, of course, to consult a specialist doctor who will help you begin effective treatment. If the first visit is very difficult, you can ask loved ones or a friend to confirm the symptoms of the disorder that have already been written down or add some others that the person himself does not notice.

Step 3. Look your fears in the eye.

A person with obsessive-compulsive disorder is usually able to understand that all fears are just a figment of his imagination. If every time a new desire arises to wash your hands or check a locked door, you remind yourself of this fact and interrupt the next “ritual” with a simple effort of will, it will be easier and easier to get rid of obsessive neurosis.

Step 4. Praise yourself.

You need to celebrate the steps towards success, even the smallest ones, and praise yourself for the work you have done. When a person suffering from the syndrome at least once feels that he is stronger than his obsessive states, that he is able to control them, the treatment of neurosis will go faster.

If a person finds it difficult to find sufficient strength within himself to get rid of obsessive-compulsive neurosis, he should consult a psychologist.

Psychotherapy methods

Treatment in the form of psychotherapeutic sessions for obsessive-compulsive syndrome is considered the most effective. Today, specialist psychologists have in their medical arsenal several effective techniques to get rid of such obsessive-compulsive neurosis:

1. Cognitive behavioral therapy for the disorder. Founded by psychiatrist Jeffrey Schwartz, the idea is to resist the syndrome by keeping compulsions to a minimum and then to their disappearance. A step-by-step method of absolute awareness of one’s disorder and its causes leads the patient to decisive steps that help get rid of neurosis for good.

2. “Thought stopping” technique. Behavioral therapy theorist Joseph Wolpe formalized the idea of using an “outside perspective.” A person suffering from neurosis is asked to remember one of the vivid situations when his obsessive states manifest themselves. At this moment, the patient is loudly told “Stop!” and the situation is analyzed using a number of questions:

Is there a high chance that this could happen?
How much does a thought interfere with living an ordinary life?
How strong is the internal discomfort?
Will life be simpler and happier without this obsession and neurosis?

Questions may vary. There may be many more. Their main task in the treatment of obsessive-compulsive neurosis is to “photograph” the situation, to examine it, as if in slow motion, to see it from all angles.

After this exercise, it becomes easier for a person to face fears and control them. The next time, when obsessive-compulsive neurosis begins to haunt him outside the walls of the psychologist’s office, the internal cry “Stop!” will be triggered, and the situation will take on completely different contours.

The given methods of psychotherapy are far from the only ones. The choice remains with the psychologist, after questioning the patient and determining the degree of obsessive-compulsive syndrome using the Yale-Brown scale, which was specially designed to identify the depth of neurosis.

Treatment with medications

Some complex cases of obsessive-compulsive disorder cannot be treated without medication. Especially when metabolic disorders necessary for the functioning of neurons were discovered. The main drugs for the treatment of neurosis are SRIs (serotonin reuptake inhibitors):

fluvoxamine or escitalopram;
tricyclic antidepressants;
paroxetine, etc.

Modern scientific research in the field of neurology has discovered therapeutic potential in agents that release the neurotransmitter glutamate and help, if not get rid of neurosis, then significantly mitigate it:

memantine or riluzole;
lamotrigine or gabapentin;
N-acetylcysteine, etc.

But conventional antidepressants are prescribed as a means of symptomatic action, for example, to eliminate neurosis, stress arising from constant obsessive states or mental disorders.

Anxiety, fear of trouble, repeated hand washing are just a few signs of a dangerous obsessive-compulsive disease. The fault line between normal and obsessive states can turn into an abyss if OCD is not diagnosed in time (from the Latin obsessive - obsession with an idea, siege, and compulsive - compulsion).

What is obsessive-compulsive disorder

The desire to check something all the time, feelings of anxiety, fear have varying degrees of severity. We can talk about the presence of a disorder if obsessions (from the Latin obsessio - “ideas with a negative connotation”) appear with a certain frequency, provoking the emergence of stereotypical behaviors called compulsions. What is OCD in psychiatry? Scientific definitions boil down to the interpretation that it is a neurosis, a syndrome of obsessive states caused by neurotic or mental disorders.

Oppositional defiant disorder, which is characterized by fear, obsession, and depressed mood, lasts for a long period of time. This specificity of obsessive-compulsive illness makes diagnosis difficult and simple at the same time, but a certain criterion is taken into account. According to the accepted classification according to Snezhnevsky, based on the peculiarities of the course, the disorder is characterized by:

a single attack lasting from a week to several years;
cases of relapse of a compulsive state, between which periods of complete recovery are recorded;
continuous dynamics of development with periodic intensification of symptoms.

Contrasting obsessions

Among the obsessive thoughts encountered in compulsive illness, there arise those that are alien to the true desires of the individual himself. Fear of doing something that a person is not capable of doing due to character or upbringing, for example, blasphemy during a religious service, or a person thinks that he can harm his loved ones - these are signs of contrasting obsession. Fear of harm in obsessive-compulsive disorder leads to strenuous avoidance of the object that caused such thoughts.

Obsessive actions

At this stage, obsessive disorder may be characterized by a need to perform certain actions that bring relief. Often senseless and irrational compulsions (compulsions) take one form or another, and such wide variation makes diagnosis difficult. The occurrence of actions is preceded by negative thoughts and impulsive actions.

Some of the most common signs of obsessive-compulsive illness include:

frequent hand washing, showering, often using antibacterial agents - this causes fear of contamination;
behavior when fear of infection forces a person to avoid contact with door handles, toilets, sinks, money as potentially dangerous carriers of dirt;
repeated (compulsive) checking of switches, sockets, door locks, when the disease of doubt crosses the line between thoughts and the need to act.

Obsessive-phobic disorders

Fear, albeit unfounded, provokes the appearance of obsessive thoughts and actions that reach the point of absurdity. An anxiety state in which obsessive-phobic disorder reaches such proportions is treatable, and rational therapy is considered to be the four-step method of Jeffrey Schwartz or working through a traumatic event or experience (aversive therapy). Among the phobias associated with obsessive-compulsive disorder, the most famous is claustrophobia (fear of enclosed spaces).

Obsessive rituals

When negative thoughts or feelings arise, but the patient’s compulsive illness is far from the diagnosis of bipolar affective disorder, one has to look for a way to neutralize the obsessive syndrome. The psyche forms some obsessive rituals, which are expressed by meaningless actions or the need to perform repeated compulsive actions similar to superstitions. The person himself may consider such rituals illogical, but anxiety disorder forces him to repeat everything all over again.

Obsessive-compulsive disorder - symptoms

Obsessive thoughts or actions that are perceived as wrong or painful can cause harm to physical health. Symptoms of obsessive-compulsive disorder can be single and have varying degrees of severity, but if you ignore the syndrome, the condition will worsen. Obsessive-compulsive neurosis can be accompanied by apathy and depression, so you need to know the signs that can be used to diagnose OCD:

the emergence of an unreasonable fear of infection, fear of contamination or trouble;
repeated obsessive actions;
compulsive behavior (defensive actions);
excessive desire to maintain order and symmetry, obsession with cleanliness, pedantry;
“getting stuck” on thoughts.

Obsessive-compulsive disorder in children

It occurs less frequently than in adults, and when diagnosed, compulsive disorder is more often detected in adolescents, and only a small percentage are children under 7 years of age. Gender does not affect the appearance or development of the syndrome, while obsessive-compulsive disorder in children does not differ from the main manifestations of neurosis in adults. If parents manage to notice signs of OCD, then it is necessary to contact a psychotherapist to choose a treatment plan using medications and behavioral or group therapy.

Obsessive-compulsive disorder - causes

A comprehensive study of the syndrome and many studies have not been able to give a clear answer to the question about the nature of obsessive-compulsive disorders. Psychological factors (stress, problems, fatigue) or physiological (chemical imbalance in nerve cells) can affect a person’s well-being.

If we look at the factors in more detail, the causes of OCD look like this:

stressful situation or traumatic event;
autoimmune reaction (consequence of streptococcal infection);
genetics (Tourette's syndrome);
disruption of brain biochemistry (decreased activity of glutamate, serotonin).

Obsessive-compulsive disorder - treatment

Almost complete recovery is not excluded, but long-term therapy will be required to get rid of obsessive-compulsive neurosis. How to treat OCD? Treatment of obsessive-compulsive disorder is carried out comprehensively with sequential or parallel use of techniques. Compulsive personality disorder in severe forms of OCD requires medication or biological therapy, and in mild cases, the following methods are used. This:

Psychotherapy. Psychoanalytic psychotherapy helps to cope with some aspects of compulsive disorder: adjusting behavior during stress (exposure and warning method), teaching relaxation techniques. Psychoeducational therapy for obsessive-compulsive disorder should be aimed at deciphering actions, thoughts, and identifying causes, for which family therapy is sometimes prescribed.
Lifestyle correction. A mandatory review of the diet, especially if there is a compulsive eating disorder, getting rid of bad habits, social or professional adaptation.
Physiotherapy at home. Hardening at any time of the year, swimming in sea water, warm baths of medium duration and subsequent wiping.

Drug treatment for OCD

A mandatory item in complex therapy, requiring a careful approach from a specialist. The success of drug treatment for OCD is associated with the correct choice of drugs, duration of use and dosage for exacerbation of symptoms. Pharmacotherapy provides for the possibility of prescribing medications of one group or another, and the most common example that can be used by a psychotherapist for the recovery of a patient is:

antidepressants (Paroxetine, Sertraline, Citalopram, Escitalopram, Fluvoxamine, Fluoxetine);
atypical antipsychotics (Risperidone);
mood stabilizers (Normotim, Lithium carbonate);
tranquilizers (Diazepam, Clonazepam).