Obsessive-compulsive disorder is a disease whose causes are rarely found on the surface. This syndrome is characterized by the presence of intrusive persistent thoughts (obsessions) to which the person responds with their respective actions (compulsions).

Obsessive Compulsive Disorder: Overview

Obsessive compulsive is deciphered as follows. Obsession (translated from Latin obsessio - "siege") - desire or thought that pops up in my brain all the time. This thought is difficult to control or get rid of it, which causes severe stress.

In obsessive-compulsive disorder, the most common obsessive thoughts (obsessions) are:

Almost everyone has experienced these intrusive thoughts. But for people with obsessive-compulsive disorder, the level of anxiety from these thoughts just rolls over. And in order to relieve anxiety, often a person is forced perform protective actions- compulsions (translated from the Latin compello - "to force").

Compulsions in this disease are a bit like rituals. These are actions that people repeat over and over in response to an obsession in order to reduce the possibility of harm. Compulsions can be physical (such as constantly checking to see if the door is closed) or mental (such as saying a phrase in your head).

In OCD, compulsions of mental rituals (special prayers or words that are repeated in a certain order), constant checks (for example, gas valves), counting are common.

The most common is considered fear of virus infection combined with obsessive cleaning and washing. A person, out of fear of getting infected, can go to great lengths: avoids shaking hands, does not touch toilet seats, door handles. Characteristically, in the obsessive compulsive syndrome, the patient does not finish washing his hands when they are already clean, but when, in the end, he feels “relief”.

Avoidance behavior is the main part of obsessive compulsive disorder, which includes:

• the need to perform obsessive actions;
• attempts to avoid situations that cause anxiety.

Obsessive-compulsive neurosis is usually accompanied by depression, guilt and shame. In human relationships, illness creates havoc and can affect performance. According to WHO, obsessive compulsive is in the top ten diseases that lead to incapacity. A person with obsessive-compulsive disorder does not seek help from doctors because he is afraid, embarrassed or does not know that his illness is being treated, including in a non-drug way.

Causes of obsessive compulsive syndrome

Despite multiple studies that focus on obsessive compulsive syndrome, it is still impossible to say unequivocally what is the main cause of OCD. Both psychological and physiological reasons can be responsible for this condition.

Genetics

Research has proven that obsessive-compulsive disorder can be passed down through the generations. The study of the problem showed that this disease is moderately hereditary, but no gene has been identified as causing such a condition. But they deserve a lot of attention. SLC1A1 and hSERT genes, they could play a role in the OCD syndrome:

• The hSERT gene is its main task, the collection of "waste" serotonin in the nerve fibers. There are studies confirming hSERT mutations in some people with OCD. As a result of such mutations, the gene works very quickly, and collects all the serotonin even before the nerve “hears” the next impulse.
• SLC1A1 - This gene is similar to hSERT, but its task is to collect another neurotransmitter - glutamate.

Neurological diseases

Brain imaging techniques have enabled scientists to study activity of certain parts of the brain. It was revealed that the activity of certain areas of the brain in OCD syndrome has a specific activity. In the syndromes of obsessive-compulsive disorder, those involved are:

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

Brain scan readings of people with obsessive compulsive disorder. The chain, which includes the sites described above, regulates behavioral factors such as bodily secretions, sexuality, and aggression. The chain activates the appropriate behavior, for example, after contact with something unpleasant, washing hands thoroughly. Normally, after the action, the desire decreases, that is, the person finishes washing his hands and begins to perform another activity.

But in people with obsessive-compulsive disorder the brain is experiencing certain complications with the circuit off, this creates communication problems. Compulsions and obsessions continue, this leads to the repetition of some action.

autoimmune reaction

Obsessive-compulsive disorder may be the result of an autoimmune disease. Certain cases of rapid development of OCD in children may be due to a streptococcal bacterium causing dysfunction and inflammation of the basal ganglia.

Another study has suggested that the episodic occurrence of OCD occurs not due to strep bacteria, rather, more due to the prophylaxis of antibiotics prescribed to treat the disease.

Psychological Causes of OCD

Taking into account the basic law of behavioral psychology, the repetition of a certain behavioral action makes it easier to reproduce it in the future.

Patients with obsessive-compulsive disorder do nothing but try to avoid things that can activate fear, perform “rituals” or “wrestle” with thoughts to reduce feelings of anxiety. These actions temporarily reduce fear, but in a paradoxical way, according to the above law, increase the likelihood of subsequent manifestation of obsessive behavior. It turns out that the main cause of OCD is avoidance. Instead of coping with fear, avoiding it occurs, this can lead to disastrous consequences.

People who are most susceptible to developing OCD are those who are under stress: they suffer from overwork, end relationships, start a new job. For example, a person who calmly used a public toilet at work all the time, in a stressful state, suddenly begins to “wind up”, they say, the toilet seat is dirty and you can catch the disease. Then, by association, fear begins to move to other similar objects: public showers, sinks, etc.

When a person begins to avoid public toilets or perform various cleansing rituals (cleaning doorknobs, seats, followed by thorough hand washing) instead of enduring fear, then this can turn into a phobia.

Distress, environment

Psychological trauma and stress activate the OCD syndrome in people who are prone to developing this condition. Studies have shown that obsessive-compulsive neurosis in 55-75% of cases appeared due to the adverse effects of the environment.

Statistics prove the fact that many people with symptoms of obsessive compulsive disorder, just before the onset of the syndrome, suffered traumatic or stressful event. These events can also exacerbate an already existing disorder. Here is a list of the most traumatic environmental causes:

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

Cognitive causes of obsessive-compulsive disorder

Cognitive theory explains the appearance of OCD syndrome by the inability to interpret thoughts correctly. Many people have intrusive or unwanted thoughts several times a day, but all people who suffer from the disorder significantly exaggerate the importance of such thoughts.

Obsessions in young mothers. For example, a woman who is raising a baby, amid fatigue, may from time to time have thoughts about harming her child. Many, of course, dismiss these obsessions, do not notice them. People who suffer from a disorder exaggerate the importance of thoughts and take them as a threat: “What if I really am capable of this ?!”

A woman thinks that she can be a threat to the baby, and this causes anxiety and other negative emotions in her, such as feelings of shame, guilt or disgust.

Fear of one's thoughts sometimes leads to attempts to neutralize the negative emotions that manifest from obsessions, for example by avoiding situations that cause these thoughts, or by participating in "rituals" of prayer or excessive cleansing.

Scientists suggest that people with the disorder syndrome attach exaggerated importance to thoughts due to false prejudice received in childhood. Among them:

Causes of the progression of obsessive-compulsive disorder

For effective treatment of the disorder, knowing the causes that caused the disease is not so important. It is much more important to know the mechanisms that support OCD. This is the key to overcoming the disorder.

Compulsive rituals and avoidance

OKR is supported by the following circle: anxiety, obsession and response to this anxiety.

Constantly, when a person avoids an action or situation, in the brain, his behavior is “fixed” in the form of an appropriate neural circuit. The next time in the same situation, he will begin to act in the same way, and accordingly, again miss the chance to reduce the activity of the neurosis.

Compulsions are also fixed. A person feels less anxious when he checked if the iron was turned off. Accordingly, he will continue to act in the same way in the future.

Impulsive actions and avoidance initially "work": the person believes that he has prevented harm, and this stops the feeling of anxiety. But in the long run, this creates even more fear and anxiety, as it feeds the obsession.

"Magical" thinking and exaggeration of one's abilities

The OCD patient greatly exaggerates his ability to influence the world and his possibilities. He convinced of his power prevent or cause negative events through thought. "Magical" thinking implies the belief that the performance of certain rituals, actions, will cause something undesirable (reminiscent of superstition).

This allows a person to feel the illusion of comfort, as if he has a huge influence on the control and events of what is happening. Most often, a person, wanting to feel calmer, constantly performs rituals, this leads to the progression of OCD.

perfectionism

Certain types of OCD involve the belief that everything must be done perfectly, that there is a perfect solution all the time, and that even That little mistake will have big consequences.. It often occurs in patients diagnosed with OCD who strive for order, and most often in those people who suffer from anorexia nervosa.

Uncertainty intolerance and risk overestimation

Also a very important aspect is the overestimation of the danger of the situation and the underestimation of the ability to cope with it. Most people who suffer from OCD feel that they have a duty to know for sure that bad things won't happen. For these people, OCD is some sort of absolute insurance. They believe that if they try hard, perform more rituals and secure themselves well, they will have more certainty. In fact, trying too hard only leads to increased feelings of uncertainty and increased doubt.

Treatment for obsessive-compulsive disorder

Studies have proven that psychotherapy significantly helps in 70% of people diagnosed with OCD. There are two main ways to treat the disorder: psychotherapy and medications. However, they can be used simultaneously.

But still, non-drug therapy is preferable, since OCD can be perfectly corrected without drugs. Psychotherapy has no side effects on the body and has a more lasting effect. Medications may be prescribed as a treatment when the neurosis is complicated, or as a short-term measure to relieve symptoms before starting psychiatric treatment.

For the treatment of OCD using EMDR therapy, cognitive behavioral therapy (CBT), hypnosis and strategic brief psychotherapy.

The first effective psychological method of treating OCD was recognized as a method of confrontation with the simultaneous suppression of disturbing emotions. Its meaning lies in a carefully dosed collision with obsessive thoughts and fears, but without the typical avoidance reaction. As a result, a person eventually gets used to it, and fears gradually disappear.

But not everyone in themselves feels the strength to go through this treatment, so this method has been improved with the help of CBT, which focuses on changing the response to the urge (behavioral part), as well as changing the meaning of the resulting obsessive urges and thoughts (cognitive part).

Any of the aforementioned psychotherapeutic methods for treating the disorder allows get out of the cycle of anxiety, obsessions and avoidance reactions. And it doesn't matter whether you and the therapist first focus on the analysis of the meanings that the patient attaches to events and thoughts, with further development of alternative reactions to them. Or the focus is on reducing the level of discomfort from working through obsessions. Or it is the restoration of the ability to unconsciously filter intrusive thoughts before they pass to the conscious level.

This treatment reduces the anxiety that OCD usually causes. Methods of therapy are assimilated by a person, after which his urge to act inconsistently with the situation and anxiety disappear. obsessive compulsive disorder is not a mental illness, since it does not lead to a change in personality, it is a neurotic disorder that is reversible with proper treatment.

Last update of the article 02.02.2018

Obsessive-compulsive disorder (OCD) is a mental illness characterized by obsessive thoughts, doubts, and constant double-checking of actions taken.

Obsessive-compulsive disorder is not as serious a pathology as schizophrenia or depression, but this mental disorder can significantly impair a person's quality of life, contribute to a decrease in self-esteem and even worsen the patient's social status.

The reasons

Obsessive-compulsive disorder can develop due to the interaction of a number of factors. First of all, it is a hereditary predisposition. Certain personality traits, a model of behavior in psychotraumatic conditions can be inherited by a person.

The development of this mental disorder can be caused by sudden mental trauma (a life-threatening situation, the death of a loved one, a natural disaster) or a long stay in stressful conditions when the human psyche is “exhausted”. Examples of such a situation are an uninteresting, hated job for a person, from which he cannot quit (he lives in a small village where another job cannot be found).

Symptoms of the disease

The first manifestations of obsessive-compulsive disorder appear in adolescence or early adulthood. At this time, obsessions arise, which are regarded by patients as something absurd, illogical.

The main obsessions characteristic of OCD are obsessive thoughts and compulsive actions.

Now let's take a closer look at each individual symptom.

obsessive thoughts

obsessive thoughts- painful thoughts, images and desires that arise against the will of a person, again and again come to his mind, and which he tries to resist. Such thoughts themselves “swarm” in the head, do not give a person peace of mind, he would be happy to switch to something else, but again and again obsessive thoughts arise in his mind.

We are all different, so each of us has our own obsessive thoughts. However, all obsessive thoughts can be divided into obsessive doubts, obsessive fears of pollution or contamination, and contrast obsessions. So, let's talk about each of these groups separately.

Obsessive doubts

Obsessive doubts arose, probably, in each of us. Have I done everything? Did you make the right decision? Did I close the door? Did I turn off the gas? Did you write everything in the answer to the ticket during the entrance exam? Familiar thoughts, right?

Obsessive doubts can be related to everyday issues (is the door closed, is the gas turned off), with official activities (a bank employee will doubt whether he correctly indicated the account to which he transferred the money, the teacher - whether he gave the correct grade to the student). To make sure that everything is done, a person will again and again check gas, electricity, water, the number of the current account. And even if everything is done carefully, then after a while doubts may return again (what if the tap was not completely closed, and I didn’t see it; what if I still mixed up the numbers in the account number?)

If such thoughts sometimes arise - it's okay, it happens to almost everyone. But if you are forced to check many times whether the gas is turned off, the light is still not sure that everything is turned off, in this case it is better to visit a psychiatrist. You may have obsessive-compulsive personality disorder. By the way, here's a little anecdote on the subject.

The appearance of various obsessions, especially obsessive doubts, is characteristic of such a personality disorder as.

Contrasting obsessions

Contrasting obsessions can also occur with obsessive-compulsive disorder. These are vivid ideas that arise in the imagination of a person, unpleasant in meaning, blasphemous thoughts.

Contrasting obsessions include an absolutely groundless fear of harming oneself or others. It may also be a desire to continue someone's remark with an ironic, offensive statement. This group of obsessions can include obsessive representations of sexual content - obsessions of the type of forbidden representations of sexual acts with animals, representatives of the same sex.

Obsessions of pollution

Obsessions of pollution are also called mysophobia. They can be manifested by fear of getting dirty with earth, feces, urine, fear of penetration into the body of microorganisms, harmful substances.

Sometimes the fear of pollution is not very pronounced. At the same time, a person for many years only washes his hands too hard or washes the floor several times a day for no apparent reason. Such phobias do not significantly affect the quality of human life, and others are regarded only as increased cleanliness.

Much worse if pollution obsessions get more complicated. At the same time, various actions, rituals appear, aimed at preventing pollution. Such a person will avoid touching objects that may have been contaminated. He will go out into the street only in special clothes, supposedly protecting him from pollution. He will also wash his hands in a certain sequence and in no case violates it (otherwise he will consider that his hands were dirty). In the later stages of the disease, some people even refuse to go outside, so as not to get dirty there, not to pick up some kind of infection.

Another manifestation of mysophobia is the fear of contracting some kind of disease. Most often, patients are afraid that pathogens will enter their body from the outside in some unusual way (for example, due to contact with old things that once belonged to a sick person).

obsessive actions

Compulsive actions- stereotypically repetitive, obsessive behavior. In some cases, obsessive actions take the form of protective rituals: by performing certain actions under certain conditions, a person tries to protect himself from something. It is these compulsions that are most often found in OCD.

Among obsessive actions, especially in childhood and adolescence, tics predominate. They differ from tics in organic brain diseases in that they are much more complex movements that have lost their original meaning. For example, compulsive actions can include hand movements, as if throwing long hair back (although a person has been walking with a short haircut for a long time) or attempts to blink their eyes hard, as if a speck has got into the eye. The performance of these movements is accompanied by a painful sense of persistence, a person understands the meaninglessness of these movements, but performs them anyway.

Many of us have bad habits - someone bites his lips, someone twists the ring, someone else periodically spits. However, these actions are not accompanied by a sense of obsession.

If you diligently take care of yourself, you can get rid of such habits. Or if someone from the outside pays attention that a person is biting his lips at that moment, then this person will stop doing this, and his mental state will not be disturbed.

In the presence of obsessive thoughts and actions that are becoming more and more absurd, it must be borne in mind that similar symptoms can also be observed with. It is also characterized by the progression of emotional impoverishment, the loss of habitual interests.

Treatment of the disorder

Antidepressants (anafranil, imipramine, amitriptyline, fluvoxamine) can be used to treat obsessive-compulsive disorder. With contrast obsessions, the antidepressant sertraline (Zoloft) has the best effect.

Tranquilizers (hydroxyzine, alprazolam, diazepam, clonazepam) may also be given for short-term treatment of OCD.

With an obsessive fear of pollution, accompanied by a complex system of protective rituals, neuroleptics (sonapax, truxal, ridazine) can be used.

In most cases, effective treatment of OCD is impossible without the use of psychotherapy. Its goal is to reduce a person’s self-control, to teach him to relax. One of the methods of psychotherapeutic treatment is the purposeful and consistent contact of a person with things that he avoids. This is done so that the patient learns to consciously control his emotions in such situations.

Article author: Maria Barnikova (psychiatrist)

Obsessive Compulsive Disorder: Causes, Symptoms, Treatment

29.04.2018

Maria Barnikova

Obsessive-compulsive disorder is manifested by the regular occurrence of obsessive thoughts (obsessions) and / or the performance of stereotypical actions (compulsions).

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

To date, information on the prevalence of the disease cannot be called reliable and accurate. The inconsistency of the data can be explained by the fact that a lot of people suffering from obsessions do not go to the psychiatric service. Therefore, in clinical practice, in terms of frequency, obsessive-compulsive disorder comes after anxiety-phobic disorders and conversion disorders. However, conducted anonymous sociological surveys show that over 3% of respondents suffer from obsessions and compulsions in varying degrees of severity.

First episode of obsessive-compulsive disorder most often occurs between 25 and 35 years of age. Neurosis is fixed 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. Often, OCD affects individuals with a high IQ, whose professional duties 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 people with OCD, the symptoms are chronic, with obsessions occurring regularly or permanently. Manifestations of obsessive-compulsive disorder may be sluggish and perceived by the patient as tolerable phenomena. Or, as the disease develops, the symptoms become aggravated at a rapid pace, preventing a person from having a normal existence. Depending on the severity and rate of development of symptoms, obsessive-compulsive disorder either partially impedes the patient's full-fledged activity, or completely prevents interaction in society. In a severe course 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 process of thinking and cannot control his behavior.

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

• It is customary to call obsessions those thoughts that come to mind involuntarily, in addition to the desire of the subject, intrusive, relentless, oppressive, languishing, frightening or threatening thoughts. Obsessive thinking includes persistent ideas, images, desires, desires, doubts, fears. A person tries with all his might to resist regularly appearing obsessive thoughts. However, attempts to distract and switch the course of thinking do not give the desired result. Intrusive ideas still cover the entire spectrum of the subject's thoughts. No other ideas, except annoying thoughts, arise in the mind of a person.
• 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. The persistent repetition of compulsive actions is designed to prevent the onset of any frightening circumstances for the object. However, according to an objective assessment, such circumstances simply cannot occur or are unlikely situations.

In obsessive-compulsive disorder, the patient may have both obsessions and compulsions at the same time. Also, exclusively obsessive thoughts without subsequent ritual actions can be observed. Or a person may suffer from an 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 of a person's stay in a severe stressful state. The debut of OCD is possible as a result of the sudden action of extreme stressful situations. Or the first episode of the disorder is the result of prolonged chronic stress. It should be pointed out that the trigger mechanism 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 those around him that after the tragedy that happened, the person began to behave differently and, as it were, is in his own world of reflection. Despite the fact that the symptoms of obsessive-compulsive disorder become pronounced precisely after extreme circumstances in the life of the subject, it acts only as a trigger for the visible manifestation of the pathology. A traumatic situation is not a direct cause of OCD, it only provokes the fastest aggravation of the disease.

Reason 1. Genetic theory

The predisposition to pathological reactions is laid down at the gene level. It has been established that the majority of patients with obsessive-compulsive disorder have defects in the gene responsible for the transport of the neurotransmitter serotonin. More than half of the examined individuals had mutations in the seventeenth chromosome in the SLC6A4 gene, a serotonin transporter.

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

Scientists also suggest that excessive anxiety is also transmitted from descendants to ancestors. Many cases have been recorded when 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 due to innate qualities and life experiences. Most OCD patients are distinguished by 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 revealed in such persons 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

At risk are anancaste personalities. They are characterized by an increased tendency to doubt. These pedantic persons are absorbed in the study of details. These are suspicious and impressionable people. They strive to do their best and suffer from perfectionism. Every day they scrupulously think over the events of their lives, endlessly analyze their actions.

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

Reason 4. The influence of neurotransmitters

Doctors suggest that a malfunction 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. Violations of serotonin metabolism do not allow for a qualitative exchange of information between nerve cells.

Reason 5. PANDAS syndrome

Nowadays, there is a lot of confirmation of the hypothesis put forward 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 such that if there is a streptococcal infection in the body, the immune system is activated and, trying to destroy microbes, mistakenly affects nerve tissues.

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 is the severity and intensity of the symptoms. Obsessions and compulsions occur in a person regularly or are present constantly. The symptoms of the disorder make it impossible for the subject to fully function and interact in society.

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

Group 1. Unremovable doubts

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

Pathological doubts of the patient may relate to traditional household chores, 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 several times to the scene of action, 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 duties. The patient is confused whether he has completed the required task or not. He is not sure that he wrote the document and sent it by e-mail. He doubts if all the details are in the weekly report. He rereads, skims, rechecks over and over 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 the will. The patient understands that his doubts are groundless. He knows he has never made the same mistake in his life. However, he cannot "persuade" his mind not to retest.

Only a sudden "insight" can break the vicious circle. This is the situation when a person's mind clears up, the symptoms of obsessive-compulsive disorder subside for a while, and the person experiences release from obsessions. However, a person cannot bring the moment of “enlightenment” closer by an effort of will.

Group 2. Immoral obsessions

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

The subject may be overcome by a thirst to offend and humiliate someone, to be nasty and rude to someone. A respectable individual may be pursued by some absurd undertaking, which is a loose immoral act. He may begin to blaspheme God and speak unflatteringly about the church. He may be overcome by the idea of ​​indulging in sexual debauchery. He may be tempted to commit a hooligan act.

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

Group 3. Overwhelming feelings about pollution

The symptoms of obsessive-compulsive disorder also affect the topic. The patient may be pathologically afraid of contracting some difficult-to-diagnose and incurable disease. In such a situation, it performs protective actions to exclude contact with microbes. He takes strange precautions, afraid of viruses.

Obsessions are also manifested by an abnormal fear of pollution. Patients with obsessive-compulsive disorder may fear that they will be soiled with dirt. They are terribly afraid of house dust, so they are engaged in cleaning for days on end. Such subjects are very careful about what they eat and drink, as they are convinced that they can be poisoned by low-quality food.

In obsessive-compulsive disorder, common themes of obsessions are the patient's thoughts about polluting his own home. Such subjects are not satisfied with standard apartment cleaning methods. They vacuum the carpets several times, wash the floor with disinfectants, wipe the surfaces of the furniture with cleaning products. For some patients, cleaning the home takes the entire period of wakefulness, they arrange a break for themselves only during the night's sleep.

Group 4. Obsessive actions

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

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 warning method - regular washing with "holy" water;
• stereotypical, mechanically performed movements, ex: pulling one's own hair out of one's head;
• devoid of common sense and the need to perform any process, for example: combing 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 shoe units in parallel;
• craving for collecting, collecting, hoarding, when the hobby goes from the category of a hobby to a pathology, for example: keeping at home all the newspapers bought in the last 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 the symptoms and the severity of the existing obsessions. In most cases, it is possible to help a person by treating on an outpatient basis. However, some patients with severe OCD require hospitalization because there is a risk that obsessive thoughts will require actions that can cause real harm to the person and their environment.

The classical method of treating obsessive-compulsive disorder provides for the consistent implementation of activities that can be divided into four groups:

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

Medical treatment

The use of medications has the following goals: to strengthen the patient's nervous system, to minimize feelings and anxieties, to help take control of one's own thinking and behavior, to 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 methods for getting rid of obsessive-compulsive disorder. Most often, the treatment of OCD is carried out using the cognitive-behavioral method. This technique involves helping the client to discover the destructive components of thinking and then gaining a functional way of thinking. During psychotherapeutic sessions, the patient acquires the skills to control his thoughts, which makes it possible to control his own behavior.

Another psychotherapeutic treatment option that is showing good results in the treatment of obsessive-compulsive disorder is exposure and reaction prevention. Placing the patient in artificially created frightening conditions, accompanied by a clear and understandable step-by-step instruction on how to prevent compulsions, gradually alleviates and eliminates the symptoms of obsessive-compulsive disorder.

Hypnosis treatment

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

During the session of hypnosis, there is a break in the associative connection between overpowering obsessions and the need to use a stereotypical behavior model. Hypnosis techniques help the patient to be convinced of the inappropriateness, absurdity and alienness of the emerging obsessive thoughts. As a result of hypnosis, he no longer needs to perform certain rituals. He acquires a mind free from prejudices and takes control of his own behavior.

Preventive actions

To prevent recurrence 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 formulations;
• ensuring a good night's sleep;
• daily walks before bed;
• being outdoors for at least two hours a day;

Reading time: 5 min

Obsessive-compulsive disorder is a dysfunction of mental activity, manifested by involuntary thoughts of an obsessive nature that interfere with normal life, as well as various fears. These thoughts give rise to anxiety, which can only be relieved by performing obsessive and tiresome activities called compulsions.

Obsessive-compulsive disorder can be progressive, episodic, or chronic. Obsessional thoughts are ideas or gravitations that are born again and again in a stereotyped form in a person's head. The essence of these thoughts is almost always painful, since they are either perceived as meaningless ideas or carry obscene or aggressive content.

Causes of Obsessive-Compulsive Disorder

The root causes of the disorder in question can rarely be found on the surface. Obsessive-compulsive OCD is characterized by compulsions (ritual acts) and obsessions (obsessive thoughts). The most common involuntary intrusive thoughts are:

Fear of contamination (eg, viruses, germs, fluids, chemicals, or excreta);

Signs of obsessive-compulsive disorder in children:

Wet, chapped hands (if the child suffers from compulsive handwashing);

Long stay in the bathroom;

Slow homework due to fear of making a mistake;

Making many corrections and amendments to school work;

Strange or repetitive behavior, such as constantly checking doors to see if they are closed or taps;

Tiresome repetitive questions that require reassurance, such as "Mom, touch me, I have a fever."

How to treat obsessive-compulsive disorder in children? Many parents want to know. First of all, it is necessary to determine exactly whether their child suffers from obsessive-compulsive disorder or simply practices some of their rituals. It is possible to single out quite normal rituals for childhood, which parents often take for violations. These include:

Children under the age of three often have certain "traditions" of going to bed, by the school period this usually either disappears or becomes mild;

Invented games with certain rules, collecting (from the age of five);

Excessive passion for some performer, subculture, which is a way of socialization, building relationships with peers who have similar hobbies.

Before getting rid of obsessive-compulsive disorder, parents need to differentiate it from the normal manifestations inherent in the age period in which their baby is. The main difference between the described syndrome and normal rituals is the understanding by adolescents and children of the abnormality of obsessive thoughts and ritual actions. Children are aware that their actions are deviant, so they try to resist them. This understanding pushes them to hide obsessive thoughts and ritual actions from the environment. Therefore, if a baby performs a certain ritual without hiding before going to bed, then this does not indicate the presence of an ailment. You need to understand that such behavior is only inherent in his age period.

Treatment of obsessive-compulsive disorder

Previously, the syndrome under consideration was considered a condition that is resistant (unresponsive) to treatment, since traditional psychotherapeutic methods based on the principles of , rarely brought an effect. Also, the results of the use of various drugs were not encouraging. However, in the 1980s, this situation changed dramatically due to the introduction of new methods of behavioral therapy and pharmacopoeial medicine, the effectiveness of which was proven through large-scale studies.

Scientists of that time, trying to find the answer to the question "how to treat obsessive-compulsive disorder" empirically proved that the most effective method of behavioral therapy for this disorder is the method of preventing reaction and exposure.

The patient is instructed on how to resist the performance of compulsive actions, after which he is placed in a situation that provokes discomfort caused by obsessions.

The main thing in the treatment of the disease in question is the timely recognition of obsessive-compulsive disorder and the correct diagnosis.

Currently, the main medications for the treatment of obsessive-compulsive disorder are selective serotonin reuptake inhibitors (clomipramine), anxiolytics (Clonazepam, Buspirone), mood stabilizers (Lithium preparations) and antipsychotics (Rimozide).

How to get rid of obsessive-compulsive disorder? Most therapists agree that the treatment of this disease should begin with the appointment of antidepressants, namely drugs of the group of selective serotonin reuptake inhibitors in an adequate dose. Drugs in this pharmacotherapeutic group are better tolerated by patients and are considered safer than clomipramine (a tricyclic antidepressant that causes blocking of serotonin reuptake), previously widely used in the treatment of the disorder in question.

It is also practiced to prescribe anxiolytics in combination with other drugs. It is not recommended to use them as a monotherapy drug. The appointment of normotimic drugs, namely Lithium preparations, is shown, since Lithium promotes the release of serotonin.

A number of researchers have proven the effectiveness of prescribing atypical antipsychotics (Olanzapine) in combination with serotonergic antidepressants.

In addition to the use of drugs in the treatment of obsessions and compulsions, the modern approach involves the use of psychotherapeutic methods. An excellent psychotherapeutic effect is given by the four-step technique, which provides the opportunity to simplify or modify ritual procedures. This method is based on the patient's awareness of the problem and the gradual overcoming of the symptoms.

Obsessive-compulsive disorder home treatment is not recommended, but there are a number of treatment and preventive measures that can reduce the severity of manifestations.

So, obsessive-compulsive disorder treatment at home involves:

Decreased consumption of alcohol and drinks containing caffeine;

Getting rid of bad habits;

Eating regularly, as hunger, lack of nutrients, low sugar levels can provoke a stressful condition that will cause symptoms of obsessive-compulsive disorder;

Regular exercise, as the systematic release of endorphins improves metabolism, increases stress resistance and improves overall human health;

Establishing an optimal sleep and wakefulness regimen;

Taking warm baths, during which a cool compress should be placed on the head of the suffering individual, this procedure should be carried out several times a week for twenty minutes, each procedure should be lowered in water temperature;

To relieve anxiety, in order to relax and calm the sick individual, the ingestion of herbal decoctions and infusions with a sedative effect (the herb of valerian officinalis, lemon balm, motherwort is used);

The systematic use of St. John's wort, which allows you to increase mental concentration, improve clarity of consciousness, which affects the power of compulsion to perform ritual actions;

Daily breathing exercises, which allows you to restore a normal emotional background, contributing to a "sober" assessment of the situation.

After the therapy, social rehabilitation is required. Only in the case of successful adaptation after the treatment of obsessive-compulsive disorder, clinical symptoms will not return. The complex of rehabilitation measures includes training in fruitful interaction with the social and immediate environment. For a complete recovery from obsessive-compulsive disorder, the support of loved ones plays a special role.

Doctor of the Medical and Psychological Center "PsychoMed"

Obsessive-compulsive disorder is a psychological disorder of a neurotic level, which is characterized by involuntary obsessions. disturbing thoughts that arise in the form of an obsession. This is followed by an obsessive behavior - repetitive actions goal reducing the level of anxiety.

A striking example of the manifestation such neurosis are rituals, for example, repeated washing of the head, hands, swinging the lower limbs, checking the doors (if they are exactly locked), twitching the muscles of the body, etc. The person seems to be stuck on an obsessive thought or idea that causes anxiety, and literally falls into a stupor: he begins to repeat the same action over and over again until it brings the desired relief. If you suppress compulsive (forced) actions, anxiety can become more pronounced.

The disease is diagnosed with the same frequency in women and men (approximately 2.5% of the population), but it has been found that it occurs more often in people with high intellectual abilities. Despite the complex clinical picture, OCD disease treatable. For this, complex therapy is carried out, consisting of medications and cognitive-behavioral psychotherapy. It is very difficult to cope with the disease on your own.

The main forms of neurosis of obsessive thoughts

obsessive-compulsive disordercan manifest itself in one of three forms: single, relapsing or progressive. Each of them has a distinctive flow pattern. It is worth mentioning right away that it is obsessive thoughts (obsessions) that provoke a series of obsessive actions (compulsions), regardless of kind diseases. According to statistics, neurosis in 20% of patients is limited only to obsessive thoughts. In rare cases, obsessions can be caused by compulsions.

Single

Under a single form of OCD understand the following clinical picture: the patient has signs of neurosis for months or years without changing the level of intensity. As they age, they may pass .

remitting

This form of the disease is characterized by an exacerbation or attenuation of symptoms. This does not allow a person to interact normally with society, to engage in ordinary work activities. As a rule, the patient is afraid of the next attacks and isolates himself as much as possible from provoking factors, even if this means not leaving the house for many months.

progressive

For a certain time, the patient has an aggravation of symptoms, namely:

• anxiety and fears become more widespread;
• new ones are joining phobias , fears and rituals that were not previously in the anamnesis.

If you do not start treatment, the mental state of a person deteriorates sharply, anxiety and depressive manifestations occur. He is so obsessed with disturbing thoughts and actions that it can harm his health.

Peak diagnostics obsessive neurosis occurs in adolescence. During this period, it is still impossible to give a clear classification of the disease, so neurosis is assessed based on the predominance of phobias, ideas or movements:

• Phobic. Teenager with OCD, phobias or specific fears dominate.
• Obsessive. Such a neurosis is more typical for adolescence. It consists in the predominance of obsessive repetitive thoughts - ideas, plans, concepts.
• Compulsive. In this case, compulsive actions predominate over obsessions. This form of OCD is sometimes compared to autism.

Symptoms of Obsessive-Compulsive Syndrome

Due to the fact that OCD most often begins to manifest itself in adolescence (although neurosis is possible in children 3-12 years), then the first symptoms are noticed by parents or doctors, but already several years after the onset of the disease.

There is a certain list of characteristics that describe the disease. If, after a conversation and examination of the patient, from 4 to 8 points are revealed, he is most often given OCD diagnosis . You yourself can carry out such test Here is a list of those features:

• Life goals for a person cease to be important due to strong anxiety about specific details, the order of things, the schedule of the day.
• Perfectionism is manifested, which does not allow to complete some task to the end (for example, two hours of washing one plate out of twenty).
• Excessive industriousness, work productivity up to the complete exclusion of rest and friends from life. At the same time, such labor assertiveness is not justified by economic reasons, in other words, a person works for wear and tear not for money, but for other personal goals.
• Personality characterized by scrupulousness, over consciousness, firm views on the concepts of ethics and morality.
• A person cannot independently (of his own free will) get rid of from worthless, spoiled things, even if they have no sentimental value.
• Unwillingness to delegate any powers to others people until they prove that they can do everything according to the rules of personality.
• Fear of spending money (for example, on yourself, children, parents) because of a deep conviction that they should be safe until some kind of disaster occurs.
• The personality shows the inability to adapt to new conditions and obvious stubbornness.

If a person has a predisposition to anxiety, then the development of OCD usually begins closer to 5 years. This is usually the time when parents start talking. to kid that he must do everything right (wash his hands, sit at the table, fold toys, etc.). Realizing that any business should be brought to perfection and act as an example, the still unformed little personality is overloaded with the duty and burden of responsibility that its parents have placed on it. If there is a predisposition to OCD, then such an attitude in childhood will certainly leave its mark on the psyche and will make itself felt in adulthood.

Due to strong pressure from parents, children, becoming adults , cannot learn to relax, rest, satisfy their desires. Often, obsessive-compulsive disorder is diagnosed in one or both parents, who also did not know how to fully relax, devoting themselves exclusively to work and household chores. From childhood, a child adopts a model of behavior that becomes an internal norm (“it is customary in our family”). Here are a few tell-tale signs of an obsessive-compulsive personality:

• painful reaction to criticism;
• pronounced perfectionism;
• doubts and fears;
• obsessive account.

A person with OCD thinks: “If I am criticized, it means that I did not manage to complete the task better and faster than others, therefore I am guilty and do not deserve to be treated well.” The tension that patients experience in order to achieve their goal is sometimes palpable almost at the physical level. If they are interrupted, they immediately begin to experience anxiety.

Anxiety and guilt pester them especially strongly if negative thoughts (including sexual ones), ideas, reactions, feelings intrude into the usual daily routine. To alleviate the condition, a person can resort to small rituals, for example:

• count (beads in a bag, the number of red traffic light switches, matches in a box, etc.);
• perform tasks/actions in a certain order so that it brings a sense of control and relieves anxiety.

A person with obsessive thoughts is prone to idealization, so he himself can act as a critic if someone from relatives or friends does not meet the expected standards. This leads to tensions in the family, difficulties in building friendships. When OCD strikes early, it is not uncommon for people to remain single and romantically deprived for many years.

Causes of OCD disorder

According to experts,obsessive-compulsive neurosiscan be caused by three factors at once: biological, psychological and social, although the exact causes of the disease have not yet been established. Thus, the disease determines upbringing, character and personality traits in general, hereditary predisposition, the presence or absence of neurological problems, and the environment.

All of the above gives rise to obsessive thoughts and phobias, which subsequently lead to rituals. The most common phobias among OCD patients are mysophobia (fear of getting dirty, leading to constant washing of hands, up to skin abrasion), carcinophobia (panic fear of getting cancer), claustrophobia (fear of enclosed spaces), agoraphobia (fear of large open spaces and crowded places ), xenophobia (fear of everything new and unknown).

Personality Features

These include traits such as increased receptivity and sensitivity, a tendency to think more than feel.

Upbringing

Neurosis can be provoked by a strict upbringing with an emphasis on a sense of duty and responsibility, excessive demands on the child's academic performance, forced adherence to religion, and excessive strictness in educational institutions.

Heredity

Approximately 50% of patients have a relative who also has OCD. If among your loved ones there is such diagnosis in history, it is worth thinking about visiting a specialized specialist.

neurological problems

One common cause is changes in neurotransmitter metabolism. In violation of the metabolism of serotonin, dopamine, gamma-aminobutyric acid, norepinephrine, the transmission of synaptic impulses worsens, and as a result, the activity of interaction between the sections of the central nervous system decreases. Other changes in the brain are also possible, such as conduction disturbances and pathological CT findings.

Stress and psychological trauma

If a person has a predisposition to develop obsessive-compulsive disorder, then constant stress or deep shock (death of a loved one, car accident) can trigger the pathological process. Without a biological predisposition, the reaction of the psyche will be different.

Treatment for obsessive-compulsive disorder

Diagnosis and therapy of the disease is carried out by two main specialists - a psychiatrist and a psychotherapist.obsessive statewell amenable to treatment with an integrated approach. The doctor is studying history patient's illness, evaluates his current condition and stage development of OCD, after which he selects the optimal treatment regimen, consisting of:

• Medical funds . All groups of drugs are prescribed by a specialist on an individual basis, taking into account the age of the patient and the intensity of symptoms.
• Cognitive Behavioral Therapy. Its essence is to teach the patient to recognize erroneous and illogical thoughts, and then replace them with logical ones. Work is also underway to form behavioral patterns that can displace obsessive behavior.
• Psychotherapy. This is an individual approach that takes into account the causes of the disease (emotional disturbances, shocks, a traumatic event, etc.) and the scope of the manifestation of the main symptoms (work, family, life).

Treatment, as a rule, is carried out at home, but in severe cases, hospitalization in a psychoneurological dispensary is required for complex therapy in a hospital setting. For a successful cure, it is important to recognize the disease in time, since the aggravation of the relapsing and progressive forms of OCD leads to pronounced problems in the social, personal life of a person and in his work activity.