Obsessive-compulsive disorder: characteristic signs and treatment methods. Impulsive (obsessive) compulsive personality disorder

(OCD)

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder(abbr. OCD) is a mental disorder characterized by the appearance of involuntary thoughts and fears (obsessions), forcing a person to perform certain actions (compulsions), which interfere with daily activities and cause a state of increased tension.

The patient may try to ignore or stop the intrusive thoughts, but this only increases stress and anxiety. Eventually, the person feels compelled to engage in compulsive behavior to try to relieve the increasing stress. Despite attempts to ignore obsessions or get rid of them, patients continue to return to them. This leads to increased ritual behavior - a vicious circle of OCD is formed.

Obsessive-compulsive disorder often centers around certain themes, such as the fear of being infected by viruses or bacteria. To cope with the fear of contamination, a person may compulsively wash their hands until the skin becomes inflamed and cracked.

Causes and risk factors for OCD

The causes of obsessive-compulsive disorder are not fully understood. Main theories of its development include:

• Biochemistry. OCD may result from changes in brain chemistry and dysfunction.
• Genetic causes. Genetic factors may play a role in the development of OCD, but scientists have yet to identify specific genes.
• Factors external environment . Some scientists consider environmental factors such as infections as a trigger for obsessive-compulsive disorder, but more research is needed to confirm this theory.

Factors that may increase your risk of developing obsessive-compulsive disorder include:

• Family history. The risk of developing OCD increases if parents or other blood relatives have this disorder.
• Stressful situations. If you have experienced stress or a traumatic situation, your risk of developing OCD may increase. This reaction may, for some reason, trigger the obsessive thoughts, rituals, and emotional experiences that are characteristic of obsessive-compulsive disorder.
• Other mental disorders. OCD may be associated with other mental disorders such as anxiety disorders, substance abuse, or tic disorders.

Symptoms and behavior of patients

Obsessive-compulsive disorder typically includes obsessions and compulsions. In some cases, only symptoms of obsession or compulsion may be expressed. You may or may not realize that your obsessions and compulsions are excessive or unreasonable, but they are time-consuming and negatively affect your daily life, work ability, and social functioning.

Obsessions

Obsessions are recurring, constant and involuntary thoughts, urges or ideas that are intrusive in nature and cause stress or anxiety. The person may try to ignore them or get rid of them through compulsive behaviors or rituals. Obsessions usually occur when a person tries to think about or do other things.

Obsessions often have specific themes, such as:

• fear of infection or contamination;
• order and symmetry - the desire to arrange objects in a certain order, symmetrically;
• aggressive or frightening thoughts about harming yourself or others;
• unwanted thoughts, including thoughts about violence or sexual or religious topics.

Signs of an obsession include:

• fear of contamination when touching objects that others have touched;
• doubts about locking the door or turning off the stove;
• severe stress that occurs when objects are not arranged in a certain order;
• thoughts of harming yourself or someone else that arise involuntarily and cause discomfort;
• thoughts of shouting obscenities or inappropriate behavior that arise involuntarily and cause discomfort;
• avoiding situations that may trigger obsessions, such as shaking hands;
• stress caused by repeated unpleasant thoughts about sexual topics.

Compulsions

Compulsions are repetitive actions that a person feels compelled to perform. These repetitive actions or mental acts are aimed at preventing or reducing anxiety associated with obsessions, or preventing something bad from happening. However, performing compulsive actions does not bring any pleasure and only temporarily helps cope with anxiety.

The patient may create rules or rituals that, when followed, help control the anxiety that occurs when obsessive thoughts appear. Compulsions are excessive and are often not really related to the problem that the patient is intended to correct.

As with obsessions, compulsions tend to have specific themes, such as:

• washing and cleaning
• checking (turning off electrical appliances, closing locks, taps, etc.)
• the desire to place objects in a certain order
• following any rules and rituals
• the desire to double-check everything

For example, a patient:

• washes hands until cracks appear on the skin;
• repeatedly checks whether the door is closed;
• repeatedly checks whether the gas stove or oven is turned off;
• considers surrounding objects in a certain way;
• mentally repeats prayers, words or phrases;
• Places cans of canned food with the label first.

Obsessive-compulsive disorder usually occurs in teenagers or young adults. Symptoms usually begin gradually and tend to vary in severity throughout life. They usually intensify when the patient experiences severe stress. In most cases, OCD is a lifelong disorder, and symptoms can be mild to moderate and in some cases severe, time-consuming, and disabling.

Complications

Problems resulting from OCD may include, but are not limited to:

• health problems such as contact from frequent hand washing;
• inability to attend work, school, or social events;
• problematic relationships;
• general poor quality of life;
• suicidal thoughts and behavior.

Diagnostics

Stages of diagnosing OCD:

• General inspection. A general examination is done to rule out other problems that may be causing your symptoms and to determine if there are any complications associated with OCD.
• Laboratory research. These may include, for example, a complete blood count (CBC), thyroid function testing, and alcohol and drug screening.
• Mental State Assessment. It involves talking with a professional about your thoughts, feelings, symptoms and behaviors. With your permission, the specialist can talk to your family or friends.
• Diagnostic criteria obsessive-compulsive disorder. Your doctor may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

Diagnostic problems

OCD can sometimes be difficult to diagnose because the signs may be similar to those of anancastic personality disorder, anxiety disorders, depression, schizophrenia, or other mental illness. A combination of obsessive-compulsive disorder and another mental illness is possible. Work with your doctor so that he can make an accurate diagnosis and prescribe the correct therapy.

Treatment of obsessive-compulsive disorder

OCD cannot be completely cured, but it is possible to keep its symptoms under control and reduce their impact on daily life. Some people require lifelong treatment.

The two main treatments for OCD are psychotherapy and medication. Often the most effective is a combination of both methods.

Psychotherapy

Cognitive behavioral therapy (CBT) is a type of psychotherapy that is effective method treatment for many people with OCD. Exposure therapy (exposure and prevention therapy), a type of CBT, involves interacting with an object of obsession, such as dirt, and learning healthy ways to cope with anxiety. Exposure therapy requires effort and practice, but the patient will be able to enjoy best quality life, as soon as he learns to manage his obsessions and compulsions.

Therapy can be carried out individually, as a family or in a group setting.

Medications

Some psychotropic medications help control OCD symptoms. The most common first-line drugs are antidepressants.

Antidepressants approved by the Food and Drug Administration for the treatment of OCD include:

• Clomipramine (Anafranil) for adults and children 10 years and older
• Fluoxetine (Prozac) for adults and children 7 years and older
• Fluvoxamine for adults and children 8 years and older
• Paroxetine (Paxil, Pexeva) for adults only
• Sertraline (Zoloft) for adults and children 6 years and older

However, your doctor may prescribe other antidepressants and medications used to treat mental illness.

Medicines: what to consider

Discuss the following questions with your doctor:

• Choice medicine . It is necessary to strive to effectively control the symptoms of the disease by taking medications in minimal doses. It is often necessary to try several drugs before finding one that is effective in a particular case. Your doctor may recommend several medications to effectively manage your symptoms. It may take several weeks to several months after starting treatment for the condition to improve.
• Side effects. All psychiatric medications have potential side effects. Discuss with your doctor possible side effects and health monitoring measures needed during drug treatment. If bothersome side effects occur, tell your doctor.
• Risk of suicide. In some cases, children, adolescents, and young adults under 25 years of age may experience suicidal thoughts or behavior while taking antidepressants, especially in the first few weeks after starting drug therapy or when the dosage of the drug is changed. If you have thoughts of suicide, tell your doctor right away. Keep in mind that antidepressants in the long term are more likely to reduce the risk of suicide by improving the emotional state.
• Interaction with other substances. When you start taking antidepressants, tell your doctor about all the prescription and over-the-counter drugs, herbal remedies, and vitamins you take. Some antidepressants in combination with certain medicines or herbal medicines can cause dangerous reactions.
• Stopping antidepressants. Antidepressants do not cause mental dependence, but physical dependence (which is different from drug addiction) can sometimes occur. Interrupting the course of treatment or missing several doses may lead to symptoms resembling withdrawal symptoms. Don't stop taking your medications without talking to your doctor, even if you feel better, because your OCD symptoms may recur. Work with your doctor to reduce your dosage gradually and safely.

Prevention

There is no way to prevent the development of OCD. However, early treatment can prevent the disorder from progressing and prevent the disease from interfering with daily life.

Forecast

Overall, about 70% of patients entering treatment experience significant improvement in their symptoms. However, OCD remains a chronic condition whose symptoms may wax and wane over the course of a patient's life.

About 15% of patients may experience progressive worsening of symptoms or worsening functioning over time.

Approximately 5% of patients experience complete remission of symptoms between exacerbations.

Interesting

A significant role among mental illnesses is played by syndromes (complexes of symptoms) grouped into obsessive-compulsive disorder (OCD), which gets its name from the Latin terms obsessio and compulsio.

Obsession (lat. obsessio - taxation, siege, blockade).

Compulsions (lat. compello - I force). 1. Obsessive drives, a type of obsessive phenomena (obsessions). Characterized by irresistible attractions that arise contrary to reason, will, and feelings. Often they turn out to be unacceptable for the patient and contradict his moral and ethical qualities. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the patient as incorrect and are painfully experienced, especially since their very occurrence, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsion is also used in a broader sense to designate any obsessions in the motor sphere, including obsessive ones rituals.

Currently, almost all obsessive-compulsive disorders are combined in the International Classification of Diseases under the concept of “obsessive-compulsive disorder.”

OCD concepts have undergone a fundamental reappraisal over the past 15 years. During this time, the clinical and epidemiological significance of OCD was completely revised. If previously it was believed that this was a rare condition observed in a small number of people, it is now known: OCD is common and has a high morbidity rate, which requires urgent attention from psychiatrists around the world. In parallel, our understanding of the etiology of OCD has expanded: the vaguely defined psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm examining the neurotransmitter abnormalities that underlie OCD. Most significantly, pharmacological interventions targeting specifically serotonergic neurotransmission have revolutionized the recovery prospects of millions of OCD sufferers around the world.

The discovery that potent serotonin reuptake inhibition (SSRI) was the key to effective treatment of OCD was the first step in the revolution and stimulated clinical research that demonstrated the effectiveness of such selective inhibitors.

According to the ICD-10 description, the main features of OCD are repetitive intrusive (obsessive) thoughts and compulsive actions (rituals).

In a broad sense, the core of OCD is the obsession syndrome, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, and memories that arise in addition to the wishes of the patients, but with awareness of their painfulness and a critical attitude towards them. Despite understanding the unnaturalness and illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessive impulses or ideas are recognized as alien to the personality, but as if coming from within. Compulsions may be the performance of rituals designed to relieve anxiety, such as hand washing to combat “pollution” and to prevent “contamination.” Trying to push away unwanted thoughts or urges can lead to severe internal struggles accompanied by intense anxiety.

Obsessions in ICD-10 are included in the group of neurotic disorders.

The prevalence of OCD in the population is quite high. According to some data, it is determined by the rate of 1.5% (meaning “fresh” cases of disease) or 2-3% if episodes of exacerbations observed throughout life are taken into account. People suffering from obsessive-compulsive disorder account for 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally.

CLINICAL PICTURE

The problem of obsessive states attracted the attention of clinicians already at the beginning of the 17th century. They were first described by Platter in 1617. In 1621, E. Barton described the obsessive fear of death. Mentions of obsessions are found in the works of F. Pinel (1829). I. Balinsky proposed the term “obsessive ideas”, which has taken root in Russian psychiatric literature. In 1871, Westphal coined the term agoraphobia, which denoted the fear of being in in public places. M. Legrand de Sol, analyzing the peculiarities of the dynamics of OCD in the form of “insanity of doubt with delusions of touch,” points to a gradually becoming more complex clinical picture - obsessive doubts are replaced by absurd fears of “touching” surrounding objects, and motor rituals are added, to the fulfillment of which the entire life of patients is subordinated. However, only at the turn of the XIX-XX centuries. The researchers were able to more or less clearly describe the clinical picture and give a syndromic description of obsessive-compulsive disorders. The onset of the disease usually occurs in adolescence and adolescence. The maximum clinically defined manifestations of obsessive-compulsive disorder are observed in the age range of 10 - 25 years.

Main clinical manifestations of OCD:

Obsessive thoughts are painful thoughts that arise against one’s will, but are recognized by the patient as his own, ideas, beliefs, images that, in a stereotypical form, forcibly invade the patient’s consciousness and which he tries to somehow resist. It is this combination of an internal sense of compulsive urge and efforts to resist it that characterizes obsessive symptoms, but of the two, the degree of effort exerted is more variable. Obsessive thoughts can take the form of individual words, phrases, or lines of poetry; they are usually unpleasant for the patient and may be obscene, blasphemous or even shocking.

Obsessive images are vividly imagined scenes that are often violent or disgusting, including, for example, sexual perversion.

Obsessive impulses are urges to perform actions that are usually destructive, dangerous, or likely to cause disgrace; for example, jumping out onto the road in front of a moving car, injuring a child, or shouting obscene words while in public.

Obsessive rituals include both mental activity (for example, repeating counting in a special way, or repeating certain words) and repetitive but meaningless behavior (for example, washing your hands twenty or more times a day). Some of them have an understandable connection with previous obsessive thoughts, for example, repeated hand washing with thoughts of infection. Other rituals (for example, regularly arranging clothes in some complex system before putting them on) have no such connection. Some patients feel an irresistible urge to repeat such actions a certain number of times; if this fails, they are forced to start all over again. Patients are invariably aware that their rituals are illogical and usually try to hide them. Some fear that such symptoms are a sign of incipient madness. Both obsessive thoughts and rituals inevitably lead to problems in daily activities.

Rumination ("mental chewing") is an internal debate in which the arguments for and against even the simplest everyday actions are endlessly revised. Some intrusive doubts concern actions that may have been performed incorrectly or not completed, such as turning off a faucet. gas stove or locking the door; others concern actions that could harm others (for example, driving a car past a cyclist and hitting them). Sometimes doubts are associated with a possible violation of religious instructions and rituals - “remorse.”

Compulsive actions are repeated stereotypical behaviors, sometimes taking on the character of protective rituals. The latter are aimed at preventing any objectively unlikely events that are dangerous for the patient or his loved ones.

In addition to those described above, among obsessive-compulsive disorders there are a number of delineated symptom complexes, including obsessive doubts, contrasting obsessions, obsessive fears - phobias (from the Greek phobos).

Obsessive thoughts and compulsive rituals may increase in certain situations; for example, obsessive thoughts about harming other people often become more persistent in the kitchen or some other place where knives are stored. Because patients often avoid such situations, there may be superficial similarities to the characteristic avoidance pattern found in anxiety-phobic disorder. Anxiety is an important component of obsessive-compulsive disorders. Some rituals reduce anxiety, while others increase it. Obsessions often develop as part of depression. In some patients this appears to be a psychologically understandable reaction to obsessive-compulsive symptoms, but in other patients there are recurrent episodes of depressive mood that occur independently.

Obsessions (obsessions) are divided into figurative or sensual, accompanied by the development of affect (often painful) and obsession with affectively neutral content.

Sensory obsessions include obsessive doubts, memories, ideas, drives, actions, fears, an obsessive feeling of antipathy, and obsessive fear of habitual actions.

Obsessive doubts are persistent uncertainty that arises, contrary to logic and reason, about the correctness of the actions being taken and completed. The content of doubts varies: obsessive everyday fears (is the door locked, are the windows or water taps closed tightly enough, is the gas or electricity turned off), doubts related to official activities (is this or that document written correctly, are the addresses on business papers mixed up? , whether inaccurate numbers are indicated, whether orders are correctly formulated or executed), etc. Despite repeated verification of the action taken, doubts, as a rule, do not disappear, causing psychological discomfort in the person suffering from this type of obsession.

Intrusive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a feeling of shame and remorse. They dominate the patient’s consciousness, despite efforts and efforts not to think about them.

Obsessive drives are urges to commit one or another harsh or extremely dangerous action, accompanied by a feeling of horror, fear, confusion with the inability to free oneself from it. The patient is overcome, for example, by the desire to throw himself under a passing train or push a loved one under it, or to kill his wife or child in an extremely cruel way. At the same time, patients are painfully afraid that this or that action will be implemented.

Manifestations of obsessive ideas can be different. In some cases, this is a vivid “vision” of the results of obsessive drives, when patients imagine the result of a cruel act committed. In other cases, obsessive ideas, often called mastering ideas, appear in the form of implausible, sometimes absurd situations that patients take as real. An example of obsessive ideas is the patient’s conviction that a buried relative was alive, and the patient painfully imagines and experiences the suffering of the deceased in the grave. At the height of obsessive ideas, the consciousness of their absurdity and implausibility disappears and, on the contrary, confidence in their reality appears. As a result, obsessions acquire the character of overvalued formations (dominant ideas that do not correspond to their true meaning), and sometimes delirium.

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) - unjustified antipathy towards a specific, often close person, driven away by the patient, cynical, unworthy thoughts and ideas in relation to respected people, in religious persons - in relation to saints or church ministers .

Obsessive actions are actions performed against the wishes of patients, despite the efforts made to restrain them. Some of the obsessive actions burden patients until they are implemented, others are not noticed by the patients themselves. Obsessive actions are painful for patients, especially in cases where they become the object of attention of others.

Obsessive fears, or phobias, include obsessive and senseless fear of heights, large streets, open or confined spaces, large crowds of people, fear of sudden death, fear of contracting one or another incurable disease. Some patients may experience a wide variety of phobias, sometimes acquiring the character of fear of everything (panphobia). And finally, an obsessive fear of fear (phobophobia) is possible.

Hypochondriacal phobias (nosophobia) are an obsessive fear of some serious illness. Most often, cardio-, stroke-, syphilo- and AIDS-phobias are observed, as well as fear of the development of malignant tumors. At the peak of anxiety, patients sometimes lose their critical attitude towards their condition - they turn to doctors of the appropriate profile, demand examination and treatment. The realization of hypochondriacal phobias occurs both in connection with psycho- and somatogenic (common non-mental diseases) provocations, and spontaneously. As a rule, the result is the development of hypochondriacal neurosis, accompanied by frequent visits to doctors and unnecessary medication use.

Specific (isolated) phobias are obsessive fears limited to a strictly defined situation - fear of heights, nausea, thunderstorms, pets, dental treatment, etc. Since contact with situations that cause fear is accompanied by intense anxiety, patients tend to avoid them.

Obsessive fears are often accompanied by the development of rituals - actions that have the meaning of “magic” spells, which are performed, despite the patient’s critical attitude towards obsession, in order to protect against one or another imaginary misfortune: before starting any important task, the patient must perform some a certain action to eliminate the possibility of failure. Rituals can, for example, be expressed in snapping fingers, playing a melody to the patient, or repeating certain phrases, etc. In these cases, even loved ones have no idea about the existence of such disorders. Rituals combined with obsessions represent a fairly stable system that usually exists for many years and even decades.

Obsessions of affective-neutral content - obsessive philosophizing, obsessive counting, remembering neutral events, terms, formulations, etc. Despite their neutral content, they burden the patient and interfere with his intellectual activity.

Contrasting obsessions (“aggressive obsessions”) - blasphemous, blasphemous thoughts, fear of harm to oneself and others. Psychopathological formations of this group relate primarily to figurative obsessions with pronounced affective intensity and ideas that take over the consciousness of patients. They are distinguished by a feeling of alienation, an absolute lack of motivation in the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions complain of an irresistible desire to add endings to the remarks they have just heard, giving what was said an unpleasant or threatening meaning, to repeat after those around them, but with a tinge of irony or anger, phrases of religious content, to shout out cynical words that contradict their own attitudes and generally accepted morality , they may experience fear of losing control of themselves and possibly committing dangerous or ridiculous actions, causing injury to themselves or their loved ones. IN recent cases obsessions are often combined with phobias of objects (fear of sharp objects - knives, forks, axes, etc.). The contrast group also partially includes obsessions with sexual content (obsessions like forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals).

Obsessions with pollution (mysophobia). This group of obsessions includes both the fear of pollution (earth, dust, urine, feces and other impurities), and the fear of penetration into the body of harmful and toxic substances (cement, fertilizers, toxic waste), small objects (shards of glass, needles, specific types of dust), microorganisms. In some cases, the fear of contamination may be limited in nature, remaining for many years at a preclinical level, manifesting itself only in some features of personal hygiene (frequent change of linen, repeated hand washing) or in housekeeping (careful handling of food, daily washing of floors , “taboo” on pets). This kind of monophobia does not significantly affect the quality of life and is assessed by others as habits (exaggerated cleanliness, excessive disgust). Clinically manifested variants of mysophobia belong to the group of severe obsessions. In these cases, gradually more complex protective rituals come to the fore: avoiding sources of pollution and touching “unclean” objects, processing things that could get dirty, a certain sequence in the use of detergents and towels, which allows you to maintain “sterility” in the bathroom. Staying outside the apartment is also accompanied by a series of protective measures: going outside in special clothing that covers the body as much as possible, special treatment of personal items upon returning home. In the later stages of the disease, patients, avoiding pollution, not only do not go outside, but do not even leave their own room. In order to avoid contacts and contacts that are dangerous in terms of contamination, patients do not allow even their closest relatives to approach them. Mysophobia is also associated with the fear of contracting any disease, which does not belong to the categories of hypochondriacal phobias, since it is not determined by the fear that the OCD sufferer has a particular disease. In the foreground is the fear of a threat from the outside: fear of pathogenic bacteria entering the body. Hence the development of appropriate protective actions.

A special place among obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, in contrast to organically caused involuntary movements, are much more complex motor acts that have lost their original meaning. Tics sometimes give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures. Patients suffering from tics may shake their heads (as if checking whether a hat fits well), make movements with their hands (as if throwing away interfering hair), and blink their eyes (as if getting rid of a speck). Along with obsessive tics, pathological habitual actions are often observed (biting lips, grinding teeth, spitting, etc.), which differ from the actual obsessive actions in the absence of a subjectively painful feeling of persistence and the experience of them as alien, painful. Neurotic conditions characterized only by obsessive tics usually have a favorable prognosis. Appearing most often in preschool and junior school age, tics usually subside towards the end of puberty. However, such disorders may also turn out to be more persistent, persisting for many years and only partially changing in manifestations.

Course of obsessive-compulsive disorder.

Unfortunately, it is necessary to indicate chronification as the most characteristic trend in the dynamics of OCD. Cases of episodic manifestations of the disease and complete recovery are relatively rare. However, in many patients, especially with the development and persistence of one type of manifestation (agoraphobia, obsessive counting, ritual hand washing, etc.), long-term stabilization of the condition is possible. In these cases, a gradual (usually in the second half of life) mitigation of psychopathological symptoms and social readaptation are noted. For example, patients who experienced fear of traveling on certain types of transport, or public speaking, stop feeling inferior and work alongside healthy people. In mild forms of OCD, the disease usually progresses favorably (on an outpatient basis). Reverse development of symptoms occurs after 1 year - 5 years from the moment of manifestation.

More severe and complex OCD, such as phobias of infection, pollution, sharp objects, contrasting ideas, numerous rituals, on the contrary, can become persistent, resistant to treatment, or show a tendency to relapse with disorders persisting, despite active therapy. Further negative dynamics of these conditions indicates a gradual complication of the clinical picture of the disease as a whole.

DIFFERENTIAL DIAGNOSIS

It is necessary to distinguish OCD from other diseases in which obsessions and rituals arise. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when the obsessive thoughts are unusual in content (for example, mixed sexual and blasphemous themes) or the rituals are extremely eccentric. The development of a sluggish schizophrenic process cannot be excluded with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity (inconsistency of thinking and actions), and the monotony of emotional manifestations. Prolonged obsessive states of a complex structure must be distinguished from manifestations of paroxysmal schizophrenia. In contrast to neurotic obsessive states, they are usually accompanied by sharply increasing anxiety, a significant expansion and systematization of the circle of obsessive associations, acquiring the character of obsessions of “special significance”: previously indifferent objects, events, random remarks from others remind patients of the content of phobias, offensive thoughts and thereby acquire in their minds there is a special, threatening meaning. In such cases, it is necessary to consult a psychiatrist to rule out schizophrenia. Differentiating OCD from conditions with a predominance of generalized disorders, known as Gilles de la Tourette syndrome, may also present certain difficulties. Tics in such cases are localized in the face, neck, upper and lower extremities and are accompanied by grimaces, opening the mouth, sticking out the tongue, and intense gesticulation. In these cases, this syndrome can be excluded by the characteristic roughness of movement disorders and more complex in structure and more severe mental disorders.

Genetic factors

Speaking about hereditary predisposition to OCD, it should be noted that obsessive-compulsive disorders are found in approximately 5-7% of parents of patients with such disorders. Although this rate is low, it is higher than in the general population. While the evidence for a genetic predisposition to OCD is unclear, psychasthenic personality traits can largely be explained by genetic factors.

In approximately two thirds of cases, improvement in OCD occurs within a year, often towards the end of this period. If the disease continues for more than a year, fluctuations are observed during its course - periods of exacerbations interspersed with periods of improved health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic person with severe symptoms of the disease, or if there are continuous stressful events in the patient's life. Severe cases can be extremely persistent; For example, a study of hospitalized patients with OCD found that three-quarters of them had unchanged symptoms 13-20 years later.

TREATMENT: BASIC METHODS AND APPROACHES

Despite the fact that OCD is a complex group of symptom complexes, the treatment principles for them are the same. The most reliable and effective method of treating OCD is considered to be drug therapy, which requires a strictly individual approach to each patient, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of other diseases. In this regard, we must warn patients and their relatives against self-medication. If any disorders similar to mental ones appear, it is necessary, first of all, to contact specialists at a psycho-neurological dispensary at your place of residence or other psychiatric medical institutions to establish the correct diagnosis and prescribe competent, adequate treatment. It should be remembered that at present a visit to a psychiatrist does not threaten any negative consequences - the notorious “registration” was canceled more than 10 years ago and replaced by the concepts of consultative and medical care and clinical observation.

When treating, it must be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement). The obvious suffering of the patient often seems to require vigorous effective treatment, but one should remember the natural course of this condition in order to avoid the typical mistake of overly intensive therapy. It is also important to consider that OCD is often accompanied by depression, the effective treatment of which often leads to an alleviation of obsessive symptoms.

Treatment of OCD begins with explaining the symptoms to the patient and, if necessary, disabusing them of the idea that they are the initial manifestation of insanity (a common cause of concern for patients with obsessions). Those suffering from one or another obsession often involve other family members in their rituals, so relatives need to treat the patient firmly but sympathetically, mitigating the symptoms as much as possible, and not aggravating them by excessively indulging the patients’ painful fantasies.

Drug therapy

In relation to the currently identified types of OCD, the following therapeutic approaches exist. The most commonly used pharmacological drugs for OCD are serotonergic antidepressants, anxiolytics (mainly benzodiazepines), beta-blockers (to relieve autonomic manifestations), MAO inhibitors (reversible) and triazole benzodiazepines (alprazolam). Anxiolytic drugs provide some short-term relief of symptoms, but they should not be prescribed for more than a few weeks at a time. If treatment with anxiolytics is required for more than one to two months, small doses of tricyclic antidepressants or minor antipsychotics are sometimes helpful. The main link in the treatment regimen for OCD, overlapping with negative symptoms or with ritualized obsessions, are atypical neuroleptics - risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants, or with antidepressants of other series - moclobemide, tianeptine, or with high-potency benzodiazepine derivatives ( alprazolam, clonazepam, bromazepam).

Any concomitant depressive disorder is treated with antidepressants in an adequate dose. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms, but the results of a controlled clinical trial showed that the effect of this drug is small and occurs only in patients with clear depressive symptoms.

In cases where obsessive-phobic symptoms are observed within the framework of schizophrenia, intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect. In some cases, it is advisable to include traditional antipsychotics (small doses of haloperidol, trifluoperazine, fluanxol) and parenteral administration of benzodiazepine derivatives.

Psychotherapy

Behavioral psychotherapy

One of the main tasks of a specialist in the treatment of OCD is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the “harm” caused by psychotropic drugs, to convey his conviction in the effectiveness of treatment, subject to systematic adherence to the prescribed prescriptions. The patient's faith in the possibility of healing must be supported in every possible way by the relatives of the OCD sufferer. If the patient has rituals, it must be remembered that improvement usually occurs when using a combination of a reaction prevention method with placing the patient in conditions that aggravate these rituals. Significant, but not complete, improvement can be expected in approximately two-thirds of patients with moderately severe rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts recede. For panphobia, behavioral techniques are used primarily aimed at reducing sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases of predominance of ritualized phobias, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for non-ritual intrusive thoughts. Some specialists have been using the “thought stopping” method for many years, but its specific effect has not been convincingly proven.

Social rehabilitation

We have already noted that obsessive-compulsive disorder has a fluctuating (fluctuating) course and over time the patient’s condition can improve, regardless of which treatment methods were used. Before recovery, patients may benefit from supportive conversations that provide ongoing hope for recovery. Psychotherapy in the complex of treatment and rehabilitation measures for patients with OCD is aimed at both correcting avoidant behavior and reducing sensitivity to phobic situations (behavioral therapy), as well as family psychotherapy with the aim of correcting behavioral disorders and improving family relationships. If marital problems aggravate symptoms, joint interviews with the spouse are indicated. Patients with panphobia (at the stage of the active course of the disease), due to the intensity and pathological persistence of symptoms, require both medical and social-labor rehabilitation. In this regard, it is important to determine adequate terms of treatment - long-term (at least 2 months) therapy in a hospital followed by continuation of the course on an outpatient basis, as well as carrying out measures to restore social ties, professional skills, and intra-family relationships. Social rehabilitation is a set of patient education programs OCD ways rational behavior both at home and in hospital settings. Rehabilitation is aimed at teaching social skills to interact correctly with other people, professional education, as well as skills needed in everyday life. Psychotherapy helps patients, especially those experiencing a feeling of inferiority, to treat themselves better and correctly, master ways to solve everyday problems, and gain faith in their strengths.

All these methods, when used wisely, can increase the effectiveness of drug therapy, but are not able to completely replace drugs. It should be noted that explanatory psychotherapy does not always help, and some patients with OCD even experience deterioration, since such procedures encourage them to think painfully and unproductively about the subjects discussed in the treatment process. Unfortunately, science still does not know how to cure mental illnesses once and for all. OCD often tends to recur, which requires long-term preventive medication.

Living with OCD is like a roller coaster. People with obsessive-compulsive disorder suffer from spontaneously appearing, frightening, and sometimes shameful thoughts, the occurrence of which can be stopped by performing certain actions - compulsions. They can be eliminated only for a short period of time, so each time the actions become more and more absurd. This condition always has a starting point, which became the cause of a disorder in the central nervous system.

OCD symptoms and treatment

Treatment for OCD involves finding the causes. In each individual case, a special treatment regimen is selected. Depending on the manifestations of OCD, treatment may be medication, include psychotherapeutic sessions with a doctor, or carried out at home.

Neurosis can develop at any age. The disease is provoked by a serious stressful situation. The severity of the condition can vary dramatically. Obsessive thoughts can force a person to simply double-check whether the door or water tap is closed, or to perform complex ritual actions: arranging objects in a certain sequence, performing complex rituals that protect against evil spirits.

Factors in the development of the disease can be very different, including genetic predisposition and congenital characteristics of the functioning of brain centers. Treatment is selected according to symptoms.

There are 3 types of the disorder.

1. Randomly arising thoughts. This form is characterized by empty thoughts on a variety of topics, sometimes self-flagellation for words not spoken on time, or imperfect actions. They do not bring any benefit, do not go away on their own, but lead to serious discomfort, interfere with sleep, do your work, and focus on what is really important.
2. Repetitive actions. They are performed with a specific purpose or are performed unconsciously: by carefully checking whether the door is closed, the individual tries to protect himself, but by running his fingers through his hair, twitching his leg, folding his hands behind his back, he harms himself unconsciously.
3. Mixed. Combines the first and second forms. Obsessive thoughts provoke the appearance of the same actions.

For any form characteristic feature is the inability to stop thoughts and actions.

Symptoms of neurosis of obsessive thoughts and states:

• sleep disorders;
• decreased appetite;
• deterioration of general condition;
• weakness;
• nervousness;
• phobic disorders;
• twitching of the lower eyelid;
• depression;
• hallucinations;
• headache.

Most patients are well aware of the problem and begin to engage in soul-searching, trying to get rid of obsessive bad thoughts, which practically does not give positive results, and can only aggravate the symptomatic picture.

Therapy

A psychotherapist should treat obsessive-compulsive disorder. Few people go to the doctor with such a problem, considering it shameful. Only a mild form of the disorder can be cured on your own. To do this, patients must clearly understand what to do with OCD and find out the cause that provoked the disease. A wide variety of therapies are now available.

Treatment of obsessive-phobic neurosis involves many methods that improve physical and mental well-being. We need to strengthen our nervous system. During stress, nerve cells die much faster, without having time to recover, the brain centers begin to function worse. The body always works at the limit of its capabilities, so it tries to protect itself.

To strengthen the body, patients need proper rest. Poor quality short-term sleep provokes the appearance of hallucinations.

You need to reconsider your diet, try to make changes to it by adding more foods that help the body produce energy. Moderate physical activity helps relieve obsessive-compulsive disorder (OCD). During monotonous exercises, the brain switches only to physiological processes. Many patients themselves notice that while jogging, thoughts first swarm in their heads like bees, but after 15 minutes they disappear. The main thing is to ensure that sport does not become a ritual.

Medicinal healing

Obsessive movement neurosis in adults requires drug treatment. Drugs for the treatment of OCD are selected according to the intensity of symptoms. Treatment of obsessional obsessive states begins with improving the performance of brain centers. Nootropic drugs (“Phenibut”, “Glycine”) are used for this purpose. Their main active ingredient helps improve the conduction of nerve impulses and directly affects GABA receptors. "Phenibut" has a tranquilizing, psychostimulating effect, helping to bring the patient out of an apathetic state. "Glycine" is used in simpler cases and in the treatment of children.

Antidepressants for OCD are used to normalize neurotransmitters and help improve emotional condition. They are used with extreme caution because they are addictive. The most commonly used medications of this type are: Amitriptyline, Zoloft, Anafranil, Pyrazidol. The course of treatment is long, up to 6 months. Upon completion of treatment, withdrawal symptoms often occur. They are used in difficult cases to relieve symptoms associated with depersonalization, hallucinations, serious sleep disorders, and pain.

Tranquilizers (Clonazmepam, Alprozalam) have a hypnotic effect. They are used to reduce excitability in the most severe cases, which are accompanied by nervous breakdowns, seizures, and aggressive states. Long-term use is not recommended.

Neuroleptics are tablets that help reduce autonomic reactions. Their action is similar to tranquilizers. Have pronounced side effects. They provoke disorders of the thyroid gland, cause drowsiness, increase muscle tone, etc. Such drugs for OCD are used in the most severe cases, when there is depersonalization syndrome with pronounced clinical depression, to suppress aggressive states, and relieve severe withdrawal syndrome in drug addiction. Atypical groups of antipsychotics are prescribed: Rispolent, Quetialin.

Treatment of obsessive-compulsive disorder with such drugs is accepted only in inpatient settings.

Psychotherapeutic practice

The main tool to help fight OCD is psychotherapy. Its main task is to help in understanding the cause that provoked such a pathological condition. Psychotherapy for OCD is used at any stage of the disease.

There are 3 methods of psychotherapy that can be used in the treatment of obsessive disorder.

1. Cognitive-behavioural.
2. Hypnosis.
3. Stopping thoughts.

Cognitive-behavioral

You can cope with OCD by taking control of your thoughts, emotions, and experiences. Trying to banish unpleasant thoughts from your mind is the biggest mistake patients make when trying to get rid of OCD on their own.

You can get rid of the problem through awareness. This is the process of tracking feelings and experiences caused by certain factors. As a result, the patient begins to understand where obsession comes from. You can get rid of OCD forever by giving yourself the will to worry and switching your attention to a pleasant thing. This way the patient forms a new neural connection, which helps strengthen the central nervous system and drive away obsessive thoughts.

Hypnosis

Hypnosis and suggestion are used in more severe cases, when the patient cannot remember what gave rise to the development of the pathological condition. The doctor, putting the patient into a trance, returns him every time to unpleasant memories. By experiencing them, patients stop being afraid of these situations in reality and learn to cope with their fear.

Treatment of obsessive-compulsive disorder with hypnosis does not involve suppressing negative emotions; the essence of the method is to change the attitude towards a certain situation. If at first it brings suffering to the individual, forcing him to seek protection, then later it fades into the background, making room for other emotions and thoughts.

It is possible to moderate behavior through suggestion, if required. Treatment of obsessive-compulsive disorders is carried out in this way when the patient has experienced serious psychological trauma, which has given rise to hallucinations, depersonalization, and an aggressive-depressive state.

No drug can treat OCD better than hypnosis.

The technique of suggestion allows you to create in a person a desire to grow and develop. Patients have the opportunity to build an adequate line of behavior and improve defensive reactions. After the sessions, patients are no longer burdened by their problems.

Stopping thoughts

The method is easily mastered by patients. Training usually takes 2-7 days. Patients are asked to make a list of unpleasant thoughts that visit them most often. Then, for each, you need to decide:

• does it interfere with normal life and work;
• does it interfere with concentration on other things;
• will it become easier if this thought stops visiting you.

Having decided these questions for yourself, you need to imagine yourself from the outside at the moment when the thought arose and determine your feelings. It is recommended to use external signals to stop thoughts. Set the timer for 3 minutes. When it goes off, say “Stop” loudly. With this action, patients seem to close the door to uninvited thoughts.

The next stage involves the rejection of external signals. When a thought appears, stop it in the same way. Say the phrase more quietly each time until you learn to give the command mentally. The final stage involves translating negative thoughts into positive ones. Calming images and phrases need to be changed every time. With prolonged use they become less effective.

When a negative thought appears, think about a pleasant moment in your life. Focus all your attention on it, try to relax as much as possible. If you are afraid of dogs, read all about them. Imagine that you have such a pet, it is a small puppy, fluffy, playful. He runs across a green field, you play with him. Feel relaxed and happy in what you are doing.

Conclusion

OCD can be overcome with the help of drug treatment and psychotherapeutic techniques aimed at adapting the patient to life with obsessive thoughts and searching for the true cause that led to the pathological condition. If all doctor's instructions are followed, OCD can be successfully treated.

Obsessive psychological disorders have been known since time immemorial: in the 4th century BC. e. this disease was attributed to melancholia, and in the Middle Ages, the disease was considered an obsession.

The disease has been studied and tried to be systematized for a long time. It was periodically attributed to paranoia, psychopathy, manifestations of schizophrenia and manic-depressive psychosis. Currently obsessive-compulsive disorder (OCD) considered one of the types of psychosis.

Facts about obsessive-compulsive disorder:

Obsessiveness can be episodic or is observed throughout the day. In some patients, anxiety and suspiciousness are perceived as a specific character trait, while in others, unreasonable fears interfere with personal and social life, and also negatively affect loved ones.

CAUSES

The etiology of OCD is not clear; there are several hypotheses on this matter. The reasons may be biological, psychological or social in nature.

Biological reasons:

• birth injuries;
• pathologies of the autonomic nervous system;
• features of signal transmission to the brain;
• metabolic disorders with changes in metabolism necessary for the normal functioning of neurons (decreased serotonin levels, increased dopamine concentrations);
• history of traumatic brain injury;
• organic brain damage (after meningitis);
• chronic alcoholism and drug addiction;
• hereditary predisposition;
• complicated infectious processes.

Social, social and psychological factors:

• childhood psychological trauma;
• psychological family trauma;
• strict religious education;
• excessive parental care;
• professional activity under stress;
• shock associated with a threat to life.

CLASSIFICATION

Classification of OCD according to the characteristics of its course:

• a single attack (observed for a day, a week or longer than a year);
• relapsing course with periods of absence of signs of the disease;
• continuous progressive course of pathology.

Classification according to ICD-10:

• mainly obsessions in the form of obsessive thoughts and ruminations;
• predominantly compulsions - actions in the form of rituals;
• mixed form;
• other OCD.

SYMPTOMS of obsessive-compulsive disorder

The first signs of OCD appear between the ages of 10 and 30 years. As a rule, by the age of thirty, the patient develops a pronounced clinical picture of the disease.

Main symptoms of OCD:

• The appearance of painful and obsessive thoughts. Usually they are in the nature of sexual perversion, blasphemy, thoughts of death, fear of reprisals, illness and loss of material wealth. A person with OCD becomes horrified by such thoughts, realizes their groundlessness, but is unable to overcome his fear.
• Anxiety. A patient with OCD experiences a constant internal struggle, which is accompanied by a feeling of anxiety.
• Repetitive movements and actions can manifest themselves in endlessly counting the steps of a staircase, frequent hand washing, arranging objects symmetrically to each other or in some order. Sometimes people with the disorder can come up with their own intricate system for storing personal belongings and constantly follow it. Compulsive checks are associated with repeated returns home in order to find that the lights and gas are not turned off, to check whether entrance doors. The patient performs a kind of ritual to prevent unlikely events and to get rid of obsessive thoughts, but they do not leave him. If the ritual cannot be completed, the person begins it again.
• Obsessive slowness, in which a person performs daily activities extremely slowly.
• Increased severity of the disorder in crowded places. The patient develops a fear of contracting infections, disgust, and nervousness for fear of losing his things. Because of this, people with obsessive-compulsive disorder try to avoid crowds whenever possible.
• Decreased self-esteem. The disorder is especially susceptible to suspicious people who are used to keeping their lives under control, but are unable to cope with their fears.

DIAGNOSTICS

To establish a diagnosis, a psychodiagnostic conversation with a psychiatrist. A specialist can differentiate OCD from schizophrenia and Tourette syndrome. Special attention deserves an unusual combination of intrusive thoughts. For example, simultaneous obsessions of a sexual and religious nature, as well as eccentric rituals.

The doctor takes into account the presence of obsessions and compulsions. Obsessive thoughts have medical significance if they are repeated, persistent and intrusive. They should cause feelings of anxiety and distress. Compulsions are considered from a medical perspective if the patient experiences fatigue when performing them in response to obsessions.

Obsessive thoughts and movements should occupy at least one hour a day, and be accompanied by difficulties communicating with loved ones and others.

To determine the severity of the disease and its dynamics, in order to standardize data use the Yale-Brown scale.

TREATMENT

According to psychiatrists, a person needs to seek medical help when a disease interferes with his daily life and communication with others.

Treatment methods for OCD:

• Cognitive behavioral psychotherapy allows the patient to resist obsessive thoughts by changing or simplifying rituals. When talking with a patient, the doctor clearly divides fears into justified and caused by the disease. At the same time, specific examples are given from the lives of healthy people, better than those who evoke respect from the patient and serve as an authority. Psychotherapy helps correct some symptoms of the disorder, but does not completely eliminate obsessive-compulsive disorder.
• Drug treatment. Taking psychotropic medications is an effective and reliable method of treating obsessive-compulsive disorder. Treatment is selected strictly individually, taking into account the characteristics of the disease, the age and gender of the patient, as well as the presence of concomitant diseases.

Drug treatments for OCD:

• serotonergic antidepressants;
• anxiolytics;
• beta blockers;
• triazole benzodiazepines;
• MAO inhibitors;
• atypical antipsychotics;
• antidepressants of the SSRI class.

Cases of complete recovery are recorded quite rarely, but with the help of medications it is possible to reduce the severity of symptoms and stabilize the patient’s condition.

Many people suffering from this type of disorder do not notice their problem. And if they still guess about it, then they understand the meaninglessness and absurdity of their actions, but do not see a threat in this pathological condition. In addition, they are convinced that they can independently cope with this disease through sheer force of will.

The unanimous opinion of doctors is that it is impossible to cure OCD on your own. Any attempts to cope on our own with such a disorder only aggravate the situation.

For the treatment of mild forms, outpatient observation is suitable; in this case, recession begins no earlier than a year after the start of therapy. More complex forms of obsessive-compulsive disorder, associated with fears of infection, pollution, sharp objects, complex rituals and varied beliefs, are particularly resistant to treatment.

The main goal of therapy should be establishing a trusting relationship with the patient, suppressing feelings of fear before taking psychotropic drugs, as well as instilling confidence in the possibility of recovery. The participation of loved ones and relatives significantly increases the likelihood of healing.

COMPLICATIONS

Possible complications of OCD:

• depression;
• anxiety;
• isolation;
• suicidal behavior;
• abuse of tranquilizers and sleeping pills;
• conflict in personal life and professional activities;
• alcoholism;
• eating disorders;
• low quality of life.

PREVENTION

Primary prevention measures for OCD:

• prevention of psychological trauma in personal life and professional activities;
• proper upbringing of a child - from early childhood not to give reasons for thoughts about one’s own inferiority, superiority over others, not to provoke feelings of guilt and deep fear;
• preventing conflicts within the family.

Methods of secondary prevention of OCD:

• regular medical examination;
• conversations with the aim of changing a person’s attitude towards situations that traumatize the psyche;
• phototherapy, increasing room illumination (sun rays stimulate the production of serotonin);
• general strengthening measures;
• the diet provides for nutritious nutrition with a predominance of foods containing tryptophan (an amino acid for the synthesis of serotonin);
• timely treatment of concomitant diseases;
• prevention of any types of drug addiction.

PROGNOSIS FOR RECOVERY

Obsessive-compulsive disorder is a chronic disease for which complete recovery and episodic episodes are not typical or observed in rare cases.

When treating mild forms of the disease in an outpatient setting, the reverse development of symptoms is observed no earlier than 1-5 years after detection of the disease. Often the patient will still have some symptoms of the disease that do not interfere with their daily life.

More severe cases of the disease are resistant to treatment and are prone to recurrence. Aggravation of OCD occurs under the influence of overwork, lack of sleep and stress factors.

According to statistics, in 2/3 of patients improvement during treatment occurs within 6-12 months. In 60-80% of them it is accompanied by clinical recovery. Severe cases of obsessive-compulsive disorder are extremely resistant to treatment.

Improvement in the condition of some patients is associated with taking medications, so after stopping them, the likelihood of relapse increases significantly.

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In Russia, the diagnosis of obsessive-compulsive disorder (OCD) and other disorders from its group has always caused a lot of controversy and controversy, and often people suffering from this disorder undeservedly received the stigmatizing diagnosis “” and did not have access to modern treatment methods.

Previously, obsessive-compulsive disorder was classified as a group, but now it is increasingly identified as a separate group of diseases that have similar neurobiological, phenomenological, psychopathological features, as well as comparable approaches to therapy. With the latest revision of the American classification of mental disorders DSM-5, a group of obsessive-compulsive disorders took its place next to anxiety disorders and stress-related disorders. It included categories such as OCD (obsessive-compulsive disorder), body dysmorphic disorder ( body dysmorphic disorder), trichotillomania (compulsive hair pulling) and compulsive excoriation ( excoriation disorder).

Obsessions, anxiety, compulsions

Obsessive-compulsive disorder is characterized by several symptoms.

Obsessions- these are obsessive thoughts, desires, doubts or images that cause anxiety. For example, an obsessive fear of contracting a dangerous infection or unacceptable thoughts of a sexual, religious nature, fear of looking ridiculous or being dangerous to other people. The more a person tries not to think about it, to get distracted and stop worrying, the more often he returns to these thoughts and images again and again, they increasingly flood the consciousness and cause severe alarm.

A person suffering from obsessions tries to cope with this condition, to do something to prevent an imaginary danger to himself or others, as well as to reduce his own anxiety, discomfort, and feel relief. These actions are called compulsions, and sometimes they become excessive and even pretentious. For example, people who have an obsessive fear of pollution may wipe all surfaces of the apartment with alcohol, wash their hands many times a day, or go outside only wearing gloves. Those who fear their own taboo thoughts, such as about sex or religion, actively avoid sexual relations or visiting religious places.

But if a collision with a frightening stimulus is inevitable, then compulsions (also called rituals) help neutralize the danger. Rituals can be actions that are incomprehensible to the people around them: for example, a person needs to turn around himself several times, knock on wood, do something at certain times and days of the week. The belief that by observing certain rituals we can influence reality is called magical thinking in psychology. In everyday life, we regularly encounter it in the form of superstitions.

Sometimes obsessive actions (compulsions) are not associated with negative emotions. Such manifestations include, for example, obsessive counting, singing, or the desire to avoid stepping on the joints of tiles on the sidewalk.

With any obsessive-compulsive disorder, there is a triad: obsessive thoughts - obsessions, the anxiety they cause, and actions aimed at reducing anxiety - compulsions. The relief that results from these actions is usually temporary. In the long term, compulsions do not help, but only support the problem and maladjust the person.

With OCD, a person spends a lot of time on obsessive thoughts and compulsive actions. Everyday life and relationships with loved ones begin to suffer. It is impossible to find time for important things, since the symptoms of the disorder take up more and more time - up to several hours a day, and in some cases even the whole day. Symptoms of obsessive-compulsive disorder significantly reduce the ability to work: patients aged 15 to 44 years The World Health Organization lists OCD as one of the twenty most frequently disabling diseases.

Different forms of OCD

There are various variants of obsessive-compulsive disorder. Some people have more pronounced obsessions, while others have more compulsions. For example, trichotillomania - obsessive pulling out hair from the head - manifests itself only as compulsions, and the obsessive part is either absent or not realized.

Intrusive thoughts and compulsive behaviors vary from person to person, but there are common themes of anxiety that are most common among people with OCD. For example, many forms of OCD involve feelings of increased responsibility for oneself or others. A typical fear is the fear of contamination or contamination. When touching dirty surfaces, objects that have been on the street, in contact with the floor, with shoes, a person fears that he may get dirty or contract a dangerous disease, and his compulsive actions are aimed at trying to clean his hands, body, clothes after a collision with the outside world.

There is also the concept of “mental dirt,” when a person feels dirty and compulsively strives to cleanse himself when morally unacceptable and unpleasant thoughts appear. This type of OCD is often associated with taboo, “blasphemous” thoughts. A deeply religious person may think of an obscene scene of a religious nature, while a person of highly moral behavior may have an obsessive thought that he is committing indecent acts in a public place. In such cases, mental rituals may appear: for example, immediately after a “bad” thought, think about something good.

Ideas related to order, symmetry and the ideal execution of actions or rituals are common. A person has an obsessive thought that it is necessary to lay out clothes in a closet in a strict order, sort them by color or other characteristics, park the car perfectly, leave things in strictly designated places, and if this is not done, then something bad may happen .

Another typical manifestation is an obsessive fear of harming others. Obsessive-compulsive disorder often occurs in young mothers in the early postpartum period in the form of a fear of harming their child: “What if I drop the baby, pick up a knife, or throw it out the window?” The mother may compulsively hide all sharp objects, mistrust herself, and ask that the baby be rocked, bathed, and swaddled only by her husband.

Intrusive thoughts are not always a disorder

Is it normal to have intrusive thoughts? Canadian scientists conducted a multicenter study in 14 countries [ 1 ]DA Clark, 2014. Healthy people were asked whether they had ever had obsessive thoughts or thoughts whose content seemed strange or unacceptable to them. The results of this study showed that normally 80% of people have such thoughts periodically, more often during stressful periods.

Why doesn’t a single obsessive thought that comes to the minds of most people become a disorder? Most of us do not evaluate obsessions as something frightening or abnormal: a strange thought came, swirled and went away. With obsessive-compulsive disorder, an obsessive thought is followed by anxiety or even fear, and this is followed by an obsessive desire to get rid of it - compulsion, then again the thought and again compulsion. The vicious circle is repeated many times and leads to maladjustment. That is, people who suffer from OCD are wary of intrusive thoughts, in contrast to people without OCD, who treat strange ideas as “brain spam” that just pop into their heads periodically.

It often happens that during life one obsessive experience replaces another. For example, at 20 years old a person was worried about the fear of infection, and at 25 years old he was worried about the idea of ​​causing harm. As the overall stress level increases, OCD symptoms increase, and as the overall stress level decreases, they decrease. However, there are observations that show that during times of severe shocks, such as wars or disasters, OCD symptoms could temporarily cease. Extreme stress can serve as an antidote, but only temporary.

Statistics

There is no specific group of people in whom OCD is more common. Obsessive-compulsive disorder can affect adults, adolescents, and children. The most common age of diagnosis is around 19–20 years, but there are cases of diagnosis after 35 years. Approximately 1.2% of US adults are thought to have obsessive-compulsive disorder, with more women being diagnosed than men: 1.8% versus 0.5%. More than half of patients hide symptoms of obsessive-compulsive disorder. On average, it takes 12–14 years between the onset of obsessive-compulsive disorder and seeing a doctor.

Genetics and biology of OCD

There are studies that confirm that there is a genetic predisposition to developing OCD. This is a polygenic disease: we cannot identify a single gene that is responsible for the disorder. So far we can say for sure: if a parent has OCD, the likelihood that the child or adolescent will have OCD is higher than in the average population. How much higher is unknown. We are talking about increased risks, and not the absolute inheritance of genetic predisposition.

Biological determinants show that people with OCD have more anxious brains. Their limbic system is more reactive. The frontal cortex, which is responsible for the cognitive regulation of emotions, is slower to respond to emotional outbursts. We are not talking about structural features, but about the functioning features of the brain of people with OCD. At the same time, numerous studies of the brain structure of patients with OCD and possible neuropsychological abnormalities have not revealed any pathologies in the anatomical structure of the brain. There is also evidence that the risk of developing OCD is higher in people who have experienced physical or sexual abuse or psychological trauma in childhood. Several cases have shown that people who have had a streptococcal infection in childhood are at risk of developing OCD or OCD-like symptoms. Science cannot yet reliably explain this phenomenon.

Combination with other diseases

Obsessive-compulsive disorder is a separate disorder and is not a symptom of another illness. This is very important, especially for the Russian context. A number of psychiatrists of the Soviet psychiatric school believed that obsessive-compulsive disorder does not exist, and its manifestations are symptoms of schizophrenia. In this regard, a large number of people suffering from obsessive-compulsive disorder have unfairly received a severe, stigmatizing diagnosis. Nowadays, all over the world, OCD is identified as a separate disease; it has its own diagnostic criteria, symptoms and strategies. effective treatment. It is very important that people receive a correct diagnosis and timely effective treatment.

People with OCD may have comorbid (coexisting) disorders. For example, against the background of obsessive-compulsive disorder, panic disorder may develop or individual panic attacks may occur. Or, due to a long illness, a person with OCD may develop depression. A person can be so immersed in his experiences that he stops going out and communicating with people around him. He understands that this is not normal, but he can’t do anything. This lifestyle inevitably leads to the formation of secondary depression.

Drug treatment and psychotherapy

There are several approaches to treating OCD. The most well-known is drug treatment. It is carried out according to a clear protocol generally accepted in the world: they start with the first-choice drugs, and if the drug does not work in maximum doses, a second drug is prescribed and its effectiveness is assessed for a certain time, and so on until the result is achieved.

The main group of drugs for the treatment of OCD are selective serotonin reuptake inhibitors. These drugs are usually used in higher dosages than those used to treat depression. The effectiveness of treatment is assessed after 8–12 weeks, which is significantly later than the standard for anxiety or depressive disorders (6 weeks). If serotonin reuptake inhibitors do not work, another drug is used, the tricyclic antidepressant clomipramine, which has shown very high effectiveness in treating OCD in many studies. Atypical antipsychotics may also be used in combination with antidepressants. With properly selected therapy, symptoms can become significantly less intense or stop altogether.

In addition, psychotherapeutic treatment is widely used for OCD. Cognitive behavioral psychotherapy has proven its effectiveness here. The psychotherapy process involves discussing the idea that people often suffer from anxiety when they perceive situations as more dangerous than they actually are. Effective cognitive work helps a person formulate an alternative, less threatening interpretation of what is happening, which coincides with his life experience and other people's ideas. Subsequently, cognitive behavioral therapists use exposure and response prevention techniques to test these new interpretations. For example, a person with a fear of infection, who is afraid to touch surfaces in public places, together with a therapist, voluntarily holds his hand on such a surface for 10 seconds. At this moment, he experiences strong anxiety and a strong desire to realize compulsion - to remove his hand and go wipe it with alcohol. Together with the therapist, the patient plans that he will not react in this way, hold it for 10 seconds and not go wash his hand. When such actions are repeated many times, the anxiety the tenth time is much less than the first time, and if this is done a sufficient number of times, the anxiety can be generally reduced. Many modern studies suggest that psychotherapy is a more effective treatment method than pharmacotherapy, with fewer relapses.

For very severe or long-term disorders, drug treatment or psychotherapy alone does not give the desired result. Then a combination of medication and psychotherapeutic treatment will be effective.

OCD Research

To date, much research has been conducted on obsessive-compulsive disorder. We roughly understand the biological background and psychological functioning of people with OCD. We know how to treat this disorder, but this knowledge is not enough. Still, there are cases in which we are unable to help the patient using known methods, and we do not really understand why this happens. New technological methods of providing assistance in resistant cases are currently being developed. For this purpose, the method of deep brain stimulation is used ( deep brain stimulation). An electrode is implanted into the brain, which stimulates the brain in a specific area and reduces OCD symptoms. Because it is an invasive treatment and little is known about its long-term effects, deep brain stimulation remains in the zone scientific research and is not used in practice.

Thanks to psychological research, we know that obsessive-compulsive disorders can manifest themselves in specific ways in different cultures, for example, if there are bad omens in a culture, compulsions may develop in response to these omens (“a black cat crossed the road”). We know that family context can influence the course of obsessive-compulsive disorder. Indulging in the obsessions and compulsions of a sick family member, unfortunately, does not contribute to recovery, but to the perpetuation of the disorder. The influence of social, cultural, and family factors on the course of this disorder is now very interesting for science.

There are studies being conducted in which experts are trying to study the connection between OCD and autism spectrum disorders. It was noted that certain correlations exist, but causation has not yet been established. We still know very little about the genetics and biology of this disorder. By knowing more about OCD, we can be more effective in treating this disease, which is difficult for patients and their families.

I think I have OCD. When is it time to see a psychotherapist?

If you notice all of the following symptoms, you should consult a psychotherapist. If the specialist confirms the diagnosis, you will receive help.

Strange, unpleasant, disturbing thoughts often come to mind. You don’t want to think about it, but thoughts keep coming beyond your desire.

Anxious thoughts occupy more than one hour a day in aggregate.

Thoughts begin to seriously interfere, causing severe worry or anxiety.

Due to obsessive thoughts, you have to miss important things and cancel plans. A lot of time is spent struggling with disturbing ideas; ordinary life begins to fade into the background.

Many patients suffering from obsessive-compulsive disorder are very embarrassed by their thoughts, they feel that they are stupid, strange or dangerous. They feel awkward and try to talk less about them, because often even their loved ones can laugh and say: “Listen, this is kind of stupid” and not take their experiences seriously.

Why is it important to contact a specialist as quickly as possible? The earlier treatment is started, the more likely it will be easier to help the patient. If treatment is started early, a person can be helped exclusively psychotherapeutically, without the use of psychopharmacological agents.

It is also important to know when not to see a therapist. If you have a ridiculous thought, an annoying song that's stuck in your head, or you've been thinking about something for days and can't get the thought out of your head, there's no need to panic. Consider the research: 80% of people may experience intrusive thoughts at some point in their lives. This is fine. So-called brain spam occurs in our heads and is not a sign of a disorder. You should be concerned when you see that these thoughts are taking up too much time and because of them your life begins to change negatively.

OCD and falling in love

There is an opinion that falling in love resembles symptoms of OCD. Indeed, falling in love is a mental fixation on one object. From the point of view of the power with which falling in love captures our thoughts, there really are similarities. But at the same time, unlike OCD, falling in love is pleasant, as a rule, you don’t want to get rid of it. Falling in love often helps a person, making him more effective and productive, unlike OCD, which can seriously interfere with the quality of life. These are different phenomena, and falling in love is a normal, healthy human state, and not at all an obsessive-compulsive disorder.

We thank Daria Maryasova, psychiatrist, psychotherapist, candidate of medical sciences, for her assistance in scientific editing of the article.