Obsessive compulsive disorder (OCD). What is obsessive-compulsive disorder, causes and symptoms of the disease, methods of treating OCD Obsessive-compulsive disorder symptoms

According to statistics from the World Health Organization, the number of people suffering from OCD has been steadily increasing in recent decades. Obsessive-compulsive disorder, although detected very often, is a mystery for the vast majority of people far from psychiatry and medicine in general. Some associate the disease with disturbances in mental activity, while others are confident that it relates to nervous ailments.

Such ignorance often becomes the reason that people develop the disease, do not consult doctors and do not receive timely treatment. Therefore, it is necessary to have an idea about the disease, because one of your loved ones or acquaintances may well suffer from it.

What it is?

OCD (obsessive-compulsive disorder) is a neurosis characterized by the appearance and progressive development of obsessive thoughts, images, and ideas. Accordingly, the disease is directly related to the human psyche, to the processes occurring in the brain. In other words, it refers to mental disorders.

The name of the pathology comes from a combination of two Latin words:

• obsessio - obsession with thought, siege, interception;
• compulsio - compulsion.

First Full description The clinical picture of this neurosis was compiled by Felix Plater, a Swiss doctor, naturalist and writer. This happened in the 17th century. At that time, OCD was not identified as a separate, independent pathology. The symptoms of this disease were considered part of the clinical picture characteristic of melancholia.

In the 19th century, the term “neurosis” appeared, which denoted a number of pathologies that were different in their essence and nature of origin. OCD also began to be classified as a neurosis, and it is still classified among them to this day.

Pathology is a vicious cycle in which obsessive thoughts, ideas, images, called obsessions, and defensive counteractions to them, called compulsions, alternate.

How serious is this disease?

Obsessive-compulsive disorder - what is it in simple words? Phobia? Mania? Obsession? This is roughly what people who are far from psychiatry talk about, trying to understand what this disease is and how serious it is.

In fact, this disease is at the intersection of phobias, manias and obsession. Accordingly, this mental disorder is a very serious pathology, which is impossible to cope with independently, without the participation and help of specialists.

In a number of countries, people with obsessive-compulsive disorder are classified as disabled citizens and receive social benefit, pension due to health reasons. Of course, the disease can be treated and the diagnosis of “OCD” is not a death sentence or a “stigma”.

What is the pathology characterized by? Description of the main manifestations of the disease

Psychotherapy ranks obsessive-compulsive disorder among the most complex personality pathologies. This means that the manifestations of neurosis are not the same in different people. But, despite the variety of private, individual symptoms, there are also signs of the disease common to all patients.

The main distinguishing feature of this pathology is suspiciousness, approaching absolute. That is, patients see subtext, hidden meaning, hidden signs in everything around them. Even in a normal greeting, someone who suffers from this disorder will hear a lot of hints. The second trait characteristic of people with this disease is secrecy. They almost never say what they really think.

Obsessive-compulsive disorder, the treatment of which is complicated by secrecy and suspiciousness, is not limited only to the presence of these personal qualities in an exaggerated form. Patients are also characterized by:

• deliberately calm dominance, that is, such people do not throw hysterics in public and do not get into fights, they demonstrate their strength mostly silently;
• habit of extremes in decisions, measures taken, way of thinking, actions;
• maximum determination, even fanaticism in any action;
• the presence in the mind of stereotypes, patterns, obsessions and thoughts, images, desires that weigh on a person and require release.

The list of general signs characteristic of the disease is reminiscent of the “psychological portraits” of intellectual maniacs from Western films. In connection with this obvious similarity, questions arise about the reasons for which obsessive-compulsive disorder appears and develops, whether its treatment brings results, and whether patients are dangerous to others. After all, every maniac who appears on the silver screen has a history of horrific psychological trauma and shock, and therapy for the characters in the films does not help at all; moreover, they themselves often work in the medical field.

Fortunately, the similarities between movie characters and real people suffering from OCD end at outwardly noticeable, specific behavioral traits.

Why does this disease appear? How does it develop?

This mental disorder develops very slowly. The period during which there are no signs of pathology noticeable to others can last about ten years. At this time, a person, as a rule, is fully aware of the irrationality of thoughts and images appearing in consciousness, but carefully hides them from other people. If left untreated, the disease progresses and the person loses control over his mind. At this moment, deviations in his psyche become obvious, and they are noticed not only by close people, but also by everyone around him.

Why does obsessive-compulsive disorder appear? The reasons for the origin and development of this pathology are not known to psychiatrists for certain. This means that doctors have still not been able to identify the inviolable relationships between the disease and life circumstances, illnesses suffered, and the personality type of people suffering from OCD. Among possible reasons doctors call hereditary predisposition, various disorders in the functionality of the nervous system, pathologies of internal organs, features of a person’s lifestyle and mental development.

What contributes to the emergence and development of pathology?

Factors contributing to the occurrence of this disorder are usually divided into two groups:

• biological;
• socio-psychological.

Biological factors include the following:

• traumatic brain injuries;
• specific diseases such as encephalitis, meningitis;
• pathologies of the nervous system;
• disturbances in hormonal balance;
• disruptions in metabolic processes.

Social and psychological factors include:

• the conditions in which the child grew up and was raised, the moral and ethical standards instilled in him;
• a person’s lifestyle, his social status and income;
• the presence of stress, severe emotional turmoil;
• social activity, degree of adaptation in society;
• surrounding reality, specific conditions, realities.

Psychiatrists believe that due to the specific conditions in which a person lives, obsessive-compulsive disorder may well develop. Army, prison, summer camp, hospital, even kindergarten may well become the very factor that triggers the development of mental illness.

As for social status and income level, it is no secret that it is the wealthy and successful people most often become patients of psychotherapists.

As for raising children, factors contributing to the appearance of OCD are:

• Puritanism;
• hypocrisy;
• excessive severity;
• manic adherence to any traditions and foundations;
• rejection of everything new or contrary to the accepted way of life.

People who have difficulty connecting with others, as well as those who have experienced serious emotional turmoil, need to be especially attentive to themselves. Constant stress can also trigger the development of OCD. As a rule, in this case, people mistake the first signs of the disease for manifestations of depression and try to cope with it. Of course, this only worsens their own condition.

What do sick people think about? The main themes of obsessions, fears, images and thoughts in OCD

Obsessive states, without a doubt, each person has their own, personal and unique. However, for those who suffer from OCD, there is a certain list of areas and topics within which this mental pathology progresses.

People have persistent fears that affect their behavior, perception of the world around them and communication with others. Most often, patients are afraid of:

• contracting an infection or disease unknown to science;
• pollution of water, air, food, oneself;
• causing pain, physical harm to both oneself and others;
• loss of necessary items or inability to purchase them.

The most typical fear in OCD is the fear of getting dirty or coming into contact with something dirty. For example, a person touches something in a store, after which thoughts appear in his head about how much dirt, germs, and uncleanness there is on the item, and he runs in horror to the nearest toilet to wash his hands.

Excessive hand washing is the most common and typical sign of OCD. At first, this habit is perceived as ordinary disgust or excessive cleanliness. Therefore, the symptom is often left unattended until hand washing takes on an exaggerated form.

Obsessive states manifest themselves not only in the form of fears. The imagination of a sick person often draws images, “pictures”. As a rule, they are devoted to the following topics:

• cruelty and violence;
• unacceptable perversions;
• non-standard sex.

The perversions that appear before the mind's eye can be anything. For example, a person may crave a meal of raw alligator brain flavored with lingonberry jam. However, these “pictures” always contradict the accepted principles, traditions and usual way of life and behavior in society.

Obsessive ideas are a manifestation of obsession, fanaticism. They can be associated with religious doctrines, with business plans, with fortune environment. What unites these ideas is “high moral significance.” That is, a person acts for a reason, not because he wants to achieve a certain position or achieve something. His actions are controlled by a certain “ highest goal", in the name of which he is capable of any act.

As for the obsessive thoughts inherent in the mind of a sick person, they always cling to one another. This is a manifestation of suspiciousness, which is initially mistaken for meticulousness, increased attention, and sometimes even for an analytical mindset. A person with OCD may spend half a day wondering why a co-worker extended his hand to him a few seconds later than usual when greeting him. The conclusions that a person suffering from a mental disorder will come to can be anything, but they will certainly turn out to be negative and painful.

At what age does this disease appear?

There are no strict age limits for this pathology. Neurosis can arise in both a small child and a pensioner. Determining the age at which this neurosis most often occurs is significantly complicated by the long asymptomatic period. The patients themselves, of course, are not able to remember when they first thought that water, things and food could be dirty, and people say something that is not what they really mean.

Obsessive-compulsive disorder in children is diagnosed very often. According to medical statistics, 1 out of 200-500 examined children and adolescents is sick with this neurosis. Among adults, 1 in 300 people suffers from the pathology.

According to average, generalized statistical data, the disease is most often detected in people aged 25-35 years. However, OCD appears much earlier, the symptoms become obvious at this age, they can no longer be controlled and hidden, so people go to doctors. The average age at which neurosis begins is considered to be from 10 to 30 years.

How is this pathology diagnosed?

Of course, the basis for identifying this disorder is the symptoms described by the patient in conversation with the doctor. Differential diagnostic techniques and testing are also used.

The Yale-Brown scale test is today the simplest and most accurate way to diagnose obsessive-compulsive disorder. The test consists of 10 questions, each of which has 4 answer options. The evaluation points correspond to the serial number of the phrases selected by the person. Test results show not only the presence or absence of pathology, but also the severity of the patient’s condition.

How is this disease treated?

If obsessive-compulsive disorder is diagnosed, how should it be treated? Do I need to see a psychotherapist? Are visits to a neurologist's office required? Is it possible to cope with pathology on your own, without the help of doctors? Will I need to take medications? These and many other questions are extremely relevant for people who suspect they have obsessive-compulsive disorder.

Treatment for this disease includes:

• psychotherapeutic sessions;
• taking medications.

In some cases, bio- and physiotherapy procedures are used.

The basis of psychotherapeutic sessions is the “four steps” program, compiled by the American doctor and publicist Jeffrey Schwartz. Its essence is for the patient to become aware of his condition, separate pathological thoughts from ordinary ones, and learn to resist the cyclical nature of the disease.

In addition to this program, psychiatrists use the “exposure with warning” technique. This is a rather interesting method of therapy, in which the patient is “immersed” in his obsessions and is not allowed to perform the “ritual” of compulsion. This breaks stereotypes, breaks the cycle inherent in neurosis. Of course, a person independently resists the need to close the cycle; no one physically restrains him from washing his hands or any other ritual.

As for the drug component of therapy, medications are prescribed individually. When prescribing, the doctor takes into account the state of mind and physiological health of a particular person.

Drugs from the following groups are used in treatment:

• antidepressants;
• tranquilizers;
• antipsychotics;
• neuroleptics;
• benzodiazepines;
• mood stabilizers.

There are incredibly many types of drugs belonging to these groups. You should not try to choose the right ones without the help of a doctor, since each of the medications has not only a beneficial effect, but also side effects.

Is it possible to cope with the disease on your own? Prevention of OCD

Different thoughts come to people who suspect they have obsessive-compulsive disorder. “How to get rid of neurosis on your own?” - this is the first and most common question that arises in such situations. Moreover, it is typical for Russians and residents of other countries of the post-Soviet space. Not a single European or American would even think that a severe mental disorder can be cured without the help of a qualified specialist.

It is impossible to cure this pathology without the help of doctors and medication. Of course, you can try to control your thoughts, suppress obsessive images and fears, and fight the desire to perform “cleansing rituals.” But this will only lead to suppression of symptoms, and these efforts will not solve the problem.

A person can independently prevent this disease. The following will help reduce the risk of developing neurosis:

• prevention of stressful and traumatic situations, the ability to avoid them;
• the ability to resolve family disputes and conflicts without hysterics and anger;
• lack of habit of abusing alcohol;
• complete and proper nutrition, without overeating or following strict diets;
• good sleep;
• active lifestyle;
• alternating periods of employment and rest;
• development of communication skills.

We must not forget that every adult is responsible not only for his own mental state, but also for the mental health of his children. OCD can be prevented if you adhere to the following principles when raising your child:

• kindness, calmness and openness;
• absence of the habit of instilling any stereotypes in the child;
• refraining from inflating or lowering children's self-esteem.

It is important to build a trusting relationship with the child, and not to instill fear in him, achieving complete obedience and ignoring his interests, tastes, and preferences.

Obsessive-compulsive disorder(from lat. obsessio- “siege”, “envelopment”, lat. obsessio- “obsession with an idea” and lat. compello- “I force”, lat. compulsio- “coercion”) ( OCD, obsessive-compulsive neurosis) - mental disorder . May be chronic, progressive or episodic.

With OCD, the patient involuntarily experiences intrusive, disturbing or frightening thoughts (so-called obsessions). He constantly and unsuccessfully tries to get rid of anxiety caused by thoughts through equally obsessive and tiresome actions (compulsions). Sometimes it stands out separately obsessive(mainly obsessive thoughts - F42.0) and separately compulsive(mainly obsessive actions - F42.1) disorders.

Obsessive-compulsive disorder is characterized by the development of obsessive thoughts, memories, movements and actions, as well as a variety of pathological fears (phobias).

To identify obsessive-compulsive disorder, the so-called Yale-Brown scale is used.

Epidemiology

CNCG study

OCD and intelligence

intelligence

OCD, 5.5% - alcoholism, 3% - psychosis and affective disorders

Story

bipolar affective disorder

Antiquity and the Middle Ages

Obsessive27 phenomena have been known for a long time. From the 4th century BC. e. obsessions were part of the structure of melancholy. So, her complex according to Hippocrates included:

“Fears and despondency that have existed for a long time.”

In the Middle Ages, such people were considered possessed.

New time

The first clinical description of the disorder belongs to Felix Plater (1614). In 1621, Robert Barton described the obsessive fear of death in his book The Anatomy of Melancholy. Similar obsessive doubts and fears were described in 1660 by Jeremy Taylor and John Moore, Bishop of El. In England in the 17th century, obsessive states were also classified as “religious melancholy,” but, on the contrary, they were believed to occur due to excessive dedication to God.

19th century

In the 19th century, the term “neurosis” became widespread for the first time, and obsessions were included in this category. Obsessions began to be differentiated from delusions, and compulsions from impulsive actions. Influential psychiatrists have debated whether OCD should be classified as a disorder of the emotions, will, or intellect.

folie de doute

obsessive-compulsive disorder Zwangsvorstellung obsession, and in the USA - English. compulsion

XX century

neurasthenia Pierre Marie Felix Janet identified this neurosis as psychasthenia in his work fr. psychasthenia phobic anxiety disorders Sigmund Freud paranoia psychoses such as schizophrenia neuroses.

• fear of infection or contamination;
• fear of harming yourself or others;

Treatment

• b) There must be at least one thought or action that the patient is unsuccessfully resisting, even if there are other thoughts and/or actions that the patient is no longer resisting.
• c) The thought30 of performing an obsessive action should not in itself be pleasant (merely reducing tension or anxiety is not considered pleasant in this sense).
• d) The thoughts, images, or impulses must be unpleasantly repetitive.

It should be noted that the performance of compulsive actions is not in all cases necessarily correlated with specific obsessive fears or thoughts, but may be aimed at getting rid of a spontaneously arising feeling of internal discomfort and/or anxiety.

It includes:

• obsessive-compulsive neurosis
• obsessive neurosis
• anancaste neurosis

To make a diagnosis, it is necessary to first exclude anancastic personality disorder (F60.5).

Differential diagnosis according to ICD-10

ICD-10 notes that the differential diagnosis between obsessive-compulsive disorder and depressive disorder (F 32., F 33.) can be difficult because these two types of symptoms often occur together. In an acute episode, preference is given to the disorder whose symptoms occurred first. When both are present but neither is dominant, it is recommended to assume that the depression was primary. For chronic disorders, it is recommended to give preference to the disorder whose symptoms persist most often in the absence of symptoms of the other.

Occasional panic attacks (F41.0) or mild phobic (F40.) symptoms are not considered a barrier to a diagnosis of OCD. However, obsessive symptoms that develop in the presence of schizophrenia (F 20.), Gilles de la Tourette syndrome (F 95.2.), or an organic mental disorder are regarded as part of these conditions.

It is noted that although obsessions and compulsions usually coexist, it is advisable to establish one of these types of symptoms as the dominant one, since this may determine how patients react to different types therapy.

Etiology and pathogenesis

Symptoms and behavior of patients. Clinical picture

Patients with OCD are suspicious people, prone to rare, maximally decisive actions, which is immediately noticeable against the background of their dominant calm. The main signs are painful stereotypical, intrusive (obsessive) thoughts, images or desires, perceived as meaningless, which in a stereotypical form come to the patient’s mind again and again and cause an unsuccessful attempt at resistance. Their typical topics include:

• fear of infection or contamination;
• fear of harming yourself or others;
• sexually explicit or violent thoughts and images;
• religious or moral ideas;
• fear of losing or not having some things that you may need;
• order and symmetry: the idea that everything should be lined up “correctly”;
• superstition, excessive attention to something that is considered as good or bad luck.

Compulsive actions or rituals are stereotypical behaviors repeated over and over again, the meaning of which is to prevent any objectively unlikely events. Obsessions and compulsions are more often experienced as alien, absurd and irrational. The patient suffers from them and resists them.

The following symptoms are indicators of obsessive-compulsive disorder:

• obsessive, recurring thoughts;
• anxiety following these thoughts;
• certain and, in order to eliminate anxiety, often repeated identical actions.

A classic example of this disease is the fear of pollution, in which the patient experiences every contact with what he considers dirty objects causing discomfort and, as a result, obsessive thoughts. To get rid of these thoughts, he starts washing his hands. But even if at some point it seems to him that he has washed his hands sufficiently, any contact with a “dirty” object forces him to start his ritual again. These rituals allow the patient to achieve temporary relief. Despite the fact that the patient realizes the meaninglessness of these actions, he is not able to fight them.

Obsessions

Patients with OCD experience intrusive thoughts (obsessions), which are usually unpleasant. Any minor events can provoke obsessions - such as an extraneous cough, contact with an object that is perceived by the patient as unsterile and non-individual (handrails, door handles, etc.), as well as personal concerns not related to cleanliness. Obsessions can be scary or obscene in nature, often alien to the patient’s personality. Exacerbations can occur in crowded places, for example, on public transport.

Compulsions

To combat obsessions, patients use protective actions (compulsions). Activities are rituals designed to prevent or minimize fears. Actions such as constantly washing hands and face, spitting saliva, repeatedly avoiding potential danger (endlessly checking electrical appliances, closing the door, closing the zipper on the fly), repeating words, counting. For example, in order to make sure that the door is closed, the patient needs to pull the handle a certain number of times (while counting the times). After performing the ritual, the patient experiences temporary relief, moving into an “ideal” post-ritual state. However, after some time, everything repeats itself again.

Etiology

At the moment, the specific etiological factor is unknown. There are several reasonable hypotheses. There are 3 main groups of etiological factors:

1. Biological:
   1. Diseases and functional-anatomical features of the brain; features of the functioning of the autonomic nervous system.
   2. Disturbances in the exchange of neurotransmitters - primarily serotonin and dopamine, as well as norepinephrine and GABA.
   3. Genetic - increased genetic concordance.
   4. Infectious factor (PANDAS syndrome theory).
2. Psychological:
   1. Psychoanalytic theory.
   2. The theory of I.P. Pavlov and his followers.
   3. Constitutional-typological - various accentuations of personality or character.
   4. Exogenously-psychotraumatic - family, sexual or industrial.
3. Sociological (micro- and macrosocial) and cognitive theories (strict religious education, modeling of the environment, inadequate response to specific situations).

Psychological theories

Psychoanalytic theory

In 1827, Jean-Etienne Dominique Esquirol described one of the forms of obsessive-compulsive neurosis - “the disease of doubt” (fr. folie de doute). He wavered between classifying it as a disorder of the intellect and the will.

I.M. Balinsky noted in 1858 that all obsessions have a common feature - alienness to consciousness, and proposed the term “ obsessive-compulsive disorder" A representative of the French psychiatric school, Benedict Augustin Morel, in 1860 considered the cause of obsessive states to be a disturbance of emotions through a disease of the autonomic nervous system, while representatives of the German school, W. Griesinger and his student Karl-Friedrich-Otto Westphal in 1877, pointed out that they emerge when unaffected in other respects the intellect and cannot be expelled from consciousness by it, but they are based on a thinking disorder similar to paranoia. It is the term of the latter that is mute. Zwangsvorstellung, translated into English in the UK as English. obsession, and in the USA - English. compulsion gave the modern name of the disease.

XX century

In the last quarter of the 19th century, neurasthenia included a huge list of different diseases, including OCD, which was still not considered a separate disease. In 1905, Pierre Marie Felix Janet isolated this neurosis from neurasthenia as a separate disease and called it psychasthenia in his work fr. Les Obsessions et la Psychasthenie(Obsessions and Psychasthenia). In the same year, data about him were systematized by S. A. Sukhanov. The term “psychasthenia” became widely used in Russian and French science, while in German and English the term “obsessive-compulsive neurosis” was used. In the USA it became known as obsessive-compulsive neurosis. The difference here is not only in terminology. In domestic psychiatry, obsessive-compulsive disorder is understood not only as obsessive-compulsive disorder, but also as phobic anxiety disorders (F40.), which both in ICD-10 and DSM-IV-TR have different designations. P. Janet and other authors considered OCD as a disease caused by congenital features of the nervous system. In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts that manifest as symptoms. E. Kraepelin placed it not among psychogeniuses, but among “constitutional mental illnesses” along with manic-depressive psychosis and paranoia. Many scientists attributed it to psychopathy, and K. Kolle and some others - to endogenous psychoses such as schizophrenia, but at the moment it is classified specifically as neuroses.

Treatment and therapy

Modern therapy for obsessive-compulsive disorder must necessarily include a complex effect: a combination of psychotherapy and pharmacotherapy.

Psychotherapy

The use of cognitive behavioral psychotherapy is producing results. The idea of ​​treating OCD with cognitive behavioral therapy is promoted by American psychiatrist Jeffrey Schwartz. The technique he developed allows the patient to resist OCD by changing or simplifying the procedure of “rituals”, reducing it to a minimum. The basis of the technique is the patient’s awareness of the disease and step-by-step resistance to its symptoms.

According to Jeffrey Schwartz's four-step method, it is necessary to explain to the patient which of his fears are justified and which are caused by OCD. It is necessary to draw a line between them and explain to the patient how a healthy person would behave in a given situation (it is better if the example is a person who represents an authority for the patient). As an additional technique, the “thought stopping” method can be used.

According to some authors, the most effective form of behavioral therapy for OCD is the exposure and warning method. Exposure involves placing the patient in a situation that provokes the discomfort associated with obsessions. At the same time, the patient is given instructions on how to resist performing compulsive rituals - preventing a reaction. According to many researchers, most patients achieve lasting clinical improvement after this form of therapy. Randomized controlled trials have shown that this form of therapy is superior to a range of other interventions, including placebo drugs, relaxation and anxiety management skills training.

Unlike drug therapy, after the withdrawal of which the symptoms of obsessive-compulsive disorder often worsen, the effect achieved by behavioral psychotherapy persists for several months and even years. Compulsions usually respond better to psychotherapy than obsessions. The overall effectiveness of behavioral psychotherapy is approximately comparable to drug therapy and is 50-60%, but many patients refuse to participate due to fear of increased anxiety.

Group, rational, psychoeducational (teaching the patient to be distracted by other stimuli that alleviate anxiety), aversive (using painful stimuli when obsessions appear), family and some other methods of psychotherapy are also used.

If there is severe anxiety in the first days of pharmacotherapy, it is advisable to prescribe benzodiazepine tranquilizers (clonazepam, alprazolam, gidazepam, diazepam, phenazepam). In chronic forms of OCD that cannot be treated with antidepressants of the serotonin reuptake inhibitor group (about 40% of patients), atypical antipsychotics (risperidone, quetiapine) are increasingly used.

According to numerous studies, the use of benzodiazepines and antipsychotics has a mainly symptomatic (anxiolytic) effect, but does not affect nuclear obsessional symptoms. Moreover, extrapyramidal side effects classical (typical) antipsychotics can lead to increased obsessions.

There is also evidence that some of the atypical antipsychotics (those with antiserotonergic effects - clozapine, olanzapine, risperidone) can cause and worsen obsessive-compulsive symptoms. There is a direct relationship between the severity of such symptoms and the doses/duration of use of these drugs.

To enhance the effect of antidepressants, you can also use mood stabilizers (lithium preparations, valproic acid, topiramate), L-tryptophan, clonazepam, buspirone, trazodone, gonadotropin-releasing hormone, riluzole, memantine, cyproterone, N-acetylcysteine.

Biological therapy

It is used only for severe OCD that is refractory to other types of treatment. In the USSR, atropinocomatosis therapy was used in such cases.

In the West, electroconvulsive therapy is used in these cases. However, in the CIS countries its indications are much narrower, and it is not used for this neurosis.

Physiotherapy

According to data for 1905, the following were used to treat obsessive-compulsive disorder in pre-revolutionary Russia:

1. Warm baths (35 °C) lasting 15-20 minutes with a cool compress on the head in a well-ventilated room 2-3 times a week with a gradual decrease in water temperature in the form of rubdowns and douches.
2. Rubbing and dousing with water from 31 °C to 23-25 ​​°C.
3. Swimming in river or sea water.

Prevention

1. Primary psychoprophylaxis:
   1. Prevention of traumatic influences at work and at home.
   2. Prevention of iatrogeny and didactogeny (proper upbringing of a child, for example, not instilling in him an opinion about his inferiority or superiority, not creating a feeling of deep fear and guilt when committing “dirty” acts, healthy relationships between parents).
   3. Preventing family conflicts.
2. Secondary psychoprophylaxis (relapse prevention):
   1. Changing the attitude of patients to traumatic situations through conversations (persuasive treatment), self-hypnosis and suggestion; timely treatment when detected. Conducting regular medical examinations.
   2. Helping to increase brightness in a room is to remove thick curtains, use bright lighting, make the most of daylight hours, and light therapy. Light promotes the production of serotonin.
   3. General restorative and vitamin therapy, adequate sleep.
   4. Diet therapy (good nutrition, avoidance of coffee and alcoholic beverages, include in the menu foods with a high content of tryptophan (the amino acid from which serotonin is formed): dates, bananas, plums, figs, tomatoes, milk, soy, dark chocolate).
   5. Timely and adequate treatment of other diseases: endocrine, cardiovascular, especially cerebral atherosclerosis, malignant neoplasms, iron and vitamin B12 deficiency anemia.
   6. It is imperative to avoid the occurrence of drunkenness and especially alcoholism, drug addiction and substance abuse. Drinking alcoholic beverages irregularly in small quantities has a sedative effect and therefore cannot provoke a relapse. The effect of using “soft drugs” such as marijuana on the relapse of OCD has not been studied, so they are also best avoided.
3. All of the above related to individual psychoprophylaxis. But it is necessary at the level of institutions and the state as a whole to carry out social psychoprophylaxis - improving the health of work and living conditions, service in the armed forces.

Forecast

Chronicity is most characteristic of OCD. Episodic manifestations of the disease and complete recovery are relatively rare (acute cases may not recur). In many patients, especially with the development and persistence of one type of manifestation (arithmomania, ritual hand washing), a long-term stable condition is possible. In such cases, a gradual mitigation of psychopathological symptoms and social readaptation are noted.

In mild forms, the disease usually occurs on an outpatient basis. Reverse development of manifestations occurs within 1-5 years from the moment of detection. There may be mild symptoms that do not significantly impair functioning except during periods of increased stress or situations in which a comorbid Axis I disorder (see DSM-IV-TR), such as depression, develops.

More severe and complex OCD with contrasting ideas, numerous rituals, complications with phobias of infection, pollution, sharp objects, and, obviously, obsessive ideas or compulsions associated with these phobias, on the contrary, may become resistant to treatment or show a tendency to relapse (50 -60% in the first 3 years) with disorders that persist despite active therapy. Further deterioration of these conditions indicates a gradual aggravation of the disease as a whole. Obsessions in this case may tend to expand. Common reason their intensification is either the resumption of a traumatic situation, or a weakening of the body, overwork and prolonged lack of sleep.

Efforts are being made to determine which patients require long-term therapy. In approximately two thirds of cases, improvement with OCD treatment occurs within 6 months to 1 year, most often by the end of this period. In 60-80% the condition not only improves, but practically recovers. If the disease continues for more than a year, fluctuations are observed during its course - periods of exacerbations alternate with periods of remission, lasting from several months to several years. The prognosis is worse if we are talking about an anancastic personality with severe symptoms of the disease, or if there is continuous stress 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. Therefore, successful drug treatment should be continued for 1–2 years before discontinuation is considered and discontinuation of pharmacotherapy should be carefully considered, with most patients being advised to continue some form of treatment. There is evidence that cognitive behavioral therapy may have a longer lasting effect than some SSRIs after discontinuation. It has also been proven that people whose condition improves based on drug therapy alone tend to experience relapses after stopping the drug.

Without treatment, OCD symptoms can progress to the point where they affect the patient's life, interfering with their ability to work and maintain important relationships. Many people with OCD have suicidal thoughts, and about 1% commit suicide. Specific symptoms of OCD rarely progress to the development of physical impairment. However, symptoms such as compulsive hand washing can lead to dry and even damaged skin, and recurring trichotillomania can lead to crusting on the patient's scalp.

However, in general, OCD, in comparison with endogenous mental illnesses, like all neuroses, has a favorable course. Although the treatment of the same neurosis in different people can vary greatly depending on the social, cultural and intellectual level of the patient, his gender and age. Thus, the most successful results are in patients aged 30-40 years, women and married people.

In children and adolescents, OCD, on the contrary, is more persistent than other emotional disorders and neuroses, and without treatment after 2-5 years, very few of them fully recover.

Between 30% and 50% of children with obsessive-compulsive disorder continue to exhibit symptoms 2 to 14 years after diagnosis. Although the majority, along with those undergoing drug treatment (for example, SSRIs), experience a slight remission, less than 10% achieve it completely. The reasons for the adverse consequences of this disease are: a weak primary response to therapy, a history of tic disorders, and psychopathy of one of the parents. Thus, obsessive-compulsive disorder is a serious and chronic condition for a significant number of children.

In some cases, a condition bordering between neurosis and anancastic personality disorder is possible, which is favored by: personality accentuation according to the psychasthenic type, personality infantilism, somatic illness, long-term psychotrauma, age over 30 years or long-term OCD, developing in 2 stages:

1. Depressive neurosis (ICD-9:300.4 / ICD-10:F0, F33.0, F34.1, F43.21).
2. Obsessive borderline state (according to O.V. Kerbikov) with a predominance of obsessions, phobias and asthenia.

Characteristics of cognitive (cognitive) function

A 2009 study that used a battery of neuropsychological tasks to assess 9 cognitive domains specifically centered on executive function concluded that there were few neuropsychological differences between people with OCD and healthy participants when confounding factors were controlled.

Labor expertise

Neuroses are usually not accompanied by temporary disability. In case of prolonged neurotic conditions, the medical control commission (MCC) decides on changing working conditions and transferring to easier work. In severe cases, the VKK refers the patient to a medical-labor expert commission (VTEK), which can determine disability group III and give recommendations regarding the type of work and working conditions (light duty, shortened working hours, work in a small team).

Legislation abroad

Although research suggests that OCD sufferers are usually remarkably predisposed to keeping themselves and others safe, some legislation has common law about mental illness, which may unintentionally have an adverse impact on the civil rights and liberties of people with OCD.

Statistical data

At the moment, information on research into the epidemiology of OCD is very contradictory. This is due to different methodological approaches to its calculation, which developed historically in connection with different diagnostic criteria, as well as insufficient research into the disorder, dissimulation and overdiagnosis.

Quite often the prevalence of OCD is stated to be between 1-3%. According to other updated data, its prevalence is approximately 1-3:100 in adults and 1:200-500 in children and adolescents, although clinically recognized cases are less common (0.05-1%), since many may not have this disorder diagnosed due to stigma.

Beginning of the disease. First medical consultation. Duration. Severity of OCD

Obsessive-compulsive disorder most often begins between the ages of 10 and 30. However, the first visit to a psychiatrist usually occurs only between 25 and 35 years. Up to 7.5 years can pass between the onset of the disease and the first consultation. The average age of hospitalization was 31.6 years.

The period of spread of OCD increases in proportion to the observation period. For a period of 12 months it is equal to 84:100000, for 18 months - 109:100000, 134:100000 and 160:100000 for 24 and 36 months, respectively. This rise exceeds what would be expected for a chronic disease with the necessary medical care in a stable population. During the 38 months available for the study, 43% of patients did not have a study diagnosis recorded in the official outpatient medical record. 19% did not visit a psychiatrist at all. However, 43% of patients visited a psychiatrist at least once during 1998-2000. The average frequency of visits to a psychiatrist per 967 patients is 6 times over 3 years. Based on these data, it can be concluded that patients with obsessive-compulsive disorder are not sufficiently supervised.

At the first medical examination, only one of 13 new cases in children and adolescents and one among 23 adults had OCD grade according to the Yale-Brown scale in the English study. CNCG study was hard. If we do not take into account the 31% of cases with questionable criteria, the number of such cases increases to 1:9 for persons under 18 years of age and 1:15 after. The proportion of mild, moderate and severe severity was the same both among newly diagnosed cases of OCD and among previously identified cases. It was 2:1:3 = mild: moderate: severe.

OCD and social conditions, including family life. Gender studies

OCD occurs in all socioeconomic levels. Studies on the distribution of patients into classes are contradictory. According to one of them, 1.5% of patients belong to the upper social class, 23.81% to the upper middle class and 53.97% to the middle class. According to another, among patients from Santiago, the lower class showed a greater tendency to the disease. These studies are significant for health care, since patients from the lower class cannot always get the help they need. The prevalence of OCD is also associated with educational level. The incidence of the disease is lower in those who have completed higher education educational institution(1.9%) than those who do not have higher education(3.4%). However, among those who graduated from higher education, the frequency is higher among those who graduated with an advanced degree (respectively 3.1%: 2.4%). Most patients who come for consultation cannot study or work, and if they can, they do so at a very low level. Only 26% of patients can work fully.

Up to 48% of OCD patients are single. If the degree of illness is severe before the wedding, the chance of a marriage union decreases, and if it is concluded, in half of the cases problems arise in the family.

There are certain gender differences in the epidemiology of OCD. At the age of 65 years, the disease was more often diagnosed in men (except for the period 25-34 years), and after that - in women. The maximum difference with a predominance of sick men was observed in the period 11-17 years. After 65, the incidence of obsessive-compulsive disorder fell in both groups. 68% of those hospitalized are women.

OCD and intelligence

Patients with OCD are most often people with a high level of intelligence. According to various data, among patients with OCD, the frequency of high IQ is from 12% to 28.53%. Wherein high performance verbal IQ.

OCD and psychogenetics. Comorbidity

The twin method shows high concordance among monozygotic twins. According to research, 18% of parents of patients with obsessive-compulsive disorder have mental disorders: 7.5% - OCD, 5.5% - alcoholism, 3% - anancastic personality disorder, psychosis and affective disorders - 2%. Among non-mental illnesses, relatives of patients with this disease often suffer from tuberculous meningitis, migraine, epilepsy, atherosclerosis and myxedema. It is unknown whether these diseases are associated with the occurrence of OCD in relatives of such patients. However, there are no absolutely accurate studies of the genetics of non-mental illnesses among patients with obsessive-compulsive disorder. 31 out of 40 patients were the first or only child. However, no correlation was found between the developmental defects and the future development of OCD. The fertility rate in patients with this disease is 0-3 for both sexes. The number of premature babies in such patients is small.

25% of patients with OCD had no comorbid conditions. 37% suffered from one other mental disorder, 38% from two or more. The most commonly diagnosed conditions were major depressive disorder (MDD), anxiety disorder (including anxiety disorder), panic disorder, and acute stress reaction. 6% were diagnosed with bipolar affective disorder. The only difference The gender breakdown was that 5% of women were diagnosed with an eating disorder. Among children and adolescents, 25% of patients with obsessive-compulsive disorder had no other mental disorders, 23% had 1, and 52% had 2 or more. The most common were MDD and ADHD. At the same time, as among healthy individuals under 18 years of age, ADHD was more common in boys (in this particular case - 2 times). 1 in 6 was diagnosed with oppositional defiant disorder and excessive anxiety disorder (F93.8). 1 in 9 girls had an eating disorder. Boys often had Tourette's syndrome.

OCD in cinema and animation

• In Martin Scorsese's film "The Aviator" main character(Howard Hughes played by Leonardo DiCaprio) suffered from OCD.
• In the movie As Good As It Gets, the main character (Melvin Adell played by Jack Nicholson) suffered from a whole complex of OCD. He constantly washed his hands, in boiling water and with new soap each time, wore gloves, ate only with his own cutlery, was afraid of stepping on a crack in the asphalt, avoided the touch of strangers, had his own ritual of turning on the light and closing the lock.
• In the TV series Scrubs, Dr. Kevin Casey, played by Michael J. Fox, suffers from OCD with a lot of rituals.
• In Orson Scott Card's novel Xenocide, an artificially bred subspecies of people who speak to the gods suffer from OCD, and their compulsive gestures are considered a rite of purification.
• The film "Dirty Love" quite realistically depicts the symptoms of OCD and Tourette's syndrome, due to which the main character Mark, played by Michael Sheen, loses his home, wife and job.
• In the series Girls, the main character Hannah Horvath suffers from OCD, which is expressed in constantly counting to eight.
• The title character of Monk suffers from OCD.
• In the movie "Inner Road" one of the main characters suffers from OCD.
• In The Big Bang Theory, main character Sheldon Lee Cooper (played by Jim Parsons) bullies his friends about the rules and conditions of being around him due to his OCD.
• On Glee, school psychologist Emma Pillsbury is obsessed with cleanliness due to OCD.
• In the TV series Scorpio, one of the characters, Sylvester Dodd, suffers from OCD.

Data

• In 2000, a group of chemists (Donatella Marazziti, Alessandra Rossi and Giovanni Battista Cassano from the University of Pisa and Hagop Suren Akiskal from the University of California, San Diego) received the Ig Nobel Prize in Chemistry for their discovery that, at the biochemical level, romantic love is indistinguishable from severe obsessive-compulsive disorder.

Literature

• Freud Z. Beyond the Pleasure Principle (1920)
• Lacan J. L'Homme aux rats. Seminaire 1952-1953
• Melman C. La nevrose obsessionelle. Seminaire 1988-1989. Paris: A.L.I., 1999.
• V. L. Gavenko, V. S. Bitensky, V. A. Abramov. Psychiatry and narcology (handbook). - Kiev: Health, 2009. - P. 512. - ISBN 978-966-463-022-8. (Ukrainian)
• A. M. Svyadoshch. Obsessive-compulsive neurosis (obsessive-compulsive and phobic neurosis). // Neuroses (a guide for doctors). - 4th, revised and expanded. - St. Petersburg: Peter (publishing house), 1997. - P. 69-95. - 448 p. - (“Practical medicine”). - 7000 copies. - ISBN 5-88782-156-6.

Author of the article: 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 heading of borderline mental disorders. Obsessive-compulsive disorder (OCD) is distinguished from pathology at the neurotic level by its greater severity, frequency of occurrence, and intensity of obsessions.

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

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

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

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

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

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

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

Obsessive-compulsive disorder: pathogenesis

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

Reason 1. Genetic theory

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

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

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

Reason 2. Features of higher nervous activity

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

Reason 3. Constitutional and typological aspects of personality

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

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

Reason 4. The influence of neurotransmitters

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

Reason 5. PANDAS syndrome

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

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

Obsessive-compulsive disorder: clinical picture

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

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

Group 1. Ineradicable doubts

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

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

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

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

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

Group 2. Immoral obsessions

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

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

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

Group 3. Overwhelming worries about pollution

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

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

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

Group 4. Obsessive actions

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

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

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

Obsessive-compulsive disorder: treatment methods

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

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

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

Drug treatment

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

Psychotherapeutic treatment

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

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

Hypnosis treatment

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

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

Preventive actions

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

• take a contrast shower in the morning;
• in the evening, take baths with the addition of relaxing natural oils or soothing herbal compositions;
• ensuring a good night's sleep;
• daily walks before bed;
• stay on fresh air at least two hours a day;

Hello, dear readers of the blog site. Surely you have seen more than once in movies or everyday life how someone performs strange actions.

For example, he flips the switch several times before leaving, steps over the joints on the floor tiles, constantly rubs his hands with an alcohol solution, or something else like that.

All such cases are united by one common point - during the day a person reproduces the same behavioral act, turning it into a daily ritual.

This is how neurotic personality disorder manifests itself - OCD (obsessive-compulsive disorder). What kind of disease is this, where does it come from and what to do - let’s figure it out together.

What is OCD in simple words

The abbreviation OCD stands for obsessive-compulsive disorder, where obsession (from the Latin “siege”, “obsession with an idea”) is thoughts, compulsions (from the Latin “coercion”) – actions.

Also called OCD obsessive states, which presupposes that the individual has thoughts and actions that he cannot get rid of (everything happens as if against his wishes) and experiences mental suffering about this.

From the inside, the mechanism of this disorder is as follows:

1. the individual experiences unconscious alarm(anxiety differs from fear in that she is pointless: “I’m scared, but I don’t understand why,” while fear is specific).
2. Psychological discomfort causes negative thoughts (obsessions): not understanding the cause of his anxiety, a person begins to look for it himself (the psyche loves order and predictability), going through all sorts of dangers that he may be exposed to. “What if this, what if that...”
3. Next stage - finding the "reason" anxiety and how to eliminate it. A person intuitively finds a relationship between some action (it is chosen at random) and the subsequent relief of his condition.
4. Next, selected ritual is reproduced every time mental stress increases. But. The whole catch is that OCD is a vicious circle: compulsions (ritual actions) - relief - obsessions (increasing anxiety) - compulsions (actions) - relief, etc.

Over time, the number of specific compulsions (ritual actions) increases, since the brain begins to understand that they do not help, anxiety still grows.

For example, a woman washes the floors every time she is worried. At first, once a day was enough for her, then she began to do it two, three times, etc.

She will rub her knuckles, cry, feel guilty and ashamed for what she is doing, but will not stop the mindless washing in the (unconscious) hope of getting satisfaction.

In the future, she may increase the washing area or start doing something else. A neurotic rarely stops at just one thing.

Types of obsessive-compulsive disorder

What is OCD: what symptoms indicate the presence of a neurotic disorder? The syndrome includes 4 large groups manifestations:

Causes of OCD

Obsessive-compulsive disorder - what it is and how it arises - can be explained from two sides, suggesting physiological and psychological factors for the formation of the disorder:

1. Biology:
   1. genetics;
   2. consequences of past infection;
   3. head injuries and, as a result, dysfunction of certain parts of the brain;
2. :
   1. death of a loved one;
   2. divorces;
   3. problems at work;
   4. difficulties in personal relationships;
   5. negative events and changes in life;
   6. endured violence, humiliation of human dignity.

It is important to emphasize once again that the basis for OCD is a feeling of psychological discomfort (anxiety) in which a person remains for a long time.

Therefore, before prescribing treatment to a person, it is necessary to understand what causes his anxiety - psychological factors or physiology.

Treatment of obsessive-compulsive disorder

So, obsessive-compulsive disorder is a neurotic syndrome that includes obsessive thoughts and actions.

Depending on the etiology, OCD is treated in three ways:

1. Psychotherapy involves multiple meetings with a psychologist, where the client understands the essence of his behavior: why is it needed, what is he trying to control and what is he avoiding?

   Gradually he comes to understand the source of his anxiety, which triggers the OCD mechanism. Then we work on how to eliminate the causes of anxiety or find healthier reactions to what is happening.

   As a rule, individuals prone to this disorder have the following characteristics(greetings from childhood):

   1. hypertrophied sense of responsibility (I am responsible for everything and everyone);
   2. the belief that thoughts are material (if I think badly, it will happen or God will punish me), “magical thinking”;
   3. habit of exaggerating, especially danger;
   4. to be correct, ideal in everything (life, thoughts, actions).
2. Pharmacology– medications are prescribed by a medical psychotherapist to eliminate fears and anxiety, secondary depression, and strengthen the central nervous system. However, with the abolition of the pills, the neurotic disorder may return again, since the individual’s thinking remains the same. Therefore, it is advisable to combine pharmacology with a visit to a psychologist, in order to partially identify those parts of it that provoke anxiety and, as a result, OCD.
3. Hypnosis– helps to break associative connections between thoughts and the actions that follow them, to realize the absurdity of obsessions. A person is freed from prejudice and regains behavioral control.

Good luck to you! See you soon on the pages of the blog site

You might be interested

What is schizophrenia - its signs and symptoms, types and causes of the disease, tests and treatment methods for schizophrenic people What is agoraphobia: description, symptoms, causes, treatment A social phobe is a person who loves solitude or a sick person suffering from social phobia What is neurosis: its signs and symptoms - types of neuroses, their diagnosis and treatment Sociopathy - what is it and who are sociopaths? What is mentality: health and illness at the mental level Is bulimia just binge eating or a serious illness? What is trypophobia: symptoms, causes, treatment Depression is a bad mood or mental illness What is abuse: signs of an abusive relationship Cognitive - this is what it is, how to develop cognitive functions and abilities so that later there are no violations and distortions

Obsessive compulsive disorder is an illness whose causes are rarely on the surface. This syndrome is characterized by the presence of intrusive, persistent thoughts (obsessions), to which the person responds with corresponding actions (compulsions).

Obsessive Compulsive Disorder: Overview

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

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

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

Compulsions with this disease are a bit like rituals. These are actions that people, in response to an obsession, repeat over and over again to reduce the possibility of harm. Compulsions can be physical (for example, constantly checking whether the door is closed) or mental (for example, saying a phrase in your head).

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

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

Avoidance behavior is a core 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 chaos and can affect performance. According to WHO, obsessive compulsive disorder is among the top ten diseases that lead to loss of ability to work. A person with obsessive-compulsive disorder syndrome does not seek help from doctors because he is afraid, embarrassed, or does not know that his illness can be treated, including in a non-drug manner.

Causes of obsessive compulsive syndrome

Despite numerous studies devoted to obsessive compulsive syndrome, it is still impossible to say for sure what is the main cause of OCD. This condition may be responsible for: psychological reasons, and physiological.

Genetics

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

• The hSERT gene is its main task, collecting “waste” serotonin in nerve fibers. There are studies that support 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 individual parts of the brain. It has been revealed that the activity of certain areas of the brain in OCD syndrome has specific activity. The obsessive compulsive disorder syndromes involved are:

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

Brain scan findings in people with obsessive compulsive disorder. The circuit, which includes the areas described above, regulates behavioral factors such as bodily secretions, sexuality and aggression. The chain activates appropriate behavior, for example, after contact with something unpleasant, washing your 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 experiences certain complications with the circuit turned off, it creates communication problems. Compulsions and obsessions continue, leading to repetition of an action.

Autoimmune reaction

Obsessive compulsive disorder can result from autoimmune diseases. Certain cases of rapid development of OCD in children may be a consequence of streptococcal bacteria, which cause dysfunction and inflammation of the basal ganglia.

Another study suggested that episodic OCD occurs not due to streptococcal bacteria, but more due to the prevention of antibiotics prescribed to treat the disease.

Psychological Causes of OCD

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

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

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

When a person starts to avoid public toilets or performs various cleansing rituals (cleaning door handles, seats, followed by thorough hand washing) instead of enduring fear, then this may develop into a phobia.

Distress, environment

Psychological trauma and stress activate OCD syndrome in people who tend to develop 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 have experienced traumatic or stressful event. These events can also worsen an existing disorder. Here is a list of the most traumatic environmental causes:

• change of housing;
• violence and abuse;
• 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 correctly interpret thoughts. 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, due to fatigue, may from time to time be visited by thoughts of harming her child. Many, naturally, brush aside these obsessions and do not notice them. People who suffer from the disorder exaggerate the importance of thoughts and take them as a threat: “What if I’m actually capable of this?!”

The woman thinks that she may 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 arise from obsessions, for example, by avoiding situations that trigger those thoughts, or by engaging in "rituals" of prayer or excessive purification.

Scientists suggest that people with the disorder give exaggerated meaning to thoughts due to false prejudices that were received in childhood. Among them:

Causes of progression of obsessive-compulsive disorder

For effective treatment of the disorder, knowledge of 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

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

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

Compulsions also become entrenched. A person feels less anxious when he has checked whether the iron is turned off. Accordingly, he will begin to act in the same way in the future.

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

“Magical” thinking and exaggeration of one’s capabilities

The OCD patient greatly exaggerates his ability to influence the world and his capabilities. He confident in his power prevent or cause negative events through thought. “Magical” thinking implies the belief that performing certain rituals or actions will cause something unwanted (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 needs to be done perfectly, that there is a perfect solution all the time, and that even a small mistake will have significant consequences. This is often found in patients diagnosed with OCD who strive for order, and most often in those people who suffer from anorexia nervosa.

Intolerance of uncertainty and overestimation of danger

Also very important aspect- overestimation of the danger of the situation and underestimation of the ability to cope with it. Most people who suffer from OCD believe that they must know for sure that bad things will not happen. For these people, OCD is a kind of absolute insurance. They believe that if they try hard, perform more rituals and take good insurance, they will have more certainty. In fact, trying too hard only leads to increased feelings of uncertainty and more doubt.

Treatment of obsessive compulsive disorder

Research has proven that psychotherapy significantly helps 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 easily corrected without drugs. Psychotherapy has no side effects on the body and has a more lasting effect. Medicines may be prescribed as treatment when the neurosis is complicated, or as a short-term measure to relieve symptoms before starting psychiatric treatment.

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

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

But not everyone has the strength to go through this treatment, so this method has been refined with CBT, which focuses on changing the response to impulses (the behavioral part), as well as changing the meaning of the intrusive urges and thoughts that arise (the cognitive part).

Any of the above psychotherapeutic treatments for the disorder allows break the cycle of anxiety, obsessions and avoidance reactions. And it makes no difference whether you and the psychotherapist first focus on analyzing the meanings that the patient attaches to events and thoughts with further elaboration 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 obsessive thoughts before they reach the conscious level.

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