What is the name of the disease when you constantly wash your hands? What obsessive thoughts do people diagnosed with OCD suffer from most often? Causes of obsessive compulsive syndrome

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of the etiology of OCD has expanded: the vaguely defined psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm examining the neurotransmitter abnormalities that underlie OCD.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 morbidity 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 to describe the fear of being 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 young adulthood. 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 the 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 gas stove tap or locking a 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 the latter 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 primary school age, tics usually subside by 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, cease to feel 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 and 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 programs for teaching OCD patients how to behave rationally both at home and in a hospital setting. Rehabilitation focuses on teaching social skills to interact properly with others, vocational training, and 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.

Obsessive-compulsive disorder (OCD) is a mental disorder that can be progressive. OCD is accompanied by repetitive thoughts and actions. This disorder is characterized by obsessions (uncontrollable, disturbing and frightening thoughts and intrusive ideas) and compulsive actions (repetitive rituals, rules and habits that serve as an expression of obsessions and figure prominently in everyday life). If you like cleanliness and order, this does not mean that you have OCD. However, OCD is quite possible when intrusive thoughts begin to dominate and control your daily life: for example, you may check that the door is locked many times before going to bed, or believe that people around you will get hurt if you do not perform certain rituals. actions.

Steps

Identifying symptoms

Learn about the obsessions and thoughts that are common in OCD. With obsessive-compulsive disorder, people experience recurring, intrusive thoughts that are often distressing and frightening. These can be various doubts, fears, obsessions or sad images that are difficult to control. With OCD, these thoughts appear at inopportune moments, completely take over your mind and paralyze it with anxiety and fear. The following obsessions and thoughts are common:

• Strong physiological craving for order, symmetry and precision. You may feel a lot of discomfort because the silverware on the table is not arranged neatly enough, your plans are not carried out down to the smallest detail, or simply one sleeve is a little longer than the other.
• Fear of contamination and infection. You may feel goosebumps just thinking about touching a trash can or handrail on public transport, or simply shaking someone's hand. Such obsessive thoughts are accompanied by excessive hand washing and increased attention to cleanliness. Constant worry about imaginary symptoms and fear of various diseases can also be expressed in suspiciousness and hypochondria.
• Excessive indecisiveness and need for constant reassurance; fear of making a mistake, getting into an awkward situation, or behaving inappropriately. This can lead to inertia and passivity. When you try to take action, you will often give up because of doubts and fears that something will go wrong.
• Fear of unpleasant and evil thoughts; intrusive and terrifying thoughts of harm to oneself or others. You may be overcome by terrible intrusive thoughts (as if rising from the subconscious) about possible accidents with you or other people, although you try in every possible way to drive them away. As a rule, such thoughts arise in everyday situations: for example, you can imagine that your friend was hit by a bus when you are crossing the street with him.

1. Learn about the compulsive behaviors that often accompany obsessive thoughts. These are various rituals, rules and habits that you perform again and again in order to get rid of obsessive and frightening thoughts. However, these thoughts often return and become even stronger. Compulsive behaviors are also distressing in themselves because they gradually become more intrusive and require more and more time. Often compulsive behavior includes the following:

   • Excessive bathing, showering and hand washing; refusal to shake hands or touch door handles; repeated checks (is the lock closed, is the iron turned off, etc.). You may wash your hands five, ten, or twelve times in a row before they feel truly clean. You can also lock, unlock, and re-lock your door many times before falling asleep.
   • Constant calculation, silently or out loud, when performing ordinary actions; eating food in a strictly established order; the desire to place things in a certain order. Perhaps before you start thinking about anything, you need to arrange things on your desk in a strictly defined order. Or maybe you can't eat while the different parts of the dish on your plate are touching each other.
   • Intrusive words, images or thoughts, usually disturbing, that can negatively affect sleep. You may experience images of a horrific, violent death. You may not be able to shake off thoughts of various frightening options and worst-case scenarios.
   • Frequent repetition of special words, phrases and spells; the need to perform certain actions a certain number of times. For example, if you fixate on the word “sorry,” you will repeat it whenever you feel regret about something. Or you might regularly slam your car door ten times before driving away.
   • Collecting and hoarding objects without a specific purpose. You may compulsively collect various useless items that you will never need and end up overfilling your car, garage, backyard or bedroom with them. You may have strong irrational cravings for certain items, despite your mind telling you not to pick up trash.

2. Learn to recognize the common "types" of OCD. Obsessions and compulsions often relate to specific topics and situations. There are several common categories, and it is not always possible to fit a particular case into one of them. However, these categories, or types, make it easier to identify factors that lead to compulsive behavior. The most common OCD behaviors include washing, checking, doubting and self-deprecating thoughts, counting and organizing, and collecting.

   • Washers afraid of pollution. In this case, compulsive behavior consists of frequent hand washing and other cleansing actions. For example, you can wash your hands five times after taking out the trash, or, after spilling something on the floor, vacuum it again and again.
   • Inspectors recheck anything that may pose a threat. For example, you can check ten times to see if the front door is locked and the stove is turned off, although you remember exactly that you closed the door and turned off the stove. After leaving the library, you can check many times whether you took the right book. You can check the same thing ten, twenty or thirty times.
   • Those who doubt and have committed wrongdoing They are afraid that something will go wrong, something terrible will happen and they will be punished. These thoughts can lead to a desire for excessive clarity and precision or paralyze the will to act. You may be constantly examining your thoughts and actions for shortcomings and mistakes.
   • Counters and fans of order obsessed with the desire for order and symmetry. Such people are characterized by superstitions regarding certain numbers, colors, or the arrangement of objects. “Bad” omens or “wrong” placement of objects make them anxious and uncomfortable.
   • Gatherers They really don’t like to part with various items. At the same time, you can collect absolutely unnecessary things that you will never need, and experience a strong irrational attachment to them, although you understand that they are useless trash.

3. Consider how severe the symptoms you are experiencing are. Typically, OCD symptoms are relatively mild at first, but their intensity may change over the course of a person's life. The disorder usually first appears in childhood, adolescence, or young adulthood. Symptoms worsen in stressful situations, and in some cases the disorder becomes so severe and consumes so much time that the person becomes incapacitated. If you frequently experience some of the intrusive thoughts described above and engage in compulsive behaviors that fall into one category or another of OCD, and it takes up a significant amount of your time, see a doctor for an accurate diagnosis.

   Diagnosis and treatment of OCD

   1. Talk to a doctor or psychologist. Don't try to diagnose yourself: While you may at times experience anxiety and intrusive thoughts, hoard unwanted items, or worry about germs, OCD has a spectrum of conditions and symptoms, and just because you have one symptom does not mean you need treatment. Only a professional doctor can determine whether you truly have OCD.

      • There are no standardized tests or tests that can definitively identify OCD. Your doctor will base your diagnosis on your symptoms and how long it takes you to perform ritual activities.
      • Don't worry if you've been diagnosed with OCD - although there is no "complete cure" for the disorder, there are medications and behavioral therapies that can help you mitigate and successfully manage your symptoms. You can learn to live with intrusive thoughts and not let them take over you.

   2. Ask your doctor about cognitive behavioral therapy. Also called “exposure therapy” or “confrontational anxiety suppression technique,” ​​the goal of this technique is to teach people with OCD to cope with their fears and suppress anxiety without engaging in ritualistic behavior. This therapy also helps reduce the tendency toward exaggeration and negative thinking that is common in people with OCD.

      • To begin CBT, you will need to see a psychologist. Ask your family doctor to recommend a suitable specialist or contact your local mental health clinic. It won't be easy at first, but if you really set out to control obsessive thoughts, you can achieve it.

   3. Ask your doctor about drug treatment. People with OCD often take antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), which include Paxil, Prozac and Zoloft. Older drugs such as tricyclic antidepressants (for example, Anafranil) are also used. Some atypical antipsychotics, such as Risperdal and Abilify, taken alone or together with SSRIs, are also prescribed to reduce symptoms of OCD.

   Warnings

   • If you don't have OCD, don't refer to it every time you feel bad. OCD is a serious and progressive disorder, and your words may offend someone who actually suffers from this disease.

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by compulsions that are associated with symptoms such as anxiety, apprehension, fear or worry (obsessions), pathological cyclical behavior aimed at reducing the accompanying anxiety (compulsive urges), or a combination of obsessive thoughts and compulsive urges. Symptoms of the disorder include: excessive washing and scrubbing of various objects, repetitive checking, excessive hoarding, preoccupation with sex life, violent and religious thoughts related to relationships, obsessions related to relationships, aversion to particular numbers, and nervous reactions such as opening and closing doors a certain number of times before entering or leaving a room. These symptoms are time-consuming, can lead to loss of relationships with others, and often cause deterioration in emotional and financial situations. The actions of those suffering from OCD are paranoid and potentially psychotic. However, people with OCD may generally recognize their obsessive thoughts and compulsive urges as irrational and subsequently suffer from them. Despite irrational behavior, OCD is often observed in patients with above-average intelligence. Many physiological and biological factors may be involved in obsessive-compulsive disorder. Standardized rating scales, such as the Yale-Brown Obsessive-Compulsive Scale, can be used to assess symptom severity. Other disorders with similar symptoms include obsessive-compulsive personality disorder, autism spectrum disorder, or disorders in which perseveration (hyperfocus) is a feature of ADHD, PTSD, physical impairment, or just a problematic habit. Treatment for OCD includes the use of behavioral therapy and, in some cases, selective serotonin reuptake inhibitors (SSRIs). The type of behavioral therapy used involves increasing exposure to the factor that is causing the problem until compulsive behavior is observed. Atypical antipsychotics such as quetiapine may be useful when used in addition to SSRIs in refractory cases, but their use is associated with an increased risk of side effects. Obsessive-compulsive disorder affects children and adolescents, as well as adults. Approximately one-third to one-half of adults with OCD report the onset of the disorder during childhood, indicating a lifelong continuity of anxiety disorders. The term obsessive-compulsive comes from the English lexicon and is often used in an informal or caricatured manner to describe someone who is overly pedantic, a perfectionist, brooding, or obsessive.

Signs and symptoms

Intrusive thoughts

Intrusive thoughts are thoughts that occur repeatedly and persist despite efforts to ignore or resist them. People with OCD often perform actions or compulsions in an attempt to relieve the anxiety associated with intrusive thoughts. Within and among subjects, initial intrusive thoughts, or intrusive thoughts, vary in intelligibility and realism. A relatively vague obsession may involve a general feeling of confusion or tension, accompanied by the belief that life cannot continue normally while the imbalance persists. A more pronounced obsession is the thought or idea that someone close to you is dying, or an obsession related to the "rightness of the relationship." Other obsessions concern the possibility that someone or something other than oneself—such as God, the Devil, or illness—could harm either the person with OCD or the people or things that person cares about. Other subjects with OCD may report feeling invisible rashes on their bodies or having the sensation that inanimate objects have come to life. Some people with OCD exhibit sexual obsessions, which may include intrusive thoughts or images of “kissing, touching, caressing, oral sex, anal sex, intercourse, incest, and rape” with “strangers, acquaintances, parents, children, family members, friends, colleagues, animals and religious figures" and may also include "heterosexual or homosexual content" with subjects of any age. As with other intrusive, distressing thoughts or ideas, most “normal” people have disturbing thoughts of a sexual nature from time to time, but people with OCD may overemphasize the thoughts. For example, obsessive fears regarding sexual orientation can be observed not only in relation to people with OCD themselves, but also in relation to the people around them, as a crisis of sexual self-determination. Moreover, the doubts that accompany OCD lead to uncertainty about whether unpleasant thoughts can be addressed by causing self-criticism or self-hatred. People with OCD understand that their beliefs do not correspond to reality; however, they feel that they must act as if their beliefs are correct. For example, a subject who is susceptible to pathological hoarding may be inclined to treat inorganic objects as if they had spiritual life or the rights of living organisms, while at the same time recognizing that such behavior is irrational, on a more intellectual level.

Primary obsessive disorder

OCD in some cases manifests itself without pronounced compulsive impulses. Nicknamed "Simple-O" or referred to as Primary Obsessive OCD, OCD without significant compulsive urges may, according to one estimate, account for approximately 50 to 60 percent of OCD cases. Primary obsessive OCD has been described as one of the most depressing and difficult to treat forms of OCD. People with this form of OCD suffer from depressing and unwanted thoughts that occur frequently, and these thoughts are usually based on the fear that someone might do something generally out of character, potentially fatal to themselves or others. The thoughts are likely to be aggressive or sexual in nature. Instead of experiencing observable compulsive impulses, a subject with this subtype may perform more secret, mental actions, or may develop a way to avoid situations that may be imposed in specific thoughts. As a result of this avoidance, people may have difficulty performing social or individual roles, even if they have high value in those roles and even if they have performed roles successfully in the past. Moreover, avoidance can be misleading to others who are unaware of its origin or intended purpose, as was the case with a man whose wife began to wonder why he did not want to hold their newborn child. Hidden mental rituals may occupy much of the subject's time throughout the day.

Compulsive urges

Some people with OCD perform compulsive actions because they inexplicably feel the need to do so, while others act compulsively to relieve anxiety that stems from specific intrusive thoughts. The subject may feel that these actions can to some extent prevent the feared event or push the event out of his thoughts. In either case, the subject's reasoning is so idiosyncratic or distorted that it causes significant distress to the subject with OCD and those around him. Excessive skin trauma (ie, dermatillomania) or hair pulling (ie, trichotillomania), as well as nail biting (ie, onychophagia) fall on the obsessive-compulsive spectrum. Subjects with OCD are aware that their thoughts and behavior are irrational, but they feel that submitting to these thoughts can prevent feelings of panic or fear. Some common compulsive urges include counting certain things (such as steps) in specific ways (for example, in two), as well as performing other repetitive actions, often with atypical sensitivity to numbers or patterns. People may wash their hands or gargle repeatedly, make sure certain objects are in a straight line, repeatedly check that they have locked a parked car, repeatedly arrange something in a certain way, turn lights on and off, keep doors closed at all times, touch an object a certain number of times before leaving the room, go the usual way, stepping only on tiles of a certain color, establish a certain order for using the stairs, for example, to end the stairs on a certain foot. Compulsive urges of OCD are distinguished by tics; movements as in other movement disorders, such as chorea, dystonia, myoclonus; movements seen in stereotypic movement disorder or in some people with autism; movements of convulsive activity. There may be a significant degree of comorbidity between OCD and tic-related disorders. People define compulsive urges as a way to avoid intrusive thoughts; however, they recognize that this avoidance is temporary and that the intrusive thoughts will soon return. Some people use compulsive behaviors to avoid situations that may contribute to their obsessions. Although many people do certain things over and over again, they do not always perform the actions compulsively. For example, getting ready for bed, learning a new skill, or religious practices are not compulsive impulses. Whether or not a behavior is a compulsive urge or just a habit depends on the context in which the behavior is observed. For example, organizing and organizing DVDs for eight hours a day might be expected of someone who works in a video store, but it would seem abnormal in other situations. In other words, habits make someone's life efficient, while compulsive urges disrupt it. In addition to the anxiety and fear that typically accompany OCD, sufferers may spend hours performing compulsive behaviors every day. In such situations, it becomes difficult for the subject to perform his or her job and maintain family or social roles. In some cases, this behavior can cause adverse physical symptoms. For example, people who compulsively wash their hands with antibacterial soap and hot water may experience reddened skin that becomes rough as a result of dermatitis. People with OCD can provide logical reasons for their behavior; however, these logical explanations do not correspond to generally accepted behavior, but are individual for each case. For example, a person who compulsively checks the front door may make the argument that the time spent and stress caused by one extra check of the front door is much less than the time and stress associated with being burglarized, and thus checking is the best remedy. In practice, after such a check, a person is still not sure and believes that it is still better to check again, and this explanation can continue indefinitely.

Dominant ideas

Some OCD sufferers exhibit thoughts known as dominant ideas. In such cases, the person with OCD is genuinely unsure whether the fears that cause them to perform compulsive actions are rational or not. After some debate, it is possible to convince the subject that his fears may be unfounded. It may be more difficult to apply ERP therapy to such patients because they may not be cooperative, at least at first. There are severe cases in which the sufferer has an unshakable belief in the context of OCD, which is difficult to distinguish from psychosis.

Cognitive performance

A 2013 meta-analysis confirmed that patients with OCD have mild but widespread cognitive deficits; it was significantly related to spatial memory, to a lesser extent to verbal memory, verbal fluency, executive functioning and processing speed, while auditory attention was not significantly affected. Spatial memory was assessed by the results of the Corsi block test, the Rey-Osterite Memory Retrieval Test "Complex Figure" and the test of spatial short-term memory among detected errors. Verbal memory was assessed by the Verbal Delayed Memory Retrieval Learning Test and the Logical Memory Test II. Verbal fluency was assessed by a test of speed of category identification and letter recognition. Auditory attention was assessed by a digit memory test. Information processing speed was assessed by Form A of the “Leaving Trace” test. In fact, people with OCD demonstrate impairments in formulating organizational strategies for encoding information, shifting attention, and motor and cognitive inhibition.

Related states

People with OCD may be diagnosed with other conditions, as well as or instead of OCD, such as the aforementioned obsessive-compulsive personality disorder, clinical depression, bipolar disorder, generalized anxiety disorder, anorexia nervosa, social phobia, bulimia nervosa, Tourette's syndrome, Asperger's syndrome, attention deficit hyperactivity disorder, dermatillomania (compulsive skin damage), body dysmorphic disorder and trichotillomania (hair pulling). In 2009, it was reported that depression among OCD sufferers is partly a warning sign because the risk of suicide is high; more than 50 percent of patients show suicidal tendencies, and 15 percent attempt suicide. Subjects with OCD are also susceptible to night owl syndrome to a significantly greater extent than the general population. Moreover, severe OCD symptoms are necessarily accompanied by more restless sleep. A decrease in total sleep time and sleep efficiency is observed in patients with OCD, with a delay in the onset and end of sleep, as well as an increase in the prevalence of night owl syndrome. In terms of behavior, some studies demonstrate a link between drug addiction and the disorder equally. For example, there is an increased risk of drug addiction among people with an anxiety disorder (perhaps as a way to cope with increased levels of anxiety), but drug addiction among patients with OCD may act as a type of compulsive behavior rather than as a coping mechanism for anxiety. Depression is also common among OCD sufferers. One explanation for the increased risk of depression among OCD sufferers was made by Myneka, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorders) may be depressed due to dysregulated perceptions. Some subjects who show signs of OCD do not necessarily have OCD. Behavior that is (or appears to be) obsessive or compulsive can also be attributed to many other conditions, including obsessive-compulsive personality disorder, autism spectrum disorders, disorders in which perseveration is a possible feature (ADHD, PTSD, physical impairments or habits), or subclinical disorders. Some individuals with OCD exhibit characteristics commonly associated with Tourette's syndrome, such as compulsive actions that may resemble motor tics; This disorder is referred to as “tic-related OCD” or “Tourette’s OCD.”

Causes

Scientists generally agree that both physiological and biological factors play a role in the causation of the disorder, although they differ in severity.

Physiological

The view from evolutionary psychology is that milder forms of compulsive behavior may have had evolutionary advantages. Examples would be constantly checking hygiene, hearth or environment for enemies. Likewise, accumulation may have evolutionary advantages. From this point of view, OCD may be the last statistical “tail” of such behavior, which is presumably associated with a high number of predisposing genes.

Biological

OCD is associated with pathological disturbances in serotonin neurotransmission, although it can be both a cause and a consequence of these disturbances. Serotonin is thought to play a role in regulating anxiety. To send chemical signals from one neuron to another, serotonin must bind to receptor centers located on a nearby nerve cell. It has been suggested that serotonin receptors may be relatively understimulated in OCD sufferers. This statement is consistent with the observation that many patients with OCD benefit from the use of selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that make more serotonin immediately available to other nerve cells. A possible genetic mutation may contribute to OCD. A mutation was found in the human serotonin transporter gene, hSERT, in unrelated families with OCD. Moreover, evidence from identical twins supports the existence of a “heritable factor for neurotic anxiety.” In addition, subjects with OCD are more likely to have first-degree family members with similar disorders than matched controls. In cases where OCD develops in childhood, there is a stronger familial association with the disorder than in cases in which OCD develops in adulthood. Overall, genetic factors account for 45–65% of symptoms in children diagnosed with the disorder. Environmental factors also play a role in how anxiety symptoms are expressed; Various studies on this topic are in progress and the presence of a genetic link has not been clearly established. Individuals with OCD demonstrate increased gray matter volumes in the bilateral lenticular nucleus, extending into the caudate nucleus, but decreased gray matter volumes in the bilateral posterior medial frontal/frontal cingulate cortex. These findings are in contrast to evidence in individuals with other anxiety disorders, who demonstrate reduced (rather than increased) gray matter volumes in the bilateral lenticular/caudate nucleus, but also reduced gray matter volumes in the bilateral posterior medial frontal/frontal cingulate cortex. Increased activity in the orbifrontal cortex is attenuated in patients who respond positively to SSRI drugs, a result thought to be due to increased stimulation of serotonin 5-HT2A and 5-HT2C receptors. The striatum, associated with planning and initiating the execution of appropriate actions, is also relevant; Mice genetically bred to have a striatal disorder exhibit OCD-like behavior, primping themselves three times more than normal mice. Recent evidence supports the possibility of a genetic predisposition to neurodevelopmental causes of OCD. Rapid onset of OCD in children and adolescents may be caused by group A streptococcal disease-associated syndrome (PANDAS) or immunological reactions to other pathogens (PANS).

Neurotransmitters

Researchers have already pinpointed the cause of OCD, but brain differences, genetic influences and environmental factors have also been explored. Brain imaging of people with OCD has shown that they have different brain activity patterns from people without OCD and that different circuit functioning in a specific area of ​​the brain, the striatum, may cause the disorder. Differences in other brain regions and dysregulation of neurotransmitters, particularly serotonin and dopamine, may also contribute to OCD. Independent studies have similarly found unusual dopamine and serotonin activity in various brain regions of subjects with OCD. This can be defined as dopaminergic hyperfunction in the prefrontal cortex (mesocortical dopamine pathway) and serotonergic hypofunction in the nucleus basalis. Glutamate dysregulation has also been the subject of recent research, although its role in the etiology of the disorder is unclear. Glutamate acts as a dopamine cotransmitter on the dopamine pathways that arise from the ventral tegmental area.

Diagnostics

A formal diagnosis may be performed by a psychologist, psychiatrist, clinical social worker, or other licensed mental health professional. To be diagnosed with OCD, a person must exhibit obsessions, compulsive urges, or both, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). A quick reference guide to the 2000 DSM variants states that certain features characterize clinically significant obsessions and compulsive behaviors. Obsessions, according to the DSM, are recurrent and persistent thoughts, impulses, or ideas that are experienced as intrusive and cause noticeable anxiety and depression. These thoughts, impulses, or ideas are of a degree or type that lies beyond normal worry about ordinary problems. The person may try to ignore or suppress such intrusive thoughts, or counteract them with other thoughts or actions, and tend to recognize such thoughts as idiosyncratic or irrational. Compulsive urges become clinically significant when a person strives to perform them in response to an urge or in accordance with rules that must be strictly followed, and when the person thereby feels or causes severe depression. For this reason, while many people who do not suffer from OCD can perform activities often associated with OCD (such as arranging things in a closet by height), what makes clinically significant OCD different is the fact that a person suffering from OCD must perform these actions despite experiencing severe psychological stress. These behaviors or thought processes are aimed at preventing or reducing stress or preventing some frightening event or situation; however, these actions are not logically or practically related to the problem, or they are excessive. In addition, at some point in the course of the illness the subject must recognize that his obsessions and compulsive urges are unreasonable or excessive. Moreover, obsessions and compulsive urges require time (taking up more than one hour per day) or cause impairment in social, occupational, or academic functioning. It is useful to quantify symptom severity and impairment before and during OCD treatment. In addition to patient-estimated daily time commitments that account for obsessive-compulsive thoughts and behaviors, Fenske and Schwenk argue in Obsessive-Compulsive Disorder: Diagnosis and Management that more accurate tools should be used to determine the patient's condition (2009). . ). These may be rating scales such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Such indicators can lead to more appropriate psychiatric consultation because they are standardized.

Differential diagnosis

OCD is often confused with the separate obsessive-compulsive personality disorder (OCPD). OCD is egodystonic, meaning that the disorder is contrary to the sufferer's self-image. Since egodystonic disorders contradict the patient's self-image, they cause a significant degree of depression. OCPD, on the other hand, is egosyntonic—meaning that the person accepts that characteristics and behavior are consistent with self-image, or, in other words, acceptable, correct, and appropriate. As a result, people with OCD are often aware that their behavior is wrong, are unhappy with the compulsive urges, but somehow feel compelled to carry them out, and may suffer from anxiety. In contrast, people with OCPD are not aware of abnormality; They immediately explain that their actions are right, it is usually impossible to convince them otherwise, and they tend to take pleasure in their obsessions and compulsive urges. OCD is different from behaviors such as gambling and overeating. People with these disorders usually demonstrate pleasure in their activities; OCD sufferers may be unwilling to perform their compulsive tasks and may not demonstrate pleasure in performing them.

Control

Behavioral therapy (BT), cognitive behavioral therapy (CBT), and medications are first-line treatments for OCD. Psychodynamic psychotherapy can help manage some aspects of the disorder. The American Psychiatric Association notes the lack of controlled manifestations and that psychoanalysis or dynamic psychotherapy is effective "in addressing the core symptoms of OCD." The fact that many subjects do not seek treatment may be due in part to stigma against OCD.

Behavioral therapy

The specific technique used in behavioral/cognitive behavioral therapy is called action presentation and prevention (also known as response presentation and prevention), or ERP; it involves gradually learning how to tolerate the anxiety associated with not performing ritual actions. First, for example, some may touch something only to become very lightly "contaminated" (because the fabric was in contact with another fabric, touching only with the tip of a finger, for example, a book from a "contaminated" place such as a school.) This "performance". The “prevention action” is not washing your hand. Another example would be leaving the house and checking the lock only once (introduction), without going back and checking again (action prevention). A person quickly gets used to an anxiety-inducing situation and realizes that his level of anxiety drops significantly; they may then progress to touching something more "contaminated" or failing to recheck the lock - failing to perform ritual actions such as hand washing or checking. Response presentation/prevention (ERP) has a strong evidence base. It is considered the most effective treatment for OCD. However, this claim has been questioned by some researchers, who have criticized the quality of many studies. It is widely accepted that psychotherapy in combination with psychiatric medications is more effective than either drug alone. However, more recent studies have shown no difference in outcomes for those treated with a combination of medications and cognitive behavioral therapy compared with cognitive behavioral therapy alone.

Medicines

Treatment options include selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, particularly clomipramine. SSRIs are the second-line treatment for adults with obsessive-compulsive disorder (OCD) who have mild functional impairment and the first-line treatment for adults with moderate to severe impairment. In children, SSRIs may be considered second-line treatment for those with moderate to severe impairment, with careful monitoring for psychiatric side effects. SSRIs are effective in treating OCD; Patients treated with SSRIs were twice as likely to respond to treatment as compared to placebo. Efficacy was seen in both short-term treatment studies (6–24 weeks) and time-interrupted studies of 28–52 weeks. Atypical antipsychotics such as quetiapine are also useful when used in addition to SSRIs in the treatment of treatment-resistant OCD. However, these drugs are often poorly tolerated and have metabolic side effects, limiting their use. None of the atypical antipsychotics are beneficial when used alone.

Electroconvulsive therapy

Electroconvulsive therapy (ECT) is effective in some severe and difficult-to-treat cases.

Psychosurgery

As with some medications, support groups and psychological treatments do not improve obsessive-compulsive symptoms. These patients may choose psychosurgery as a last resort. In this procedure, surgical damage is made to a region of the brain (anterior cingulate cortex). In one study, 30% of participants benefited significantly from the procedure. Deep brain stimulation and cranial nerve stimulation are possible surgical options but do not require damage to brain tissue. In the United States, the Food and Drug Administration has approved deep brain stimulation for the treatment of OCD under humanistic guidelines, requiring that the procedure be performed exclusively in a medical setting by a suitably qualified professional. In the US, psychosurgery for OCD is a last resort treatment and is not performed until the patient has responded to medication (full dosage) with the addition of and many months of intensive cognitive behavioral therapy with imagery and ritual/action prevention. Similarly, in the UK, psychosurgery cannot be performed until a course of treatment by a suitably qualified cognitive behavioral therapist has been completed.

Children

Therapeutic treatment may be effective in reducing ritualistic behavior in OCD in children and adolescents. Family involvement, in the form of behavioral observations and reports, is a key component to the success of this treatment. Parental intervention also provides positive reinforcement for children who exhibit appropriate behavior as an alternative to compulsive urges. After one or two years of therapy, during which children learn the nature of their obsessions and learn coping strategies, these children have a wider circle of friends, are less shy, and become less self-critical. Although the causes of OCD in childhood groups range from pathological brain disorders to psychological biases, stress from life circumstances, such as frightening and traumatic deaths of family members, may also contribute to a child's case of OCD, and knowledge of these stressors may be important in the treatment of the disorder.

Epidemiology

OCD occurs in 1 to 3% of children and adults. It is observed equally in both sexes. In 80% of cases, symptoms appear before the age of 18. A 2000 study by the World Health Organization found some degree of variability in the prevalence and incidence of OCD around the world, with rates in Latin America, Africa and Europe two to three times higher than those in Asia and Oceania. One Canadian study found that the prevalence of OCD had little correlation with race. However, respondents who identify Judaism as their religion are overrepresented among OCD patients.

Forecasting

Psychological interventions such as behavioral and cognitive behavioral therapy, as well as medication treatments, can produce significant relief from the average patient's OCD symptoms. However, OCD symptoms may persist at moderate levels even after adequate treatment, and a completely symptom-free period is rare.

Story

From the 14th to the 16th centuries in Europe, it was claimed that people who had blasphemous, sexual, or other obsessive thoughts were possessed by the devil. Based on this reason, treatment involved driving out the "evil" from the "possessed" person through exorcism. In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts that manifest as symptoms. Freud described the clinical history of a typical case of “touch phobia,” beginning in early childhood when the person had a strong desire to touch objects. In response, the person developed an “external inhibition” against this type of touch. However, “this prohibition did not succeed in eliminating” the desire to touch; all he could do was suppress the desire and "make it involuntary."

Society and culture

Movies and television often present idealized portrayals of disorders such as OCD. These descriptions may lead to increased public awareness, understanding and empathy for such disorders. In the 1997 film As Good As It Gets, actor Jack Nicholson portrays a man "with obsessive-compulsive disorder (OCD)." "Throughout the film, [he] exhibits ritualized behaviors (i.e., compulsive acts) that disrupt his interpersonal and professional life," "a cinematic depiction of psychopathology [that] accurately depicts the functional interaction and stress associated with OCD." The 2004 film The Aviator depicts the biography of Howard Hughes, starring Leonardo DiCaprio. In the film, "Hughes is subject to OCD symptoms that are periodically severe and disabling." “Many of Hughes' OCD symptoms are quite classic, particularly his fears of contamination.” The film The Great Con (2003), directed by Ridley Scott, portrays a conman named Roy (Nicolas Cage) who suffered from obsessive-compulsive disorder. The film "begins with Roy at home, suffering from numerous compulsive symptoms that take the form of a need for order and cleanliness and a compulsive urge to open and close doors three times, while counting loudly before walking through them." British poet, essayist and lexicographer Samuel Johnson provides an example of a historical figure with a retrospective diagnosis of OCD. He carefully thought out rituals for crossing the thresholds of doorways and repeatedly walked up and down stairwells, counting his steps. American aviator and director Howard Hughes suffered from OCD. "Approximately two years after his death, Hughes' estate attorney called upon former APA CEO Raymond D. Fowler, Ph.D., to conduct a psychological evaluation to determine Hughes' mental and emotional state in the last year of his life in order to understand the origins of his mental disorder." Fowler determined that "Hughes's fear of germs was present throughout his life, and he concurrently developed obsessive-compulsive symptoms while making efforts to protect himself from germs." Friends of Hughes also mentioned his compulsive urge to dress less revealingly. English footballer David Beckham has spoken about his struggle with OCD. He said he was counting all his clothes and his magazines were in a straight line. Canadian comedian, actor, television host and voice actor Huey Mandel, best known for hosting the game show The Deal, wrote an autobiography, The Layout: Don't Touch Me, describing how OCD and mysophobia (fear of germs) affected his life. American show host Mark Summers wrote Everything in its Place: My Trials and Trials over Obsessive-Compulsive Disorder, describing the effects of OCD on his life.

Study

The naturally occurring sugar inositol has been shown to be useful in the treatment of OCD. Nutritional deficiencies can also contribute to OCD and other mental disorders. Vitamin and mineral supplements can help with these disorders and provide the nutrients needed for proper mental functioning. μ-opioids, such as hydrocodone and tramadol, may relieve OCD symptoms. Opiate use may be contraindicated in subjects concomitantly taking CYP2D6 inhibitors such as paroxetine. Much ongoing research is focusing on the therapeutic potential of agents that affect the release of the neurotransmitter glutamate or its binding to receptors. These include riluzole, memantine, gabapentin, N-acetylcysteine, topiramate and lamotrigine.

Obsessive-compulsive disorder (OCD) may first appear when a child reaches 10 years of age. At first it manifests itself as a certain kind of obsessive state, and the person is able to see the irrationality of his anxiety and cope with it. Subsequently, self-control is lost and the condition worsens.

Obsessive-compulsive syndrome

Obsessive-compulsive disorder or syndrome is an obsessive-compulsive disorder during which a person is obsessed with a disturbing thought or idea and performs compulsive (compulsory) actions. The disorder can be single-component, or obsessive - emotional, or compulsive - with ritual obsessive actions. It manifests itself in different ways:

• occasionally;
• progresses every year;
• persistent chronic.

Obsessive-compulsive disorder - causes

Everything happens for a reason – and compulsive and obsessive behavior is no exception. Medical specialists and psychologists put forward many theories about the occurrence of the disease. Obsessive-compulsive disorder - predisposing factors and causes:

• violation of homeostasis and general;
• hormonal disorders;
• consequences of severe traumatic brain injuries;
• infectious diseases;

Other reasons:

• strict moral and religious education;
• difficult relationships with people;
• low stress resistance.

Obsessive-compulsive disorder - symptoms

The main symptom of compulsive disorder is one or another obsessive state, repetitive thoughts, the subject of which can be different. Signs and symptoms of the disorder:

• a state of unreasonable anxiety preceding obsessive thoughts;
• ritual behavior - obsessive movements aimed at eliminating anxiety;
• increasing anxiety in crowded places to the point of panic;
• physiologically manifested: increased heart rate, difficulty breathing, pale skin, cold sweating.

Obsessive-compulsive disorder - examples

All people have, as a result of overwork and stress, anxious thoughts that pop up, they scroll through their heads for some time, but after a good, complete rest, the intensity decreases, the person solves the problem that has arisen and the anxiety goes away. Otherwise, everything happens with true compulsions and obsessions; they are cyclical, gaining strength and becoming established on a “permanent basis.”

Obsessive-compulsive disorder - real-life examples:

• infection with microbes - a person is afraid to touch door handles, taps, handrails of public transport;
• fear of possible dangers (robbery, murder, rape);
• repeated checks: is the door locked, is the gas, iron, light turned off (returning from work to check again);
• superstitiousness - a person will not leave the house without a certain ritual, reading a prayer;
• obsessive thoughts of a sexual nature with elements of cruelty - a person avoids intimacy for fear of harming a partner.

Obsessive compulsive disorder - consequences

Compulsive-obsessive disorder adversely affects a person’s daily life, obsessive thoughts and actions complicate relationships with loved ones, and the person becomes tired of himself. Among people suffering from this neurotic illness, a large percentage of unemployed people are sometimes simply afraid to leave the house and become unable to work because of their fears. Personal life also collapses.

Obsessive-compulsive disorder - treatment

How to treat obsessive-compulsive disorder - psychotherapists often answer this question that without determining the cause that caused the disease, it will not be possible to achieve remission or cure it “for good”. When all stress factors are identified, the doctor prescribes comprehensive treatment: drug therapy and long-term psychological support. Obsessive-compulsive anxiety disorder can be successfully treated if a person stops hoping for an independent outcome of the disease and avoids disturbing situations.

Obsessive-compulsive disorder - treatment at home

Obsessions or compulsions are difficult to correct on your own - this is the case when seeking help from a specialist is the right thing to do. A person drives himself into a vicious circle from breakdown to breakdown and begins to hate himself for his weakness and lack of self-control even more. But you shouldn’t give up, even if breakdowns happen. Using the example of overeating, which is common among both women and men, we can consider tactics to combat obsessive disorder at home.

Compulsive overeating – how to deal with it yourself, steps:

• work with thinking - ;
• getting rid of harmful foods - refined, high-carbohydrate foods should be ruthlessly excluded from the diet;
• playing sports - moderate physical activity increases stress resistance and increases the amount of your own endorphins;
• keeping a food diary - all foods eaten during the day should be written down in it - this helps to analyze and record in the mind how much and what kind of food is eaten;
• breathing practices and meditation – balance the mental state;
• full-fledged

Obsessive-compulsive disorder – hospitalization

Obsessive-compulsive personality disorder - an illness rarely requires hospital treatment, unless it is accompanied by the imposition of schizotypal, paranoid personality traits in a person, then the course and prognosis worsen. Inpatient treatment is mainly indicated. Obsessive-compulsive disorder - patient management tactics include:

1. Psychotherapy. The cognitive-behavioral approach allows you to analyze situations that provoke anxiety and panic and learn to manage your condition. The patient is exposed to a real or imagined stimulus and, with the help of the therapist, learns to interrupt the response by forming a new behavioral pattern. The longer the interaction with provoking stimuli, the more effectively the new behavior is reinforced. On its own, without medication, psychotherapy is rarely successful in treating OCD.
2. Pharmacotherapy. Obsessive-compulsive behavioral disorder greatly depletes a person’s nervous system and medications are sometimes the only option to alleviate the condition. Drugs of choice in the treatment of OCD:

Obsessive-compulsive disorder (OCD) is a mental disorder that significantly affects a person's life. It, like phobias, refers to obsessive-compulsive neuroses. But, if phobias include only obsessions (obsessive thoughts and fears), then OCD also includes compulsions (actions aimed at overcoming fears). A person who does not perform these actions experiences severe anxiety, which sooner or later will force him to follow compulsions.

The name of the disease comes from the English words "obsessio", meaning obsession with an idea, and "compulsio" - compulsion. It was chosen well - it succinctly and briefly describes the essence of the disease. People suffering from this disorder are considered disabled in some countries, losing their jobs. Even without taking this fact into account, patients tend to spend a lot of time pointlessly due to compulsions. Obsessions can be expressed by phobias, obsessive thoughts, memories or fantasies, which also significantly worsens the patient’s quality of life.

What it is?

Obsessions are obsessive thoughts, memories and fears that repeat over and over again. People who suffer from OCD simply cannot control them. They find these thoughts unpleasant and sometimes frightening, but over time they come to realize that these fears are not meaningful.

Often obsessions do not come alone, they are followed by feelings of fear, doubt and disgust of varying intensity. In obsessive-compulsive disorder, obsessions eat up time and interfere with important tasks. This feature is important for diagnosing OCD; one must distinguish between a person with a mental disorder and simply an impressionable person. People suffering from OCD experience obsessions regularly and they cause great anxiety.

Compulsions - "rituals" - are another part of OCD. These are constantly repeated actions that the patient uses to neutralize or counteract obsessions. People suffering from obsessive-compulsive disorder understand that this is not a solution to the problem, but, having no choice, rely on compulsions to get temporary relief. They also include behavior in which the patient tries to avoid places or situations that can cause obsession.

As with obsessions, not all repeated “rituals” are compulsive. For example, routine hygiene practices, religious practices, and learning new skills involve repeating the same actions over and over again, but these are part of daily life. People with OCD, on the other hand, have the feeling that something is forcing them to follow “rituals” even though they don’t want to. Compulsive actions are entirely aimed at trying to reduce the anxiety caused by the obsession.

Causes

There is no consensus on the origin of the disease. Research points to 2 reasons - brain disease and genetic predisposition. In OCD, there are problems with the exchange of synapses between the frontal lobes of the brain and its internal structures. To transmit nerve impulses, a neurotransmitter substance called serotonin is used. Studies have shown that the connection is restored when using medications that affect serotonin levels (serotonin reuptake inhibitors) combined with cognitive psychotherapy.

Statistics have shown that OCD tends to run in families, so genes play a role in the development of the disease. No one knows what factors may actually trigger the activity of genes associated with OCD. These could be illnesses of the body, ordinary life troubles, or the use of psychoactive substances. The infectious theory - the so-called PANDAS syndrome - should also be included among the biological factors.

Diagnostics

Diagnosis of OCD can only be made by a psychiatrist with appropriate education and experience. He pays attention to 3 things:

• The person has obsessive obsessions.
• There is compulsive behavior, attempts to get rid of obsessions.
• Obsessions and compulsions take up a lot of time and interfere with daily activities such as work, school, or going out with friends.

To be medically significant, symptoms must recur on at least 50 percent of days or more over a period of at least two weeks. For an accurate diagnosis, it is necessary to exclude anancastic personality disorder.

Treatment

There are several treatment methods, the use of which depends on the form and severity of the disease. For milder forms, cognitive behavioral psychotherapy is sufficient:

• "Exposure and reaction prevention" technique. The doctor discusses each obsession with the patient to find out which fears are real and which are imposed by the disease. After this, he, sometimes with the help of a person close to the patient, explains what a healthy individual would do in his situation.
• Mindfulness-based cognitive behavioral therapy. Mindfulness is about accepting an unpleasant experience as a passing process in the mind, rather than identifying it with yourself.
• Psychotherapy of acceptance and commitment. This method asks a person to focus on accepting an unpleasant psychological experience (anxiety) without using compulsive actions to eliminate it.

Despite the existing successes, some doctors consider psychotherapy ineffective, preferring drug treatment.

• To eliminate anxiety at the first stages of treatment, tranquilizers are used.
• If the disease is adjacent to depression, selective serotonin reuptake inhibitors are used.
• If there is no depression, drugs of the atypical antipsychotic class are prescribed.

The use of these drugs is relatively safe for the patient; they have few contraindications and side effects, but effectively cope with the disease.

In severe forms of the disease, extreme measures are used: biological therapy in the form of atropinocomatous and electroconvulsive therapy. These types of treatments have many contraindications, so doctors try not to use them, and, believe me, their choice is completely justified.

Below are videos on the topic, in which the therapist examines the origins of the problem and helps find a solution: