Obsessive-compulsive disorder: characteristic signs and treatment methods

Obsessive-compulsive syndrome, obsessive-compulsive disorder (OCD) is a psychoneurotic disorder manifested by obsessive thoughts and actions of the patient. The concept of “obsession” is translated from Latin as siege or blockade, and “compulsion” is coercion. Healthy people have no problem brushing aside unpleasant or frightening thoughts, images, or impulses. People with OCD cannot do this. They constantly think about such thoughts and get rid of them only after performing certain actions. Gradually, obsessive thoughts begin to conflict with the patient’s subconscious. They become a source of depression and anxiety, and rituals and repetitive movements cease to have the expected effect.

The very name of the pathology contains the answer to the question: what is OCD? Obsession is the medical term for obsessive, disturbing or frightening thoughts, while compulsion is a compulsive action or ritual. It is possible to develop local disorders - only obsessive with a predominance of emotional experiences, or only compulsive, manifested by restless actions. The disease is a reversible neurotic process: after psychotherapeutic and drug treatment, its symptoms completely disappear.

Obsessive Obsessive Disorder occurs in all socioeconomic levels. Under the age of 65, it affects mostly men. At older ages, the disease is diagnosed in women. The first signs of pathology appear in patients by the age of ten. Various phobias and obsessive states arise that do not require immediate treatment and are adequately perceived by the person. Thirty-year-old patients develop a pronounced clinical picture of the syndrome. At the same time, they cease to perceive their fears. They require qualified medical care in a hospital setting.

Patients with OCD are tormented by thoughts of countless bacteria, and they wash their hands a hundred times a day. They are not sure whether the iron is turned off, and they return home from the street several times to check it. Patients are confident that they are capable of harming loved ones. To prevent this from happening, they hide dangerous objects and avoid casual communication. Patients will double-check several times whether they forgot to put all the necessary things in their pocket or bag. Most of them carefully monitor the order in the room. If things are out of place, emotional tension arises. Such processes lead to decreased ability to work and poor perception of new information. The personal life of such patients usually does not work out: they either do not create families, or their families quickly fall apart.

Tormenting obsessive thoughts and similar actions lead to depression, reduce the quality of life of patients and require special treatment.

Obsessive-compulsive disorder

Mild evidence of obsessive-compulsive disorder may occur in up to 30% of adults and up to 15% of adolescents and children. Clinically confirmed cases account for no more than 1%.

The appearance of the first symptoms is usually attributed to the age of 10 to 30 years. People usually seek medical help between 25 and 35 years old.

In pathology, two components are distinguished: obsession (obsession) and compulsion (coercion). Obsession is associated with the occurrence of obsessive, constantly recurring emotions and thoughts. It can be triggered by coughing, sneezing, or another person touching a doorknob. A healthy person will note to himself that someone sneezed and move on. The patient becomes fixated on what happened.

Obsessive thoughts fill his entire being, giving rise to anxiety and fear. This happens because some object, a person, becomes important and valuable to him. At the same time, the environment appears too dangerous.

Compulsions are actions that a person is forced to perform to protect himself from moments that provoke obsessive thoughts or fears. Actions can be a response to what happened. In some cases, they are preventive in nature, that is, they are the result of some idea, idea, fantasy.

Compulsion can be not only motor, but also mental. It consists in the constant repetition of the same phrase, for example, a conspiracy aimed at protecting a child from illness.

The obsession and compulsion component form an OCD attack. In principle, we can talk about the cyclical nature of pathology: the appearance of an obsessive thought leads to filling it with meaning and the emergence of fear, which, in turn, causes certain defensive actions. After completing these movements, a period of calm begins. After some time, the cycle starts again.

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 may be related to religious doctrines, business plans, or the state of the 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 guided by a certain “higher goal”, in the name of which he is capable of any action.

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.

Types of OCD

When obsessive thoughts and ideas are predominantly present, they speak of intellectual obsessive-compulsive disorder. The predominance of obsessive movements indicates motor pathology. Emotional disorder is associated with the presence of constant fears that turn into phobias. Mixed syndrome is said to occur when obsessive movements, thoughts or fears are detected. Although all three components are part of the disorder, categorizing the predominance of one has implications for treatment decisions.

The frequency of symptoms makes it possible to distinguish a pathology with an attack that occurred only once, regularly occurring incidents and a constant course. In the latter case, it is impossible to distinguish between periods of health and pathology.

The nature of obsession affects the characteristics of the disease:

1. Symmetry. All items must be placed in a certain order. The patient constantly checks how they are placed, corrects them, rearranges them. Another type is the tendency to constantly check whether appliances are turned off.
2. Beliefs. These can be all subjugating beliefs of a sexual or religious nature.
3. Fear. The constant fear of becoming infected or getting sick leads to the appearance of obsessive actions in the form of cleaning the room, washing hands, using a napkin when touching something.
4. Accumulation. Often there is an uncontrollable passion to accumulate something, including things that are absolutely unnecessary for a person.

The most common types of thoughts that occur with OCD are:

• overly expressed concern for order around, sometimes the need for absolute symmetry, accuracy;
• fear of becoming infected or poisoned by something (from pollution, microorganisms, viruses, chemicals, biological fluids);
• anxiety due to possible threats (external (for example, fear of becoming a laughing stock) and internal (for example, fear of causing damage or any harm to loved ones due to loss of control));
• excessive fixation on sexually oriented thoughts.

Naturally, various thoughts of this nature periodically visit every person, but healthy people do not experience unbearable anxiety when they appear. The anxiety of people with OCD from such thoughts reaches a sufficient height and in order to reduce it at least a little, patients resort to performing certain rituals, obsessive actions - compulsions (Latin compello - “to force”).

At the moment when an obsessive thought settles in the head, a person reacts to it with actions of a certain nature. Compulsion can have both physical expression (for example, repeatedly checking whether the iron is turned off) and mental (for example, mentally pronouncing some special phrase designed to “protect oneself from failure” - the so-called “neutralization”).

Causes

Today there is no clear and unambiguous reason why obsessive-compulsive disorders develop. Hypotheses are identified, most of which seem logical and reasonable. They are divided into groups: biological, psychological and social.

Biological

One of the well-known theories is the neurotransmitter theory. The basic idea is that in obsessive-compulsive disorder, too much serotonin is taken up into the neuron. The latter is a neurotransmitter. It is involved in the transmission of nerve impulses. As a result, the impulse cannot reach the next cell. This hypothesis is proven by the fact that when taking antidepressants, the patient feels better.

Another neurotransmitter hypothesis relates to dopamine excess and dependence. The ability to resolve a situation related to an obsessive thought or emotion leads to “pleasure” and increased dopamine production.

Symptoms

The following symptoms indicate obsessive-compulsive disorder:

• the appearance of recurring thoughts or fears;
• monotonous actions;
• anxiety;
• high level of anxiety;
• panic attacks;
• phobias;
• appetite disorders.

Adults in some cases realize the groundlessness of their fears, thoughts, and the meaninglessness of their actions, but they cannot help themselves. The patient loses control over his thoughts and actions.

In children, the disorder is extremely rare. It most often appears after 10 years. Associated with the fear of losing something. A child, afraid of losing his family, tends to constantly clarify whether his mother or father loves him. He is afraid of getting lost himself, so he holds his parents’ hands tightly. The loss of any item at school or the fear of it forces the child to double-check the contents of his backpack and wake up at night.

Obsessive-compulsive disorder may be accompanied by nightmares, tearfulness, moodiness, dejection, and loss of appetite.

Symptoms

Clinical signs of pathology in adults:

1. Thoughts about sexual perversion, death, violence, intrusive memories, fear of harming someone, getting sick or infected, worry about material loss, blasphemy and sacrilege, fixation on purity, pedantry. In relation to moral and ethical principles, unbearable and irresistible attractions are contradictory and unacceptable. Patients are aware of this, often resist and are very worried. Gradually, a feeling of fear arises.
2. Anxiety that follows obsessive, recurring thoughts. Such thoughts cause panic and horror in the patient. He realizes the groundlessness of his ideas, but is unable to control superstition or fear.
3. Stereotypical actions - counting steps on the stairs, washing hands frequently, arranging books “correctly”, double-checking turned off electrical appliances or closed taps, symmetrically ordering objects on the table, repeating words, counting. These actions are a ritual that supposedly relieves obsessive thoughts. Some patients are helped to get rid of tension by reading a prayer, cracking their joints, or biting their lips. Compulsions are a complex and confusing system, and when it is destroyed, the patient carries it out again. The ritual is performed slowly. The patient seems to be stalling for time, fearing that this system will not help, and that internal fears will intensify.
4. Panic attacks and nervousness in a crowd are associated with the risk of contact with the “dirty” clothes of surrounding people, the presence of “strange” smells and sounds, “sideways” glances, and the possibility of losing your things. Patients avoid crowded places.
5. Obsessive-compulsive syndrome is accompanied by apathy, depression, tics, dermatitis or alopecia of unknown origin, and excessive preoccupation with one’s appearance. In the absence of treatment, patients develop alcoholism, isolation, rapid fatigue, thoughts of suicide, mood swings, quality of life decreases, conflict increases, disorders of the gastrointestinal tract, irritability, concentration decreases, and abuse of sleeping pills and sedatives occurs.

In children, the signs of pathology are less pronounced and occur somewhat less frequently. Sick children are afraid of getting lost in the crowd and constantly hold adults’ hands, tightly clasping their fingers. They often ask their parents if they love them because they are afraid of ending up in an orphanage. Having lost a notebook at school one day, they experience severe stress, forcing them to count the school supplies in their briefcase several times a day. The dismissive attitude of classmates leads to the formation of complexes in the child and skipping classes. Sick children are usually sullen, unsociable, suffer from frequent nightmares and complain of poor appetite. A child psychologist will help stop the further development of the syndrome and rid the child of it.

OCD in pregnant women has its own characteristics. It develops in the last trimester of pregnancy or 2-3 months after birth. The mother's obsessive thoughts are the fear of harming her baby: she thinks she is dropping the baby; she is visited by thoughts of sexual attraction to him; She has difficulty making decisions about vaccinations and choosing a feeding method. To get rid of obsessive and frightening thoughts, a woman hides objects with which she can harm the child; constantly washes bottles and diapers; guards the baby's sleep, fearing that he will stop breathing; examines him for certain symptoms of the disease. Relatives of women with similar symptoms should encourage her to see a doctor for treatment.

Video: analysis of OCD manifestations using the example of Sheldon Cooper

Diagnostics

The diagnosis is determined by a psychiatrist. The main diagnostic methods are conversation and testing. During the conversation, the doctor identifies characteristics associated with the manifestation of significant symptoms. So, thoughts must belong to the patient, they are not the product of delusion or hallucination, and the patient understands this. In addition to obsessional ones, he has ideas that he can resist. Thoughts and actions are not perceived by him as something pleasant.

Testing is based on the Yale-Brown obsessive-compulsive scale. Half of its items assess how severe obsessions are, the other half helps analyze the severity of actions. The scale is completed during the interview based on symptoms experienced over the past week. The level of psychological discomfort, the duration of symptoms during the day, the impact on the patient’s life, the ability to resist symptoms and exercise control over them are analyzed.

The test determines 5 different degrees of the disorder - from subclinical to extremely severe.

The disease is differentiated from depressive disorders. In the presence of symptoms of schizophrenia, organic disorders, and neurological syndromes, obsession is considered part of these diseases.

Folk remedies

Any folk remedies do not guarantee 100% relief; they should be used with caution and only with the consent of the attending physician.

You can treat obsessive-compulsive disorder at home like this:

• infusions of chamomile, valerian, linden and others have a calming effect;
• Ginseng infusion helps in the fight against depression:
• the root is poured with boiling water in a ratio of 1:10 and drunk 3-4 times a day, 1 tbsp. l.;
• An infusion of zamanika will help fight the disorder: 1 part of the root should be poured with 10 parts of boiling water, leave for a week and apply 2-3 times a day, 30-40 drops before meals.

Treatment

The main methods of treating obsessive-compulsive disorder are psychotherapy, the use of medications, and physical therapy.

Psychotherapy

The disease can be treated using hypnosis, cognitive-behavioral, and aversive methods of psychoanalysis.

The main goal of the cognitive-behavioral method is to help the patient understand the problem and resist illness. The patient may be placed in an artificially created stress situation, and during the session the doctor and the patient try to cope with it. The psychotherapist comments on the fears and meaning that the patient puts into his thoughts, focuses his attention on actions, and helps change the ritual. It is important that a person learns to identify which of his fears really make sense.

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.

Forecast

Obsessive-compulsive disorder is a chronic pathology. Usually, the use of any treatment stops and softens its manifestations. The disease can be cured in a mild to moderate degree, but in the future, in some emotionally difficult situations, an exacerbation is possible.

The severe disorder is difficult to treat. Relapses are likely.

Lack of treatment can lead to impaired performance, suicidal intentions (up to 1% of patients commit suicide), and some physical problems (frequent hand washing leads to skin damage).

Causes of the disease

Obsessive-compulsive neurosis develops against the background of disturbances in the metabolism of norepinephrine and serotonin. This leads to pathological changes in thought processes and increased anxiety. Metabolic disorders are diagnosed under the influence of hereditary or acquired factors.

Obsessive-compulsive neurosis develops against the background of abnormalities in genes that are responsible for the synthesis of substances that are components of neurotransmitter systems. The pathological condition develops in patients when the body is exposed to external provoking factors that lead to disruption of the central nervous system. The appearance of a pathological process is observed in infectious diseases:

• Corey.
• Viral hepatitis.
• Infectious monoculosis.

Obsessive-compulsive neurosis appears in patients with traumatic brain injuries. Pathology develops against the background of nervous tension and stressful situations. Obsessive neurosis appears during acute psychotrauma. The disease appears against the background of chronic somatic diseases - pyelonephritis, chronic pancreatitis, hyperthyroidism, gastroduodenitis.

Obsessive-compulsive neurosis develops with a hereditary predisposition and the course of various diseases in the body. To prescribe rational treatment for pathology, it is recommended to determine its cause.

Prevention

Primary prevention includes preventing the occurrence of traumatic factors, including conflicts at home, at school, and at work. If we are talking about a child, it is important to avoid imposing on him thoughts about his inferiority, instilling fears and guilt.

It is recommended to include bananas, tomatoes, figs, milk, and dark chocolate in your diet. These foods contain tryptophan, from which serotonin is formed. It is important to take vitamins, get enough sleep, and avoid alcohol, nicotine, and drugs. The rooms should have as much light as possible.

Obsessive-compulsive disorder, even in mild degrees, cannot be ignored. The condition of such a patient may worsen over time, which leads to severe disturbances in the emotional sphere and the inability to adapt to society. Psychotherapeutic and medication methods allow a person to return to normal life.