People with obsessive compulsive disorder. Self-diagnosis and treatment of obsessive-compulsive disorder

Medical help

Psychotherapy is a wonderful, if not quick, way of treatment. Yes, hypnosis can be offered to the patient and it will scare him. But, firstly, you can refuse it, and, secondly, it is not so scary. The compulsive part of the syndrome is easier to treat.

Standard clinical management of OCD:

• Pharmacotherapy. It is unlikely to do without drugs. Judge for yourself, if the disease has biological causes, you cannot do without pills. The patient will be prescribed antidepressants. The specialist will select them correctly, dispel the patient's fears about such therapy. The treatment will be long-term. Additionally, most likely, the patient will be prescribed B vitamins, they are reliable protectors of the body from stress.
• Cognitive Behavioral Therapy. These are psychotherapeutic methods of treatment that also take a lot of time. But it is they who help to unravel the tangle of anxiety, obsessive thoughts and fears.
• Physiotherapy. Patients are advised to focus on water procedures. They can be different, but the goal is the same - to relax, bring pleasure, remove clamps.

Additionally, you can turn to family psychotherapy, patient support groups. The patient should not avoid his mental diagnosis, but accept it and begin to fight it. Fight like any other disease: patiently, responsibly, disciplined.

OCD is not a verdict, not a shameful diagnosis, not a sign of irreversible consequences. But nevertheless, this is a serious disorder that needs to be treated by specialists. If this is not done, the disease can progress, making life more difficult for the patient.

The author of the article is Katerina Ivanova: “Even while studying at the university, I was carried away by research work in the field of medical psychology. And for 15 years the topic of healthy lifestyle interests me both as a researcher and as a supporter healthy way life. Herbal medicine, proper nutrition (but not diet!), Physical activity (exercise therapy, cardio training, fitness), taking care of psychological health, active rest - this is what I have in my life. "

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

Such ignorance often becomes the reason that people start the disease, do not go to doctors and do not receive timely treatment. Therefore, it is necessary to have an idea of \u200b\u200bthe ailment, because someone from relatives or friends may well suffer from it.

What it is?

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

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

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

For the first time, a complete description of the clinical picture of this neurosis was made by Felix Plater, a Swiss physician, naturalist and writer. It happened in the 17th century. At that time, it did not stand out as a separate, independent pathology of OCD. The symptoms of this disease were considered part of the clinical picture characteristic of melancholy.

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

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

How serious is this disease?

Obsessive-compulsive disorder - what is it in simple terms? Phobia? Mania? Obsession? Something like this is argued by people far from psychiatry, trying to understand what this disease is and how serious it is.

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

In a number of countries, people with obsessive-compulsive disorder are classified as disabled and receive social benefits and a pension for health reasons. Of course, the disease is treated and the diagnosis of OCD is not a sentence or a stigma.

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

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

The main distinguishing feature of this pathology is suspiciousness, approaching absolute. That is, patients in everything around them see subtext, hidden meaning, hidden signs. Even in a casual greeting, the person suffering from this disorder will hear many hints. The second trait common to people with this condition is secretiveness. They almost never say what they really think.

Obsessive-compulsive disorder, the treatment of which is complicated by secrecy and suspiciousness, is not limited only to the presence of these personality traits in a hypertrophied form. Patients are also characterized by:

• deliberately calm domination, that is, such people publicly do not arrange hysterics and do not enter into fights, they demonstrate their strength mainly in silence;
• habit to extremes in decisions, measures taken, way of thinking, actions;
• maximum determination, even fanaticism in any action;
• the presence in the mind of stereotypes, patterns, obsessions and thoughts, images, desires that weigh on a person and require an exit.

The list of common symptoms characteristic of the disease is reminiscent of "psychological portraits" of maniac intellectuals from Western films. In connection with this obvious similarity, questions arise about the reasons for the appearance and development of obsessive-compulsive disorder, whether its treatment brings results and whether the patients are dangerous for others. After all, every maniac who appears on the movie screen has a history of horrific psychological trauma and shock, and therapy does not help the characters of films at all, moreover, they themselves often work in the medical field.

Fortunately, the similarities between movie characters and real OCD sufferers end in outwardly visible, specific behaviors.

Why does this disease appear? How is it developing?

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

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

What contributes to the emergence and development of pathology?

The factors contributing to the onset of this disorder are usually divided into two groups:

• biological;
• socio-psychological.

Biological factors include the following:

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

Socio-psychological factors include:

• the conditions in which the child grew up and was brought up, the moral and ethical norms instilled in him;
• a person's way of life, his social status and income;
• the presence of stress, severe emotional distress;
• social activity, the degree of adaptation in society;
• surrounding reality, specific conditions, realities.

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

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

When it comes to parenting, the factors that contribute to OCD are:

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

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

What do sick people think about? Key Topics of Obsessions, Fears, Images, and Thought in OCD

Obsessive states, no doubt, each person has their own, personal and unique. However, for those who are sick with OCD, there is a certain list of directions, topics, within which this mental pathology progresses.

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

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

The most common fear in OCD is the fear of getting dirty or touching something dirty. For example, a person touched some thing in a store, after which thoughts appear in his head about how much dirt, microbes, sewage is on the subject, and he runs in horror to the nearest toilet in order to wash his hands.

Excessive hand washing is the most common and common symptom of OCD. At first, this habit is perceived as common 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. A sick person's imagination 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 to dine on raw alligator brains flavored with lingonberry jam. However, these "pictures" always contradict the foundations, traditions and usual way of life and behavior accepted in society.

Obsessions are a manifestation of obsession, fanaticism. They can be associated with religious doctrines, with plans in business, with 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" for the sake 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 at first is mistaken for meticulousness, increased attention, and sometimes for an analytical mindset. An OCD sufferer may spend half a day wondering why a coworker extended his hand a few seconds later than usual when greeting. The conclusions that a person suffering from a mental disorder will come to can be any, but they will necessarily turn out to be negative, painful.

At what age does this disease appear?

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

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

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

How is this pathology diagnosed?

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

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

How is this disease treated?

If obsessive-compulsive disorder is diagnosed, how should it be treated? Do I need to see a psychotherapist? Are visits to the neurologist's office required? Is it possible to cope with pathology on your own, without the help of doctors? Do I need to take medication? 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 involved.

The basis of psychotherapy sessions is the "four steps" program, compiled by the American physician 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 "warning exposure" 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 destroys stereotypes, breaks the cycle inherent in neurosis. Of course, a person independently resists the need to close the cycle; no one physically keeps him from washing his hands or any other ritual.

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

In the treatment, drugs from the following groups are used:

• antidepressants;
• tranquilizers;
• antipsychotics;
• antipsychotics;
• benzodiazepines;
• normotimics.

There are incredibly many varieties 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 drugs has not only a beneficial effect, but also side effects.

Is it possible to cope with the disease on my own? Preventing OCD

People who suspect they have obsessive-compulsive disorder have different thoughts. "How to get rid of neurosis on your own?" is the first and most common question that arises in such situations. Moreover, it is typical for Russians and residents of other post-Soviet countries. Not a single European or American would ever think that it is possible to cure a severe mental disorder without the help of a qualified specialist.

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

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

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

We must not forget that every adult is responsible not only for his own mental state, but also for the mental health of his children. OCD can be prevented by adhering to the following principles when raising a baby:

• kindness, calmness and openness;
• lack of habit to instill in the child any stereotypes;
• refraining from overestimating or decreasing children's self-esteem.

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

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

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

Obsessions, anxiety, compulsions

Obsessive-compulsive disorder has several symptoms.

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

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

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

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

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

With OCD, a person spends a lot of time on obsessive thoughts and compulsive actions. Everyday life, relationships with loved ones begin to suffer. It is not possible to find time for important things, since the symptoms of the disorder take more and more time - up to several hours a day, and in some cases even the whole day. The symptoms of obsessive-compulsive disorder significantly reduce the ability to work: in patients aged 15 to 44, the World Health Organization lists OCD as one of the twenty most commonly disabling diseases.

Different forms of OCD

There are various types of obsessive-compulsive disorder. Some people have more obsessions, others have compulsions. For example, trichotillomania - compulsive pulling of hair from the head - manifests itself only in compulsions, and the obsessive part is either absent or not recognized.

Obsessive thoughts and compulsive actions are different for everyone, but there are typical themes of anxiety that are most common among people with OCD. For example, many forms of OCD are associated with a sense of increased responsibility for oneself or others. A typical fear is the fear of contamination or contamination. Touching dirty surfaces, objects that have been on the street, in contact with the floor, with shoes, a person fears that he may get dirty or contract a dangerous disease, and his compulsive actions are aimed at trying to cleanse his hands, body, clothes after colliding with the outside world.

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

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

Another typical manifestation is an obsessive fear of harming others. Obsessive-compulsive disorder often occurs in young mothers in the early postpartum period in the form of fear of harming their child: “What if I drop the baby, take a knife or throw it out the window?” The mother may compulsively hide all sharp objects, distrust herself, and ask only her husband to swing, bathe, and swaddle the child.

Obsessive thoughts aren't always upset

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

Why does not a single obsessive thought that occurs to most people become a disorder? Most of us do not rate obsessions as scary or abnormal: a strange thought came, twisted, and left. In obsessive-compulsive disorder, an obsessive thought is followed by anxiety or even fear, and then an obsessive desire to get rid of it arises - a compulsion, then again a thought and again a compulsion. The vicious circle repeats itself many times and leads to maladjustment. That is, people who have OCD fear intrusive thoughts, in contrast to people without OCD who treat strange ideas as "brain spam" that just comes to mind from time to time.

It often happens that during life, some obsessive experiences replace others. For example, at the age of 20, a person was worried about the fear of infection, and at the age of 25, the idea of \u200b\u200bharm was disturbed. As overall stress levels increase, OCD symptoms increase, and as overall stress levels decrease, OCD symptoms decrease. However, there are observations that show that during times of severe turmoil, such as wars or disasters, OCD symptoms may have temporarily stopped. Extreme stress can serve as an antidote, but only temporary.

Statistics

There is no specific group of people who are more likely to have OCD. Obsessive-compulsive disorder can affect both adults and adolescents and children. The most common age of diagnosis is about 19–20 years, but there are cases of diagnosis even after 35 years. It is estimated that approximately 1.2% of the US adult population has obsessive-compulsive disorder, with women diagnosed with obsessive-compulsive disorder more often than men: 1.8% versus 0.5%. More than half of patients hide the symptoms of obsessive-compulsive disorder. On average, 12-14 years elapse between the onset of obsessive-compulsive disorder and the visit to a doctor.

Genetics and biology of OCD

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

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

Combination with other diseases

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

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

Medication and psychotherapy

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

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

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

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

OCD research

To date, a lot of research has been done on obsessive-compulsive disorder. We have a rough understanding of the biological background and psychological functioning of people with OCD. We know how to treat this disorder, but this knowledge is not enough. All the same, there are cases in which we are unable to help the patient using known methods, and we do not really understand why this happens. New technological solutions are now being developed to assist in resistant cases. For this, the method of deep brain stimulation ( deep brain stimulation). An electrode is inserted into the brain, which stimulates the brain in a specific area and reduces OCD symptoms. Because it is an invasive treatment and its long-term effects are poorly understood, deep brain stimulation remains in the research area and is not used in practice.

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

Research is underway trying to investigate the link between OCD and autism spectrum disorders. It was noted that some correlations exist, but causal relationships have not yet been established. We still know very little about the genetics and biology of this disorder. By knowing more about OCD, we can be more effective in treating this disease, which is difficult for patients and their families.

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

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

Strange, unpleasant, disturbing thoughts often come to mind. You don't want to think about it, but thoughts continue to come outside of your desire.

Anxious thoughts take up more than one hour a day collectively.

Thoughts begin to seriously interfere, causing intense anxiety or anxiety.

Because of obsessive thoughts, you have to skip important things, cancel plans. Much time is spent fighting disturbing ideas, and ordinary life begins to fade into the background.

Many patients with obsessive-compulsive disorder are very shy about their thoughts, they think that they are stupid, strange or dangerous. They feel embarrassed and try to talk less about them, because often even those close to them can laugh and say: “Listen, this is some kind of stupidity” and not take their experiences seriously.

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

It is also important to know when to see a psychotherapist. If you have a ridiculous thought, an annoying song stuck, or you have been thinking about something for several days and cannot get this thought out of your head, you do not need to panic. Think about research: 80% of people at one time or another in their life may experience obsessive thoughts. This is normal. So-called brain spam comes to our minds and is not a sign of disorder. You should be concerned when you see these thoughts taking too long and causing your life to begin to negatively transform.

OCD and falling in love

It is believed that falling in love resembles OCD symptoms. Indeed, falling in love is a mental fixation on one object. In terms of the power with which falling in love captures our thoughts, there really is a similarity. But at the same time, unlike OCD, falling in love is pleasant, as a rule, you do not want to get rid of it. Falling in love often helps a person, makes him more efficient and productive, in contrast to OCD, which can seriously disrupt the quality of life. These are different phenomena, and falling in love is a normal, healthy state of a person, and not obsessive-compulsive disorder at all.

We are grateful to Daria Maryasova, psychiatrist, psychotherapist, candidate of medical sciences, for help in the scientific editing of the article.

Obsessive-compulsive disorder: causes, symptoms, treatment

Maria Barnikova

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

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

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

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

In most people with OCD, symptoms are chronic, with obsessions occurring regularly or persistently. The manifestations of obsessive-compulsive disorder can be sluggish and perceived by the patient as tolerable. Or, as the disease progresses, the symptoms are aggravated at a rapid rate, preventing a person from having a normal existence. Depending on the severity and rate of development of symptoms, obsessive-compulsive disorder either partially hinders the patient's full-fledged activity, or completely prevents interaction in society. In severe OCD, the patient becomes a hostage of obsessive compulsions. In some cases, the patient completely loses the ability to control the thinking process and cannot control his behavior.

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

• It is customary to call obsessions the thoughts that come to mind involuntarily, in addition to the subject's desire, annoying, persistent, oppressive, weary, frightening or threatening thoughts. Obsessive thinking includes obsessive ideas, images, desires, drives, doubts, fears. A person tries with all his might to resist regularly appearing obsessive thoughts. However, attempts to distract and switch the course of thinking do not give the desired result. Intrusive ideas still cover the entire spectrum of the subject's thinking. No other ideas, except for annoying thoughts, do not arise in the mind of a person.
• Compulsions are exhausting and exhausting actions that are regularly and many times repeated in an unchanged constant form. Standardly performed processes and manipulations are a kind of protective and protective rituals. Persistent repetition of compulsive actions is designed to prevent the occurrence of any frightening circumstances. However, according to an objective assessment, such circumstances simply cannot occur or are unlikely situations.

With obsessive-compulsive disorder, the patient can be simultaneously determined both obsessions and compulsions. Exceptionally obsessive thoughts can also be observed without subsequent ritual actions. Or the person may suffer from an oppressive sense of the need for compulsive actions and their repeated execution.

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

Obsessive-compulsive disorder: pathogenesis

Most often, a person pays attention to the existence of obsessions and compulsions after he has experienced a serious life drama. It also becomes noticeable to others that after the tragedy that happened, a person began to behave differently and, as it were, stay in his own world of thought. Despite the fact that the symptoms of obsessive-compulsive disorder become pronounced precisely after extreme circumstances in the life of the subject, it acts only as a trigger for the visible manifestation of pathology. The traumatic situation is not directly the cause of OCD, it only provokes the fastest aggravation of the disease.

Reason 1. Genetic theory

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

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

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

Reason 2. Features of higher nervous activity

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

Reason 3. Constitutional and typological aspects of personality

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

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

Reason 4. Influence of neurotransmitters

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

Reason 5. PANDAS syndrome

Nowadays, there is a lot of confirmation of the put forward assumption about the connection of obsessive-compulsive disorder with infection of the patient's body with group A beta-hemolytic streptococcus. These cases are denoted by the English term

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

Obsessive-compulsive disorder: clinical presentation

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

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

Group 1. Fatal doubts

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

The patient's pathological doubts can relate to traditional household chores, which, as a rule, are performed automatically. Such a person will check several times: whether the gas valve is closed, whether the water tap is closed, whether the front door is locked. He returns to the scene several times, touches these objects with his hands. However, as soon as he leaves his home, doubts overwhelm him with greater force.

Painful doubts can also affect professional duties. The patient is confused as to whether he has completed the required task or not. He is not sure if he wrote the document and sent it by email. He wonders if all the details are in the weekly report. He reads over and over again, looks over, rechecks. However, after leaving the workplace, obsessive doubts arise again.

It is worth pointing out that obsessive thoughts and compulsive actions resemble a vicious circle, which a person cannot break with an effort of will. The patient understands that his doubts are unfounded. He knows that he has never made similar mistakes in his life. However, he cannot "persuade" his mind not to re-check.

Only a sudden "insight" can break the vicious circle. This is the situation when a person's mind becomes clear, the symptoms of obsessive-compulsive disorder temporarily subside, and the person experiences a release from obsessions. However, a person cannot bring the moment of "illumination" closer by an effort of will.

Group 2. Immoral obsessions

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

The subject may be overwhelmed by a thirst to offend and humiliate someone, to be rude and rude to someone. A respectable individual may be pursued by some absurd undertaking, which is a licentious immoral act. He may begin to blaspheme God and speak unflatteringly about the church. He may be overcome with the idea of \u200b\u200bindulging in sexual debauchery. He may feel thirsty to commit a bully.

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

Group 3. Anxiety about pollution

The symptoms of obsessive-compulsive disorder are also relevant. The patient may be pathologically afraid of contracting some difficult-to-diagnose and incurable disease. In such a situation, he performs protective actions in order to exclude contact with microbes. He takes strange precautions for fear of viruses.

Obsessions also manifest with an abnormal fear of pollution. People with obsessive-compulsive disorder may fear being covered in dirt. They are terrified of house dust, so they are cleaning day and night. Such subjects are very attentive to what they eat and drink, as they are convinced that they can be poisoned by poor quality food.

In obsessive-compulsive disorder, common themes of obsession are thoughts of the patient about contamination of their own home. Such subjects are not satisfied with standard apartment cleaning methods. They vacuumed carpets several times, wash the floor using disinfectants, and wipe the surfaces of furniture using cleaning agents. In some patients, cleaning the home takes the entire waking period, they take a break for themselves only for a night's sleep.

Group 4. Obsessive actions

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

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

• activities carried out due to existing superstitions and prejudices, for example: fear of the evil eye and a preventive method - regular washing with "holy" water;
• stereotyped, mechanically performed movements, for example: pulling your own hair off your head;
• devoid of common sense and the need to perform any process, eg: combing hair for five hours;
• excessive adherence to personal hygiene, for example: taking a shower ten times a day;
• uncontrollable need to recalculate all surrounding objects, for example: counting the number of dumplings in a serving;
• an uncontrollable desire to place all objects symmetrically to each other, the desire to arrange things in a strictly established sequence, for example: arranging shoe units in parallel;
• craving for gathering, collecting, hoarding, when a hobby passes from the category of a hobby to a pathology, for example: keeping at home all the newspapers purchased in the last ten years.

Obsessive Compulsive Disorder: Treatments

The treatment regimen for obsessive-compulsive disorder is selected for each patient individually, depending on the severity of symptoms and the severity of existing obsessions. In most cases, it is possible to help a person by conducting treatment on an outpatient basis. However, some patients with severe OCD may need to be admitted to an inpatient facility because there is a risk that obsessive thoughts will require actions that can cause real harm to the person and their environment.

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

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

Drug treatment

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

Psychotherapeutic treatment

Modern psychotherapy has in its arsenal a variety of proven and effective methods for getting rid of obsessive-compulsive disorder. The most common treatment for OCD is a cognitive-behavioral method. This technique provides for helping the client to identify the destructive components of thinking and the subsequent acquisition of a functional way of thinking. During psychotherapy sessions, the patient gains the skills to control his thoughts, which makes it possible to control his own behavior.

Another option for psychotherapeutic treatment that shows good results in the treatment of obsessive-compulsive disorder is the technique of exposure and prevention of reactions. Placing the patient in an artificially created frightening environment, accompanied by a clear and understandable step by step instructionshow to prevent compulsions, gradually alleviates and eliminates the symptoms of obsessive-compulsive disorder.

Hypnosis treatment

Many people with obsessive-compulsive disorder indicate that by giving in to their obsessive ideas and committing compulsive actions, they seem to be in a trance state. That is, they concentrate within themselves, so the fruits of their imagination become more real than objectively existing reality. That is why it is advisable to influence obsessions precisely in a state of trance, the immersion into which occurs during a hypnosis session.

During a hypnosis session, there is a break in the associative connection between overwhelming obsessions and the need to use a stereotyped model of behavior. Techniques of hypnosis help the patient to make sure of the inexpediency, absurdity and alienation of the obsessive thoughts that arise. As a result of hypnosis, the need for certain rituals disappears. He gains a mind free from prejudices and takes control of his own behavior.

Preventive actions

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

• take a contrast shower in the morning;
• in the evening, arrange a bath with the addition of relaxing natural oils or soothing herbal formulations;
• providing a full night's sleep;
• daily walks before bed;
• stay in the fresh air for at least two hours a day;