Obsessive depressive syndrome. OCD is obsessive-compulsive disorder (obsessive-compulsive disorder): causes, symptoms and treatment

Unwanted and fearful thoughts arise from time to time in every person. And if for most people it is not difficult to drive them away from themselves, then for others it is more difficult. This type of people begins to think about why they had such a thought, and will constantly return in their minds to this question that bothers them. And until they do specific actions or actions, they will not be able to free themselves from these thoughts.

Attention! A state of anxiety, fear of annoying incidents, frequent hand washing - this is all just a small part of compulsive disorder.

This annoying state of mind can bring a lot of problems to a person. And the main thing in this is to identify in time the fact that these thoughts come for a reason. They are a disease called obsessive-compulsive disorder, otherwise known as obsessive-compulsive disorder.

What is obsessive compulsive disorder?

Depressing thoughts very often arise in a person's mind (obsessions). It is very difficult to get rid of them, or to have control over them. The inability to get rid of such thoughts leads a person to a stressful state and causes obsessive compulsive disorder. With the help of certain actions (compulsions), a person manages to temporarily remove persistent and depressing thoughts, in this way reducing obsessive-compulsive disorder. The condition may make the person feel worse, forcing the person to do more of certain things, so it can become an episodic or chronic form of the disease.

Important! Compulsive disorder is a condition that lasts for a long time and is characterized by symptoms such as fear, intrusiveness and depression.

This feature of obsessive-compulsive disorder makes recognizing such a disease simple, although at the same time it has a certain complexity.

The disease of doubt has the following characteristics:

• A one-time attack of obsessive-compulsive disorder that may last 7 days or may last a couple of years;
• Repeated exacerbation of obsessive-compulsive disorder, during the interval between which there was a recovery from the disease;
• Constant growth and development of OCD, with an increase in symptoms of the disease that occurs periodically.

Obsessiveness of actions

Obsessive compulsive disorder is defined by the need to do certain things. When a person does them, it gives him a feeling of calm. Often, obsessive actions are absurd and unreasonable, and take on different forms. Such a variety of forms often brings complications in that it becomes difficult to establish a diagnosis.

Intrusive thoughts (obsession)

Such thoughts give rise to various fears, negative thoughts, and lead to the performance of certain actions.

What fears and actions might these be?:

• Fear of contracting any disease or fear of catching some viruses and germs in obsessive compulsive disorder. To avoid such infection, people often try to wash their hands and bathe. He changes into clean clothes and linen as often as possible, and carefully washes and disinfects everything in the apartment. Such manipulations can take him a lot of time;
• Fear of perceived dangers and fear of doing something to the detriment of loved ones or oneself. A person is afraid that he may be robbed. He also fears that while he is in a position to lose control of himself, he may cause harm to himself and others. To avoid this, he puts away those objects with which he can cause harm (knife, ax, etc.);
• Fear that if necessary, he will not have the necessary item with obsessive compulsive disorder. The patient checks his pockets and bag several times to see if he has taken with him all the necessary things that he may need (documents, medicines, money, etc.);
• Obsessive compulsive disorder about having everything in order and arranged symmetrically. It becomes extremely important for a person that where he is, everything is arranged in a certain order. If this is not so, then this causes a feeling of tension in him;
• Prejudice. A person with compulsive disorder experiences the fear that if he does not do certain things, he will definitely be unlucky. This may not be a one-time check, for example, whether he locked the door; he must turn around his axis three times before leaving the house, sit down twice and walk backwards out of the door. All this becomes a kind of ritual for obsessive compulsive disorder;
• Avoiding thoughts that are contrary to religious or moral principles. To prevent such thoughts from arising, a person prays or donates his last money to the church;
• Fear of sexual thoughts. The patient tries not to engage in intimate contact with obsessive compulsive disorder, as he is afraid of doing something inappropriate to his partner.

Causes of the disorder

Many scientific studies have been conducted on what causes obsessive disorders. But the answer to it was never fully received. The occurrence of obsessive-compulsive disorder can be influenced by physiological and psychological factors.

1. Genetically. According to research, it has been found that obsessive disorders can pass from person to person who are closely related;
2. Autoimmune reaction. In certain cases, children who have had streptococcus have a rapid development of obsessive-compulsive disorder;
3. Severe overvoltage which led to stress obsessive compulsive disorder;
4. Brain dysfunction due to biochemistry;
5. Past streptococcal infection can be the cause of a compulsive disorder, because this causes a disruption and inflammation of the basal ganglia.

Behavioral psychology

People with compulsive disorder are constantly busy trying to avoid things that might make them afraid. They constantly struggle with their thinking, and in an attempt to overcome their thoughts, they try to perform certain actions to drive away the oppressive feeling of anxiety.

Such attempts and actions can temporarily reduce their fear, but at the same time there is a possibility that this will double the possibility of obsessive actions in the future. It follows from this that the cause of obsessive-compulsive disorder is specifically the avoidance of fear itself. By avoiding what causes fear and apprehension in them, they intensify these fears even more. All this can bring negative results.

Attention! People who are most prone to obsessive-compulsive disorder are those who are in a state of mental tension that can cause them stress.

For example, if a person previously usually calmly went to a public toilet, then in a state of nervous tension he begins to convince himself that the restroom is dirty and full of germs, he can pick them up there and get sick. Other places, such as shower stalls and others with obsessive compulsive disorder, can cause similar fear.

Cognitive Causes of OCD

The cognitive theory interprets the formation of obsessive-compulsive disorder by the fact that a person is not able to correctly interpret the thoughts that arise in him. After all, for many people, such inappropriate thoughts come to mind repeatedly throughout the day. But those people who have compulsive disorders are capable of significantly exaggerating the meaning of thoughts that come to their mind.

For example, a woman who is raising a child may from time to time have thoughts that she is able to do something bad for her child. Most women drive away such thoughts. But a woman with OCD begins to think about the possibility that she might actually harm her baby. Such thoughts give her anxiety and other negative feelings, and she begins to feel shame and condemnation.

The fear of such thoughts arising often leads her to the desire to get rid of negative emotions, and in an attempt to avoid thoughts, she begins to resort to actions that are associated with an excessive ritual of cleansing the soul and reading prayers.

Such repeated behavior becomes a habit. It follows from this that the cause of obsessive-compulsive disorder is the misinterpretation of depressing thoughts, from which ordinary fears turn into something catastrophic, and are mistaken for a real danger.

Wrong thoughts can be formed due to childhood convictions and arise subsequently due to the following reasons:

• Exaggeration of the importance of commitment in obsessive-compulsive disorder. Confidence that each person has a direct obligation to ensure the safety of other people and is responsible for the harm that is caused to them.
• The belief that thoughts can materialize. The belief that negative thoughts are able to come true and affect those around them to whom these thoughts are applied, and thus must be carefully controlled.
• Overinflation of danger and predisposition to exaggerate the possibility of probable risk in obsessive compulsive disorder.
• An excessive exaggeration of confidence in such concepts that everything must be at the highest level and there should be no mistakes.

Attention! Frequent stressful situations and psychological stress can provoke obsessive-compulsive disorder in those people who are predisposed to such a disease. In most cases, neurosis manifested itself due to a negative reaction to the environment surrounding the person.

How does OCD occur?

First, a peculiar thought appears, which frightens and forces a person to feel embarrassment, confusion, and gives rise to a feeling of guilt. After this, the patient focuses his attention on the thought that has appeared and begins to think about it against his will. As a result, mental stress arises and this aggravates the feeling of obsessive-compulsive disorder.

Calm comes to a person when he performs certain ritual acts, believing that they can relieve him of fear and anxiety. A short-term calm comes to him. But the thought does not leave him for long, it hurries to return to him again, and he feels inferior because of this.

Origin of neurosis

If a person with a disorder increasingly uses rituals, then this makes him more and more dependent on them. Addiction occurs, and these actions become as necessary as drug use by a drug addict.

The patient who often has to face situations that frighten him, and he is not able to overcome his fears, but only returns to them again, comes to the understanding that not everything is all right with him.

Important! This state of affairs can be further complicated by the actions of relatives who consider a person suffering from obsessive compulsive disorder to be mentally ill and do not allow him to perform his ritual actions.

He begins to think that if in fact everything is not right with his head, then he is able to do those things that terrify him. The prohibition to perform actions only fuels his fears. But another state of affairs also occurs when close people begin to carry out his actions together with him, thus emphasizing his importance.

Establishing a diagnosis of obsessive compulsive disorder

The symptoms of obsessive compulsive disorder are similar to those of schizophrenia. To distinguish one disease from another it is carried out using a differential diagnosis. The fact of how these thoughts are perceived, as one’s own or as suggested in the case of a compulsive type of disorder, also matters a lot.

In addition, depressive disorders are often concomitant with obsessive-compulsive disorder. If one and the second disease affects a person equally, then the depressive state is considered to be primary in obsessive-compulsive disorder.

In order to find out the degree of the disorder, a special test for obsessive compulsive disorder is used. If the disease is in a mild stage, the patient will be able to try to overcome it himself. To successfully overcome obsessive-compulsive disorder, he should learn to shift his thoughts in a different direction and concentrate his attention on certain actions, for example, reading a book.

This distraction will help delay the execution of obsessive compulsive disorder actions. It should be postponed at first for at least 15 minutes and over time lengthen the minutes, delaying the performance of rituals for obsessive compulsive disorder. This will help the patient understand that he is able to pacify himself on his own, and for this it is not necessary to do certain ritual actions.

Important! If obsessive compulsive disorder is of moderate severity, it is recommended not to delay visiting any of their specialists, such as a psychologist, psychiatrist or psychotherapist.

But if obsessive compulsive disorder has a very pronounced degree, then the specialist, after making a diagnosis, begins treatment with medications.

How to treat OCD?

A complete cure for this disease is not excluded, but still, in order to recover from obsessive-compulsive disorder, you will need to undergo a course of long-term treatment. It is carried out comprehensively, using other techniques.

• Treatment of obsessive compulsive disorder. With the help of psychotherapy. Therapy such as psychoanalytic therapy helps to successfully combat individual moments of compulsive neurosis. It helps regulate your behavior in obsessive compulsive disorder. The patient undergoes a relaxation study. Psychotherapy is aimed at understanding the patient’s thoughts and actions and diagnosing the motive for obsessive-compulsive disorder. It happens that family therapy is prescribed for this;
• Treatment of obsessive compulsive disorder with physical therapy, which the person receives at home. Procedures are needed that help strengthen the body;
• Adjustment of lifestyle in case of impulsive syndrome.

Drug treatment for obsessive compulsive disorder

How effectively the treatment will help depends on the choice of medications and the precisely selected dose for obsessive-compulsive disorder. Antidepressants, tranquilizers, and atypical antipsychotics are usually prescribed for treatment. Such drugs help calm the nerves and reduce the anxious symptoms of obsessive-compulsive disorder.

A specialist can also use cognitive behavioral therapy and hypnosis sessions for obsessive-compulsive disorder as a complex treatment, along with medication.

Attention! An effective method for obsessive compulsive disorder is a technique to avoid reactions. Its meaning is that when the patient encounters his anxieties in circumstances that can be controlled, he learns how to cope with his anxieties without the help of what he is used to. Treatment consists of helping the person overcome their fear of obsessive compulsive disorder.

For example, a patient with obsessive compulsive disorder is asked to touch stair railings, handrails or door handles in public places, and then take the time to wash their hands for some time, the longer the better. Over time, the task is made more difficult for him with obsessive compulsive disorder. After some time, with repeated repetition, the patient learns not to be afraid, his fear gradually disappears. But it should be taken into account that many of the patients are not able to cope with this method of treating obsessive-compulsive disorder. They are unable to overcome their fear and do not agree to perform such a task.

Family therapy can also be beneficial for patients with obsessive compulsive disorder. With its help, loved ones will be able to understand the source of the disorder as well as possible and understand how to act when obsessive-compulsive disorder begins to manifest itself. After all, family members can provide the best help in overcoming the patient’s difficulties, or they can cause harm with their attitude.

How to cope with obsessive compulsive disorder?

Obsessive compulsive disorder can be prevented and will help:

• Using techniques to cope in stressful situations.
• Rest on time to avoid excessive fatigue due to obsessive compulsive disorder.
• Prompt resolution of personal differences.

Important to Know! Obsessive compulsive disorder is not a mental illness, because it does not entail a personality change, and the person does not have a split personality. Obsessive compulsive disorder is a nervous disorder. With proper and timely treatment, it can be completely cured.

Any mental disorder has an extremely negative impact on the state of the nervous system as a whole; such a disease quickly “shatters” the stability of neuronal connections and affects all levels of the psyche.

Modern methods of treating neurotic disorders, including drug therapy, psychotherapy and auxiliary techniques, can achieve cure or significantly improve the condition of almost any mental illness, but for this it is extremely important to seek medical help in a timely manner and strictly adhere to medical recommendations. It is especially important to promptly begin treatment for a disease such as obsessive-compulsive disorder or.

Or obsessive-compulsive neurosis is a mental disorder in which patients periodically experience obsessive thoughts or actions.

Most often, they feel fear, worry and anxiety when certain thoughts arise and try to get rid of unpleasant experiences through certain actions.

The severity of the patient's condition can vary significantly - from mild anxiety, which makes you return and check whether the door is locked or whether the iron is turned off, to constant obsessive movements or the creation of complex rituals designed to protect against evil spirits.

Usually this disease develops from nervous exhaustion, stress, severe somatic illness or a long-term psychologically traumatic situation.

Risk factors for development also include heredity and personality traits.

There are 3 forms of the disease:

All forms of disorders are characterized by the patient’s inability to control his thoughts or behavior, increased anxiety, and suspiciousness. Obsessive-compulsive disorder occurs equally often in both sexes and can develop in children over 10 years of age.

Treatment methods

Treatment of obsessive convulsive disorder should only be carried out by specialists. Often patients do not understand the severity of their condition or do not want to seek help from psychiatrists, preferring to be treated independently or using traditional methods of treatment. But such treatment can cause a sharp worsening of the patient’s condition or cause the development of a more severe nervous disorder.

These methods can only be used for the mildest forms of the disorder, and if the patient has sufficient willpower and is able to control the treatment process himself. To do this, the patient must independently find out what exactly caused the development, clearly control his condition, noting when and why he has obsessive thoughts or movements, and also learn to “switch”, gradually displacing these symptoms.

For the treatment and prevention of OCD, it is very important to improve the condition of the nervous system and the body as a whole. A number of measures are recommended for this. In addition to changing lifestyle, increasing sleep and rest time, proper nutrition and giving up bad habits, patients must learn to control the flow of their thoughts and clearly delineate responsibilities.

To do this, it is recommended to make a daily list of what needs to be done (you need to make sure that making a list does not turn into an obsession), be sure to take up some kind of sport - active physical activity helps to “switch” thoughts and get rid of the neurosis of obsessive movements and learn to relax .

Every patient suffering from obsessive-compulsive disorder needs to spend 1-2 hours every day doing something that helps relieve nervous tension and brings positive emotions. This could be dancing, listening to your favorite music, swimming, walking in the fresh air, any hobby, the main thing is complete switching and pleasure from the activity.

Watching TV or sitting at the computer is absolutely not suitable for relaxation. If patients do not have favorite activities or hobbies, it is recommended to simply spend an hour in the bathroom, lie down listening to the sounds of nature, or take a walk in the nearest park.

Obsessive-compulsive disorder, called impulsive (obsessive) compulsive disorder, can significantly worsen the quality of life of the patient suffering from it.

Many patients mistakenly put off visiting a doctor, not realizing that a timely visit to a specialist will reduce the risk of developing a chronic disease and help get rid of obsessive thoughts and panic fears forever.

Impulsive (obsessive) compulsive disorder is a disorder of a person’s mental activity, manifested by increased anxiety, the appearance of involuntary and obsessive thoughts that contribute to the development of phobias and interfere with the patient’s normal life.

Mental health disorders are characterized by the presence of obsessions and compulsions. Obsessions are thoughts that arise involuntarily in the human mind, which lead to compulsions - special rituals, repeated actions that allow you to get rid of obsessive thoughts.

In modern psychology, mental health disorders are classified as a type of psychosis.

The disease may:

• be in a progressive stage;
• be episodic in nature;
• proceed chronically.

How does the disease begin?

Obsessive-compulsive disorder develops in people aged 10-30 years. Despite the fairly wide age range, patients turn to a psychiatrist at approximately the age of 25-35 years, which indicates the duration of the disease before the first consultation with a doctor.

Mature people are more susceptible to the disease; among children and adolescents, symptoms of the disorder are detected less frequently.

Obsessive-compulsive disorder at the very beginning of its formation is accompanied by:

• increased anxiety;
• the emergence of fears;
• obsession with thoughts and the need to get rid of them through special rituals.

The patient at this stage may not be aware of the illogicality and compulsiveness of his behavior.

Over time, the deviation begins to worsen and becomes active. progressive form when the patient:

• cannot adequately perceive his own actions;
• feels very anxious;
• cannot cope with phobias and panic attacks;
• requires hospitalization and drug treatment.

Main reasons

Despite a large number of studies, it is impossible to unambiguously determine the main cause of obsessive-compulsive disorder. This process can arise due to psychological, sociological, and biological reasons, which can be classified in tabular form:

Biological

Among the biological causes of obsessive-compulsive disorder, scientists identify genetic factors. Research into the occurrence of the disorder using adult twins has led scientists to conclude that the disease is moderately heritable.

The state of mental disorder is not generated by any specific gene, but scientists have identified a connection between the formation of the disorder and the functioning of the SLC1A1 and hSERT genes.

In people suffering from the disorder, mutations can be observed in these genes, which are responsible for transmitting impulses in neurons and collecting the hormone serotonin in nerve fibers.

There are cases of early onset of the disease in a child due to complications after infectious diseases suffered in childhood.

In the first study to examine the biological link between the disorder and the body's autoimmune response, scientists have concluded that the disorder occurs in children infected with streptococcal infection, which causes inflammation of clusters of nerve cells.

The second study looked for the cause of mental abnormalities in the effects of prophylactic antibiotics taken to treat infectious diseases. Also, the disorder may be a consequence of other reactions of the body to infectious agents.

As for the neurological causes of the disease, using methods of imaging the brain and its activity, scientists were able to establish a biological connection between obsessive-compulsive disorder and the functioning of parts of the patient’s brain.

The symptoms of mental disorder included the activity of parts of the brain that regulate:

• human behavior;
• emotional manifestations of the patient;
• bodily reactions of the individual.

Excitation of certain areas of the brain creates a desire in a person to perform some action, for example, wash your hands after touching something unpleasant.

This reaction is normal and the urge that arises after one procedure decreases. Patients with the disorder have problems stopping these urges, so they are forced to perform the ritual of hand washing more often than normal, receiving only temporary satisfaction of the need.

Social and psychological

From the point of view of behavioral theory in psychology, obsessive-compulsive disorder is explained on the basis of a behavioral approach. Here, illness is perceived as a repetition of reactions, the reproduction of which facilitates their subsequent implementation in the future.

Patients spend a lot of energy constantly trying to avoid situations where panic might arise. As a protective reaction, patients perform repetitive actions that can be performed both physically (washing hands, checking electrical appliances) and mentally (prayers).

Their implementation temporarily reduces anxiety, but at the same time increases the likelihood of repeating obsessive actions in the near future again.

People with an unstable psyche most often fall into this state, are exposed to frequent stress or are going through difficult periods in life:

From the point of view of cognitive psychology, the disorder is explained as the patient’s inability to understand himself, a violation of a person’s connection with his own thoughts. People with obsessive-compulsive disorder are often unaware of the deceptive meaning they give to their fears.

Patients, out of fear of their own thoughts, try to get rid of them as soon as possible, using defensive reactions. The reason for the intrusiveness of thoughts is their false interpretation, giving them great significance and catastrophic meaning.

Such distorted perceptions appear as a result of attitudes formed in childhood:

1. Basal anxiety, arising due to a violation of the sense of security in childhood (ridicule, overprotective parents, manipulation).
2. Perfectionism, consisting in the desire to achieve the ideal, non-acceptance of one’s own mistakes.
3. Exaggerated feeling human responsibility for the impact on society and the safety of the environment.
4. Hypercontrol mental processes, conviction in the materialization of thoughts, their negative impact on oneself and others.

Also, obsessive-compulsive disorder can be caused by trauma received in childhood or a more conscious age and constant stress.

In most cases of the formation of the disease, patients succumbed to the negative influence of the environment:

• were subjected to ridicule and humiliation;
• entered into conflicts;
• worried about the death of loved ones;
• could not solve problems in relationships with people.

Symptoms

Impulsive (obsessive) compulsive disorder is characterized by certain manifestations and symptoms. The main feature of mental deviation can be called a strong aggravation in crowded places.

This is due to the high likelihood of panic attacks arising from fear:

• pollution;
• pickpocketing;
• unexpected and loud sounds;
• strange and unknown smells.

The main symptoms of the disease can be divided into certain types:

Obsessions are negative thoughts that can be presented as:

• words;
• individual phrases;
• full dialogues;
• proposals.

Such thoughts are obsessive and cause very unpleasant emotions in the individual.

Repeated images in a person’s thoughts are most often represented by scenes of violence, perversion and other negative situations. Intrusive memories are memories of life events where the individual felt shame, anger, regret or remorse.

Obsessive-compulsive disorder impulses are urges to commit negative actions (enter into conflict or use physical force against others).

The patient fears that such impulses may be realized, which is why he feels shame and regret. Obsessive thoughts are characterized by constant disputes between the patient and himself, in which he considers everyday situations and gives arguments (counter-arguments) to solve them.

Obsessive doubt in committed actions concerns certain actions and doubts about their correctness or incorrectness. Often this symptom is associated with the fear of violating certain regulations and causing harm to others.

Aggressive obsessions are obsessive ideas associated with prohibited actions, often of a sexual nature (violence, sexual perversions). Often such thoughts are combined with hatred of loved ones or popular personalities.

Phobias and fears that are most common during an exacerbation of obsessive-compulsive disorder include:

Often, phobias can contribute to the emergence of compulsions - defensive reactions that reduce anxiety. Rituals involve both the repetition of mental processes and the manifestation of physical actions.

Often, among the symptoms of the disorder one can note motor disorders, in the event of which the patient does not realize the intrusiveness and unreasonableness of the movements being reproduced.

Symptoms of deviation include:

• nervous tics;
• certain gestures and movements;
• reproduction of pathological repetitive actions (biting a cube, spitting).

Diagnostic methods

A mental disorder can be diagnosed using several tools and methods for identifying the disease.

When designating methods for studying impulsive (obsessive) compulsive syndrome, first of all, diagnostic criteria for deviation are distinguished:

1. Repeated occurrence of obsessive thoughts in the patient, accompanied by the manifestation of compulsions within two weeks.

2. The patient’s thoughts and actions have special characteristics:

• they, in the patient’s opinion, are considered his own thoughts not imposed by external circumstances;
• they are repeated for a long time and cause negative emotions in the patient;
• a person tries to resist obsessive thoughts and actions.

3. Patients feel that emerging obsessions and compulsions limit their lives and interfere with productivity.

4. The formation of the disorder is not associated with diseases such as schizophrenia or personality disorders.

A screening questionnaire for obsessive disorders is often used to identify the disease. It consists of questions that the patient can answer positively or negatively. As a result of passing the test, an individual’s tendency to obsessive disorder is revealed by the predominance of positive answers over negative ones.

Equally important for diagnosing the disease are the consequences of the symptoms of the disorder:

Among the methods for diagnosing obsessive-compulsive disorder, analysis of the patient’s body using computed tomography and positron emission tomography is of great importance. As a result of the examination, the patient may exhibit signs of internal brain atrophy (death of brain cells and its neural connections) and increased cerebral blood supply.

Can a person help himself?

If symptoms of obsessive-compulsive disorder occur, the patient should carefully analyze his condition and contact a qualified specialist.

If the patient is temporarily unable to visit a doctor, then it is worth trying Reduce symptoms on your own with the following tips:

Psychotherapy methods

Psychotherapy is the most effective treatment for obsessive-compulsive disorder. Unlike the drug method of suppressing symptoms, therapy helps you independently understand your problem and weaken the disease for a sufficiently long time, depending on the mental state of the patient.

Cognitive behavioral therapy has been found to be the most appropriate treatment for obsessive-compulsive disorder. At the very beginning of the sessions, the patient becomes familiar with the general concepts and principles of therapy, and after some time The study of the patient’s problem is divided into several blocks:

• the essence of the situation causing a negative mental reaction;
• the content of obsessive thoughts and ritual actions of the patient;
• the patient's intermediate and deep beliefs;
• the fallacy of deep-seated beliefs, the search for life situations that provoked the appearance of obsessive ideas in the patient;
• the essence of the patient’s compensatory (protective) strategies.

After analyzing the patient’s condition, a psychotherapy plan is formed, during which the person suffering from the disorder learns:

• use certain self-control techniques;
• analyze your own condition;
• monitor your symptoms.

Special attention is paid to working with the patient’s automatic thoughts. Therapy consists of four stages:

Psychotherapy develops the patient's awareness and understanding of his own condition, does not have a negative effect on the patient's body, and generally demonstrates a very beneficial effect on the treatment process of obsessive-compulsive disorder.

Drug treatment: drug lists

Impulsive (obsessive) compulsive disorder often requires medical treatment through the use of certain medications. Carrying out therapy requires a strictly individual approach, which takes into account the patient’s symptoms, his age and the presence of other diseases.

The following medications are used only as prescribed by a doctor and taking into account special factors:

Treatment at home

It is impossible to accurately determine a universal method of getting rid of the disease, because each patient suffering from the disorder requires an individual approach and special treatment methods.

There are no specific instructions for self-recovery of obsessive-compulsive disorder at home, but it is possible to highlight general tips that can help alleviate symptoms of the disease and avoid deterioration of mental health:

Rehabilitation

Obsessive-compulsive disorder is characterized by irregular changes, so, regardless of the type of treatment, any patient can experience improvement over time.

After supportive conversations that instill self-confidence and hope for recovery, and psychotherapy, where techniques for protecting against obsessive thoughts and fears are developed, the patient feels much better.

After the recovery stage, social rehabilitation begins, which includes certain programs for teaching the abilities necessary for a comfortable sense of self in society.

Such programs include:

• developing communication skills with other people;
• training in the rules of communication in the professional sphere;
• developing an understanding of the characteristics of everyday communication;
• development of correct behavior in everyday situations.

The rehabilitation process is aimed at building mental stability and building personal boundaries for the patient, gaining faith in his own strength.

Complications

Not all patients manage to recover from obsessive-compulsive disorder and undergo full rehabilitation.

Experience has shown that patients with the disease who are in the recovery stage are prone to relapse (resumption and exacerbation of the disease), therefore, only as a result of successful therapy and independent work on oneself is it possible to get rid of the symptoms of the disorder for a long time.

The most likely complications of obsessive-compulsive disorder include:

Prognosis for recovery

Impulsive (obsessive) compulsive disorder is a disease that most often occurs in a chronic form. Complete recovery for such a mental disorder is quite rare.

With a mild form of the disease, the results of the treatment begin to be observed no earlier than 1 year of regular therapy and possible use of medications. Even five years after the diagnosis of the disorder, the patient may experience anxiety and some symptoms of the disease in his daily life.

A severe form of the disease is more resistant to treatment, so patients with this degree of disorder are prone to relapse, the recurrence of the disease after an apparent complete recovery. This is possible due to stressful situations and overwork of the patient.

Statistics show that the vast majority of patients experience improvements in their mental state after a year of treatment. Through behavioral therapy, a significant reduction of symptoms by 70% is achieved.

In severe cases of the disease, a negative prognosis for the disorder is possible, which manifests itself in the appearance of:

• negativism (behavior when a person speaks out or behaves demonstratively opposite to what is expected);
• obsessions;
• severe depression;
• social isolation.

Modern medicine does not identify a single method of treating impulsive (obsessive) compulsive disorder that would be guaranteed to relieve the patient of negative symptoms forever. To regain mental health, the patient must consult a doctor in a timely manner and be prepared to overcome internal resistance on the path to successful recovery.

Article format: Vladimir the Great

Video about OCD syndrome

The doctor will tell you about obsessive-compulsive disorder:

Obsessive-compulsive disorder (OCD) is one of the common syndromes of psychological illness. A severe disorder is characterized by the presence of disturbing thoughts (obsessions) in a person, which provoke the appearance of constantly repeating certain ritual actions (compulsions).

Obsessive thoughts conflict with the patient’s subconscious, causing him depression and anxiety. And manipulative rituals designed to relieve anxiety do not bring the expected effect. Is it possible to help a patient, why does this condition develop, turning a person’s life into a painful nightmare?

Obsessive-compulsive disorder causes suspiciousness and phobias in people

Every person has encountered this type of syndrome in their life. People call this an “obsession.” Such ideas-states are divided into three general groups:

1. Emotional. Or pathological fears that develop into a phobia.
2. Intelligent. Some thoughts, fantastic ideas. This includes intrusive disturbing memories.
3. Motor. This type of OCD manifests itself in the unconscious repetition of certain movements (wiping the nose, earlobes, frequent washing of the body, hands).

Doctors classify this disorder as a neurosis. The name of the disease “obsessive-compulsive disorder” is of English origin. Translated it sounds like “obsession with an idea under duress.” The translation very accurately defines the essence of the disease.

OCD negatively affects a person's standard of living. In many countries, a person with such a diagnosis is even considered disabled.

People encountered obsessive-compulsive disorder back in the dark Middle Ages (at that time this condition was called obsession), and in the 4th century it was classified as melancholy. OCD was periodically recorded as paranoia, schizophrenia, manic psychosis, and psychopathy. Modern doctors classify pathology as neurotic conditions.

Obsessive-compulsive disorder is amazing and unpredictable. It is quite common (statistically, it affects up to 3% of people). Representatives of all ages are susceptible to it, regardless of gender and level of social status. Studying the features of this disorder for a long time, scientists made interesting conclusions:

• It has been noted that people suffering from OCD have suspiciousness and increased anxiety;
• obsessive states and attempts to get rid of them with the help of ritual actions can occur periodically or torment the patient for whole days;
• the disease has a bad effect on a person’s ability to work and perceive new information (according to observations, only 25-30% of patients with OCD can work productively);
• Patients’ personal lives also suffer: half of people diagnosed with obsessive-compulsive disorder do not create families, and in the case of illness, every second couple breaks up;
• OCD more often attacks people who do not have a higher education, but representatives of the intelligentsia and people with a high level of intelligence are extremely rare with this pathology.

How to recognize the syndrome

How to understand that a person suffers from OCD and is not subject to ordinary fears or is not depressed and protracted? To understand that a person is sick and needs help, pay attention to the typical symptoms of obsessive-compulsive disorder:

Intrusive thoughts. Anxious thoughts that constantly follow the patient often concern fear of illness, germs, death, possible injuries, and loss of money. From such thoughts, an OCD patient becomes panicked, unable to cope with them.

Constant anxiety. Being caught up in obsessive thoughts, people with obsessive-compulsive disorder experience an internal struggle with their own condition. Subconscious “eternal” anxieties give rise to a chronic feeling that something terrible is about to happen. It is difficult to remove such patients from a state of anxiety.

Repeating movements. One of the most striking manifestations of the syndrome is the constant repetition of certain movements (compulsions). Obsessive actions come in a wide variety. The patient can:

• count all the steps of the ladder;
• scratching and twitching certain parts of the body;
• constantly wash your hands for fear of contracting the disease;
• synchronously arrange/lay out objects and things in the closet;
• come back many times to once again check whether household appliances, lights are turned off, and whether the front door is closed.

Often, impulsive-compulsive disorder requires patients to create their own system of checks, some kind of individual ritual of leaving the house, going to bed, and eating. Such a system can sometimes be very complex and confusing. If something in it is violated, a person begins to carry it out again over and over again.

The entire ritual is carried out deliberately slowly, as if the patient is delaying time in fear that his system will not help, and internal fears will remain.

Attacks of the disease are more likely to occur when a person finds himself in the middle of a large crowd. He immediately awakens with disgust, fear of illness and nervousness from the feeling of danger. Therefore, such people deliberately avoid communication and walking in crowded places.

Causes of pathology

The first causes of obsessive-compulsive disorder usually appear between the ages of 10 and 30. By the age of 35-40, the syndrome is already fully formed and the patient has a pronounced clinical picture of the disease.

But why does obsessive neurosis not come to all people? What must happen for the syndrome to develop? According to experts, the most common culprit of OCD is an individual characteristic of a person’s mental make-up.

Doctors divided provoking factors (a kind of trigger) into two levels.

Biological provocateurs

The main biological factor causing obsessive-compulsive disorder is stress. A stressful situation never goes away without leaving a trace, especially for people prone to OCD.

In susceptible individuals, obsessive-compulsive disorder can even cause overwork at work and frequent conflicts with relatives and colleagues. Other common biological causes include:

• heredity;
• traumatic brain injuries;
• alcohol and drug addiction;
• disturbance of brain activity;
• diseases and disorders of the central nervous system;
• difficult birth, trauma (for the child);
• complications after severe infections affecting the brain (after meningitis, encephalitis);
• metabolic disorder, accompanied by a drop in the levels of the hormones dopamine and serotonin.

Social and psychological reasons

• family serious tragedies;
• severe psychological trauma from childhood;
• parental long-term overprotection of the child;
• long work accompanied by nervous overload;
• strict puritanical, religious education, based on prohibitions and taboos.

The psychological state of the parents themselves also plays an important role. When a child constantly observes their manifestations of fear, phobias, and complexes, he himself becomes like them. The problems of loved ones seem to be “drawn in” by the baby.

When to see a doctor

Many people suffering from OCD often do not even understand or perceive the existing problem. And even if they notice strange behavior, they do not appreciate the seriousness of the situation.

According to psychologists, a person suffering from OCD must undergo a full diagnosis and begin treatment. Especially when obsessive states begin to interfere with the lives of both the individual and those around him.

It is imperative to normalize the condition, because OCD has a strong and negative impact on the well-being and condition of the patient, causing:

• depression;
• alcoholism;
• isolation;
• thoughts of suicide;
• rapid fatigue;
• mood swings;
• decline in quality of life;
• growing conflict;
• gastrointestinal disorder;
• constant irritability;
• difficulty making decisions;
• loss of concentration;
• abuse of sleeping pills.

Diagnosis of the disorder

To confirm or refute the mental disorder OCD, a person should consult a psychiatrist. After a psychodiagnostic conversation, the physician will differentiate the presence of pathology from similar mental disorders.

The psychiatrist takes into account the presence and duration of compulsions and obsessions:

1. Obsessive states (obsessions) acquire a medical basis when they are stable, regularly repeated and intrusive. Such thoughts are accompanied by feelings of anxiety and fear.
2. Compulsions (obsessive actions) arouse the interest of a psychiatrist if, at the end of them, a person experiences a feeling of weakness and fatigue.

Attacks of obsessive-compulsive disorder should last for an hour, accompanied by difficulty communicating with others. To accurately identify the syndrome, doctors use a special Yale-Brown scale.

Treatment of obsessive-compulsive disorder

Doctors are unanimously inclined to believe that it is impossible to cope with obsessive-compulsive disorder on your own. Any attempts to take control of your own consciousness and defeat OCD lead to a worsening of the condition. And the pathology is “driven” into the crust of the subconscious, destroying the patient’s psyche even more.

Mild form of the disease

Treatment of OCD in the initial and mild stages requires constant outpatient monitoring. During the course of psychotherapy, the doctor identifies the reasons that provoked obsessive-compulsive neurosis.

The main goal of treatment consists of establishing a trusting relationship between the sick person and his close circle (relatives, friends).

Treatment of OCD, including combinations of psychological correction methods, may vary depending on the effectiveness of the sessions.

Treatment of complicated OCD

If the syndrome occurs in more complex stages, accompanied by the patient’s obsessive phobia of the possibility of contracting diseases, fears of certain objects, treatment becomes more complicated. Specific medications (in addition to psychological correction sessions) enter the fight for health.

Medicines are selected strictly individually, taking into account the state of health and concomitant diseases of the person. The following groups of medications are used in treatment:

• anxiolytics (tranquilizers that relieve anxiety, stress, panic);
• MAO inhibitors (psychoenergizing and antidepressant medications);
• atypical antipsychotics (antipsychotics, a new class of drugs that relieve symptoms of depression);
• serotonergic antidepressants (psychotropic drugs used in the treatment of severe depression);
• antidepressants of the SSRI category (modern third-generation antidepressants that block the production of the hormone serotonin);
• beta blockers (medicines whose action is aimed at normalizing cardiac activity, problems with which are observed during attacks of acute respiratory syndrome).

Prognosis of the disorder

OCD is a chronic disease. This syndrome is not characterized by complete recovery, and the success of therapy depends on the timely and early start of treatment:

1. In mild forms of the syndrome, recession (relief of manifestations) is observed 6-12 months after the start of therapy. Patients may remain with some symptoms of the disorder. They are expressed in a mild form and do not interfere with everyday life.
2. In more severe cases, improvement becomes noticeable 1-5 years after the start of treatment. In 70% of cases, obsessive-compulsive disorder is clinically curable (the main symptoms of the pathology are relieved).

OCD in severe, advanced stages is difficult to treat and prone to relapse. Aggravation of the syndrome occurs after discontinuation of medications, against the background of new stress and chronic fatigue. Cases of complete recovery of OCD are very rare, but they are diagnosed.

With adequate treatment, the patient is guaranteed stabilization of unpleasant symptoms and relief of severe manifestations of the syndrome. The main thing is not to be afraid to talk about the problem and start therapy as early as possible. Then the treatment of neurosis will have a much greater chance of complete success.

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 emotional and financial deterioration. 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 red 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 drive them to perform compulsive behaviors 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.”

Reasons

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 neurological development contributing to 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 second-line treatment for adults with obsessive-compulsive disorder (OCD) who have mild functional impairment and 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) plus 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 illness." 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.