Obsessive-compulsive disorder is a psychological disorder of a neurotic level, which is characterized by involuntary obsessions. disturbing thoughts that arise in the form of an obsession. This is followed by an obsession behavior - repetitive actions purpose reducing the level of anxiety.

A striking example of the manifestation such neurosis are rituals, for example, repeated washing of the head, hands, swinging the lower limbs, checking the doors (if they are exactly locked), twitching the muscles of the body, etc. The person seems to be stuck on an obsessive thought or idea that causes anxiety, and literally falls into a stupor: he begins to repeat the same action over and over again until it brings the desired relief. If you suppress compulsive (forced) actions, anxiety can become more pronounced.

The disease is diagnosed with the same frequency in women and men (approximately 2.5% of the population), but it has been found that it occurs more often in people with high intellectual abilities. Despite the complex clinical picture, OCD disease treatable. For this, complex therapy is carried out, consisting of medications and cognitive-behavioral psychotherapy. It is very difficult to cope with the disease on your own.

The main forms of neurosis of obsessive thoughts

obsessive-compulsive disordercan manifest itself in one of three forms: single, relapsing or progressive. Each of them has a distinctive flow pattern. It is worth mentioning right away that it is obsessive thoughts (obsessions) that provoke a series of obsessive actions (compulsions), regardless of kind diseases. According to statistics, neurosis in 20% of patients is limited only to obsessive thoughts. In rare cases, obsessions can be caused by compulsions.

Single

Under a single form of OCD understand the following clinical picture: the patient has signs of neurosis for months or years without changing the level of intensity. As they age, they may pass .

remitting

This form of the disease is characterized by an exacerbation or attenuation of symptoms. This does not allow a person to interact normally with society, to engage in ordinary work activities. As a rule, the patient is afraid of the next attacks and isolates himself as much as possible from provoking factors, even if this means not leaving the house for many months.

progressive

For a certain time, the patient has an aggravation of symptoms, namely:

• anxiety and fears become more widespread;
• new ones are joining phobias , fears and rituals that were not previously in the anamnesis.

If you do not start treatment, the mental state of a person deteriorates sharply, anxiety and depressive manifestations occur. He is so obsessed with disturbing thoughts and actions that it can harm his health.

Peak diagnostics obsessive neurosis occurs during adolescence. During this period, it is still impossible to give a clear classification of the disease, so neurosis is assessed based on the predominance of phobias, ideas or movements:

• Phobic. Teenager with OCD, phobias or specific fears dominate.
• Obsessive. Such a neurosis is more typical for adolescence. It consists in the predominance of obsessive repetitive thoughts - ideas, plans, concepts.
• Compulsive. In this case, compulsive actions predominate over obsessions. This form of OCD is sometimes compared to autism.

Symptoms of Obsessive-Compulsive Syndrome

Due to the fact that OCD most often begins to manifest itself in adolescence (although neurosis is possible in children 3-12 years), then the first symptoms are noticed by parents or doctors, but already several years after the onset of the disease.

There is a certain list of characteristics that describe the disease. If, after a conversation and examination of the patient, from 4 to 8 points are revealed, he is most often given OCD diagnosis . You yourself can carry out such test Here is a list of those features:

• Life goals for a person cease to be important due to strong anxiety about specific details, the order of things, the schedule of the day.
• Perfectionism is manifested, which does not allow to complete some task to the end (for example, two hours of washing one plate out of twenty).
• Excessive industriousness, work productivity up to the complete exclusion of rest and friends from life. At the same time, such labor assertiveness is not justified by economic reasons, in other words, a person works for wear and tear not for money, but for other personal goals.
• Personality characterized by scrupulousness, over consciousness, firm views on the concepts of ethics and morality.
• A person cannot independently (of his own free will) get rid of from worthless, spoiled things, even if they have no sentimental value.
• Unwillingness to delegate any powers to others people until they prove that they can do everything according to the rules of personality.
• Fear of spending money (for example, on yourself, children, parents) because of a deep conviction that they should be safe until some kind of disaster occurs.
• The personality shows the inability to adapt to new conditions and obvious stubbornness.

If a person has a predisposition to anxiety, then the development of OCD usually begins closer to 5 years. This is usually the time when parents start talking. to kid that he must do everything right (wash his hands, sit at the table, fold toys, etc.). Realizing that any business should be brought to perfection and act as an example, the still unformed little personality is overloaded with the duty and burden of responsibility that its parents have placed on it. If there is a predisposition to OCD, then such an attitude in childhood will certainly leave its mark on the psyche and will make itself felt in adulthood.

Due to strong pressure from parents, children, becoming adults , cannot learn to relax, rest, satisfy their desires. Often, OCD is diagnosed in one or both parents, who also did not know how to fully relax, devoting themselves exclusively to work and household chores. From childhood, a child adopts a model of behavior that becomes an internal norm (“it is customary in our family”). Here are a few tell-tale signs of an obsessive-compulsive personality:

• painful reaction to criticism;
• pronounced perfectionism;
• doubts and fears;
• obsessive account.

A person with OCD thinks: “If I am criticized, it means that I did not manage to complete the task better and faster than others, therefore I am guilty and do not deserve to be treated well.” The tension that patients experience in order to achieve their goal is sometimes palpable almost at the physical level. If they are interrupted, they immediately begin to experience anxiety.

Anxiety and guilt pester them especially strongly if negative thoughts (including sexual ones), ideas, reactions, feelings intrude into the usual daily routine. To alleviate the condition, a person can resort to small rituals, for example:

• count (beads in a bag, the number of red traffic light switches, matches in a box, etc.);
• perform tasks/actions in a certain order so that it brings a sense of control and relieves anxiety.

A person with obsessive thoughts is prone to idealization, so he himself can act as a critic if someone from relatives or friends does not meet the expected standards. This leads to tensions in the family, difficulties in building friendships. When OCD strikes early, it is not uncommon for people to remain single and romantically deprived for many years.

Causes of OCD disorder

According to experts,obsessive-compulsive neurosiscan be caused by three factors at once: biological, psychological and social, although the exact causes of the disease have not yet been established. Thus, the disease determines upbringing, character and personality traits in general, hereditary predisposition, the presence or absence of neurological problems, and the environment.

All of the above gives rise to obsessive thoughts and phobias, which subsequently lead to rituals. The most common phobias among OCD patients are mysophobia (fear of getting dirty, leading to constant washing of hands, up to skin abrasion), carcinophobia (panic fear of getting cancer), claustrophobia (fear of enclosed spaces), agoraphobia (fear of large open spaces and crowded places ), xenophobia (fear of everything new and unknown).

Personality Features

These include traits such as increased receptivity and sensitivity, a tendency to think more than feel.

Upbringing

Neurosis can be provoked by a strict upbringing with an emphasis on a sense of duty and responsibility, excessive demands on the child's academic performance, forced adherence to religion, and excessive strictness in educational institutions.

Heredity

Approximately 50% of patients have a relative who also has OCD. If among your loved ones there is such diagnosis in history, it is worth thinking about visiting a specialized specialist.

neurological problems

One common cause is changes in neurotransmitter metabolism. In case of violation of the metabolism of serotonin, dopamine, gamma-aminobutyric acid, norepinephrine, the transmission of synaptic impulses worsens, and as a result, the activity of interaction between the sections of the central nervous system. Other changes in the brain are also possible, such as conduction disturbances and pathological CT findings.

Stress and psychological trauma

If a person has a predisposition to develop obsessive-compulsive disorder, then constant stress or deep shock (death of a loved one, car accident) can trigger the pathological process. Without a biological predisposition, the reaction of the psyche will be different.

Treatment for obsessive-compulsive disorder

Diagnosis and therapy of the disease is carried out by two main specialists - a psychiatrist and a psychotherapist.obsessive statewell amenable to treatment with an integrated approach. The doctor is studying history patient's illness, evaluates his current condition and stage development of OCD, after which he selects the optimal treatment regimen, consisting of:

• Medical funds . All groups of drugs are prescribed by a specialist on an individual basis, taking into account the age of the patient and the intensity of symptoms.
• Cognitive Behavioral Therapy. Its essence is to teach the patient to recognize erroneous and illogical thoughts, and then replace them with logical ones. Work is also underway to form behavioral patterns that can displace obsessive behavior.
• Psychotherapy. This is an individual approach that takes into account the causes of the disease (emotional disturbances, shocks, a traumatic event, etc.) and the scope of the manifestation of the main symptoms (work, family, life).

Treatment, as a rule, is carried out at home, but in severe cases, hospitalization is required in a psychoneurological dispensary for complex therapy in a hospital setting. For a successful cure, it is important to recognize the disease in time, since the aggravation of the relapsing and progressive forms of OCD leads to pronounced problems in the social, personal life of a person and in his work activity.

Every person is visited by unpleasant or frightening thoughts, but if most can easily dismiss them, then for some it is impossible.

Such people ponder why such a thought occurred to them, returning to it again and again. They can get rid of it only by performing certain actions.

In psychiatry, this is called obsessive-compulsive disorder (OCD) or, in foreign literature, obsessive compulsive.

Obsessions are frightening thoughts, images or impulses that do not leave a person. Compulsions are certain actions that help temporarily eliminate obsessive thoughts and reduce anxiety. The condition can progress, causing the person to commit more and more compulsions, be chronic or episodic.

Common intrusive thoughts

The most common obsessions and related compulsions are:

1. Fear of contracting disease or fear of germs. In order to prevent this, a person tries to wash his hands or take a shower as often as possible, wash clothes, thoroughly wash all surfaces with which he comes into contact. This can take many hours every day.
2. Fear of harming yourself or your loved ones. The patient tries not to be alone or with the person whom, as he believes, he can harm. Hides potentially dangerous things, such as knives, ropes, heavy objects.
3. Fear that the right thing will not be. The person double-checks his pockets and bags repeatedly to see if he has forgotten to put documents, essentials, or medicines.
4. Order and symmetry. It should be in a room where everything is in its place and subject to certain rules. They are very careful to ensure that even insignificant objects melt in a certain order, for example, set in height or symmetrically. And if someone touched or incorrectly put the folder on the table, the person experiences emotional stress.
5. superstition. A person may be afraid that he will not be lucky if he does not perform a certain ritual. So an OCD patient, leaving the house, had to put on “happy” shoes, look in the mirror twice and stick out his tongue, pull the door handle seventeen times. If something unpleasant happened to him, then he increased the number of actions.
6. Thoughts that are forbidden by religion or morality. In order to drive away images or inappropriate thoughts, a person can read a prayer or carry donations to the church, giving the latter.
7. Thoughts of a sexual nature with elements of cruelty. A person tries to avoid intimacy out of fear of committing an unacceptable act against a partner.

Clinical manifestations of OCD

Compulsive-obsessional disorder has characteristic symptoms:

• thoughts should be perceived as one's own, and not as a voice from above or another person;
• the patient resists these thoughts, tries unsuccessfully to switch to others.
• the thought that what is presented can happen frightens a person, makes one feel shame and guilt, causes tension and loss of activity;
• the obsession often recurs.

OCD in its purest form

OCD may be dominated by compulsions or obsessions, but pure so-called OCD also occurs.

Those suffering from this disease admit that they have obsessive thoughts that are contrary to their beliefs and values, but believe that they do not have compulsive behavior, that is, there are no ritual actions. In order to get rid of thoughts that cause fear and shame, they can spend hours explaining to themselves why they should not pay attention to it.

When working through the problem, it turns out that they perform certain actions to get rid of tension. These actions are not obvious to others. This may be reading a prayer or spell, counting, clicking joints, stepping from foot to foot, shaking the head.

Causes of the disorder

Impulsive-compulsive disorder is believed to be caused by a combination of biological, social, and psychological factors.

Modern medicine is able to visualize the anatomy and physiology of the human brain. Studies have shown that there are a number of significant differences in the way the brain works in people with OCD.

There are differences in the connections of various departments, for example, the anterior part of the frontal lobe, the thalamus and striatum, the anterior cingulate cortex.

Anomalies were also found in the transmission of nerve impulses between the synapses of neurons. Scientists have identified a mutation in the genes of serotonin and glutamate carriers. As a result of the anomaly, the neurotransmitter is processed even before it transmits an impulse to another neuron.

A quarter of people with the disorder have relatives with the same disorder, indicating genetics.

Group A streptococcal infection can cause OCD by causing malfunction and inflammation of the basal ganglia.

Psychologists say that people who have developed obsessive-compulsive personality disorder have some features of thinking:

1. Confident that they can control everything even your own thoughts. If a thought appeared, then it was in the subconscious and the brain had been thinking about it for a long time, and, accordingly, this is part of the personality.
2. Hyperresponsibility. A person is responsible not only for actions, but also for thoughts.
3. Belief in the materiality of thought. If a person imagines something terrible, then it will happen. He believes that he is capable of inviting trouble.
4. perfectionism. A person has no right to make a mistake. He must be perfect.

Compulsive personality disorder often occurs in a person who was brought up in a family where parents controlled all areas of the child's life, making excessive demands, and sought ideal behavior from him.

In the presence of the above two components, a stressful situation, overwork, overstrain or abuse of psychotropic substances can serve as an impetus for the manifestation of the disorder. Stress can cause moving, job change, threat to life and health, divorce, death of a loved one.

The actions of a person with obsessive-compulsive disorder are cyclical.

First, a certain thought arises, which frightens and makes you feel shame and guilt for it. Then there is a concentration on this thought against desire. As a result, mental stress and increasing anxiety appear.

A person's psyche finds a way to calm down by performing stereotyped actions that they think will save them. Thus, short-term relief occurs. But the feeling of his abnormality due to the thought that has arisen does not leave him and he returns to it again. The cycle gets a new turn.

What influences the development of neurosis

The more often the patient resorts to ritual actions, the more he becomes dependent on them. It's like a drug.

Reinforce disorders and avoidance of situations or activities that cause obsessions. A person, trying not to face a potentially dangerous situation, still thinks about it and is convinced of his abnormality.

The situation can be aggravated by the behavior of loved ones who call the person suffering from the disorder crazy or forbid performing the ritual.

After all, if he is crazy, then he can really carry out the actions that he is so afraid of. And the imposition of a ban on compulsions leads to an increase in anxiety. But there is also the opposite situation, when relatives are involved in the performance of the ritual, thereby confirming its necessity.

Diagnosis and treatment

The symptoms of obsessive-compulsive disorder are similar to those of schizophrenia. Therefore, a differential diagnosis must be made. Especially if the obsessive thoughts are unusual and the compulsions are eccentric. What is important is whether thoughts are perceived as one's own or as imposed.

Also, depression often accompanies OCD. If they are equally strong, then it is advised to consider depression as primary.

The obsessive-compulsive disorder test or the Yale-Brown scale is used to determine the severity of the symptoms of the disorder. It consists of two parts of five questions: the first part allows you to understand how often obsessive thoughts appear and whether they can be attributed to OCD; the second part analyzes the impact of compulsions on everyday life.

If obsessive and compulsive disorder are not very pronounced, then a person can try to cope on their own. To do this, you need to learn how to switch your attention to other actions. For example, start reading a book.

Postpone the ritual for 15 minutes, and gradually increase the delay time and reduce the number of ritual actions. Thus, you will understand that you can calm down without performing stereotypical actions.

With moderate severity and above, you need to seek help from any of the specialists: a psychotherapist, psychologist, psychiatrist.

With a strong severity of the disorder, the psychiatrist will make a diagnosis and prescribe drug treatment. Medications to relieve the condition are prescribed - serotonin reuptake antidepressants or selective serotonin reuptake inhibitors. Also, atypical ones are used to control symptoms. They can help you calm down and reduce your anxiety levels.

However, drug treatment for compulsive obsessive disorder does not have a permanent effect. After the end of the intake OCD drugs are coming back. Most in an efficient way is psychotherapy. With its help, almost 75% of those who seek help recover.

The therapist may offer: cognitive-behavioral therapy, exposure, hypnosis.

An exposure technique that prevents a reaction is effective in OCD. It lies in the fact that a person, faced with his experiences in a controlled situation, learns to cope with them without the usual reaction of avoidance.

So, to treat a person with a fear of germs, they may offer to touch the handrail in the subway or the elevator button and not wash their hands for as long as possible. The tasks gradually become more difficult and are asked to reduce the number of actions and the duration of the ritual. uh

Over time, the patient gets used to and ceases to be afraid. However, not everyone can handle this technique. More than half of patients refuse it because of strong feelings.

Cognitive therapy helps the patient see the irrationality of their fears, disassemble the way of thinking and realize its fallacy. Teaches effective ways switching attention and adequately respond to obsessive thoughts without the use of a ritual.

Family therapy can help the patient. Thanks to her, family members will be able to better understand the causes of the disorder and learn how to behave if obsessions begin. After all, close people can both help to cope with the problem, and harm their behavior.

Group psychotherapy will provide support and approval, reduce feelings of inferiority. The successes of a comrade in misfortune are highly motivating. And the person understands that he can cope with the problem.

Let the trouble pass by everyone

Obsessive-compulsive syndrome can and should be stopped on the outskirts of mental and neurological health, for this it is necessary:

• applying techniques to deal with stress;
• timely rest, avoid overwork;
• timely resolution of intrapersonal conflicts.

OCD is not a mental illness, as it does not lead to personality changes, it is a neurotic disorder. It is reversible and proper treatment disappears completely.

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

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

Obsessive-compulsive disorder causes suspiciousness and phobias in people

General information about the disorder

Every person has experienced this type of syndrome in their life. This is popularly known as 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 kind of OCD is manifested in the unconscious repetition of some movements (wiping the nose, earlobes, frequent washing of the body, hands).

Doctors refer to this disorder as a neurosis. The name of the disease "obsessive-compulsive disorder" is of English origin. In translation, it sounds like "obsession with an idea under duress." Translation very accurately defines the essence of the disease.

OCD has a negative impact on a person's standard of living. In many countries, a person with such a diagnosis is even considered disabled.

OCD is "an obsession with an idea under duress"

People encountered obsessive-compulsive disorders back in the dark Middle Ages (at that time this condition was called obsession), and in the 4th century it was ranked as melancholy. OCD has been periodically written down as paranoia, schizophrenia, manic psychosis, psychopathy. Modern doctors refer pathology to neurotic conditions.

Obsessive Compulsive Syndrome is amazing and unpredictable. It is quite common (according to statistics, up to 3% of people suffer from it). Representatives of all ages are subject to it, regardless of gender and level of social status. studying for a long time features of this disorder, scientists made curious conclusions:

• it is 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 OCD patients can work productively);
• in patients, personal life also suffers: 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 world of intellectuals and people with high level intelligence are extremely rare with such a 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:

obsessive thoughts. Anxious thoughts that relentlessly follow the patient are more often related to fear of disease, germs, death, possible injury, loss of money. From such thoughts, the OCD sufferer becomes panic-stricken, unable to cope with them.

Components of obsessive-compulsive disorder

Constant anxiety. Being held captive by obsessive thoughts, people with obsessive-compulsive disorder experience an internal struggle with their own condition. Subconscious "eternal" anxiety gives rise to a chronic feeling that something terrible is about to happen. It is difficult to bring such patients out of a state of anxiety.

Repetition of movements. One of the striking manifestations of the syndrome is the constant repetition of certain movements (compulsions). Obsessive actions are rich in variety. The patient may:

• count all the steps of the stairs;
• scratching and twitching certain parts of the body;
• wash your hands constantly for fear of contracting a disease;
• synchronously arrange / lay out objects, things in the closet;
• repeatedly return back to once again check whether the Appliances, light, is the front door closed.

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

The whole 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 often occur when a person is in the middle of a large crowd. He instantly wakes up disgust, fear of illness and nervousness from a sense of danger. Therefore, such people deliberately avoid communication and walks 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.

Frequent couples (thought-ritual) in OCD

But why doesn't obsessional neurosis come to all people? What must happen for the syndrome to develop? According to experts, the most common culprit of OCD is an individual feature of a person’s mental makeup.

Provoking factors (a kind of trigger) doctors divided into two levels.

Biological provocateurs

The main biological factor causing obsessive-compulsive disorders is stress. A stressful situation never goes unnoticed, especially for people predisposed 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 injury;
• alcohol and drug addiction;
• violation of brain activity;
• diseases and disorders of the central nervous system;
• difficult childbirth, trauma (for a child);
• complications after severe infections affecting the brain (after meningitis, encephalitis);
• a metabolic disorder (metabolism), accompanied by a drop in the level of the hormones dopamine and serotonin.

Social and psychological reasons

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

An important role is played by the psychological state of the parents themselves. When a child constantly observes manifestations of fear, phobias, complexes from their side, 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 who suffer from OCD often do not even understand or accept the problem. And if they notice strange behavior behind themselves, they do not appreciate the seriousness of the situation.

According to psychologists, a person suffering from OCD should definitely undergo a full diagnosis and be taken for treatment. Especially when obsessive states begin to interfere with the life of both the individual and others.

It is imperative to normalize the condition, because the OCD disease strongly and negatively affects the well-being and condition of the patient, causing:

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

Diagnosis of the disorder

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

Diagnosis of obsessive-compulsive disorder

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

1. Compulsive states (obsessions) acquire a medical background due to their stability, regular repetitions and importunity. 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 difficulties in 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 attempt to take control of your own mind and defeat OCD leads 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 illness

The treatment of OCD in the initial and mild stages requires constant outpatient monitoring. In the process of conducting a course of psychotherapy, the doctor identifies the causes that provoked obsessive-compulsive disorder.

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

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

Treatment for Complicated OCD

If the syndrome passes in more complex stages, is accompanied by an obsessive phobia of the patient before the possibility of contracting diseases, fears of certain objects, treatment is complicated. In the struggle for health enter specific medical preparations(in addition to psychological correctional sessions).

Clinical Therapy for OCD

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

• anxiolytics (tranquilizers that relieve anxiety, stress, panic conditions);
• MAO inhibitors (psychoenergizing and antidepressant medications);
• atypical neuroleptics (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 (drugs, their action is aimed at normalizing cardiac activity, problems with which are observed during attacks of ORG).

Prognosis of the disorder

OCD is a chronic disease. For such a syndrome, a complete recovery is not typical, and the success of therapy depends on the timely and early start of treatment:

1. With a mild form of the syndrome, recession (stopping of manifestations) is observed after 6-12 months from the start of therapy. Patients may have some manifestations of the disorder. They are expressed in a mild form and do not interfere ordinary 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 cured (the main symptoms of the pathology are removed).

Severe, advanced OCD is difficult to treat and prone to relapse. The aggravation of the syndrome occurs after the withdrawal of medications, against the background of new stresses and chronic fatigue. Cases of complete cure of OCD are very rare, but they are diagnosed.

With adequate treatment, the patient is guaranteed stabilization of unpleasant symptoms and relief of the vivid manifestation 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 is a syndrome whose causes rarely lie on the surface. It is characterized by the presence of obsessive thoughts (obsessions), to which a person responds with certain actions (compulsions).

Obsession (lat. obsessio - "siege") - a thought or desire that constantly pops up in the mind. This thought is difficult to control or get rid of, and it causes a lot of stress.

Common obsessions (obsessions) with OCD are:

• fear of infection (from dirt, viruses, germs, body fluids, excrement or chemicals);
• fears about possible dangers (external, for example, the fear of being robbed and internal, for example, the fear of losing control and harming someone close to you);
• excessive concern for precision, order, or symmetry;
• sexual thoughts or images.

Almost everyone has experienced these intrusive thoughts. However, for a person with OCD, the level of anxiety from such thoughts goes through the roof. And in order to avoid too much anxiety, a person is often forced to resort to some "protective" actions - compulsions (Latin compello - "to force").

Compulsions in OCD are somewhat ritualistic. These are actions that a person repeats over and over again in response to an obsession in order to reduce the risk of harm. The compulsion can be physical (like repeatedly checking to see if the door is locked) or mental (like saying a certain phrase in your mind). For example, it can be the pronunciation of a special phrase to "protect relatives from death" (this is called "neutralization").

Common in OCD are compulsions in the form of endless checks (for example, gas taps), mental rituals (special words or prayers repeated in a set order), counting.

The most common is the fear of germs in combination with compulsive washing and cleaning. Because of the fear of getting infected, people go to great lengths: do not touch the door handles, toilet seats, avoid shaking hands. Tellingly, with OCD, a person stops washing their hands not when they are clean, but when they finally feel “released” or “as they should.”

Avoidance behavior is a central part of OCD and includes:

1. the desire to avoid situations that cause anxiety;
2. the need to perform coercive actions.

Obsessive-compulsive disorder can cause many problems, and is usually accompanied by shame, guilt, and depression. The disease creates chaos in human relationships and affects performance. According to the WHO, OCD is one of the top ten diseases leading to disability. People with OCD do not seek professional help because they are embarrassed, afraid or do not know that their condition is treatable, incl. non-drug.

What Causes OCD

Despite many studies on OCD, it is still not clear what is the main cause of the disorder. Both physiological factors (imbalance of the chemical balance in nerve cells) and psychological factors can be responsible for this condition. Let's consider them in detail.

Genetics

Research has shown that OCD can be passed down through the generations to close relatives, in the form of a greater tendency to develop painful obsessions.

A study of the problem in adult twins has shown that the disorder is moderately hereditary, but no gene has been identified as causing the condition. However special attention deserve genes that could play a role in the development of OCD: hSERT and SLC1A1.

The task of the hSERT gene is to collect "waste" serotonin in nerve fibers. Recall that the neurotransmitter serotonin is necessary for the transmission of impulses in neurons. There are studies that support unusual hSERT mutations in some patients with obsessive-compulsive disorder. As a result of these mutations, the gene starts to work too fast, collecting all the serotonin before the next nerve "hears" the signal.

SLC1A1 is another gene that may be involved in OCD. This gene is similar to hSERT, but its job is to transport another neurotransmitter, glutamate.

autoimmune reaction

Some cases of rapid onset of OCD in children can be a consequence of Group A streptococcal infection, which causes inflammation and dysfunction of the basal ganglia. These cases are grouped into clinical conditions called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection).

Another study suggested that the episodic occurrence of OCD is not due to streptococcal infection, but rather to prophylactic antibiotics given to treat infections. OCD conditions may also be associated with immunological reactions to other pathogens.

neurological problems

Brain imaging techniques have allowed researchers to study the activity of specific areas of the brain. The activity of some parts of the brain in OCD sufferers has been shown to be unusually active. Involved in OCD symptoms are:

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

The circuit that includes the above areas regulates primitive behavioral aspects such as aggression, sexuality and bodily secretions. Activation of the circuit triggers the appropriate behavior, such as thoroughly washing hands after contact with something unpleasant. Normally, after the necessary act, the desire decreases, that is, the person stops washing his hands and moves on to another activity.

However, in patients diagnosed with OCD, the brain has some difficulty turning off and ignoring the urges from the circuit, which creates communication problems in these areas of the brain. The obsessions and compulsions continue, leading to the repetition of certain behaviors.

The nature of this problem is not yet clear, but it is probably associated with a violation of the biochemistry of the brain, which we talked about earlier (decreased activity of serotonin and glutamate).

Causes of OCD in terms of behavioral psychology

According to one of the fundamental laws of behavioral psychology, the repetition of a particular behavioral act makes it easier to reproduce it in the future.

People with OCD do nothing but try to avoid things that trigger fear, "fight" thoughts, or perform "rituals" to reduce anxiety. Such actions temporarily reduce fear, but paradoxically, according to the law voiced above, increase the likelihood of occurrence of obsessive behavior in the future.

It turns out that avoidance is the cause of obsessive-compulsive disorder. Avoiding the object of fear, instead of enduring it, can lead to sad consequences.

The most prone to pathology are people who are under stress: they start a new job, end relationships, suffer from overwork. For example, a person who has always calmly used public latrines, suddenly, in a state of stress, begins to “twist” himself, saying that the toilet seat is dirty and there is a danger of catching the disease ... Further, by association, fear can spread to other similar objects: public sinks, showers, etc.

If a person begins to avoid public toilets or begins to perform complex cleansing rituals (cleaning the seat, door handles, followed by a thorough hand washing procedure) instead of coping with fear, then this can result in the development of a real phobia.

Cognitive Causes of OCD

The behavioral theory described above explains the occurrence of pathology by "wrong" behavior, while the cognitive theory explains the occurrence of OCD by the inability to correctly interpret one's thoughts.

Most people have unwanted or intrusive thoughts several times a day, but all those suffering from the disorder greatly exaggerate the importance of these thoughts.

For example, in the background of fatigue, a woman who is raising a child may periodically have thoughts about harming her baby. The majority, of course, dismisses such obsessions, ignores them. People with OCD exaggerate the importance of thoughts and react to them as a threat: “What if I really am capable of this ?!”

A woman begins to think that she can become a threat to the child, and this causes her anxiety and other negative emotions, such as disgust, guilt and shame.

Fear of one's own thoughts can lead to attempts to neutralize the negative feelings that arise from obsessions, for example by avoiding thought-provoking situations or engaging in "rituals" of excessive self-cleansing or prayer.

As we noted earlier, repetitive avoidance behaviors can get stuck, tend to repeat themselves. It turns out that the cause of obsessive-compulsive disorder is the interpretation of obsessive thoughts as catastrophic and true.

Researchers suggest that OCD sufferers place exaggerated importance on thoughts due to false beliefs acquired during childhood. Among them :

• exaggerated responsibility: the belief that a person is solely responsible for the safety of others or the harm caused to them;
• belief in the materiality of thoughts: the belief that negative thoughts can "come true" or affect other people and must be controlled;
• exaggerated sense of danger: a tendency to overestimate the likelihood of danger;
• exaggerated perfectionism: the belief that everything should be perfect and mistakes are unacceptable.

Environment, distress

Stress and trauma can trigger the OCD process in people who are prone to developing the condition. Studies of adult twins have shown that obsessive-compulsive neurosis in 53-73% of cases arose due to the adverse effects of the environment.

Statistics support the fact that most people with OCD symptoms experienced a stressful or traumatic life event just before the onset of the disease. Such events may also cause exacerbation of already existing manifestations of the disorder. Here is a list of the most traumatic environmental factors:

• mistreatment and violence;
• change of housing;
• disease;
• death of a family member or friend;
• changes or problems at school or at work;
• relationship problems.

What contributes to the progression of OCD

For effective treatment obsessive-compulsive disorder, knowing the causes of the pathology is not so important. It is much more important to understand the mechanisms that support OCD. That is the key to overcoming the problem.

Avoidance and compulsive rituals

Obsessive-compulsive disorder is maintained in a vicious circle: obsession, anxiety, and response to anxiety.

Whenever a person avoids a situation or action, their behavior is “reinforced” in the form of a corresponding neural circuit in the brain. The next time in a similar situation, he will act in a similar way, which means he will again miss the chance to reduce the intensity of his neurosis.

Compulsions are also fixed. The person feels less anxious after checking to see if the lights are off. Therefore, it will continue to do the same in the future.

Avoidance and impulsive actions initially "work": the patient thinks that he has prevented harm, and this stops the feeling of anxiety. But in the long run, they will create even more anxiety and fear because they feed the obsession.

Exaggeration of one's abilities and "magical" thinking

A person with OCD overexaggerates their abilities and ability to influence the world. He believes in his power to cause or prevent bad events with his mind. "Magical" thinking involves the belief that the performance of certain special actions, rituals, will prevent something unwanted (similar to superstition).

This allows a person to feel the illusion of comfort, as if he has more influence on events and control over what is happening. As a rule, the patient, wanting to feel calmer, performs rituals more and more often, which leads to the progression of neurosis.

Over-concentration on thoughts

This refers to the degree of importance a person attaches to intrusive thoughts or images. It is important to understand here that obsessive thoughts and doubts - often absurd and opposite to what a person wants or does - appear in everyone! In the 1970s, researchers conducted experiments in which they asked people with and without OCD to list their obsessive thoughts. No difference was found between the thoughts recorded by both groups of subjects - with and without the disease.

The actual content of obsessive thoughts comes from the person's values: the things that are most important to him. Thoughts represent the deepest fears of the individual. So, for example, any mother is always worried about the health of the child, because he is the greatest value in her life, and she will be in despair if something bad happens to him. This is why intrusive thoughts about harming the baby are so common among mothers.

The difference is that people with obsessive-compulsive disorder have more painful thoughts than others. But this is due to the too great importance that patients attribute to these thoughts. It's no secret: the more attention you pay to your obsessive thoughts, the worse they seem. Healthy people can simply ignore obsessions and not focus on them.

Overestimation of danger and intolerance to uncertainty

Another important aspect is overestimating the danger of the situation and underestimating one's ability to cope with it. Many OCD patients feel they need to know for sure that bad things won't happen. For them, OCD is a kind of absolute insurance policy. They think that if they try hard and do more rituals and better insurance, they will get more certainty. In fact, trying harder only leads to more doubt and more uncertainty.

perfectionism

Some varieties of OCD involve the belief that there is always a perfect solution, that everything should be done perfectly, and that the slightest mistake will have serious consequences. This is common in people with OCD who strive for order, and is especially common in those who suffer from anorexia nervosa.

looping

As they say, fear has big eyes. There are typical ways to “wind up” yourself, to increase anxiety with your own hands:

• "Everything is terrible!" - refers to the tendency to describe something as "terrible", "nightmarish" or "the end of the world". It only makes the event seem more frightening.
• "Catastrophe!" - means expecting a catastrophe as the only possible outcome. The thought that something catastrophic is bound to happen if it is not prevented.
• Low tolerance for disappointment - when any excitement is perceived as "unbearable" or "intolerant".

In OCD, a person first involuntarily plunges himself into a state of extreme anxiety due to his obsessions, then tries to escape from them by suppressing them or performing compulsive actions. As we already know, it is this behavior that increases the frequency of occurrence of obsessions.

Treatment for OCD

Studies show that psychotherapy significantly helps 75% of patients with obsessive-compulsive disorder. There are two main ways to treat neurosis: drugs and psychotherapy. They can also be used together.

However, non-drug treatment is preferable because OCD responds well without medication. Psychotherapy has no side effects on the body and has a more stable effect. Medications may be recommended as a treatment if the neurosis is severe, or as a short-term measure to relieve symptoms while you are just beginning psychotherapy.

For the treatment of obsessive-compulsive disorder, cognitive behavioral therapy (CBT), short-term strategic psychotherapy, as well as is used.

Exposure - controlled confrontation with fear - is also used in the treatment of OCD.

The first effective psychological method of dealing with OCD was recognized as a technique of confrontation with parallel suppression of an anxious reaction. Its essence consists in a carefully dosed collision with fears and obsessive thoughts, but without the usual avoidance reaction. As a result, the patient gradually gets used to them, and fears begin to fade away.

However, not everyone feels able to go through such treatment, so the technique has been perfected with CBT, which focuses on changing the meaning of obsessive thoughts and urges (the cognitive part) as well as changing the response to the urge (behavioral part).

Each of the mentioned psychotherapeutic methods of treatment of the disorder helps to break out of the cycle of obsession, anxiety and avoidance reactions. It doesn't matter if you and the therapist first focus on thinking about the meanings the person attaches to thoughts and events, and then working through alternative responses to them. Or the focus will be on reducing the level of discomfort from scrolling obsessions. Or it will be the restoration of the ability to unconsciously filter out intrusive thoughts before they penetrate the conscious level.

All the way to complete relief from symptoms, a person suffering from OCD can, in the most comfortable conditions for himself.

(OKR)

What is obsessive-compulsive disorder?

Obsessive Compulsive Disorder(abbr. OKR) is a mental disorder, which is characterized by the appearance of involuntary thoughts and fears (obsessions), forcing a person to perform certain actions (compulsions), which interferes with daily activities and causes a state of increased stress.

The patient may try to ignore or stop the intrusive thoughts, but this only increases stress and anxiety. Eventually, the person feels compelled to commit compulsive acts to try and alleviate the mounting tension. Despite attempts to ignore obsessions or get rid of them, patients continue to return to them. This leads to an increase in ritual behavior - a vicious cycle of OCD is formed.

Obsessive-compulsive disorder often centers around specific themes, such as the fear of being infected by viruses or bacteria. To cope with the fear of contamination, a person may compulsively wash their hands until the skin becomes inflamed and cracked.

Causes and risk factors for OCD

The causes of obsessive-compulsive disorder are not fully understood. The main theories of its development include:

• Biochemistry. OCD may be the result of changes in the biochemical processes in the brain and disorders of its function.
• Genetic Causes. Genetic factors may play a role in the development of OCD, but scientists have yet to identify specific genes.
• Factors external environment . Some scientists consider environmental factors such as infections as a trigger for OCD, but more research is needed to support this theory.

Factors that can increase your risk of having an obsessive-compulsive disorder include:

• Family history. The risk of developing OCD is increased if parents or other blood relatives have the disorder.
• stressful situations. If you have experienced stress or a traumatic situation, your risk of developing OCD may increase. This response may, for some reason, trigger the obsessive thoughts, rituals, and emotional experiences that are characteristic of obsessive-compulsive disorder.
• Other mental disorders. OCD may be associated with other psychiatric disorders such as anxiety disorders, substance abuse, or tic disorders.

Symptoms and behavior of patients

Obsessive-compulsive disorder usually includes obsessions and compulsions. In some cases, only symptoms of obsession or compulsion may be expressed. You may or may not be aware that your obsessions and compulsions are excessive or unreasonable, but they are time consuming and negatively affect your daily life, work capacity and social functioning.

obsessions

Obsessions are repetitive, constant and involuntary thoughts, urges or ideas that are obsessive and cause stress or anxiety. The person may try to ignore them or get rid of them through compulsions or rituals. Obsessions usually occur when a person is trying to think about something else or do other things.

Obsessions often have specific themes, such as:

• fear of infection or contamination;
• order and symmetry - the desire to arrange objects in a certain order, symmetrically;
• aggressive or frightening thoughts about hurting yourself or others;
• unwanted thoughts, including about violence or about sexual or religious topics.

Signs of an obsession include:

• fear of pollution when touching objects that others have touched;
• doubts that they locked the door or turned off the stove;
• pronounced stress that occurs when objects are not arranged in a certain order;
• thoughts of harming yourself or someone else that occur involuntarily and cause discomfort;
• thoughts of shouting obscenities or inappropriate behavior that occur involuntarily and cause discomfort;
• avoiding situations that can trigger obsessions, such as shaking hands;
• stress caused by repetitive unpleasant thoughts about sexual topics.

Compulsions

Compulsions are repetitive actions that a person feels compelled to perform. These repetitive actions or mental acts are aimed at preventing or reducing the anxiety associated with obsessions or preventing something bad from happening. However, doing compulsive actions does not bring any pleasure and only temporarily helps to cope with anxiety.

The patient may create rules or rituals to help control the anxiety that occurs when intrusive thoughts appear. The compulsions are excessive and often not really related to the problem the patient is intended to correct.

As with obsessions, compulsions tend to have specific themes, such as:

• washing and cleaning
• checking (switching off electrical appliances, closing locks, taps, etc.)
• desire to arrange things in a certain order
• following any rules and rituals
• the desire to double-check everything

For example, the patient:

• washes hands until cracks appear on the skin;
• repeatedly checks if the door is closed;
• repeatedly checks whether the gas stove or oven is turned off;
• considers surrounding objects in a certain way;
• mentally repeats prayers, words or phrases;
• arranges cans with labels forward.

Obsessive-compulsive disorder usually occurs in teenagers or young adults. Symptoms usually begin gradually and tend to vary in severity throughout life. They usually increase when the patient is under severe stress. In most cases, OCD is a lifelong disorder, and symptoms can be mild to moderate, and in some cases, severe, time consuming, and disabling.

Complications

Problems resulting from OCD may include, but are not limited to:

• health problems such as pin off frequent washing hands;
• inability to attend work, school or social events;
• problematic relationships;
• general poor quality of life;
• suicidal thoughts and behavior.

Diagnostics

Stages of diagnosing OCD:

• General inspection. A general exam is done to rule out other problems that may be causing your symptoms and to look for any complications associated with OCD.
• Laboratory research. They may include, for example, general analysis blood test (UAC), function test thyroid gland and screening for alcohol and drugs.
• Mental state assessment. It involves talking with a specialist about your thoughts, feelings, symptoms, and behaviors. With your permission, the specialist can talk to your family or friends.
• Diagnostic criteria obsessive-compulsive disorder. Your doctor may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

Diagnostic problems

It can sometimes be difficult to diagnose OCD because the symptoms may be similar to those of an anancaste personality disorder, anxiety disorders, depression, schizophrenia, or other psychiatric illnesses. There may be a combination of obsessive-compulsive disorder and another mental illness. Collaborate with your doctor so that he can make an accurate diagnosis and prescribe the right therapy.

Treatment of obsessive-compulsive disorder

There is no cure for OCD, but it is possible to keep its symptoms under control and reduce their impact on daily life. Some people require lifelong treatment.

The two main treatments for OCD are psychotherapy and medication. Often the most effective is a combination of both methods.

Psychotherapy

Cognitive behavioral therapy (CBT) is a type of psychotherapy that is an effective treatment for many people with OCD. Exposure therapy (exposure and warning method) - a type of CBT - involves interacting with the object of obsession, such as dirt, and learning healthy ways to cope with anxiety. Exposure therapy requires effort and practice, but the patient will be able to enjoy best quality life once he learns to control his obsessions and compulsions.

Therapy can be done on an individual, family or group basis.

Medications

Some psychotropic medications help control the symptoms of OCD. The most common first-line drugs are antidepressants.

Antidepressants approved by the Food and Drug Administration for the treatment of OCD include:

• Clomipramine (Anafranil) for adults and children 10 years of age and older
• Fluoxetine (Prozac) for adults and children 7 years and older
• Fluvoxamine for adults and children 8 years and older
• Paroxetine (Paxil, Pekseva) for adults only
• Sertraline (Zoloft) for adults and children 6 years of age and older

However, your doctor may prescribe other antidepressants and drugs used to treat mental illness.

Medications: what to consider

Discuss the following questions with your doctor:

• Choice medicinal product . It is necessary to strive to effectively control the symptoms of the disease, taking drugs in minimal doses. Often you have to try several drugs before you find one that will be effective in a particular case. Your doctor may recommend several medications to effectively manage your symptoms. It may take several weeks to several months after the start of treatment for the condition to improve.
• Side effects. All psychiatric drugs have potential side effects. Discuss with your doctor the possible side effects and health management measures needed during drug treatment. If you experience any worrisome side effects, tell your doctor.
• Suicide risk. In some cases, children, adolescents, and young people under the age of 25 may experience suicidal thoughts or behavior while taking antidepressants, especially in the first few weeks after starting drug therapy or when the dosage of the drug is changed. If you have thoughts of suicide, tell your doctor immediately. Keep in mind that antidepressants are more likely to reduce the risk of suicide in the long run by improving the emotional background.
• Interaction with other substances. When you start taking antidepressants, tell your doctor about all prescription and over-the-counter medications, herbal remedies, and vitamins you are taking. Some antidepressants in combination with certain medicines or herbal remedies can cause dangerous reactions.
• Stopping antidepressants. Antidepressants do not cause psychological dependence, but physical dependence (which is different from drug addiction) can sometimes occur. Interrupting the course of treatment or missing several doses can lead to the development of withdrawal symptoms. Do not stop taking your medications without talking to your doctor, even if you feel better, as OCD symptoms may recur. Work with your doctor to gradually and safely reduce doses.

Prevention

There is no way to prevent the development of OCD. However, early treatment can prevent the progression of the disorder and prevent the disease from interfering with daily life.

Forecast

Overall, about 70% of patients entering treatment experience a significant improvement in their symptoms. However, OCD remains a chronic disease whose symptoms may wax and wane over the course of a patient's life.

Approximately 15% of patients may experience a progressive worsening of symptoms or worsening of functioning over time.

Approximately 5% of patients experience complete remission of symptoms between episodes of exacerbation.

Interesting