Acute compulsive disorder. Obsessive-compulsive disorder - symptoms and treatment

What is OCD, how does it manifest itself, who is prone to obsessive-compulsive disorder and why, what accompanies OCD. Causes

Hello! Usually in articles I try to give useful recommendations, but this one will be more educational in nature in order to generally understand what people are faced with. We will look at how the disorder most often manifests itself and who is most prone to it. This will give you some idea of what to pay attention to and where to start moving towards recovery.

What is OCD (obsession and compulsion)

So, what is obsessive-compulsive disorder and, in particular, obsessive-compulsive disorder (OCD)?

Obsession- an obsession, a periodically occurring annoying, unwanted thought. People are bothered by repetitive thoughts and thought images. For example, about possible errors, omissions, inappropriate behavior, the possibility of getting infected, losing control, etc.

compulsion- this is an obsessive behavior that a person feels he is forced to do in order to prevent something bad, that is, actions aimed at avoiding a perceived danger.

Obsessive-compulsive disorder was not so long ago considered a disease, but now in the international medical classification (ICD-10) OCD is classified as a neurotic disorder, which can be successfully and permanently treated with modern psychotherapeutic methods, in particular, CBT (cognitive behavioral therapy), based renowned psychotherapist Aaron Beck (although, in my opinion and experience, this method lacks some important points).

This is a very viscous, tenacious and heavy state that can absorb almost all of your time, filling it with meaningless actions and repetitive thoughts and images. Against this background, people begin to experience difficulties in communication, in everyday activities, study and work.

Obsessive-compulsive disorder is divided into two forms:

Obsessions when a person has only obsessive thoughts and images, be they contrasting (single) or numerous thoughts replacing each other on various occasions, which he is afraid of, tries to get rid of and distract himself from them.
Obsessions-compulsives when obsessive thoughts and actions (rituals) are present. If a person is completely unable to control his anxious thoughts and feelings, he can try to do something, use some actions to extinguish anxiety and get rid of annoying thoughts and fears.

Over time, these actions themselves become obsessive and seem to stick to the person’s psyche, then an irresistible feeling arises to continue performing rituals, and in the future, even if the person decides not to do them, it simply does not work out.

Compulsive disorder – obsessive behavior.

Most often, rituals are associated with double-checking, washing, cleaning, counting, symmetry, hoarding and, sometimes, the need to confess.

Such actions include, for example, counting windows, turning lights off and on, constantly checking the door, stove, arranging things in a specific order, frequently washing hands (apartments), and so on.

There are also many who use mental rituals associated with pronouncing certain words, self-persuasion, or constructing images according to a specific pattern. People do such rituals because it seems to them that if everything is done exactly (as needed), then terrible thoughts will go away, and the first time they use it, it really helps them.

As I wrote earlier, the main cause of obsessive-compulsive disorder is people’s harmful beliefs, which are often acquired in childhood, and then everything is reinforced by emotional addiction.

Such beliefs and beliefs primarily include:

Thought is material - when unwanted thoughts come to mind, there is a fear that they will come true, for example, “what if I hurt someone if I think about it.”

The belief of perfectionists is that everything must be perfect and mistakes cannot be made.

Suspiciousness – belief in amulets and evil eyes, a tendency to exaggerate (catastrophize) any more or less possible danger.

Hyperresponsibility (I must control everything) - when a person believes that he is responsible not only for himself, but also for the appearance of thoughts and images in his head, as well as for the actions of other people.

Beliefs associated with the internal assessment of any phenomena and situations: “good - bad”, “right - wrong” and others.

Manifestations of obsessive-compulsive disorder.

So, let's look at all the most common manifestations of OCD in life.

1. Constant hand washing

Obsessive thoughts and desire to wash your hands frequently (for a long time) (bathroom, apartment), use protective hygiene products everywhere, wear gloves due to fear of infection (contamination).

Real example. As a child, one woman was frightened by her mother, who was anxious by nature, with a good intention - to warn her daughter - with worms. As a result, fear stuck in the child’s psyche to such an extent that, having matured, the woman learned everything she could about worms: from the stages of reproduction, how and where one can catch it, to the symptoms of infection. She tried to protect herself from the slightest possibility of infection. However, knowledge did not help her catch the infection and, on the contrary, her fear worsened and grew into a constant and alarming suspicion.

Note that the risk of infection in modern life with frequent examinations, hygiene and good living conditions is small, however, it is this fear as a risk to life, and not other possible threats, even more likely, that has become constant and main for a woman.

This can also include an obsession with cleaning around the house, where fear of germs or a disturbing feeling of “uncleanliness” manifests itself.

In general, you can teach a child to fear everything, even God, if you raise him in religion and often say: “Don’t do this and that, otherwise God will punish you.” This often happens that children are taught to live in fear, shame and before God (life, people), and not in freedom and love for God and the entire world (universe).

3. Obsessive checking of actions (control)

Also a common manifestation of obsessive-compulsive disorder. Here people check many times whether the doors are locked, whether the stove is turned off, etc. Such repeated checks, to convince themselves that everything is in order, arise out of anxiety for the safety of themselves or their loved ones.

And often a person is driven by an anxious feeling that I did something wrong, missed something, didn’t finish it and am not in control; the thought may arise: “what if I did something terrible, but I don’t remember and don’t know how to check it.” Background (chronic) anxiety simply suppresses a person's will.

4. Obsessive counting

Some people with obsessive-compulsive disorder count everything that catches their eye: how many times the lights are turned off, the number of steps or blue (red) cars that have passed, etc. The main reasons for this behavior are superstitions (suspiciousness) associated with the fear that if I don’t do it exactly or don’t count the exact number of times, then something bad might happen. This also includes an attempt to escape from some disturbing, intrusive thoughts.

People “by counting”, without realizing it, pursue the main goal - to extinguish the oppressive anxiety, but in their minds it seems to them that by doing the ritual they will protect themselves from some consequences. Most realize that all this is unlikely to help them in any way, but by trying not to do the ritual, anxiety intensifies, and they again begin to count, wash their hands, turn on and off the light, etc.

5. Total correctness and organization

The same is a common form of obsessive-compulsive disorder. People with this obsession are able to bring organization and order to perfection. For example, in the kitchen everything should be symmetrical and on shelves, otherwise I feel internal, emotional discomfort. The same applies to any work or even eating.

In a state of severe anxiety, a person ceases to take into account the interests of others, like other negative emotions, aggravate a person’s selfishness, and therefore affects close people.

6. Obsessive-compulsive dissatisfaction with one's appearance

Dysmorphophobia, when a person believes that he has some kind of serious external defect (ugliness), is also classified as obsessive-compulsive disorder.

People, for example, can stare for hours until they like their facial expression or some part of their body, as if their life directly depends on it, and only by liking themselves can they calm down somewhat.

In another case, it is avoiding looking in the mirror for fear of seeing one’s “flaws.”

7.Beliefs of wrongness and feelings of incompleteness.

It happens that some people are oppressed by a feeling of incompleteness, when it seems that something is not good enough or that something has not been completed; in such a situation, they can shift things from place to place many times until, finally, they are satisfied with the result.

And believers (although not only them) very often encounter the “wrongness” and “obscenity” of their thoughts. Something comes to their mind, in their opinion, obscene (blasphemous), and they are absolutely convinced that thinking (imagining) like that is a sin, I shouldn’t have people like that. And as soon as they start thinking like that, the problem immediately grows. Others may even have fear associated with words, such as black, devil, blood.

8.Compulsive overeating (in brief)

Most often, the causes of compulsive overeating are psychological factors associated with society, when a person is ashamed of his figure, experiences negative emotions, and with food, often sweet, unconsciously tries to extinguish unpleasant feelings, and this works to a certain extent, but it affects appearance.

Psychological (personal) problems - depression, anxiety, boredom, dissatisfaction with some areas of your life, uncertainty, constant nervousness and inability to control your emotions - often lead to compulsive overeating.

Best regards, Andrey Russkikh

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 causes of the disease	Psychological and social causes of the disease
Diseases and functional-anatomical features of the brain	Disorders of the human psyche due to the occurrence of neuroses
Features of the functioning of the autonomic nervous system	Increased susceptibility to certain psychogenic influences due to the strengthening of certain character or personality traits
Metabolic disorders, most often accompanied by changes in the levels of the hormones serotonin and dopamine	Negative influence of the family on the formation of a healthy psyche of the child (overprotection, physical and emotional violence, manipulation)
Genetic factors	The problem is the perception of sexuality and the emergence of sexual deviations (deviations)
Complications after infectious diseases	Production factors most often associated with long work, accompanied by nervous overload

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 a catastrophic meaning.

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

Basal anxiety, arising due to a violation of the sense of security in childhood (ridicule, overprotective parents, manipulation).
Perfectionism, consisting in the desire to achieve the ideal, non-acceptance of one’s own mistakes.
Exaggerated feeling human responsibility for the impact on society and the safety of the environment.
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 disturbances, 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.

In obsessive compulsive disorder you will find the difference

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;
intermediate and deep beliefs of the patient;
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 still feel anxiety and some symptoms of the disease in his or her Everyday 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 is a human mental illness, otherwise called obsessive-compulsive disorder. For example, a pathological desire to wash your hands two hundred times in one day because of thoughts about countless bacteria, or counting the pages of a book you are reading in an effort to know exactly how much time to spend on one sheet, or returning home many times before work in doubt whether the iron is turned off or gas.

That is, a person suffering from obsessive-compulsive disorder suffers from obsessive thoughts that dictate the need for tedious, repetitive movements, which leads to stress and depression. This condition undoubtedly reduces the quality of life and requires treatment.

Description of the disease

The official medical term “obsessive-compulsive disorder” is based on two Latin roots: “obsession,” which means “being overwhelmed or besieged by an obsessed idea,” and “compulsion,” which means “compulsory action.”

Sometimes local disorders occur:

a purely obsessive disorder, experienced only emotionally and not physically;
separately compulsive disorder, when restless actions are not caused by clear fears.

Obsessive-compulsive disorder occurs in about three out of a hundred cases in adults and about two out of five hundred in children. Mental pathology can manifest itself in different ways:

occur sporadically;
progress from year to year;
be chronic.

The first signs are usually observed no earlier than 10 years and rarely require immediate treatment. Initial obsessive-compulsive neurosis appears in the form of various phobias and strange obsessive states, the irrationality of which a person is able to understand independently.

By the age of 30, the patient may have already developed a pronounced clinical picture, with a refusal to perceive his fears adequately. In advanced cases, a person, as a rule, has to be hospitalized and treated with more effective methods than conventional psychotherapeutic sessions.

Causes

Today, the exact etiological factors for the occurrence of obsessive-compulsive syndrome are unknown. There are only a few theories and assumptions.

Among the biological causes, the following factors are considered possible:

pathologies of the autonomic nervous system;
peculiarity of the transmission of electronic impulses in the brain;
disruption of the metabolism of serotonin or other substances necessary for the normal functioning of neurons;
suffered traumatic brain injuries;
infectious diseases with complications;
genetic inheritance.

In addition to biological factors, obsessive-compulsive disorder can have a lot of psychological or social causes:

psychotraumatic family relationships;
strictly religious upbringing;
work in stressful working conditions;
experienced fear due to a real threat to life.

Panic fear may have roots in personal experience or be imposed by society. For example, watching crime news provokes anxiety about being attacked by robbers on the street or fear of car theft.

The person tries to overcome the obsessions that arise by repeating “control” actions: looking over his shoulder every ten steps, pulling the car door handle several times, etc. But such compulsions do not provide relief for long. If you don’t start fighting them in the form of psychotherapeutic treatment, obsessive-compulsive syndrome threatens to completely overwhelm a person’s psyche and turn into paranoia.

Symptoms in adults

Symptoms of obsessive-compulsive disorder in adults develop approximately the same clinical picture:

1. First of all, neurosis manifests itself in obsessive painful thoughts:

about sexual perversions;
about death, physical harm or violence;
blasphemous or sacrilegious ideas;
fears of diseases, viral infections;
anxiety about the loss of material values, etc.

Such painful thoughts terrify a person with obsessive-compulsive disorder. He understands their groundlessness, but cannot cope with the irrational fear or superstition that all this will one day come true.

2. The syndrome in adults also has external symptoms, expressed in repetitive movements or actions:

recalculation of the number of steps on the stairs;
very frequent hand washing;
rechecking turned off taps and closed doors several times in a row;
putting the table in symmetrical order every half hour;
arranging books on a shelf in a certain order, etc.

All these actions are a kind of ritual to “get rid” of an obsessive state.

3. Obsessive-compulsive disorder tends to worsen in crowded places. In a crowd, the patient may experience periodic panic attacks:

fear of infection due to the slightest sneeze from someone else;
fear of coming into contact with the “dirty” clothes of other passers-by;
nervousness due to “strange” smells, sounds, sights;
fear of losing personal belongings or becoming a victim of pickpockets.

Due to such obsessive-compulsive disorders, a person with obsessive-compulsive neurosis tries to avoid crowded places.

4. Since obsessive-compulsive disorder affects, to a greater extent, people who are suspicious and have the habit of controlling everything in their lives, the syndrome is often accompanied by a very strong decrease in self-esteem. This happens because a person understands the irrationality of the changes happening to him and is powerless in the face of his own fears.

Symptoms in children

Obsessive-compulsive disorder occurs less frequently in children than in adults. But it has a similar obsessive state:

the fear of getting lost in the crowd forces children who are already quite old to hold their parents’ hands and constantly check whether the hoop is tightly clasped together;
the fear of ending up in an orphanage (if adults have at least once threatened such “punishment”) makes the child want to very often ask his mother if he is loved;
panic at school over a lost notebook leads to a frantic counting of all school subjects while folding a briefcase, and at night waking up in a cold sweat and rushing back to this activity;
obsessive complexes, which are intensified by the “persecution” of classmates because of dirty cuffs, can torment so much that the child completely refuses to go to school.

Obsessive-compulsive disorder in children is accompanied by sullenness, unsociability, frequent nightmares and poor appetite. Contacting a child psychologist will help you get rid of the syndrome faster and prevent its development.

What to do

Obsessive-compulsive personality disorder can occur occasionally in any person, even a completely mentally healthy person. It is very important to recognize the beginning symptoms at the very first stages and begin treatment with a psychologist, or at least try to help yourself by analyzing your own behavior and developing a certain defense against the syndrome:

Step 1. Learn what obsessive-compulsive disorder is.

Read the causes, symptoms and treatments several times. Write down on a piece of paper the signs that you observe. Next to each disorder, leave space for a detailed description and a plan describing how to get rid of it.

Step 2. Ask for an outside assessment.

If you suspect obsessive-compulsive disorder, it is best, of course, to consult a specialist doctor who will help you begin effective treatment. If the first visit is very difficult, you can ask loved ones or a friend to confirm the symptoms of the disorder that have already been written down or add some others that the person himself does not notice.

Step 3. Look your fears in the eye.

A person with obsessive-compulsive disorder is usually able to understand that all fears are just a figment of his imagination. If every time a new desire arises to wash your hands or check a locked door, you remind yourself of this fact and interrupt the next “ritual” with a simple effort of will, it will be easier and easier to get rid of obsessive neurosis.

Step 4. Praise yourself.

You need to celebrate the steps towards success, even the smallest ones, and praise yourself for the work you have done. When a person suffering from the syndrome at least once feels that he is stronger than his obsessive states, that he is able to control them, the treatment of neurosis will go faster.

If a person finds it difficult to find sufficient strength within himself to get rid of obsessive-compulsive neurosis, he should consult a psychologist.

Psychotherapy methods

Treatment in the form of psychotherapeutic sessions for obsessive-compulsive syndrome is considered the most effective. Today, specialist psychologists have in their medical arsenal several effective techniques to get rid of such obsessive-compulsive neurosis:

1. Cognitive behavioral therapy for the disorder. Founded by psychiatrist Jeffrey Schwartz, the idea is to resist the syndrome by keeping compulsions to a minimum and then to their disappearance. A step-by-step method of absolute awareness of one’s disorder and its causes leads the patient to decisive steps that help get rid of neurosis for good.

2. “Thought stopping” technique. Behavioral therapy theorist Joseph Wolpe formalized the idea of using an “outside perspective.” A person suffering from neurosis is asked to remember one of the vivid situations when his obsessive states manifest themselves. At this moment, the patient is loudly told “Stop!” and the situation is analyzed using a number of questions:

Is there a high chance that this could happen?
How much does a thought interfere with living an ordinary life?
How strong is the internal discomfort?
Will life be simpler and happier without this obsession and neurosis?

Questions may vary. There may be many more. Their main task in the treatment of obsessive-compulsive neurosis is to “photograph” the situation, to examine it, as if in slow motion, to see it from all angles.

After this exercise, it becomes easier for a person to face fears and control them. The next time, when obsessive-compulsive neurosis begins to haunt him outside the walls of the psychologist’s office, the internal cry “Stop!” will be triggered, and the situation will take on completely different contours.

The given methods of psychotherapy are far from the only ones. The choice remains with the psychologist, after questioning the patient and determining the degree of obsessive-compulsive syndrome using the Yale-Brown scale, which was specially designed to identify the depth of neurosis.

Treatment with medications

Some complex cases of obsessive-compulsive disorder cannot be treated without medication. Especially when metabolic disorders necessary for the functioning of neurons were discovered. The main drugs for the treatment of neurosis are SRIs (serotonin reuptake inhibitors):

fluvoxamine or escitalopram;
tricyclic antidepressants;
paroxetine, etc.

Modern scientific research in the field of neurology has discovered therapeutic potential in agents that release the neurotransmitter glutamate and help, if not get rid of neurosis, then significantly mitigate it:

memantine or riluzole;
lamotrigine or gabapentin;
N-acetylcysteine, etc.

But conventional antidepressants are prescribed as a means of symptomatic action, for example, to eliminate neurosis, stress arising from constant obsessive states or mental disorders.

Anxiety, fear of trouble, repeated hand washing are just a few signs of a dangerous obsessive-compulsive disease. The fault line between normal and obsessive states can turn into an abyss if OCD is not diagnosed in time (from the Latin obsessive - obsession with an idea, siege, and compulsive - compulsion).

What is obsessive-compulsive disorder

The desire to check something all the time, feelings of anxiety, fear have varying degrees of severity. We can talk about the presence of a disorder if obsessions (from the Latin obsessio - “ideas with a negative connotation”) appear with a certain frequency, provoking the emergence of stereotypical behaviors called compulsions. What is OCD in psychiatry? Scientific definitions boil down to the interpretation that it is a neurosis, a syndrome of obsessive states caused by neurotic or mental disorders.

Oppositional defiant disorder, which is characterized by fear, obsession, and depressed mood, lasts for a long period of time. This specificity of obsessive-compulsive illness makes diagnosis difficult and simple at the same time, but a certain criterion is taken into account. According to the accepted classification according to Snezhnevsky, based on the peculiarities of the course, the disorder is characterized by:

a single attack lasting from a week to several years;
cases of relapse of a compulsive state, between which periods of complete recovery are recorded;
continuous dynamics of development with periodic intensification of symptoms.

Contrasting obsessions

Among the obsessive thoughts encountered in compulsive illness, there arise those that are alien to the true desires of the individual himself. Fear of doing something that a person is not capable of doing due to character or upbringing, for example, blasphemy during a religious service, or a person thinks that he can harm his loved ones - these are signs of contrasting obsession. Fear of harm in obsessive-compulsive disorder leads to strenuous avoidance of the object that caused such thoughts.

Obsessive actions

At this stage, obsessive disorder may be characterized by a need to perform certain actions that bring relief. Often senseless and irrational compulsions (compulsions) take one form or another, and such wide variation makes diagnosis difficult. The occurrence of actions is preceded by negative thoughts and impulsive actions.

Some of the most common signs of obsessive-compulsive illness include:

frequent hand washing, showering, often using antibacterial agents - this causes fear of contamination;
behavior when fear of infection forces a person to avoid contact with door handles, toilets, sinks, money as potentially dangerous carriers of dirt;
repeated (compulsive) checking of switches, sockets, door locks, when the disease of doubt crosses the line between thoughts and the need to act.

Obsessive-phobic disorders

Fear, albeit unfounded, provokes the appearance of obsessive thoughts and actions that reach the point of absurdity. An anxiety state in which obsessive-phobic disorder reaches such proportions is treatable, and rational therapy is considered to be the four-step method of Jeffrey Schwartz or working through a traumatic event or experience (aversive therapy). Among the phobias associated with obsessive-compulsive disorder, the most famous is claustrophobia (fear of enclosed spaces).

Obsessive rituals

When negative thoughts or feelings arise, but the patient’s compulsive illness is far from the diagnosis of bipolar affective disorder, one has to look for a way to neutralize the obsessive syndrome. The psyche forms some obsessive rituals, which are expressed by meaningless actions or the need to perform repeated compulsive actions similar to superstitions. The person himself may consider such rituals illogical, but anxiety disorder forces him to repeat everything all over again.

Obsessive-compulsive disorder - symptoms

Obsessive thoughts or actions that are perceived as wrong or painful can cause harm to physical health. Symptoms of obsessive-compulsive disorder can be single and have varying degrees of severity, but if you ignore the syndrome, the condition will worsen. Obsessive-compulsive neurosis can be accompanied by apathy and depression, so you need to know the signs that can be used to diagnose OCD:

the emergence of an unreasonable fear of infection, fear of contamination or trouble;
repeated obsessive actions;
compulsive behavior (defensive actions);
excessive desire to maintain order and symmetry, obsession with cleanliness, pedantry;
“getting stuck” on thoughts.

Obsessive-compulsive disorder in children

It occurs less frequently than in adults, and when diagnosed, compulsive disorder is more often detected in adolescents, and only a small percentage are children under 7 years of age. Gender does not affect the appearance or development of the syndrome, while obsessive-compulsive disorder in children does not differ from the main manifestations of neurosis in adults. If parents manage to notice signs of OCD, then it is necessary to contact a psychotherapist to choose a treatment plan using medications and behavioral or group therapy.

Obsessive-compulsive disorder - causes

A comprehensive study of the syndrome and many studies have not been able to give a clear answer to the question about the nature of obsessive-compulsive disorders. Psychological factors (stress, problems, fatigue) or physiological (chemical imbalance in nerve cells) can affect a person’s well-being.

If we look at the factors in more detail, the causes of OCD look like this:

stressful situation or traumatic event;
autoimmune reaction (consequence of streptococcal infection);
genetics (Tourette's syndrome);
disruption of brain biochemistry (decreased activity of glutamate, serotonin).

Obsessive-compulsive disorder - treatment

Almost complete recovery is not excluded, but long-term therapy will be required to get rid of obsessive-compulsive neurosis. How to treat OCD? Treatment of obsessive-compulsive disorder is carried out comprehensively with sequential or parallel use of techniques. Compulsive personality disorder in severe forms of OCD requires medication or biological therapy, and in mild cases, the following methods are used. This:

Psychotherapy. Psychoanalytic psychotherapy helps to cope with some aspects of compulsive disorder: adjusting behavior during stress (exposure and warning method), teaching relaxation techniques. Psychoeducational therapy for obsessive-compulsive disorder should be aimed at deciphering actions, thoughts, and identifying causes, for which family therapy is sometimes prescribed.
Lifestyle correction. A mandatory review of the diet, especially if there is a compulsive eating disorder, getting rid of bad habits, social or professional adaptation.
Physiotherapy at home. Hardening at any time of the year, swimming in sea water, warm baths of medium duration and subsequent wiping.

Drug treatment for OCD

A mandatory item in complex therapy, requiring a careful approach from a specialist. The success of drug treatment for OCD is associated with the correct choice of drugs, duration of use and dosage for exacerbation of symptoms. Pharmacotherapy provides for the possibility of prescribing medications of one group or another, and the most common example that can be used by a psychotherapist for the recovery of a patient is:

antidepressants (Paroxetine, Sertraline, Citalopram, Escitalopram, Fluvoxamine, Fluoxetine);
atypical antipsychotics (Risperidone);
mood stabilizers (Normotim, Lithium carbonate);
tranquilizers (Diazepam, Clonazepam).

Video: obsessive-compulsive disorders

A significant role among mental illnesses is played by syndromes (complexes of symptoms) grouped into obsessive-compulsive disorder (OCD), which gets its name from the Latin terms obsessio and compulsio.

Obsession (lat. obsessio - taxation, siege, blockade).

Compulsions (lat. compello - I force). 1. Obsessive drives, a type of obsessive phenomena (obsessions). Characterized by irresistible attractions that arise contrary to reason, will, and feelings. Often they turn out to be unacceptable for the patient and contradict his moral and ethical qualities. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the patient as incorrect and are painfully experienced, especially since their very occurrence, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsion is also used in a broader sense to designate any obsessions in the motor sphere, including obsessive ones rituals.

Currently, almost all obsessive-compulsive disorders are combined in the International Classification of Diseases under the concept of “obsessive-compulsive disorder.”

OCD concepts have undergone a fundamental reappraisal over the past 15 years. During this time, the clinical and epidemiological significance of OCD was completely revised. If previously it was believed that this was a rare condition observed in a small number of people, it is now known: OCD is common and has a high morbidity rate, which requires urgent attention from psychiatrists around the world. In parallel, our understanding of the etiology of OCD has expanded: the vaguely defined psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm examining the neurotransmitter abnormalities that underlie OCD. Most significantly, pharmacological interventions targeting specifically serotonergic neurotransmission have revolutionized the recovery prospects of millions of OCD sufferers around the world.

The discovery that potent serotonin reuptake inhibition (SSRI) was the key to effective treatment of OCD was the first step in the revolution and stimulated clinical research that demonstrated the effectiveness of such selective inhibitors.

According to the ICD-10 description, the main features of OCD are repetitive intrusive (obsessive) thoughts and compulsive actions (rituals).

In a broad sense, the core of OCD is the obsession syndrome, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, and memories that arise in addition to the wishes of the patients, but with awareness of their morbidity and a critical attitude towards them. Despite understanding the unnaturalness and illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessive impulses or ideas are recognized as alien to the personality, but as if coming from within. Compulsions may be the performance of rituals designed to relieve anxiety, such as hand washing to combat “pollution” and to prevent “contamination.” Trying to push away unwanted thoughts or urges can lead to severe internal struggles accompanied by intense anxiety.

Obsessions in ICD-10 are included in the group of neurotic disorders.

The prevalence of OCD in the population is quite high. According to some data, it is determined by the rate of 1.5% (meaning “fresh” cases of disease) or 2-3% if episodes of exacerbations observed throughout life are taken into account. People suffering from obsessive-compulsive disorder account for 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally.

CLINICAL PICTURE

The problem of obsessive states attracted the attention of clinicians already at the beginning of the 17th century. They were first described by Platter in 1617. In 1621, E. Barton described the obsessive fear of death. Mentions of obsessions are found in the works of F. Pinel (1829). I. Balinsky proposed the term “obsessive ideas”, which has taken root in Russian psychiatric literature. In 1871, Westphal coined the term agoraphobia to describe the fear of being in public places. M. Legrand de Sol, analyzing the peculiarities of the dynamics of OCD in the form of “insanity of doubt with delusions of touch,” points to a gradually becoming more complex clinical picture - obsessive doubts are replaced by absurd fears of “touching” surrounding objects, and motor rituals are added, to the fulfillment of which the entire life of patients is subordinated. However, only at the turn of the XIX-XX centuries. The researchers were able to more or less clearly describe the clinical picture and give a syndromic description of obsessive-compulsive disorders. The onset of the disease usually occurs in adolescence and young adulthood. The maximum clinically defined manifestations of obsessive-compulsive disorder are observed in the age range of 10 - 25 years.

Main clinical manifestations of OCD:

Obsessive thoughts are painful thoughts that arise against one’s will, but are recognized by the patient as his own, ideas, beliefs, images that, in a stereotypical form, forcibly invade the patient’s consciousness and which he tries to somehow resist. It is this combination of an internal sense of compulsive urge and efforts to resist it that characterizes obsessive symptoms, but of the two, the degree of effort exerted is more variable. Obsessive thoughts can take the form of individual words, phrases, or lines of poetry; they are usually unpleasant for the patient and may be obscene, blasphemous or even shocking.

Obsessive images are vividly imagined scenes that are often violent or disgusting, including, for example, sexual perversion.

Obsessive impulses are urges to perform actions that are usually destructive, dangerous, or likely to cause disgrace; for example, jumping out onto the road in front of a moving car, injuring a child, or shouting obscene words while in public.

Obsessive rituals include both mental activity (for example, repeating counting in a special way, or repeating certain words) and repetitive but meaningless behavior (for example, washing your hands twenty or more times a day). Some of them have an understandable connection with previous obsessive thoughts, for example, repeated hand washing with thoughts of infection. Other rituals (for example, regularly arranging clothes in some complex system before putting them on) have no such connection. Some patients feel an irresistible urge to repeat such actions a certain number of times; if this fails, they are forced to start all over again. Patients are invariably aware that their rituals are illogical and usually try to hide them. Some fear that such symptoms are a sign of incipient madness. Both obsessive thoughts and rituals inevitably lead to problems in daily activities.

Rumination ("mental chewing") is an internal debate in which the arguments for and against even the simplest everyday actions are endlessly revised. Some intrusive doubts concern actions that may have been performed incorrectly or not completed, such as turning off a gas stove tap or locking a door; others concern actions that could harm others (for example, driving a car past a cyclist and hitting them). Sometimes doubts are associated with a possible violation of religious instructions and rituals - “remorse.”

Compulsive actions are repeated stereotypical behaviors, sometimes taking on the character of protective rituals. The latter are aimed at preventing any objectively unlikely events that are dangerous for the patient or his loved ones.

In addition to those described above, among obsessive-compulsive disorders there are a number of delineated symptom complexes, including obsessive doubts, contrasting obsessions, obsessive fears - phobias (from the Greek phobos).

Obsessive thoughts and compulsive rituals can certain situations intensify; for example, obsessive thoughts about harming other people often become more persistent in the kitchen or some other place where knives are stored. Because patients often avoid such situations, there may be superficial similarities to the characteristic avoidance pattern found in anxiety-phobic disorder. Anxiety is an important component of obsessive-compulsive disorders. Some rituals reduce anxiety, while others increase it. Obsessions often develop as part of depression. In some patients this appears to be a psychologically understandable reaction to obsessive-compulsive symptoms, but in other patients there are recurrent episodes of depressive mood that occur independently.

Obsessions (obsessions) are divided into figurative or sensual, accompanied by the development of affect (often painful) and obsession with affectively neutral content.

Sensory obsessions include obsessive doubts, memories, ideas, drives, actions, fears, an obsessive feeling of antipathy, and obsessive fear of habitual actions.

Obsessive doubts are persistent uncertainty that arises, contrary to logic and reason, about the correctness of the actions being taken and completed. The content of doubts varies: obsessive everyday fears (is the door locked, are the windows or water taps closed tightly enough, is the gas or electricity turned off), doubts related to official activities (is this or that document written correctly, are the addresses on business papers mixed up? , whether inaccurate numbers are indicated, whether orders are correctly formulated or executed), etc. Despite repeated verification of the action taken, doubts, as a rule, do not disappear, causing psychological discomfort in the person suffering from this type of obsession.

Intrusive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a feeling of shame and remorse. They dominate the patient’s consciousness, despite efforts and efforts not to think about them.

Obsessive drives are urges to commit one or another harsh or extremely dangerous action, accompanied by a feeling of horror, fear, confusion with the inability to free oneself from it. The patient is overcome, for example, by the desire to throw himself under a passing train or push a loved one under it, or to kill his wife or child in an extremely cruel way. At the same time, patients are painfully afraid that this or that action will be implemented.

Manifestations of obsessive ideas can be different. In some cases, this is a vivid “vision” of the results of obsessive drives, when patients imagine the result of a cruel act committed. In other cases, obsessive ideas, often called mastering ideas, appear in the form of implausible, sometimes absurd situations that patients take as real. An example of obsessive ideas is the patient’s conviction that a buried relative was alive, and the patient painfully imagines and experiences the suffering of the deceased in the grave. At the height of obsessive ideas, the consciousness of their absurdity and implausibility disappears and, on the contrary, confidence in their reality appears. As a result, obsessions acquire the character of overvalued formations (dominant ideas that do not correspond to their true meaning), and sometimes delirium.

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) - unjustified antipathy towards a specific, often close person, driven away by the patient, cynical, unworthy thoughts and ideas in relation to respected people, in religious persons - in relation to saints or church ministers .

Obsessive actions are actions performed against the wishes of patients, despite the efforts made to restrain them. Some of the obsessive actions burden patients until they are implemented, others are not noticed by the patients themselves. Obsessive actions are painful for patients, especially in cases where they become the object of attention of others.

Obsessive fears, or phobias, include obsessive and senseless fear of heights, large streets, open or confined spaces, large crowds of people, fear of sudden death, fear of contracting one or another incurable disease. Some patients may experience a wide variety of phobias, sometimes acquiring the character of fear of everything (panphobia). And finally, an obsessive fear of fear (phobophobia) is possible.

Hypochondriacal phobias (nosophobia) are an obsessive fear of some serious illness. Most often, cardio-, stroke-, syphilo- and AIDS-phobias are observed, as well as fear of the development of malignant tumors. At the peak of anxiety, patients sometimes lose their critical attitude towards their condition - they turn to doctors of the appropriate profile, demand examination and treatment. The realization of hypochondriacal phobias occurs both in connection with psycho- and somatogenic (common non-mental diseases) provocations, and spontaneously. As a rule, the result is the development of hypochondriacal neurosis, accompanied by frequent visits to doctors and unnecessary medication use.

Specific (isolated) phobias are obsessive fears limited to a strictly defined situation - fear of heights, nausea, thunderstorms, pets, dental treatment, etc. Since contact with situations that cause fear is accompanied by intense anxiety, patients tend to avoid them.

Obsessive fears are often accompanied by the development of rituals - actions that have the meaning of “magic” spells, which are performed, despite the patient’s critical attitude towards obsession, in order to protect against one or another imaginary misfortune: before starting any important task, the patient must perform some a certain action to eliminate the possibility of failure. Rituals can, for example, be expressed in snapping fingers, playing a melody to the patient, or repeating certain phrases, etc. In these cases, even loved ones have no idea about the existence of such disorders. Rituals combined with obsessions represent a fairly stable system that usually exists for many years and even decades.

Obsessions of affective-neutral content - obsessive philosophizing, obsessive counting, remembering neutral events, terms, formulations, etc. Despite their neutral content, they burden the patient and interfere with his intellectual activity.

Contrasting obsessions (“aggressive obsessions”) - blasphemous, blasphemous thoughts, fear of harm to oneself and others. Psychopathological formations of this group relate primarily to figurative obsessions with pronounced affective intensity and ideas that take over the consciousness of patients. They are distinguished by a feeling of alienation, an absolute lack of motivation in the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions complain of an irresistible desire to add endings to the remarks they have just heard, giving what was said an unpleasant or threatening meaning, to repeat after those around them, but with a tinge of irony or anger, phrases of religious content, to shout out cynical words that contradict their own attitudes and generally accepted morality , they may experience fear of losing control of themselves and possibly committing dangerous or ridiculous actions, causing injury to themselves or their loved ones. In the latter cases, obsessions are often combined with phobias of objects (fear of sharp objects - knives, forks, axes, etc.). The contrast group also partially includes obsessions with sexual content (obsessions like forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals).

Obsessions with pollution (mysophobia). This group of obsessions includes both the fear of pollution (earth, dust, urine, feces and other impurities), and the fear of penetration into the body of harmful and toxic substances (cement, fertilizers, toxic waste), small objects (shards of glass, needles, specific types of dust), microorganisms. In some cases, the fear of contamination may be limited in nature, remaining for many years at a preclinical level, manifesting itself only in some features of personal hygiene (frequent change of linen, repeated hand washing) or in housekeeping (careful handling of food, daily washing of floors , “taboo” on pets). This kind of monophobia does not significantly affect the quality of life and is assessed by others as habits (exaggerated cleanliness, excessive disgust). Clinically manifested variants of mysophobia belong to the group of severe obsessions. In these cases, gradually more complex protective rituals come to the fore: avoiding sources of pollution and touching “unclean” objects, processing things that could get dirty, a certain sequence in the use of detergents and towels, which allows you to maintain “sterility” in the bathroom. Staying outside the apartment is also accompanied by a series of protective measures: going outside in special clothing that covers the body as much as possible, special treatment of personal items upon returning home. In the later stages of the disease, patients, avoiding pollution, not only do not go outside, but do not even leave their own room. In order to avoid contacts and contacts that are dangerous in terms of contamination, patients do not allow even their closest relatives to approach them. Mysophobia is also associated with the fear of contracting any disease, which does not belong to the categories of hypochondriacal phobias, since it is not determined by the fear that the OCD sufferer has a particular disease. In the foreground is the fear of a threat from the outside: fear of pathogenic bacteria entering the body. Hence the development of appropriate protective actions.

A special place among obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, in contrast to organically caused involuntary movements, are much more complex motor acts that have lost their original meaning. Tics sometimes give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures. Patients suffering from tics may shake their heads (as if checking whether a hat fits well), make movements with their hands (as if throwing away interfering hair), and blink their eyes (as if getting rid of a speck). Along with obsessive tics, pathological habitual actions are often observed (biting lips, grinding teeth, spitting, etc.), which differ from the actual obsessive actions in the absence of a subjectively painful feeling of persistence and the experience of them as alien, painful. Neurotic conditions characterized only by obsessive tics usually have a favorable prognosis. Appearing most often in preschool and junior school age, tics usually subside towards the end of puberty. However, such disorders may also turn out to be more persistent, persisting for many years and only partially changing in manifestations.

Course of obsessive-compulsive disorder.

Unfortunately, it is necessary to indicate chronification as the most characteristic trend in the dynamics of OCD. Cases of episodic manifestations of the disease and complete recovery are relatively rare. However, in many patients, especially with the development and persistence of one type of manifestation (agoraphobia, obsessive counting, ritual hand washing, etc.), long-term stabilization of the condition is possible. In these cases, a gradual (usually in the second half of life) mitigation of psychopathological symptoms and social readaptation are noted. For example, patients who experienced fear of traveling on certain types of transport, or public speaking, cease to feel inferior and work alongside healthy people. In mild forms of OCD, the disease usually progresses favorably (on an outpatient basis). Reverse development of symptoms occurs after 1 year - 5 years from the moment of manifestation.

More severe and complex OCD, such as phobias of infection, pollution, sharp objects, contrasting ideas, numerous rituals, on the contrary, can become persistent, resistant to treatment, or show a tendency to relapse with disorders persisting, despite active therapy. Further negative dynamics of these conditions indicates a gradual complication of the clinical picture of the disease as a whole.

DIFFERENTIAL DIAGNOSIS

It is necessary to distinguish OCD from other diseases in which obsessions and rituals arise. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when the obsessive thoughts are unusual in content (for example, mixed sexual and blasphemous themes) or the rituals are extremely eccentric. The development of a sluggish schizophrenic process cannot be excluded with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity (inconsistency of thinking and actions), and the monotony of emotional manifestations. Prolonged obsessive states of a complex structure must be distinguished from manifestations of paroxysmal schizophrenia. In contrast to neurotic obsessive states, they are usually accompanied by sharply increasing anxiety, a significant expansion and systematization of the circle of obsessive associations, acquiring the character of obsessions of “special significance”: previously indifferent objects, events, random remarks from others remind patients of the content of phobias, offensive thoughts and thereby acquire in their minds there is a special, threatening meaning. In such cases, it is necessary to consult a psychiatrist to rule out schizophrenia. Differentiating OCD from conditions with a predominance of generalized disorders, known as Gilles de la Tourette syndrome, may also present certain difficulties. Tics in such cases are localized in the face, neck, upper and lower extremities and are accompanied by grimaces, opening the mouth, sticking out the tongue, and intense gesticulation. In these cases, this syndrome can be excluded by the characteristic roughness of movement disorders and more complex in structure and more severe mental disorders.

Genetic factors

Speaking about hereditary predisposition to OCD, it should be noted that obsessive-compulsive disorders are found in approximately 5-7% of parents of patients with such disorders. Although this rate is low, it is higher than in the general population. While the evidence for a genetic predisposition to OCD is unclear, psychasthenic personality traits can largely be explained by genetic factors.

In approximately two thirds of cases, improvement in OCD occurs within a year, often towards the end of this period. If the disease continues for more than a year, fluctuations are observed during its course - periods of exacerbations interspersed with periods of improved health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic person with severe symptoms of the disease, or if there are continuous stressful events in the patient's life. Severe cases can be extremely persistent; For example, a study of hospitalized patients with OCD found that three-quarters of them had unchanged symptoms 13-20 years later.

TREATMENT: BASIC METHODS AND APPROACHES

Despite the fact that OCD is a complex group of symptom complexes, the treatment principles for them are the same. The most reliable and effective method of treating OCD is considered to be drug therapy, which requires a strictly individual approach to each patient, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of other diseases. In this regard, we must warn patients and their relatives against self-medication. If any disorders similar to mental ones appear, it is necessary, first of all, to contact specialists at a psycho-neurological dispensary at your place of residence or other psychiatric medical institutions to establish the correct diagnosis and prescribe competent, adequate treatment. It should be remembered that at present a visit to a psychiatrist does not threaten any negative consequences - the notorious “registration” was canceled more than 10 years ago and replaced by the concepts of consultative and medical care and clinical observation.

When treating, it must be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement). The obvious suffering of the patient often seems to require vigorous effective treatment, but one should remember the natural course of this condition in order to avoid the typical mistake of overly intensive therapy. It is also important to consider that OCD is often accompanied by depression, the effective treatment of which often leads to an alleviation of obsessive symptoms.

Treatment of OCD begins with explaining the symptoms to the patient and, if necessary, disabusing them of the idea that they are the initial manifestation of insanity (a common cause of concern for patients with obsessions). Those suffering from one or another obsession often involve other family members in their rituals, so relatives need to treat the patient firmly but sympathetically, mitigating the symptoms as much as possible, and not aggravating them by excessively indulging the patients’ painful fantasies.

Drug therapy

In relation to the currently identified types of OCD, the following therapeutic approaches exist. The most commonly used pharmacological drugs for OCD are serotonergic antidepressants, anxiolytics (mainly benzodiazepines), beta-blockers (to relieve autonomic manifestations), MAO inhibitors (reversible) and triazole benzodiazepines (alprazolam). Anxiolytic drugs provide some short-term relief of symptoms, but they should not be prescribed for more than a few weeks at a time. If treatment with anxiolytics is required for more than one to two months, small doses of tricyclic antidepressants or minor antipsychotics are sometimes helpful. The main link in the treatment regimen for OCD, overlapping with negative symptoms or with ritualized obsessions, are atypical neuroleptics - risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants, or with antidepressants of other series - moclobemide, tianeptine, or with high-potency benzodiazepine derivatives ( alprazolam, clonazepam, bromazepam).

Any concomitant depressive disorder is treated with antidepressants in an adequate dose. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms, but the results of a controlled clinical trial showed that the effect of this drug is small and occurs only in patients with clear depressive symptoms.

In cases where obsessive-phobic symptoms are observed within the framework of schizophrenia, intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect. In some cases, it is advisable to include traditional antipsychotics (small doses of haloperidol, trifluoperazine, fluanxol) and parenteral administration of benzodiazepine derivatives.

Psychotherapy

Behavioral psychotherapy

One of the main tasks of a specialist in the treatment of OCD is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the “harm” caused by psychotropic drugs, to convey his conviction in the effectiveness of treatment, subject to systematic adherence to the prescribed prescriptions. The patient's faith in the possibility of healing must be supported in every possible way by the relatives of the OCD sufferer. If the patient has rituals, it must be remembered that improvement usually occurs when using a combination of a reaction prevention method and placing the patient in conditions that aggravate these rituals. Significant, but not complete, improvement can be expected in approximately two-thirds of patients with moderately severe rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts recede. For panphobia, behavioral techniques are used primarily aimed at reducing sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases of predominance of ritualized phobias, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for non-ritual intrusive thoughts. Some specialists have been using the “thought stopping” method for many years, but its specific effect has not been convincingly proven.

Social rehabilitation

We have already noted that obsessive-compulsive disorder has a fluctuating (fluctuating) course and over time the patient’s condition can improve, regardless of which treatment methods were used. Before recovery, patients may benefit from supportive conversations that provide ongoing hope for recovery. Psychotherapy in the complex of treatment and rehabilitation measures for patients with OCD is aimed at both correcting avoidant behavior and reducing sensitivity to phobic situations (behavioral therapy), as well as family psychotherapy with the aim of correcting behavioral disorders and improving family relationships. If marital problems aggravate symptoms, joint interviews with the spouse are indicated. Patients with panphobia (at the stage of the active course of the disease), due to the intensity and pathological persistence of symptoms, require both medical and social-labor rehabilitation. In this regard, it is important to determine adequate terms of treatment - long-term (at least 2 months) therapy in a hospital followed by continuation of the course on an outpatient basis, as well as carrying out measures to restore social ties, professional skills, and intra-family relationships. Social rehabilitation is a set of programs for teaching OCD patients how to behave rationally both at home and in a hospital setting. Rehabilitation focuses on teaching social skills to interact properly with others, vocational training, and skills needed in everyday life. Psychotherapy helps patients, especially those experiencing a feeling of inferiority, to treat themselves better and correctly, master ways to solve everyday problems, and gain faith in their strengths.

All these methods, when used wisely, can increase the effectiveness of drug therapy, but are not able to completely replace drugs. It should be noted that explanatory psychotherapy does not always help, and some patients with OCD even experience deterioration, since such procedures encourage them to think painfully and unproductively about the subjects discussed in the treatment process. Unfortunately, science still does not know how to cure mental illnesses once and for all. OCD often tends to recur, which requires long-term preventive medication.