Let's talk about anxiety-phobic disorder. Phobic anxiety disorders Phobic anxiety disorders treatment

A. V. Snezhnevsky (1983) divides obsessive phenomena into the following forms: figurative, sensitive (often extremely heavy in content) and abstract (indifferent in their content). The figurative form includes obsessive memories, blasphemous thoughts (contrasting ideas), obsessive doubts, obsessive fears, the inability to perform primary actions, etc., the abstract form includes obsessive reproduction in memory of forgotten names, surnames, definitions, fruitless obsessive calculation, philosophizing (“mental chewing gum"), etc.

Obsessive states are divided into motor (compulsion) spheres, emotional (phobia) and intellectual obsession. This division can be considered conditional, since to one degree or another, each obsessive phenomenon contains movements, fears, and obsessive thoughts, which are closely interrelated. An example of this is patients suffering from severe forms of obsessive-compulsive neurosis. Such patients sometimes develop protective actions (behaviors) of various types in the form of so-called rituals.

Obsessive phenomena such as “mental chewing gum” are manifested in obsessive doubts and thoughts that accompany various activities of patients. Originating during various intellectual activities, they force patients to return to the same thoughts, check the work done many times, recalculate, reread, leading to a state of fatigue and weariness.

Obsessive doubts can sometimes manifest themselves as uncertainty about the correctness and completeness of various actions with a continuous desire to check their implementation. Thus, patients check many times whether the iron is turned off, whether the door is locked, etc. At the same time, real (real) events attract their interest to a much lesser extent.

Obsessive counting (arrhythmomania) sometimes has an independent, independent meaning in neuroses, but is still more common in phobic syndrome, acquiring a protective-ritual character. For example, the patient almost always counts some objects (steps, window frames, performs counting operations in his head, chair legs, etc. (obsessive phobic disorders)) in order not to get some dangerous disease (for example, cancer). Obsessive phenomena that are noted and indifferent in their content also include repetition in memory of various forgotten names, dates, and obsessive recall of names (onomamania).

Obsessive memories, as a rule, are expressed in an irresistible memory that appears in the patient’s mind, most often relating to a traumatic situation that was the basis of a neurotic breakdown, or some unfortunate events in the past.

Obsessive movements or actions during neuroses sometimes occur independently or are more often included in the complex structure of the phobic syndrome and are presented as rituals. An obsessive nature can have both light, simple movements (for example, tapping, etc.), and more complex movements, actions (a strict sequence of something, for example, a sequence in a certain order of things on a desk or a day precisely planned by the hour, etc.). d.). In cases of painful forms of neuroses, including obsessive-compulsive neurosis, patients not only perform ritual actions themselves, but also force their loved ones to do them.

Complex obsessive motor rituals often have the character of a “cleansing”, protective and protective act (for example, hand washing for mysophobia).

Tics described in the group of obsessive movements in the form of stereotypically repeated involuntary twitching of muscles, usually related to the facial muscles, and blepharospasm, often found in neuroses, may have a neurotic origin, but in some cases require careful differential diagnosis with organic diseases of the central nervous system, local hyperkinesis of other origins etc. At the same time, according to many authors, an increase in the clinical manifestations of hyperkinesis during emotional stress, sometimes considered as evidence of the neurotic nature of the symptom, is usually observed with hyperkinesis of organic origin.

It should be noted that if in some cases the patient, against his will, is forced to perform certain logically unmotivated movements and actions, since this leads to calm, then in other cases all his efforts are aimed at not performing any actions.

Along with the more frequent obsessive phenomena in the form of obsessive actions, in the clinic of neuroses there are symptoms expressed in an obsessive fear of the inability to perform any action. This kind of obsessively arising fear is characteristic of syndromes of disautomatization of autonomic functions, manifested in disorders of breathing, swallowing, and urination. In the latter case, this is, for example, the inability to urinate in the presence of strangers.

Isolated obsessions

Obsessions in isolated form in neuroses are relatively rare. Authors who recognize obsessive-compulsive neurosis as an independent form describe obsessive phenomena more often within the framework of this neurosis. The same clinicians who do not distinguish obsessional neurosis consider obsessive symptoms to be quite typical for patients with neurasthenia.

Patients with various forms of neuroses may experience a wide variety of obsessive symptoms. Patients with neurasthenia are characterized by obsessive thoughts of hypochondriacal content, the fixation of which can be facilitated by various unpleasant somatic sensations. In the obsessive symptom complex of hysteria there is more demonstrativeness, avoidance of difficulties, “flight into illness” than the actual experiences of obsessions. The emotional intensity of these states is noted. A. M. Svyadosh (1982) suggests classifying as hysterical only those obsessions that are based on the mechanism of “conditioned pleasantness or desirability of a painful symptom.” Obsessive thoughts during hysteria are much less common. Sometimes patients with hysteria experience obsessive ideas that reach the level of hallucinations (usually visual and auditory).

Obsessive motor rituals more often occur in patients with obsessive-compulsive neurosis and hysteria, and less often with neurasthenia.

In most cases, obsessive manifestations in isolated form occur in psychopathy (psychasthenic or anankastic), as well as process diseases and organic brain lesions.

Diagnosis of the disease

Questions of differential diagnosis of obsessive-compulsive states in neuroses and schizophrenia (especially its sluggish, neurosis-like form) often present significant difficulties.

D. S. Ozeretskovsky (1950) believes that in schizophrenia one should distinguish between obsessive states that carry an undoubted emotional overtones (the presence of which, according to the author, is a consequence of the psychasthenic anxious-suspicious nature that is detected in patients with schizophrenia), and obsessive states that are fundamentally differ from the first ones in the absence of emotional coloring and which should be regarded as schizophrenic symptoms.

E.K. Yakovleva, who studied obsessive phenomena in our clinic for many years, showed that in most cases, obsessive states that develop in schizophrenia (as in other neuropsychiatric diseases) are not one of the components of the disease process, but only a consequence of complex experiences that arose in a person with psychasthenic traits, which is why they derail the meaningful character. As for the external manifestations of obsessions and the attitude of patients towards them, their certain originality in nervous and mental diseases, E.K. Yakovleva considers them to be the result of the influence of the main disease process on nervous activity and emphasizes (agreeing with D.S. Ozeretskovsky) that the diagnosis of schizophrenia in the presence of obsessive-compulsive syndrome can only be made on the basis of psychopathological disorders specific to this disease and cannot be determined by obsessive phenomena alone, no matter how striking they are with their unusualness.

Most authors emphasize the following differential diagnostic signs of obsessions in schizophrenia: lack of imagery, pallor of emotional components, monotony, the presence of a monotonous stamp of obsessions, rigidity, an abundance of rituals, a tendency to systematize. The suddenness and lack of motivation of their occurrence is also emphasized. As the disease process deepens, the addition of stereotypical motor and ideation rituals, which are characterized by meaninglessness and absurdity, is often observed. Prognostically unfavorable and also in favor of obsession within the framework of sluggish schizophrenia are obsessive doubts that arise when the syndrome becomes more complex. The severity of obsessions and their changes usually do not depend on external factors, as is observed with neuroses. In schizophrenia, obsessions are often combined with symptoms of derealization and depersonalization.

Signs such as the degree of critical attitude towards obsessive phenomena and the presence of a fight against them are of relatively less importance in differential diagnosis.

As E. S. Matveeva (1975) notes, in the clinic of low-progressive schizophrenia, patients at the onset of the disease can display a certain critical attitude towards ideas of an obsessive nature and regard them as painful; pathological ideas are not of the nature of delusional conviction and are constantly questioned; patients regard these phenomena as alien to their personality; patients strive to overcome them, opposing them to a system of protective measures characteristic of anankastic psychopaths. In this regard, monitoring the dynamics of the development of psychopathological disorders is essential. With obsessions within schizophrenia, as the disease progresses, there is a weakening of the critical attitude towards them, the disappearance of the painful experience of a fruitless struggle with them. There is also a “fading” of the affective attitude towards these disorders, the appearance of other above-mentioned signs of obsessive disorders (obsessive disorder), characteristic of process diseases. clearer identification of symptoms of a different register.

In the case of manic-depressive psychosis, psychogenically caused obsessive states usually arise in the depressive phase; they are closely associated with the onset of the attack and disappear with its end.

Encephalitis

Many authors describe obsessions with encephalitis. These patients may have real obsessive states caused by the reaction of an anxious person to the disease encephalitis, as well as in connection with more complex psychogenies accompanying the organic disease. At the same time, the actual obsessive formations in encephalitis are characterized by some features that are usually emphasized in the literature: violent irresistibility, dominance, stereotyping, and often suddenness of onset; it is more correct to classify them not as obsessive, but as violent phenomena.

Certain features characterize contrastive obsessions in patients with organic brain diseases.

Their obsessive urge component borders on violence.

Motor acts in patients with postencephalitic parkinsonism are also violent in nature, having nothing in common with obsessive compulsions (obsessive-compulsive personality disorder).

Epilepsy

In patients with epilepsy, it is necessary to distinguish symptoms within the framework of special conditions that are associated with disturbances in the field of drives and cannot be attributed to true obsessive states: influxes of thoughts, violent aspirations, violent desires. They are characterized by short duration, pronounced affective intensity, almost violent irresistibility, and lack of connection with mental trauma.

M. Sh. Wolf (1974) notes in patients with epilepsy an obsessive need to move, remove or destroy individual objects, as well as the appearance of obsessive, often meaningless phrases, individual phrases, fragments of memories or painful doubts, the meaning and significance of which patients are poorly aware of and do not understand. able to convey accurately.

At the same time, in patients with epilepsy, as in other neuropsychiatric diseases, obsessive phenomena, psychogenically caused, can be observed, which are characterized by special torpidity during the period of weakening of nervous activity.

Obsessive-phobic disorder

What is obsessive-phobic disorder? This is a neurotic disorder in which a person suffers from obsessive fears, thoughts, actions, and memories.

If you want to find out if you have it, you can take the test on the “Obsessive-phobic disorder” scale in the article “Neurosis. What is it and how to identify it” on our website.

And there is disappointment if your indicator is below the coefficient of 1.28.

As a rule, obsessive-phobic disorder can be accompanied by the following fears (phobias):

• fear of getting a serious disease (AIDS, cancer, etc.);
• fear of staying indoors, in an elevator (claustrophobia);
• fear of going out into open spaces (agarophobia).

Moreover, anxiety reaches such proportions that a person will use all available means to avoid situations where these fears arise.

But, in addition to fears, this disorder has the following obsessions:

• obsessive thoughts;
• intrusive memories;
• obsessive counting (counting steps of a staircase, cars of a certain color, the number of letters in words, etc.);
• compulsive hand washing;
• obsessive checks (is the door closed, is the iron, light, gas, etc. turned off);
• rituals (to eliminate obsessive actions).

The person himself understands the groundlessness of these actions, but cannot get rid of them.

Is there a way to be cured? Eat!

This is cognitive behavioral therapy (CBT). A very effective method in this therapy is Jeffrey Schwartz's 4-step program.

And there is a therapy method called EMDR, in which we work through traumatic experiences, events that lead to disorder. Read more about the method on our website in the “Methods” section.

Obsessive-compulsive disorder - symptoms and treatment. Diagnosis of obsessive-compulsive disorder neurosis and test

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.

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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 the 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:

1. stressful situation or traumatic event;
2. autoimmune reaction (consequence of streptococcal infection);
3. genetics (Tourette's syndrome);
4. 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).

Let's talk about anxiety-phobic disorder

Anxiety-phobia disorder is a neurotic condition in which obsessive fears (phobias), thoughts, and memories arise. All these obsessions (obsessions) are unpleasant and alien to patients, but they cannot get rid of them on their own.

Anxiety-phobic disorder, obsessive-phobic disorder, obsessional neurosis, obsessive-phobic neurosis are all different names for the same disease. Let's take a closer look at the causes of the development of this disease, its manifestations, and its treatment.

Who has problems?

The predisposition to the development of obsessive-phobic neurosis is inherited.

Some personal qualities are fertile ground for the development of anxiety-phobic disorder. These include anxiety, suspiciousness, caution, responsibility, and pedantry. Such people live by reason, and not by emotions; they are used to thinking through everything in detail and weighing it. Also, people suffering from obsessive-phobic neurosis are demanding of themselves and prone to introspection.

Obsession neurosis almost never occurs in people who are able to easily transfer responsibility for an unpleasant situation to others, who are prone to aggression, and who achieve their goal at any cost.

One of the variants of psychopathy, psychasthenia, is the background for the development of anxiety-phobic disorder and is constantly manifested by more or less pronounced obsessions.

At certain age periods, the risk of developing neuroses, including anxiety-phobic disorders, increases. This is adolescence, the period of early adulthood (25-35 years) and the time preceding menopause.

Obsessive-phobic neurosis occurs with approximately equal frequency among both men and women.

Reasons for the development of neurosis

All neuroses, including phobic anxiety disorder, usually arise when mental trauma is combined with excessively stressful work and lack of rest, and chronic lack of sleep. Various infections, alcohol abuse, endocrine disorders, and poor nutrition act as factors that weaken the body.

Clinical picture

The main manifestations of obsessive-phobic neurotic disorder include panic attacks, agoraphobia and hypochondriacal phobias.

Panic attacks

Panic attacks are manifested by severe fear and a feeling of impending death, accompanied by vegetative symptoms (sweating, dizziness, feeling of lack of air, palpitations, nausea). Such attacks can last from several minutes to an hour. During panic attacks, there is often a fear of going crazy and losing control over your behavior. Panic attacks are characteristic of panic disorder; I devoted a separate article to its detailed description.

Some diseases of internal organs can cause the first panic attacks. These are gastritis, pancreatitis, osteochondrosis, heart disease, thyroid dysfunction.

Agoraphobia

Agoraphobia is not only a fear of open spaces, but also a fear of crowds, crowded places, and a fear of going outside.

There are a number of obsessive fears similar to agoraphobia. Among them are claustrophobia (fear of enclosed spaces), transport phobias (fear of traveling on a train, plane, bus).

As a rule, the first manifestations of anxiety-phobic disorders are panic attacks, followed by agoraphobia.

With phobias, anxiety and obsessive fear appear not only in specific situations, but even when people remember similar situations and imagine them.

Typical for the development of phobic disorders is the expansion of situations that cause fear. For example, with transport phobias, an obsessive fear of moving in the subway first appears, then the fear of public ground transport and taxis joins. People suffering from obsessive-phobic neurotic disorders are not afraid of transport itself, but of situations that may arise in them. For example, the fear that in the metro, due to the large distance between stations, a person will not be able to receive medical assistance in a timely manner if a panic attack occurs.

Hypochondriacal phobias

Hypochondriacal phobias are the fear of some serious illness. They are also called nosophobias.

The most common are carcinophobia (fear of getting cancer), cardiophobia (obsessive fear of heart disease), stroke phobia (fear of stroke), AIDS phobia and syphilophobia (fear of contracting AIDS or syphilis). Hypochondriacal phobias can also be manifestations of hypochondriacal depression.

People suffering from phobias do everything to avoid the situation that causes them fear. With transport phobias, people with anxiety-phobic disorder do not use elevators or transport; they walk everywhere. Those who are pathologically afraid of getting cancer constantly turn to doctors to conduct thorough examinations. But even good test results do not reassure patients for long. The first minor deviations in the functioning of internal organs are immediately perceived as the appearance of a serious, incurable disease.

Social phobias

Phobic anxiety disorder can be accompanied by a range of social phobias.

Social phobias involve a fear of being the center of attention and fear of being judged negatively by others, and people avoid social situations as much as possible.

The first signs of social phobias usually appear during adolescence or young adulthood. Quite often, the appearance of phobias is provoked by adverse psychological or social influences. Initially, the fear of being the center of attention affects only certain situations (for example, answering at the blackboard, appearing on stage) or contact with a certain group of people (the local “elite” among students at school, representatives of the opposite sex). At the same time, communication with loved ones and family does not cause fear.

Over time, social phobia can manifest itself only in relative restrictions in the sphere of social activity (fear of communicating with superiors, fear of eating in public places). If a person finds himself in a similar situation, then shyness, embarrassment, a feeling of inner constraint, trembling, and sweating appear.

Some people may have generalized social phobia. Such people avoid public places in every possible way, fearing to appear funny or to discover signs of imaginary inferiority in people. Any presence in public places, public speaking causes them an unreasonable feeling of shame.

Obsessive-phobic disorders can also manifest themselves as specific phobias - obsessive fears associated only with a specific situation. Such phobias include fear of thunderstorms, heights, pets, and visiting the dentist.

Variants of the course of disorders

The first option is the rarest. It manifests itself exclusively in attacks of panic attacks. The phenomena of agoraphobia and nosophobia occur rarely and do not form close connections with panic attacks.

The second variant of obsessive-phobic neurotic disorders is manifested by panic attacks and persistent agoraphobia. A distinctive feature of panic attacks is that they occur suddenly, in the midst of complete health, are accompanied by severe anxiety and are perceived by patients as a life-threatening physical catastrophe. At the same time, vegetative symptoms are weakly expressed.

In the second version of phobic anxiety disorder, agoraphobia, obsessions and hypochondriacal symptoms very quickly join panic attacks. At the same time, the entire lifestyle of patients is subordinated to the elimination of the conditions for the occurrence of panic attacks. Patients can develop a whole range of protective measures to avoid the slightest possibility of getting sick or getting into a situation accompanied by the appearance of a phobia. Often patients change jobs or even quit, move to a more environmentally friendly area, lead a gentle lifestyle, and avoid “dangerous” contacts.

The third variant of obsessive-phobic neurosis is panic attacks that develop as a vegetative crisis. Panic attacks are preceded by mild anxiety and various pains throughout the body. In most cases, a panic attack is psychogenically provoked. Its main symptoms are rapid heartbeat, a feeling of lack of air, and suffocation. Even after the panic attack passes, a state of complete well-being does not occur. Patients begin to scrupulously observe all, even the smallest, deviations in the functioning of internal organs and consider them signs of a serious pathology.

Features of treatment

Treatment of obsessive-phobic disorders should be comprehensive, including drug treatment along with psychotherapy.

Drug therapy

The most commonly used antidepressant to treat panic attacks is anafranil (clomipramine). Antidepressants fluvoxamine, sertraline, fluoxetine, which are also used to treat depression, help cope with panic attacks and other manifestations of anxiety-phobic disorders. The drug of choice for the treatment of social phobia is moclobemide (Aurox).

In addition to antidepressants, tranquilizers (meprobamate, hydroxyzine) can also be used to treat phobic anxiety disorder. These drugs have minimal side effects, and their long-term use does not lead to the development of drug dependence.

For acute forms of anxiety-phobic disorders, the benzodiazepine tranquilizers alprazolam and clonazepam are most effective. Diazepam and Elenium can also be used intramuscularly or in the form of droppers. However, these drugs can only be used for a short time to avoid addiction to them.

For phobias accompanied by a complex system of protective rituals (obsessive counting, obsessive decomposition of words), when obsessions are combined with delusional inclusions, antipsychotics - triftazine, haloperidol and others - can be prescribed.

Psychotherapy

Psychotherapeutic interventions are aimed at eliminating anxiety and correcting inappropriate forms of behavior (avoidance in anxiety-phobic disorders), teaching patients the basics of relaxation. Both group and individual psychotherapy methods can be used.

If phobias predominate during the course of the disorder, patients need psycho-emotional support therapy, which can improve the psychological well-being of such people. Behavioral therapy and hypnosis help eliminate phobias. During the sessions, patients are taught to resist the feared object and to use various types of relaxation.

Also, rational psychotherapy can be used to treat obsessive fears, while the true essence of the disease is explained to patients, and an adequate understanding of the manifestations of the disease is formed by the patient (so that the slightest changes in the internal organs are not perceived as signs of a serious disease).

I was always afraid to speak in public. It started at school. After I once forgot the words during a performance in which I participated, I began to be manically afraid of any performance, I found any reason for this, just so that I didn’t have to go on stage.

And now more than 10 years have passed, I graduated from college, have a job I love, I was promoted, appointed head of the department, and now I need to periodically report to management to all the employees of our large company! But I’m just terrified of this! What should I do to cope with anxiety?

Antonina, I think you are a strong person and will be able to overcome your fear of speaking in front of an audience.

Read Dale Carnegie's book, How to Build Confidence and Influence People in Public Speaking, and follow the guidelines in it. I think this book will help you overcome your fear and become a good speaker, especially since this skill will be needed in your work.

I never thought that panic could overtake me too. I am a calm, balanced person by nature, a fighter in life. She always achieved her goals and was afraid of practically nothing.

And now I have a fear of cars. I have about 5 years of driving experience. She always drove smoothly and carefully. A month ago I was in an accident. I myself was not hurt at all, the car needs a little repair, but the problem is that I am now catastrophically afraid to drive, I’m afraid that I might get into an accident again. I literally panic, my hands start shaking as soon as I get behind the wheel, and I can’t do anything about it, calm down. What should I do?

Lisa, I know from the experience of some of my driver friends that after you get into an accident, even if you were not driving, you may become afraid of the car.

What is the best thing to do in this case? You need to believe in yourself again, perhaps learn a little. The best way to do this is to use the services of a driving instructor. When you get into the car and know that a professional is sitting next to you, who will insure you at any moment, it will be easier for you to overcome your fear. Well, the experience that you will gain from this, new information (maybe there is something you didn’t know or forgot) will further contribute to restoring faith in yourself.

an antidepressant such as anafranil (clomipramine) is used.

Vasily, where did you get the idea? I just indicated the most common and effective drugs.

Hello! I start to panic (excitement, nausea, palpitations) when I ride in the subway or car. It started after I took a car trip to the sea. I have some kind of negative connection with all these types of transport. It’s very difficult to live with this, the problem is to move far from home. Tell me what to do?

Nata, consult a specialist (psychiatrist, psychotherapist).

Good evening. Please tell me what’s happening to me: I recently went to the store and I felt bad because there were so many people there, I literally felt lost in the crowd, I didn’t understand what I was doing there, why I came there, I it was very scary to go there. And I look at everyone as if in a dream, and the people passing by formed like pictures in my mind. I quickly went out into the fresh air and felt better. Also on the bus I felt bad, at this time I was overcome by a lack of air, my palms were sweating and I felt as if I was about to faint, as if I was going crazy, and this made it even worse. In general, lately I have been very tense, every rustle, the cry of children, light, loud noises scares me, I shudder, it’s as if I tensed up with fear, and this makes me feel even worse. I am registered with a neurologist with a diagnosis of epilepsy, but I have not had seizures for a very long time. I don’t know what’s happening to me, I’m very afraid that my illness will return to me. Please tell me what's wrong with me.

Good afternoon, a very similar situation, almost identical, but it began some time after a nervous breakdown and lasts almost a year. It seems to be easier lately. How did you deal with it?

Yulia, given that you suffer from epilepsy (even if you haven’t had seizures for a long time), I recommend that you seek advice from a neurologist or epileptologist. You may need to adjust your treatment.

Before describing my problem, I’ll tell you a little background. This is probably important.

Since childhood I have been very impressionable. Attention to others and compassion have never been alien to me. I have always loved pets, a puppy or a kitten being hit by a car always caused shock and lasting emotions in me. I also had compassion for the poultry that was put into the soup.

Once, at the age of 5-6 years, I saw a scene in a film of a man being beheaded. This picture stuck in my head for a long time. I wondered, how can you be so cruel?

Then, as I grew older, I calmed these fears, explaining to myself that sometimes this happens on the roads and I personally cannot influence it in any way, and some pets are specially bred to be killed and eaten. This is a necessity that, if you are not a vegetarian, cannot be avoided. I also realized that people can be incredibly cruel. You could say that with age I developed a certain “thick skin” in myself in order not to take such phenomena to heart. Let me clarify, I didn’t become cruel, it’s just that some kind of defense mechanism probably worked so as not to torture myself.

Now I am 31 years old, I got married not so long ago. I recently watched the movie “Game of Thrones”. Very interesting movie, exciting plot. But there are plenty of scenes of violence using knives. All the way in the film they cut, stab their enemies, cut off their heads left and right. This slightly refreshed the childhood fears that I wrote about above.

Recently, in my life there has been a confluence of many factors causing psychological stress:

My work is connected with people, investigation of various conflicts, disputes, crimes, you often come across moral filth. It’s not always possible not to let other people’s negative emotions pass through you. In a word, there was a lot of stress, I became nervous, irritable, and overly aggressive.

On top of that, my wife is now pregnant. The psychological state of pregnant women is very specific. Moods can change hourly. If earlier, before pregnancy, her attempts to dominate in our couple were stopped by me very quickly and without problems, now it’s just a disaster - any irritation can lead to hysterics, the slightest thing - she immediately bursts into tears. It is impossible to argue with her now; excessive emotionality and capriciousness defeat any rational arguments. In the sense that I simply began to avoid conflicts so that my wife’s nervousness and predisposition to stress would not harm her and the child. Avoiding a conflict without resolving it does not relieve my psychological stress; there is no outlet into which negative emotions can be drained. That is, if earlier it was possible to sternly say “stop”, to stop arguing with a serious look, now I cannot do this because of caring for my wife and child.

Against the backdrop of all these stress factors, I had one very harmful association - at the peak of the conflict, scenes of the use of edged weapons (various piercing and cutting objects) surfaced in my mind. That is, being irritated, angry, I clearly imagined, like a picture in a movie, that out of hopelessness I poked and slashed my opponent with a knife. This association is further strengthened by the fact that one day my wife and I had a very strong fight like never before on the day when I was helping my father-in-law cut up a pig. The connection “conflict -> what is sharp, cutting” was deposited in the consciousness. If I’m not mistaken, in psychology the term “anchor” is used when one event is fixed in memory with reference to another.

When I first realized this, it horrified me and threw me into a cold sweat, because in fact, I don’t want to cause pain, suffering, or any harm to anyone, and especially to my loved ones.

I understand that my accumulated psychological fatigue, caused by exposure to many stress factors at the same time, led to the fact that for some brief moment during the conflict, a picture flashed in my mind, similar to my childhood fears, gleaned from films / television, before which I never would have thought of this without seeing such shocking things on screen.

The above led me to an extremely depressed state.

Knowing the main reason, I, following the example of my colleagues, began to take a sedative (extract of valerian and other herbs, Novo-Passit).

Now I’ve been taking sedatives for about a month and I can say that my state of mind has almost completely returned to balance.

However, what worries me is that, firstly, I am terribly ashamed, first of all, of myself, that I, an adult with fairly strong self-control and will, who never allowed myself to harm anyone or even think about it, allowed in my mind such.

My intuition tells me that taking sedatives needs to be supplemented by introducing more positivity and positive emotions into life.

I would be very grateful for your advice. Thank you very much in advance!

KVD, there are many popular techniques when negative thoughts spill out into some kind of destructive actions, and this really helps to restore balance and not do anything bad. For example, people break dishes, cut some things, clothes. You can even practice with a punching bag, trying to throw out all the accumulated negativity during punches.

In principle, there is nothing wrong with the fact that during conflicts you imagine something piercing or cutting, no. You understand that you won’t do anything like that in real life, you don’t wish harm on anyone, and the fact that you are capable of experiencing anger and rage are normal human feelings from which no one is immune.

Look for a way for yourself to “throw out” the accumulated negativity - anything will do, the main thing is that bad thoughts and emotions do not accumulate and destroy you from the inside.

When I turned 40, an event happened - the strange death of a friend of mine, a completely healthy woman. 5-6 days later, on a day off, I dug in the garden, drank coffee and decided to do a little physical exercise. But suddenly I felt bad. I endured it for a couple of hours, thinking it would go away, and then I called an ambulance, and the doctors discovered the pressure was 170/100. I treated my blood pressure for five years, but along with it came the fear of death. There was practically no result from medications for hypertension, and panic attacks only became more frequent.

I went to the neurosis department. Two weeks from shock doses - like in a dream... Then I was discharged with an order to drink anafranil. For two years he noticeably reduced both the frequency and duration of panic attacks. But then the cases became more frequent and, of course, were accompanied by high blood pressure readings. I don’t know what came first? Pressure or attacks? Slowly I learned to live with this.

Now, after several stays in the neurosis department, the doctors settled on a dose of 150 mg of Seroquel per day in two doses: 100 at night and 50 during the day. Of the antidepressants, Adepress turned out to be the most effective. The rest (pirazidol, amitriptyline, oleval) either do not work, or are even worse. Fears: space, appearing in front of unfamiliar people, speaking, even saying a toast is a problem. At home I’m afraid to argue with my wife, children, guests, so as not to provoke an attack. Inside, of course, there remains a feeling of injustice.

In a word - life is not happy at all. And I’m only 55. I look at other people without this disease, for me they are like alien heroes.

And I want to live like them.

Help me please!? Maybe some kind of medication? I'm afraid to talk about this topic with my local police officer. What if he stops taking Seroquel?

Igor, you need to simultaneously treat both panic attacks and hypertension. I cannot recommend any medications to you, because first you need to conduct a full examination, assess the patient’s condition (and not just complaints), and only after that can you draw some conclusions and select treatment.

Another thing I can recommend in your case is to contact a psychotherapist (just first find out about this from specialists and try to find out reviews).

With panic attacks, the maximum result is always achieved by combining drug treatment with psychotherapy. After all, it is necessary not only to eliminate existing symptoms with the help of medications, but also to change your view of problematic situations.

For the last few years I have been having panic attacks of fear, I even dream of horrors in my dreams. I can wake up as if paralyzed and scared to open my eyes. Sometimes I catch myself thinking about how I will save someone close to me or myself, no matter how funny it may sound, from a fire/robbery and I get scared, it’s like uncontrollable thoughts, I don’t want to think about bad, but it is automatic. And it also happens that I imagine, involuntarily, that I look, for example, out the window and fall out.

I also have very bad sleep, I don’t sleep at all at night, I fall asleep in the morning, and even if I sleep long and soundly, it’s as if I’m not getting enough sleep. I tried not to sleep for several days, then I fell asleep, but the next day everything happened again. You know, if I won a million, I would not think about how to spend it well, but how to get rid of it, as a potential threat.

Phobic disorders

Phobic disorder (phobia) is a sudden, intense fear that persistently arises in connection with certain objects, actions or situations. Combined with avoidance of frightening situations and anticipatory anxiety. Mild forms of phobias are widespread, but the diagnosis of “phobic disorder” is established only when fear limits the patient and negatively affects various aspects of his life: personal relationships, social activity, professional fulfillment. The diagnosis is made on the basis of anamnesis. Treatment – ​​psychotherapy, pharmacotherapy.

Phobic disorders

Phobic disorders are intense, unreasonable fear that occurs when coming into contact with certain objects, getting into specific situations, or having to perform certain actions. At the same time, patients with a phobic disorder retain a critical perception of reality and realize the groundlessness of their own fears. The exact number of phobias is unknown, but there are lists that indicate more than 300 types of this disorder. Phobic disorders are widespread. Every tenth inhabitant of the Earth experiences a single panic attack associated with being in a phobic situation.

Clinically significant phobic disorders occur in approximately 1% of the population, but the extent to which they affect patients' lives can vary significantly depending on the type and severity of the phobia, as well as the likelihood of contact with the object of fear. Women suffer from phobic disorders twice as often as men. Phobias usually arise in childhood; manifestations over the age of 40 are extremely rare. Treatment of this pathology is carried out by specialists in the field of psychotherapy, psychiatry and clinical psychology.

Causes of phobic disorders

The exact cause of the development of phobias has not been established. There are several concepts to explain the occurrence of this disorder. From a biological point of view, phobic disorders are provoked by a hereditary or acquired imbalance of certain substances in the brain. It has been established that in people suffering from phobic disorders, there is an increase in the level of catecholamines, blockade of receptors that regulate GABA metabolism, excessive stimulation of beta-adrenergic receptors and some other disorders.

Psychoanalysts consider phobic disorder as a protective mechanism of the psyche, which allows one to control the level of hidden anxiety and symbolically reflects certain taboo ideas of the patient. An object that causes anxiety, but cannot be controlled, along with the feeling of anxiety itself, is repressed into the unconscious and transferred to another object, somewhat reminiscent of the first, which provokes the development of a phobic disorder. For example, anxiety when feeling the hopelessness of one’s own situation in relationships with other people is transformed into a fear of closed spaces (claustrophobia).

Experts in the field of behavioral therapy believe that phobic disorder is the result of the patient's reinforcement of an incorrect response to a stimulus. Once having experienced panic in some situation, the patient associates his condition with a certain object, and subsequently this object becomes a stimulus that provokes a panic reaction. It follows from this that in order to eliminate a phobic disorder it is necessary to “relearn”, to develop a new reaction to a familiar stimulus.

Sometimes adults convey their fears to children. For example, if a child sees his mother being afraid of spiders, he may also subsequently develop arachnophobia. If parents constantly tell their child that dogs are dangerous and demand that he stay away from them, the child is more likely to develop cynophobia. In some patients, there is a clear connection between phobic disorder and acute mental trauma. For example, claustrophobia can develop after being in a closed, overturned car or under rubble caused by an earthquake or industrial accident.

Classification of phobic disorders

There are three groups of phobic disorders: social phobia, agoraphobia and specific (simple) phobias. Psychologists and psychotherapists count several hundred simple phobias, including the well-known claustrophobia (fear of enclosed spaces) or aerophobia (fear of flying on airplanes), and arctophobia (fear of plush toys), tetraphobia (fear of numbers), which are quite exotic for most people. four) or megalophobia (fear of large objects).

Agoraphobia is a phobic disorder characterized by the fear of being in a place or situation from which it is impossible to escape unnoticed or from which it is impossible to immediately obtain help when intense anxiety occurs. Patients suffering from this phobic disorder may avoid squares, wide streets, crowded shopping centers, public transport, theaters, train stations, classrooms and other similar places. The severity of the phobia can vary significantly. Some patients remain able to work and lead a fairly active lifestyle, while in others the phobic disorder is so pronounced that patients stop leaving the house.

Social phobia is a phobic disorder characterized by severe anxiety and fear when entering certain social situations. Anxiety and fear develop due to fears of experiencing humiliation, not meeting the expectations of others, demonstrating to other people one’s weakness and inadequacy through trembling, redness of the face, nausea and other physiological reactions. Patients with this phobic disorder may be afraid to speak in public, use public baths, eat with other people, etc.

Specific phobias are phobic disorders that manifest themselves as fear when confronted with a specific object or situation. The most common disorders in this group are acrophobia (fear of heights), zoophobia (fear of animals), claustrophobia (fear of enclosed spaces), aviophobia (fear of flying on airplanes), hemophobia (fear of blood), trypanophobia (fear of pain). The impact of a phobic disorder on a patient’s life is determined not only by the severity of fear, but also by the likelihood of encountering the object of the phobia; for example, for a city dweller, ophidophobia (fear of snakes) is practically insignificant, but for a rural dweller it can pose a serious problem.

Symptoms of phobic disorders

Common symptoms of phobic disorders are intense acute fear when confronted with the object of the phobia, avoidance, anticipatory anxiety, and awareness of the irrationality of one's own fear. Fear upon contact with an object provokes some narrowing of consciousness and is usually accompanied by violent vegetative reactions. A patient with a phobic disorder completely focuses on the frightening object, to one degree or another ceases to monitor the environment and partially loses control over his own behavior. Possible increased breathing, increased sweating, dizziness, weakness in the legs, palpitations and other vegetative symptoms.

The first encounters with the object of a phobic disorder provoke a panic attack. Subsequently, the fear worsens, exhausts the patient, and interferes with his normal existence. In an effort to eliminate unpleasant sensations and make life more acceptable, a patient with a phobic disorder begins to avoid frightening situations. Subsequently, avoidance is reinforced and becomes a habitual pattern of behavior. Panic attacks stop, but the reason for their cessation is not the disappearance of the phobic disorder, but the lack of contact with the object.

Anticipation anxiety is manifested by fear when imagining a frightening object or realizing the need to get into a situation of contact with this object. Erased vegetative reactions arise, thoughts appear about intolerance to such a situation; a patient suffering from a phobic disorder plans actions to prevent contact. For example, a patient with agoraphobia, if necessary to visit a large shopping center, thinks through alternative options (visiting small stores selling similar goods); a patient with claustrophobia, before visiting an office located on the upper floors of a building, finds out whether there are stairs in this building that can be used instead elevator, etc.

Patients with phobic disorders are aware of the irrationality of their own fears, but ordinary rational arguments (their own and those of others) do not influence the perception of a frightening object or situation. Some patients, forced to regularly be in frightening situations, begin to take alcohol or sedatives. With phobic disorders, the risk of developing alcoholism, dependence on tranquilizers and other drugs increases. Debilitating fear and restrictions in social, professional and personal life often provoke depression. In addition, phobic disorders are often combined with generalized anxiety disorder and obsessive-compulsive disorder.

Diagnosis and treatment of phobic disorders

The diagnosis is made on the basis of anamnesis, ascertained from the patient’s words. In the process of diagnosing phobic disorders, the Zang scale for self-assessment of anxiety, the Beck Anxiety and Depression Scale and other psychodiagnostic methods are used. When making a diagnosis, DSM-4 criteria are taken into account. Treatment tactics are determined individually, taking into account the type, duration and severity of the phobic disorder, the presence of concomitant disorders, the psychological state of the patient and his readiness to use certain methods.

Cognitive behavioral therapy is considered the most effective psychotherapeutic method for treating phobic disorders. Various techniques are used during the treatment process. Systemic desensitization is most often used against the background of deep muscle relaxation. First, a psychologist or psychotherapist teaches a patient with a phobic disorder special relaxation techniques, and then helps him gradually immerse himself in frightening situations. Along with systemic sensitization, the principle of visualization (observation of other people in situations that frighten the patient) and other techniques can be used.

Psychoanalysts believe that phobic disorder is an external symptom, an expression of a severe internal conflict. To eliminate a phobia, it is necessary to discover and eliminate the conflict that underlies it. Conversations and analysis of the patient's dreams are used as a means to identify the problem hidden behind a phobic disorder. In the process of work, the patient not only discovers and works through an internal conflict, but also strengthens his “I”, and also gets rid of the habitual reaction of pathological regression in response to traumatic external influences.

If necessary, cognitive behavioral therapy and psychoanalysis for phobic disorders are carried out against the background of drug treatment with antidepressants and tranquilizers. Medicines are usually prescribed in short courses to avoid addiction. The prognosis is determined by the severity of the phobic disorder, the presence of concomitant diseases, the patient’s level of motivation and his readiness for active work. With adequate therapy, in most cases it is possible to achieve improvement or long-term remission.

Today, three in one hundred adults and two in five hundred children are diagnosed with obsessive-compulsive disorder. This is a disease that requires mandatory treatment. We suggest that you familiarize yourself with the symptoms of ACS, the causes of its occurrence, as well as possible treatment options.

What is OKS?

Obsessive-compulsive syndrome (or disorder) is constantly repeating identical obsessive involuntary thoughts and (or) actions (rituals). also called obsessive-compulsive disorder.

The name of the disorder comes from two Latin words:

• obsession, which literally means siege, blockade, taxation;
• compulsion - coercion, pressure, self-coercion.

Doctors and scientists began to be interested in the syndrome back in the 17th century:

• E. Barton described the obsessive fear of death in 1621.
• Philippe Pinel conducted research on obsession in 1829.
• Ivan Balinsky introduced the definition of “obsessive thoughts” into Russian literature on psychiatry and so on.

According to modern research, obsessive syndrome is characterized as a neurosis, that is, it is not a disease in the literal sense of the word.

Obsessive-compulsive syndrome can be schematically depicted as the following sequence of situations: obsessions (obsessive thoughts) - psychological discomfort (anxiety, fears) - compulsions (obsessive actions) - temporary relief, after which everything repeats again.

Types of ACS

Depending on the accompanying symptoms, obsessive syndrome can be of several types:

1. Obsessive-phobic syndrome. Characterized by the presence of only anxieties, fears, doubts that do not lead to any further action. For example, constant rethinking of situations in the past. May also appear as
2. Obsessive-convulsive syndrome- presence of compulsive actions. They may be related to establishing constant order or monitoring security. In terms of time, these rituals can take up to several hours daily and take a lot of time. Often one ritual can be replaced by another.
3. Obsessive-phobic syndrome accompanied by convulsive, that is, (thoughts) and actions arise.

Depending on the time of manifestation, ACS can be:

• episodic;
• progressive;
• chronic.

Causes of obsessive syndrome

Experts do not give a clear answer as to why obsessive syndrome may appear. In this regard, there is only an assumption that some biological and psychological factors influence the development of ACS.

Biological reasons:

• heredity;
• consequences of traumatic brain injuries;
• complications in the brain after infectious diseases;
• pathologies of the nervous system;
• disruption of the normal functioning of neurons;
• decreased levels of serotonin, norepinephrine or dopamine in the brain.

Psychological reasons:

• psychotraumatic relationships in the family;
• strict ideological education (for example, religious);
• experienced serious stressful situations;
• stressful work;
• strong impressionability (for example, an acute reaction to bad news).

Who is susceptible to ACS?

There is a high risk of developing obsessive syndrome in people who have already had similar cases in their family - a hereditary predisposition. That is, if there is a person in the family diagnosed with ACS, then the probability that his immediate offspring will have the same neurosis is from three to seven percent.

The following types of individuals are also susceptible to ACS:

• overly suspicious people;
• those who want to keep everything under their control;
• people who suffered various psychological traumas in childhood or in whose families there were serious conflicts;
• people who were overprotected in childhood or, conversely, who did not receive enough attention from their parents;
• suffered various brain injuries.

According to statistics, there is no division in the number of patients with obsessive-compulsive disorder syndrome between men and women. But there is a tendency that neurosis most often begins to manifest itself in people aged 15 to 25 years.

Symptoms of ACS

The main symptoms of obsessive-compulsive disorder include the appearance of anxious thoughts and monotonous daily activities (for example, a constant fear of saying the wrong word or a fear of germs that forces you to wash your hands frequently). Accompanying symptoms may also appear:

• sleepless nights;
• nightmares;
• poor appetite or complete loss of it;
• gloominess;
• partial or complete detachment from people (social isolation).

Examples of manifestations of ACS in adults

How to diagnose obsessive-compulsive disorder? Symptoms of the disease can manifest differently in each person.

The most common obsessions are:

• thoughts of attacking your loved ones;
• for drivers: worry that they will hit a pedestrian;
• anxiety that you could accidentally cause harm to someone (for example, start a fire, flood, etc. in someone’s house);
• fear of becoming a pedophile;
• fear of becoming homosexual;
• thoughts that there is no love for your partner, constant doubts about the correctness of your choice;
• fear of accidentally saying or writing something wrong (for example, using inappropriate language in a conversation with your superiors);
• fear of living not in accordance with religion or morality;
• anxious thoughts about physiological problems (for example, with breathing, swallowing, blurred vision, etc.);
• fear of making mistakes in work or tasks;
• fear of losing material well-being;
• fear of getting sick, becoming infected with viruses;
• constant thoughts about happy or unlucky things, words, numbers;
• other.

Common obsessive behaviors include:

• constant cleaning and maintaining a certain order of things;
• frequent hand washing;
• security check (are the locks locked, are electrical appliances, gas, water, etc. turned off);
• often repeating the same set of numbers, words or phrases to avoid bad events;
• constant re-checking of the results of your work;
• constant counting of steps.

Examples of manifestations of ACS in children

Children are susceptible to obsessive-compulsive disorder much less frequently than adults. But the symptoms are similar, only adjusted for age:

• fear of ending up in a shelter;
• fear of falling behind parents and getting lost;
• anxiety about grades, which develops into obsessive thoughts;
• frequent hand washing, brushing teeth;
• complexes in front of peers, developing into obsessive syndrome, and so on.

Diagnosis of ACS

Diagnosis of obsessive-compulsive syndrome consists of identifying those same obsessive thoughts and actions that have occurred over a long period of time (at least half a month) and are accompanied by a depressed state or depression.

Among the characteristics of obsessive symptoms for diagnosis, the following should be highlighted:

• the patient has at least one thought or action, and he resists it;
• the idea of ​​fulfilling an impulse does not bring any joy to the patient;
• repeating an obsessive thought causes anxiety.

The difficulty is that it is often difficult to separate obsessive-depressive syndrome from simple ACS, since their symptoms occur almost simultaneously. When it is difficult to determine which of them appeared earlier, then depression is considered to be the primary disorder.

The test will help you identify the diagnosis of obsessive-compulsive syndrome. As a rule, it contains a number of questions related to the type and duration of actions and thoughts characteristic of a patient with ACS. For example:

• the amount of daily time spent thinking about obsessive thoughts (possible answers: not at all, a couple of hours, more than 6 hours, and so on);
• the amount of daily time spent performing obsessive actions (same answers as to the first question);
• sensations from obsessive thoughts or actions (possible answers: none, strong, moderate, etc.);
• Do you control obsessive thoughts/actions (possible answers: yes, no, slightly, etc.);
• do you have problems washing your hands/showering/brushing your teeth/getting dressed/washing clothes/putting things in order/taking out the trash, etc. (possible answers: yes, like everyone else, no, I don’t want to do it, constant cravings, etc.);
• how much time do you spend showering/brushing your teeth/hairstyle/dressing/cleaning/taking out the trash, etc. (possible answers: like everyone else, twice as much; several times as much, etc.).

For a more accurate diagnosis and determination of the severity of the disorder, this list of questions can be much longer.

The results depend on the number of points scored. Most often, the more of them, the higher the likelihood of having obsessive-compulsive syndrome.

Obsessive-compulsive syndrome - treatment

For help in treating ACS, you should contact a psychiatrist, who will not only help in making an accurate diagnosis, but will also be able to identify the dominant type of obsessive disorder.

How can you generally defeat obsessive syndrome? Treatment of ACS involves a series of psychological therapeutic measures. Medicines fade into the background here, and often they can only maintain the result achieved by the doctor.

As a rule, tricyclic and tetracyclic antidepressants are used (for example, Melipramin, Mianserin and others), as well as anticonvulsants.

If there are metabolic disorders that are necessary for the normal functioning of brain neurons, then the doctor prescribes special drugs for example, Fluvoxamine, Paroxetine, and so on.

Hypnosis and psychoanalysis are not used as therapy. In the treatment of obsessive-compulsive disorder, cognitive-behavioral approaches are used, which are more effective.

The goal of this therapy is to help the patient stop focusing on obsessive thoughts and ideas, gradually drowning them out. The principle of operation is as follows: the patient should focus not on anxiety, but on refusing to perform the ritual. Thus, the patient no longer experiences discomfort from obsession, but from the result of inaction. The brain switches from one problem to another, and after several such approaches, the urge to perform obsessive actions subsides.

Among other well-known methods of therapy, in addition to cognitive behavioral, the “thought stopping” technique is also used in practice. The patient, at the moment of an obsession or action, is advised to mentally say to himself “Stop!” and analyze everything from the outside, trying to answer the following questions:

1. How likely is it that this will actually happen?
2. Do obsessive thoughts interfere with your normal life and to what extent?
3. How strong is the feeling of internal discomfort?
4. Will life become much easier without obsessions and compulsions?
5. Will you be happier without obsessions and rituals?

The list of questions goes on. The main thing is that their goal is to analyze the situation from all sides.

There is also the possibility that the psychologist will decide to use another treatment method as an alternative or as additional help. This depends on the specific case and its severity. For example, this could be family or group psychotherapy.

Self-help for ACS

Even if you have the best therapist in the world, you still need to make an effort yourself. Quite a few doctors - one of them, Jeffrey Schwartz, a very well-known ACS researcher - note that independent work on your condition is very important.

For this you need:

• Study all possible sources about obsessive disorder yourself: books, medical journals, articles on the Internet. Learn as much as you can about neurosis.
• Practice the skills your therapist taught you. That is, try to suppress obsessions and compulsive behavior on your own.
• Maintain constant contact with loved ones - family and friends. Avoid social isolation, as it only makes OCD worse.

And most importantly, learn to relax. Learn at least the basics of relaxation. Use meditation, yoga or other methods. They will help reduce the impact of OCD symptoms and the frequency of their occurrence.

2016-07-01 Phobic anxiety disorder

Recently, the concept of “panic attack” has become firmly established in our lives. This is an attack of panic, or uncontrollable fear, that occurs in certain situations. The main feature of a panic attack is its irrationality, that is, the reason that caused the fear is not actually threatening to the person. Most people have experienced an irrational panic attack at least once. If panic attacks are repeated and negatively affect the quality of life, we are talking about anxiety disorder.

Phobic anxiety disorder or anxiety-phobic neurosis is a disease in which a person reacts to harmless stimuli with an attack of fear.

There may be one reason for a panic attack, or less often - several. This disease is also called a phobia, with a prefix in Greek denoting a reason for fear:

• claustrophobia (fear of closed spaces),
• agoraphobia (fear of open space),
• aquaphobia (fear of water, fear of swimming),
• anthropophobia (fear of people, communication), etc.

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Social anxiety disorder manifests itself in the form of a fear of being in public, in the center of attention, combined with the fear of “embarrassment,” that is, of receiving a negative assessment of one’s actions from others. Social phobia can be isolated or generalized. Both forms of the disorder lead to avoidance of anxious situations, that is, patients do not find any other way to remove the anxious state other than self-isolation.

A tenth of the world's population suffers from periodic panic attacks to one degree or another. And about one percent of people experience regular episodes of anxiety and fear. Such experiences are always subjective and have no obvious basis. However, living with an anxiety-phobic disorder is very difficult, as it severely limits a person in his daily activities.

What is anxiety-phobic disorder

Anxiety-phobic disorder is a pathology characterized by attacks of inexplicable anxiety, fear, restlessness, and nervousness. The occurrence of this disease is associated with the initial predisposition of a person. The disorder is predominantly observed in people who are timid, suspicious, shy, emotional, and vulnerable.

The first attack of fear occurs in the case of a truly dangerous or disturbing situation, when the person actually had a reason to be nervous and worried. Impressionable individuals remember what happened and periodically return to it in their thoughts, re-focusing on unpleasant sensations. Several such “sessions” - and the general level of anxiety increases, and the initial situation becomes a source of fear.

ICD-10 classifies anxiety-phobic disorders into category F40:

1. Agoraphobia (F40.0) – fear of open space and being in a crowd. A person feels the need to be in a safe and comfortable place, where everything is subject to his personal control. This cannot be achieved on the street, so agoraphobes avoid public transport, walking through squares, and attending city festivals. At the same time, the level of fear is significantly reduced if a person is in an open area with someone. Patients are often socially maladjusted, as they prefer not to leave the house.
2. Social phobias (F40.1) – phobias associated with the fear of judgment and criticism from others. Patients are afraid to speak in public, eat in the presence of unfamiliar people, and meet with the opposite sex. Mostly patients complain of redness of the skin, trembling hands, and dry mouth. Fear can extend both to a specific situation and to all incidents outside the family circle. Since the disorder limits social activity, the patient finds himself somewhat isolated after some time.
3. Isolated/specific phobias (F40.2) – phobias that are associated with strictly defined situations. This includes a significant number of different fears - flying, using a public toilet, insects, darkness, etc.

In anxiety-phobic disorder, fear is limited to a certain situation (unlike generalized anxiety disorder, in which experiences and unpleasant sensations are constant and do not depend on what is happening now).

Anxiety-phobic disorder: symptoms

Signs of an anxiety-phobic disorder appear when a person finds himself in a stressful situation. The most typical symptoms:

1. Unreasonable fear when confronted with an object of phobia.
2. Reflections and memories of a negative event in the past, and the thoughts are intrusive.
3. The desire to avoid contact with an object that inspires fear by any means possible.
4. Sudden intense thoughts of death that accompany an exacerbation of the disorder.
5. Persistence of symptoms even when the patient recognizes their irrationality.

In addition to psychological signs of pathology, somatic ones are usually observed. They manifest themselves most clearly if there is an anxiety-phobic disorder with panic attacks. An attack is characterized by:

• skin redness;
• sweating;
• tremor;
• nausea, vomiting;
• dizziness;
• faintness, loss of consciousness;
• tingling and pain throughout the body;
• feeling of lack of air;
• lump in throat;
• chest tightness;
• a sudden urge to urinate or defecate;
• stuttering, trembling voice.

The severity of symptoms depends on the individual case. In addition, a person does not necessarily exhibit all the signs: usually only a few of them are observed. A panic attack lasts fifteen minutes on average, but it is not the panic attack that is more harmful to the patient, but the intrusive memories of it. A person becomes convinced that a certain situation causes him extreme discomfort and then avoids it even more carefully.

Factors that increase the likelihood of developing an anxiety-phobic disorder

In addition to genetic predisposition, there are a number of factors that can push a person into the arms of the disorder. Among them:

1. Chronic fatigue, non-compliance with work and rest schedules.
2. Frequent conflicts and other stressful situations.
3. Abuse of drugs, alcohol, nicotine, caffeine and all kinds of intoxication.
4. Diseases of internal organs.

The general condition of the patient must be taken into account before prescribing therapy. For successful treatment, the influence of individual factors must be minimized to avoid the likelihood of relapse.

Anxiety-phobic disorder: treatment of pathology

Therapy for anxiety-phobic disorder is carried out under the supervision of a psychotherapist. Treatment involves an integrated approach that allows you to get rid of any manifestations of anxiety - both mental and somatic. The emphasis in therapy is on the following areas:

1. Psychotherapy, including cognitive-behavioral methods and psychoanalysis. If necessary, a specialist can use hypnosis or suggestion.
2. Drug treatment, which involves taking tranquilizers, antidepressants, sedatives. The accuracy of dosage selection and determination of the optimal duration of therapy is very important, since there is a possibility of provoking dependence on the drugs.

In each case, it is necessary to identify the event that caused the development of anxiety-phobic disorder. Awareness of the real “reason” for fears and worries allows the patient to deal with the problem more effectively. In the context of cognitive behavioral therapy, the patient is deliberately confronted with his fear and taught to defend himself against it. In this sense, hypnotic methods lose, since they involve a direct invasion of a person’s subconscious and the fixation of new attitudes in it, but do not make it possible to realize the true cause of the disorder.

The prognosis for treatment is mostly favorable. At least eighty percent of patients achieve good results, provided they contact a specialist in a timely manner. Ignoring the symptoms of the disorder and the lack of necessary help leads to the fact that the anxiety-phobic syndrome becomes chronic, which is much more difficult to treat.

Any disorders associated with mental activity require consultation with a doctor. All such pathologies tend to intensify over time and be supplemented by new diseases. Therefore, the sooner the visit to the clinic takes place, the higher the chances of success.

In the classification of neuroses, obsessive-phobic disorders are considered separately, i.e. impulsive disorders. The problem combines obsessions and phobias, which arise in the form of a panic attack followed by a transition to moderate feelings.

Forms of manifestations

Obsessive-phobic neurosis can manifest itself in several forms.

• Figurative.
• Distracted.

A characteristic feature of the figurative form is obsessive pictures of past events, accompanied by vivid memories, doubts, and apprehension. Abstract includes constant attempts to remember facts, names, surnames, faces, accounts, as well as replaying imperfect actions in the head.

An obsessive state is manifested by compulsion in the motor-physical aspect, phobia in the emotional aspect and obsession in the intellectual aspect. All these components are closely connected and alternately trigger each other.

A striking example: patients with severe forms of neurosis develop ritual actions that allow them to find peace for a while.

Experiences usually appear during mental activity and provoke a return to the same thought and repeated actions in order to double-check the work. Endless repetition leads to fatigue. Doubts cause a persistent need to perform the same actions, at a time when reality is of less interest.

Features of phobias

Phobias develop in childhood. The main reasons: improper upbringing, negative psychogenic environment, which negatively affects the development of the psyche. Under the influence of certain factors, the child forms protective attitudes in the brain in an attempt to adapt to the stimulus.

Fear is an evolutionary feeling. Without him, humanity could not survive. Under the influence of stress, the higher nervous system forms a special model of behavior to adapt the body to life in certain conditions.

When experiencing fear, a person tries to hide from danger or takes a blow, acting as an aggressor. With an inadequate assessment of the situation, severe fear arises, accompanied by obsessive thoughts, actions, and panic attacks.

The formation of a behavior model depends largely on parental upbringing and the influence of social values, prejudices, and religious attitudes. A child frightened by “babayki” will be afraid of the dark, assuming that the creature comes out at night to kill him. Everything that is beyond the reach of human understanding causes fear. The child, due to his inexperience, does not know how to react to stimuli. The most common phobia is the fear of death.

A person who is not afraid of anything does not exist.

People who calmly react to factors that cause horror and panic in others know how to live with fear and use this feeling for their own purposes. Their nervous system and body have high adaptive abilities.

Patients suffering from phobic disorders are characterized by a high level of emotionality and suggestibility. For example, when some religious traditions prohibit the consumption of certain types of meat.

A person is initially proven that something like this kills him, and the deity he worships will not forgive him, banishing him to the farthest corner of hell (a play on the unknown, since a person cannot know for sure whether he will live after death).

Features of obsessions

An obsession is a series of obsessive thoughts and associations that arise involuntarily at a certain time interval. A person loses the ability to concentrate on his main work because he is unable to get rid of them by willpower.

Obsessions are classified as symptoms of intrapsychic activity, i.e., disorders of the central part of the psyche. They are classified as a subgroup of thought disorders. Of the 9 productive circles of damage, obsession belongs to the 3rd, i.e., it can be easily stopped with timely treatment.

Regarding pathogenesis, 2 groups of obsessions are distinguished.

1. Elementary - observed immediately after the appearance of a super-strong psychogenic stimulus. The reasons for obsessive thoughts are clear to the patient.
2. Cryptogenic - occurs spontaneously, the reasons are unclear. Misunderstanding of the process of formation of obsession is due to the body’s defensive reaction when it hides in the nooks and crannies of consciousness some traumatic facts from the life of an individual.

Features of compulsion

Compulsion - obsessive rituals - behavioral reactions that occur after a certain period of time. The patient feels that he is obliged to perform some action. If he refuses or cannot do this, anxiety increases and obsessions arise.

Compulsions vary in type of manifestation, but have similar features. The main problem is that they cannot be abandoned. If initially it is enough to perform the action once, then over time it is necessary to perform the ritual several times. The demands of the subconscious become more stringent every time. Thus, a disorder accompanied by a feeling of dirt on the hands requires more thorough washing.

Causes of obsessive-phobic neurosis

From a biological point of view, disorders of this type appear as a result of genetically determined or acquired in the process of life disturbances in the balance of substances in the brain. People suffering from obsessive-phobic syndrome experience an increase in the production of adrenaline and catecholamines.

Copying the behavior of adults is the most common factor influencing the formation of perception of the world around us. The child's psyche is a blank slate. He does not know how to behave correctly, so he takes an example from his parents and follows their guidelines, believing that their reactions are truly the correct behavior.

Obsessive-phobic neurosis can be a symptom of schizophrenia. Here the reasons mainly lie in genetic factors and living conditions.

Symptoms of the disease

Obsessive-phobic disorder is characterized by a number of psychological symptoms that cause physiological abnormalities. Under the influence of fear and anxiety, patients feel dizziness and numbness in their limbs. Tremors and convulsive contractions of the facial muscles may be observed. Severe conditions in the acute period are accompanied by hysterical fits and panic attacks.

From the cardiovascular system, tachycardia, chest compression, shortness of breath, surges in blood pressure, and increased sweating are observed. Often, under the influence of anxiety, patients suffer from diarrhea. In women, neurosis can provoke a change in the cycle. For men, obsessive-phobic disorder can cause impotence.

More than 40% of patients have a history of sleep disturbances; a long absence of sleep provokes the appearance of hallucinations.

Obsessive and phobic neurosis

Comparative characteristics of obsessive and phobic neuroses:

• phobias and obsessions arise due to high suggestibility;
• behavioral reactions in both types of neurosis depend to a greater extent on the level of adaptive capabilities of the body;
• obsessions can arise against the background of phobias, and phobias can appear against the background of obsessions;
• both pathologies can be accompanied by compulsions;
• phobias are caused by heredity, because fear is the body’s natural reaction to danger, it is a defense mechanism;
• obsessions are more common in adolescents; in children, such manifestations are rarely recorded;
• Phobias are observed in people of any age, and are more pronounced in children.

From this it follows that all pathological deviations are inextricably linked. They can manifest themselves to varying degrees, under the influence of certain psychogenic factors. The main role in the formation of neurosis is played not by the strength of the influencing factor, but by the person’s personal perception of it.

Conclusion

Obsessive-phobic disorders are characterized by a number of mental and physiological abnormalities. This is due to disruption of the central nervous system. Pathology refers to neuroses. In mild form, it is reversible with the help of psychocorrection. Severe forms of the disease require long-term hospital treatment. The disease can be triggered by biological, genetic and psychogenic factors. The main role in the formation of neurotic deviations is given to the adaptive abilities of the individual.