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Obsessive-compulsive disorder. Obsessive Compulsive Disorder: Treatment, Causes, Symptoms What does okr mean

Obsessive-compulsive syndrome, obsessive-compulsive disorder (OCD) is a psychoneurotic disorder, manifested by obsessive thoughts and actions of the patient. The concept of "obsession" is translated from Latin as a siege or blockade, and "compulsion" is coercion. Healthy people have no problem brushing off unpleasant or frightening thoughts, images, or impulses. Individuals with OCD cannot do this. They constantly ponder such thoughts and get rid of them only after performing certain actions. Gradually, obsessive thoughts begin to conflict with the subconscious of the patient. They become a source of depression and anxiety, and rituals and repetitive movements cease to have the expected effect.

In the very name of the pathology lies the answer to the question: what is OCD? Obsession is a medical term for obsessive ideas, disturbing or frightening thoughts, while compulsion is a compulsive act or ritual. It is possible to develop local disorders - only obsessive with a predominance of emotional experiences, or only compulsive, manifested by restless actions. The disease is a reversible neurotic process: after psychotherapeutic and drug treatment, its symptoms completely disappear.

Obsessive compulsive disorder occurs in representatives of all socioeconomic levels. Men under the age of 65 are predominantly affected. At an older age, the disease is diagnosed in women. The first signs of pathology appear in patients by the age of ten. There are various phobias and obsessive states that do not require immediate treatment and are adequately perceived by a person. In thirty-year-old patients, a pronounced clinic of the syndrome develops. At the same time, they cease to perceive their fears. They need qualified medical care in a hospital setting.

People with OCD are plagued by thoughts of countless bacteria and wash their hands a hundred times a day. They are not sure if the iron is turned off, and they return home from the street several times to check it. Patients are sure that they can harm loved ones. To prevent this from happening, they hide dangerous items and avoid casual communication. Patients will double-check several times whether they forgot to put all the necessary things in their pocket or bag. Most of them carefully monitor the order in the room. If things are out of place, emotional tension arises. Such processes lead to a decrease in working capacity and poor perception of new information. The personal life of such patients usually does not add up: they either do not create a family, or their families quickly disintegrate.

Painful obsessive thoughts and actions of the same type lead to depression, reduce the quality of life of patients and require special treatment.

Etiology and pathogenesis

The causes of obsessive-compulsive disorder are currently not fully understood. There are several hypotheses regarding the origin of this disease.

Provoking factors include biological, psychological and social.

Biological factors in the development of the syndrome:

• acute infectious diseases - meningitis, encephalitis,
• autoimmune diseases - group A hemolytic streptococcus causes inflammation of the basal ganglia,
• genetic predisposition,
• alcohol and drug addiction,
• neurological diseases,
• metabolic disorders of neurotransmitters - serotonin, dopamine, norepinephrine.

Psychological or social factors of pathology:

1. special religious beliefs
2. stressful relationships at home and at work
3. excessive parental control of all spheres of a child's life,
4. severe stress, psycho-emotional outburst, shock,
5. long-term use of psychostimulants,
6. experienced fear due to the loss of a loved one,
7. avoidance behavior and misinterpretation of one's thoughts,
8. psychological trauma or depression after childbirth.

Panic and fear can be imposed by society. When the news is about an attack by robbers on the street, it causes anxiety, which is helped to cope with special actions - constant looking back on the street. These compulsions help patients only at the initial stage of mental disorders. In the absence of psychotherapeutic treatment, the syndrome suppresses the human psyche and turns into paranoia.

Pathogenetic links of the syndrome:

• the emergence of thoughts that frighten and torment the sick,
• concentration on this thought against desire,
• mental stress and increasing anxiety,
• performance of stereotyped actions that bring only short-term relief,
• return of intrusive thoughts.

These are the stages of one cyclic process leading to the development of neurosis. Patients become addicted to ritual activities that have a narcotic effect on them. The more patients think about the current situation, the more they are convinced of their inferiority. This leads to an increase in anxiety and a deterioration in the general condition.

Obsessive Compulsive Syndrome can be inherited through generations. This disease is considered moderately hereditary. However, the gene causing this condition has not been identified. In some cases, not the neurosis itself is inherited, but a genetic predisposition to it. Clinical signs of pathology arise under the influence of negative conditions. Proper upbringing and a favorable atmosphere in the family will help to avoid the development of the disease.

Symptoms

Clinical signs of pathology in adults:

1. Thoughts of sexual perversion, death, violence, intrusive memories, fear of harming someone, getting sick or infected, anxiety about material loss, blasphemy and sacrilege, obsession with cleanliness, pedantry. In relation to moral and ethical principles, unbearable and irresistible attractions are contradictory and unacceptable. Patients are aware of this, often resist and are very worried. Gradually, a feeling of fear develops.
2. Anxiety following obsessive, repetitive thoughts. Such thoughts cause panic and horror in the patient. He is aware of the groundlessness of his ideas, but is not able to control superstition or fear.
3. Stereotypical actions - counting the steps on the stairs, frequent washing of hands, "correct" arrangement of books, double-checking turned off electrical appliances or closed taps, symmetrical order of objects on the table, repetition of words, counting. These actions are a ritual supposedly relieving obsessive thoughts. For some patients, reading prayers, clicking joints, biting lips helps to get rid of tension. Compulsions are a complex and intricate system, in the event of the destruction of which, the patient conducts it again. The ritual is performed slowly. The patient, as it were, is delaying time, fearing that this system will not help, and internal fears will intensify.
4. Panic attacks and nervousness in the crowd are associated with the risk of contact with the "dirty" clothes of people around, the presence of "strange" smells and sounds, "oblique" looks, the possibility of losing one's things. Patients avoid crowded places.
5. Obsessive-compulsive syndrome is accompanied by apathy, depression, tics, dermatitis or alopecia of unknown origin, excessive preoccupation with one's appearance. If left untreated, patients develop alcoholism, isolation, rapid fatigue, thoughts of suicide appear, mood swings, quality of life decreases, conflict increases, disorders of the gastrointestinal tract, irritability, concentration decreases, and abuse of sleeping pills and sedatives occurs.

In children, the signs of pathology are less pronounced and occur somewhat less frequently. Sick children are afraid to get lost in the crowd and constantly hold adults by the hand, tightly clasping their fingers. They often ask their parents if they are loved because they are afraid to end up in an orphanage. Having once lost a notebook at school, they experience severe stress, forcing them to count the school supplies in their briefcase several times a day. The dismissive attitude of classmates leads to the formation of complexes in the child and skipping classes. Affected children are usually gloomy, unsociable, suffer from frequent nightmares and complain of poor appetite. A child psychologist will help to stop the further development of the syndrome and save the child from it.

OCD in pregnant women has its own characteristics. It develops in the last trimester of pregnancy or 2-3 months after childbirth. The obsessive thoughts of the mother are the fear of harming her baby: it seems to her that she is dropping the baby; she is visited by thoughts of sexual attraction to him; she has difficulty making decisions about vaccinations and feeding choices. To get rid of intrusive and frightening thoughts, a woman hides objects with which she can harm a child; constantly washes bottles and washes diapers; guards the sleep of the baby, fearing that he will stop breathing; examines him for certain symptoms of the disease. Relatives of women with similar symptoms should encourage her to see a doctor for treatment.

Video: analysis of the manifestations of OCD on the example of Sheldon Cooper

Diagnostic measures

Diagnosis and treatment of the syndrome are carried out by specialists in the field of psychiatry. Specific signs of pathology are obsessions - obsessive thoughts with stable, regular and annoying repetitions. They cause anxiety, anxiety, fear and suffering in the patient, are practically not suppressed or ignored by other thoughts, are psychologically incompatible and irrational.

For physicians, compulsions are important, which cause overwork and suffering in patients. Patients understand that compulsions are unrelated and excessive. For specialists, it is important that the manifestations of the syndrome last more than an hour a day, complicate the life of patients in society, interfere with work and study, and disrupt their physical and social activity.

Many people with the syndrome often do not understand or accept their problem. Psychiatrists advise patients to undergo a full diagnosis, and then begin treatment. This is especially true when obsessive thoughts interfere with life. After a psychodiagnostic conversation and differentiation of pathology from similar mental disorders, specialists prescribe a course of treatment.

Treatment

Treatment of obsessive-compulsive syndrome should begin immediately after the onset of the first symptoms. Carry out complex therapy, consisting in psychiatric and medical effects.

Psychotherapy

Psychotherapeutic sessions for obsessive-compulsive syndrome are considered more effective than drug treatment. Psychotherapy cures neurosis gradually.

The following methods help to get rid of this ailment:

• Cognitive Behavioral Therapy - resistance to the syndrome, in which compulsions are minimized or completely eliminated. Patients in the course of treatment become aware of their disorder, which helps them to get rid of it forever.
• “Stopping thoughts” is a psychotherapeutic technique that consists in stopping memories of the most vivid situations, manifested by an obsessive state. Patients are asked a series of questions. To answer them, patients must view the situation from all angles, as in slow motion. This technique makes it easier to face fears and control them.
• The method of exposure and warning - the patient is created conditions that provoke discomfort and cause obsessions. Before this, the patient is counseled on how to resist compulsive rituals. This form of therapy achieves sustained clinical improvement.

The effect of psychotherapy lasts much longer than that of drug treatment. Patients are shown the correction of behavior under stress, training in various relaxing techniques, a healthy lifestyle, proper nutrition, the fight against smoking and alcoholism, hardening, water procedures, breathing exercises.

Currently, group, rational, psycho-educational, aversive, family and some other types of psychotherapy are used to treat the disease. Non-drug therapy is preferable to drug therapy, since the syndrome is perfectly amenable to correction without drugs. Psychotherapy has no side effects on the body and has a more stable therapeutic effect.

Medical treatment

Treatment of a mild form of the syndrome is carried out on an outpatient basis. Patients undergo a course of psychotherapy. Doctors find out the causes of pathology and try to establish a trusting relationship with patients. Complicated forms are treated with the use of medications and psychological corrective sessions.

Patients are prescribed the following groups of drugs:

1. antidepressants - Amitriptyline, Doxepin, Amizol,
2. neuroleptics - "Aminazin", "Sonapaks",
3. normothymic drugs - "Cyclodol", "Depakin Chrono",
4. tranquilizers - "Phenozepam", "Clonazepam".

It is impossible to cope with the syndrome on your own without the help of a specialist. Any attempts to control your mind and defeat the disease lead to a deterioration in the condition. In this case, the psyche of the patient is destroyed even more.

Compulsive-obsessional syndrome does not apply to mental illness, since it does not lead to a change and personality disorder. It is a neurotic disorder that is reversible with proper treatment. Mild forms of the syndrome respond well to therapy, and after 6-12 months its main symptoms disappear. The residual effects of the pathology are expressed in a mild form and do not interfere with the normal life of patients. Severe cases of the disease are treated for an average of 5 years. Approximately 70% of patients report an improvement in their condition and are clinically cured. Since the disease is chronic, relapses and exacerbations occur after discontinuation of drugs or under the influence of new stresses. Cases of a complete cure are very rare, but possible.

Preventive actions

Prevention of the syndrome consists in the prevention of stress, conflict situations, the creation of a favorable environment in the family, the exclusion of mental injuries at work. It is necessary to properly educate a child, not to give rise to feelings of fear in him, not to instill in him thoughts about his inferiority.

Secondary psychoprophylaxis is aimed at preventing relapses. It consists in regular medical examination of patients, conversations with them, suggestions, timely treatment of the syndrome. With a preventive purpose, phototherapy is carried out, since light contributes to the production of serotonin; restorative treatment; vitamin therapy. Experts recommend that patients get enough sleep, diet, give up bad habits, and timely treatment of concomitant somatic diseases.

Forecast

Obsessive-compulsive syndrome is characterized by a chronic process. Complete recovery of the pathology is quite rare. Usually there are relapses. In the process of treatment, the symptoms gradually go away, and social adaptation begins.

Without treatment, the symptoms of the syndrome progress, disrupt the patient's ability to work and the ability to be in society. Some patients commit suicide. But in most cases, OCD has a benign course.

OCD is essentially a neurosis that does not lead to temporary disability. If necessary, patients are transferred to lighter work. Advanced cases of the syndrome are considered by VTEC specialists, who determine the III group of disability. Patients are issued a certificate for light work, excluding night shifts, business trips, irregular working hours, direct exposure to harmful factors on the body.

Adequate treatment guarantees patients stabilization of symptoms and relief of vivid manifestations of the syndrome. Timely diagnosis of the disease and treatment increase the chances of patients for success.

Video: about obsessive-compulsive disorders

Living with obsessive-compulsive disorder (OCD) is not easy. With this disease, intrusive thoughts arise, causing severe anxiety. To get rid of anxiety, a person suffering from OCD is often forced to certain rituals.

In the classification of mental illness, OCD is classified as an anxiety disorder, and anxiety is familiar to almost everyone. But this does not mean that any healthy person understands what an OCD sufferer has to experience. Headaches are also familiar to everyone, but this does not mean that we all know what migraine sufferers feel.

Symptoms of OCD can interfere with a person's ability to work, live, and relate to others.

“The brain is designed in such a way that it always warns us of the dangers that threaten survival. But in OCD patients, this brain system does not work properly. As a result, they are often overwhelmed by a tsunami of unpleasant experiences and are unable to focus on anything else,” explains psychologist Stephen Philipson, clinical director of the Center for Cognitive Behavioral Therapy in New York.

OCD is not associated with any one specific fear. Some obsessions are well known - for example, patients may constantly wash their hands or check to see if the stove is turned on. But OCD can also manifest as hoarding, hypochondria, or the fear of harming someone. A fairly common type of OCD, in which patients are tormented by a paralyzing fear about their sexual orientation.

As with any other mental illness, only a professional doctor can make a diagnosis. But there are still a few symptoms that experts say can indicate the presence of OCD.

1. They bargain with themselves.

OCD sufferers often believe that if they check the stove again or search the Internet for symptoms of the illness they claim to be suffering from, they will finally be able to calm down. But OCD is often deceptive.

“Biochemical associations arise in the brain with the object of fear. The repetition of obsessive rituals further convinces the brain that the danger is indeed real, and thus completes the vicious circle.

2. They feel an obsessive need to perform certain rituals.

Would you agree to stop doing your usual rituals (for example, not checking the front door 20 times a day if the front door is locked) if you were paid $10 or $100 or some other amount that is significant enough for you? If your anxiety is so easily bribed, then most likely you are just more afraid of robbers than usual, but you do not have OCD.

For a person suffering from this disorder, the performance of rituals seems to be a matter of life and death, and survival can hardly be valued in money.

3. It is very difficult to convince them that their fears are unfounded.

OCD sufferers are familiar with the verbal construction “Yes, but...” (“Yes, the last three tests showed that I do not have this or that disease, but how do I know that the samples were not mixed up in the laboratory?”). Since it is rarely possible to be absolutely sure of something, no amount of belief helps the patient overcome these thoughts, and he continues to be tormented by anxiety.

4. They usually remember when the symptoms started.

“Not everyone with OCD can tell exactly when the disorder first appeared, but most do remember,” Philipson says. At first, there is just an unreasonable anxiety, which then takes shape in a more specific fear - for example, that you, while preparing dinner, will suddenly stab someone with a knife. For most people, these experiences pass without consequences. But OCD sufferers seem to be falling into an abyss.

If the patient is afraid of pollution, the first exercise for him will be to touch the doorknob and not wash his hands afterwards.

“At such moments, panic makes an alliance with a certain idea. And it’s not easy to end it, like any unhappy marriage, ”Philipson says.

5. They are consumed by anxiety.

Almost all the fears that torment OCD sufferers have some basis. Fires do happen, and hands are really full of bacteria. It's all about the intensity of the fear.

If you are able to live a normal life despite the constant uncertainty associated with these risk factors, you most likely do not have OCD (or a very mild case). Problems begin when anxiety completely consumes you, preventing you from functioning normally.

Fortunately, OCD can be adjusted. Medications play an important role in therapy, including some types of antidepressants, but psychotherapy, especially cognitive behavioral therapy (CBT), is equally effective.

Within CBT, there is an effective treatment for OCD called reaction-avoidance exposure. In the course of treatment, the patient, under the supervision of a therapist, is specifically placed in situations that cause increasing fear, while he must not succumb to the desire to perform the usual ritual.

For example, if the patient is afraid of pollution and constantly washes his hands, the first exercise for him will be to touch the doorknob and not wash his hands after that. In the following exercises, the perceived danger is increased - for example, you will need to touch the handrail on the bus, then the faucet in the public toilet, and so on. As a result, fear gradually begins to subside.

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

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

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

The main forms of neurosis of obsessive thoughts

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

Single

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

remitting

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

progressive

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

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

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

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

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

Symptoms of Obsessive-Compulsive Syndrome

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

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

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

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

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

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

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

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

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

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

Causes of OCD disorder

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

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

Personality Features

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

Upbringing

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

Heredity

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

neurological problems

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

Stress and psychological trauma

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

Treatment for obsessive-compulsive disorder

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

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

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

Anxiety is inherent in all people to one degree or another, and many of us sometimes perform rituals of varying degrees of irrationality designed to insure us from trouble - bang the table with our fist or put on a lucky T-shirt for an important event. But sometimes this mechanism gets out of control, causing a serious mental disorder. Theories and Practices explains what tormented Howard Hughes, how an obsession differs from schizophrenic delusions, and what magical thinking has to do with it.

Endless Ritual

The hero of Jack Nicholson in the famous film “It doesn’t get better” was distinguished not only by a complex character, but also by a whole set of oddities: he constantly washed his hands (and every time with new soap), ate only with his cutlery, avoided other people’s touches and tried not to step on cracks on asphalt. All these "eccentricities" are typical signs of obsessive-compulsive disorder, a mental illness in which a person is obsessed with obsessive thoughts that make him repeat the same actions regularly. OCD is a real godsend for a screenwriter: this disease is more common in people with high intelligence, it gives the character originality, noticeably interferes with his communication with others, but at the same time is not associated with a threat to society, unlike many other mental disorders. But in reality, the life of a person with obsessive-compulsive disorder cannot be called easy: constant tension and fear are hidden behind innocent and even funny, at first glance, actions.

In the head of such a person, it’s as if a record is stuck: the same unpleasant thoughts regularly come to his mind, which have little rational basis. For example, he imagines that dangerous microbes are everywhere, he is constantly afraid of hurting someone, losing some thing, or leaving the gas on when leaving home. A leaky faucet or an asymmetrical arrangement of objects on a table can drive him crazy.

The flip side of this obsession, that is, obsession, is compulsion, the regular repetition of the same rituals, which should prevent impending danger. A person begins to believe that the day will go well only if, before leaving the house, he reads a children's rhyme three times, that he will protect himself from terrible diseases if he wash his hands several times in a row and use his own cutlery. After the patient performs the ritual, he experiences relief for a while. 75% of patients suffer from both obsessions and compulsions at the same time, but there are cases when people experience only obsessions without performing rituals.

At the same time, obsessive thoughts differ from schizophrenic delusions in that the patient himself perceives them as absurd and illogical. He is not at all happy to wash his hands every half an hour and zip up his fly five times in the morning - but he simply cannot get rid of the obsession in another way. The level of anxiety is too high, and rituals allow the patient to achieve temporary relief from the condition. But at the same time, in itself, the love of rituals, lists or putting things on the shelves, if it does not bring discomfort to a person, does not belong to the disorder. From this point of view, the aesthetes who diligently arrange carrot peels lengthwise in Things Organized Neatly are absolutely healthy.

Obsessions of an aggressive or sexual nature cause the most problems in OCD patients. Some become afraid that they will do something bad to other people, up to and including sexual violence and murder. Obsessive thoughts can take the form of individual words, phrases, or even lines of poetry - a good illustration is the episode from the movie The Shining, where the protagonist, going crazy, starts typing the same phrase “all work and no play makes Jack a dull boy." A person with OCD experiences tremendous stress - he is both horrified by his thoughts and tormented by guilt for them, tries to resist them, and at the same time tries to make the rituals he performs go unnoticed by others. In all other respects, however, his consciousness functions perfectly normally.

There is an opinion that obsessions and compulsions are closely related to "magical thinking", which arose at the dawn of mankind - the belief in the ability to take control of the world with the help of the right mood and rituals. Magical thinking draws a direct parallel between a mental desire and a real consequence: if you draw a buffalo on the wall of a cave, tuning in to a successful hunt, you will certainly be lucky. Apparently, this way of perceiving the world is born in the deep mechanisms of human thinking: neither scientific and technological progress, nor logical arguments, nor sad personal experience proving the uselessness of magical passes, do not save us from the need to look for the relationship between random things. Some scientists believe that it is embedded in our neuropsychology - the automatic search for patterns that simplify the picture of the world helped our ancestors survive, and the most ancient parts of the brain still work according to this principle, especially in a stressful situation. Therefore, with an increased level of anxiety, many people begin to be afraid of their own thoughts, fearing that they can become reality, and at the same time believe that a set of some irrational actions will help prevent an undesirable event.

Story

In ancient times, this disorder was often associated with mystical causes: in the Middle Ages, people obsessed with obsessions were immediately sent to exorcists, and in the 17th century the concept was reversed - it was believed that such states arise due to excessive religious zeal.

In 1877, one of the founders of scientific psychiatry, Wilhelm Griesinger, and his student Karl-Friedrich-Otto Westphal found that the basis of "compulsive disorder" is a thought disorder, but it does not affect other aspects of behavior. They used the German term Zwangsvorstellung, which, being variously translated in Britain and the United States (as obsession and compulsion respectively), became the modern name for the disease. And in 1905, the French psychiatrist and neurologist Pierre Maria Felix Janet singled out this neurosis from neurasthenia as a separate disease and called it psychasthenia.

Opinions differed about the cause of the disorder - for example, Freud believed that obsessive-compulsive behavior refers to unconscious conflicts that manifest themselves in the form of symptoms, and his German colleague Emil Kraepelin attributed it to "constitutional mental illness" caused by physical causes.

Famous people also suffered from obsessional disorder - for example, the inventor Nikola Tesla counted steps while walking and the volume of food portions - if he could not do this, the dinner was considered spoiled. And entrepreneur and American aviation pioneer Howard Hughes was terrified of dust and ordered employees to “wash themselves four times, each time using a large amount of lather from a new bar of soap,” before visiting him.

Defense mechanism

The exact causes of OCD are not clear even now, but all hypotheses can be divided into three categories: physiological, psychological and genetic. Proponents of the first concept associate the disease either with the functional and anatomical features of the brain, or with metabolic disorders (biologically active substances that transmit electrical impulses between neurons, or from neurons to muscle tissue) - first of all, serotonin and dopamine, as well as norepinephrine and GABA. Some researchers have noted that many patients with OCD had birth trauma at birth, which also confirms the physiological causes of OCD.

Supporters of psychological theories believe that the disease is associated with personality traits, character traits, psychological trauma and an incorrect reaction to the negative impact of the environment. Sigmund Freud suggested that the occurrence of obsessive-compulsive symptoms is associated with the protective mechanisms of the psyche: isolation, elimination and reactive formation. Isolation protects a person from anxiety-causing affects and impulses, forcing them into the subconscious, liquidation is aimed at combating repressed impulses that pop up - the compulsive act is, in fact, based on it. And, finally, reactive formation is a manifestation of patterns of behavior and consciously experienced attitudes that are opposite to emerging impulses.

There is also scientific evidence that genetic mutations contribute to OCD. They were found in unrelated families whose members suffered from OCD - in the serotonin transporter gene, hSERT. Studies of identical twins also confirm the existence of a hereditary factor. In addition, people with OCD are more likely to have close relatives with the same disorder than healthy people.

Maksim, 21 years old, suffering from OCD since childhood

It started for me around 7 or 8 years old. The neurologist was the first to report the likelihood of OCD, even then there was a suspicion of obsessive neurosis. I was constantly silent, scrolling through various theories in my head like "mental chewing gum." When I saw something that caused me anxiety, obsessive thoughts about it began, although the reasons were very insignificant in appearance and, perhaps, would never have touched me.

At one time there was an obsessive thought that my mother might die. I turned over the same moment in my head, and it captured me so much that I could not sleep at night. And when I ride in a minibus or in a car, I constantly think about the fact that now we will have an accident, that someone will crash into us or we will fly away from the bridge. A couple of times the thought arose that the balcony under me would fall apart, or someone would throw me out of there, or I myself would slip in the winter and fall.

We never really talked to the doctor, I just took different medications. Now I am moving from one obsession to another and I am following some rituals. I constantly touch something, no matter where I am. I go from corner to corner throughout the room, adjusting the curtains, wallpaper. Maybe I am different from other people with this disorder, everyone has their own rituals. But it seems to me that those people who accept themselves as they are are more lucky. They are much better than those who want to get rid of it and are very worried about it.

Many terms from the field of psychiatry and neurology are not clear to every person. This category includes such a thing as obsessive-compulsive disorder (OCD). Meanwhile, OCD is a disease that can often be found in people around us. How dangerous is this syndrome, and can it be cured?

OCD disease

The disease in the International Classification of Diseases (ICD) is designated as OCD (Obsessive–compulsive disorder). The disease code in ICD-11 is 6B20. Also, in the old terminology, the disease was often called "compulsive disorder." Pathology was described by ancient and medieval doctors.

Obsessive Compulsive Syndrome: What is it?

Obsessions in psychiatry are obsessive, usually unpleasant, frightening or annoying thoughts, and compulsions are obsessive actions aimed at eliminating them. There are also separate syndromes - obsessive and compulsive, in which these phenomena are observed separately.

The disease may be chronic or occur episodically. In a severe form, OCD negatively affects all aspects of a person's life - relationships with people, family life, professional activities.

OCD has evolved over many years. The first symptoms of the disease begin to appear between the ages of 10 and 30. In childhood, the development of the syndrome is also not excluded. Under the age of 65, the majority of patients are men; among the elderly, the disease is more often observed in women. On average, the disease occurs in every hundredth person.

Causes of OCD

The causes of the syndrome have not been precisely established. The most common neurotransmitter theory. She claims that with OCD, there is a violation of the reuptake of serotonin in the nerve circuits, as well as the development of dependence on the "hormone of joy" - which is produced in the process of getting rid of obsessive thoughts. Also, undoubtedly, genetic, psychological and social factors play a role in the development of the disease. A number of genes have been identified that contribute to the development of the disease. There is also a hypothesis suggesting the occurrence of brain damage associated with the development of the disease as a result of streptococcal infection in childhood.

Causes of OCD:

• somatic disease,
• violence,
• loss of loved ones
• changing of the living place,
• work stress,
• family conflicts.

Adverse external circumstances of a person's life are responsible for more than half of the cases of OCD. In many patients, immediately before the onset of the syndrome, some traumatic life situations were observed.

Also of some importance are the wrong psychological attitudes laid down in childhood.

Is OCD a mental illness?

According to scientists, OCD refers to mental disorders. Therefore, psychiatrists, psychotherapists and psychologists should treat the condition. You should not hope that the condition will pass by itself, such cases are very rare.

However, here it must be borne in mind that not always obsessions or compulsions are evidence of OCD. Obsessive thoughts are considered a sign of illness only when they appear too often, causing anxiety in the patient and causing him suffering. Episodic obsessive thoughts, fears can also occur in healthy people, as well as in those suffering from other mental disorders (for example, anancaste disorder). The same applies to compulsions. Separate ritual or obsessive actions can be performed by healthy people. Episodic obsessions or compulsions can occur in about 30% of people.

In OCD, obsessions and compulsions take a significant amount of the patient's time (at least an hour a day) or cause inconvenience in daily activities.

Symptoms and signs in adults

The main characterizing feature of OCD is the simultaneous presence of obsessions and compulsions in the patient. Obsessions include:

• fear of infection
• fear of pollution
• fear of losing things
• fear of harm (others or yourself),
• superstition,
• sexual thoughts and images,
• religious thoughts,
• morbid predilection for order and symmetry.

Most often (45%) in patients with this mental disorder, there is a fear of infection (, microbes) or pollution (excrement, chemicals, etc.).

Obsessive thoughts are obsessive and accompanied by anxiety. The patient almost always exaggerates the threat to which his thoughts are devoted.

The second element of OCD symptomatology is compulsive actions aimed at getting rid of anxiety. Actions often do not have a logical justification and have a ritual character. When there is fear of infection or pollution, there are actions aimed at preventing these events. For example, a sick person may wash their hands or body for a whole day. It is characteristic that these actions stop not after the hands become clean, but only after the patient feels relief, getting rid of obsessive thoughts.

Compulsions can manifest themselves in the form of not only physical, but also mental actions. For example, constantly repeating conspiracies, spells can be attributed to compulsions.

In some cases obsessions may prevail over compulsions, in others there is a predominance of actions over obsessive thoughts.

Patients with obsessive-compulsive disorder also often have a belief in the materiality of thoughts, an overdeveloped sense of danger and a desire for perfection.

OCD: what is it in psychology and psychiatry?

The diagnosis is made by a psychiatrist after talking and testing the patient. The most commonly used scale is the Yale-Brown scale. When filling out the test, only symptoms that have manifested during the past week should be taken into account. When diagnosing, it is necessary to separate OCD from anancaste and anxiety disorders,.

Treatment for OCD should be comprehensive. For therapy, medications and psychotherapy methods are used. Among the most commonly used drugs are antidepressants, especially clomipramine. SSRI drugs (sertraline, fluoxetine) are also used. Nootropic substances, vitamins and microelements are also prescribed to improve the functioning of the nervous system.

Among the psychotherapeutic methods, the greatest effect is demonstrated by:

• cognitive Behavioral Therapy,
• aversive therapy,
• group therapy,
• family psychotherapy,
• psychoanalysis,
• hypnosis.

The most widely used cognitive behavioral technique. In her arsenal there are various ways of interaction between the doctor and the patient. For example, a patient may be subjected to artificial This promotes learning (with the help of a psychiatrist) to overcome stress and phobias. The aversive method is based on getting rid of obsessive actions by creating discomfort in the patient when they are performed. Family therapy is most often used in the treatment of children.

Therapy is usually aimed at relieving and relieving symptoms. However, with a mild degree of the disease, a complete cure is possible.