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Obsessive Syndrome. How to get rid of obsessive thoughts in your head? Obsessive-compulsive disorder How is obsessive-compulsive disorder treated?

An obsessive state (synonyms: obsessive-compulsive disorder; obsession; obsessive compulsive disorder; obsessive compulsive disorder) is a disease caused by trauma, and also often occurs in people with certain personality accentuations. Obsessive states are manifested in the form of images, thoughts, feelings or actions that involuntarily invade the consciousness, the unfoundedness of which the patient understands and with which the patients struggle, but cannot overcome them on their own.

Options for the course of the obsessive state

• A single attack of the disease.
• Alternation of exacerbations and remissions.
• Continuous course with periodic intensification of symptoms.

Lack of sleep, alcohol and somatic diseases provoke an exacerbation.

What is the cause of the obsessional state

The cause of the obsessive state is trauma. This could be:

• One-time severe psychotrauma (death of a loved one, separation, from parents with a serious illness of their child, etc.).
• Intrapsychic conflict is a conflict between duty and responsibility.
• Long-term mild psychotrauma.
• Constant presence in a traumatic situation (irritable leadership in the team, poor material and living conditions, living in the same apartment with the mother-in-law in the absence of mutual understanding, etc.).
• Behavioral reason (in a certain place, some traumatic events occurred, and in the future, it is in this place that the symptoms of an obsessive state arise).

How does the obsessive state manifest?

Clinical manifestations of an obsessive state depend on the area in which the obsession itself takes place, and are also characterized by common features and properties of obsession itself (obsession syndrome).

Obsessive compulsive disorder

Obsessive compulsive disorder is characterized by:

• A feeling of alienation of the content of thinking and its painfulness. A person feels discomfort due to an obsessive state, it bothers him, interferes with living a full life. There is also a clear understanding that this obsession does not correspond to the conscious processes of a given person, which is why it is perceived as alien (sometimes frightening).
• The presence of criticism. The person realizes that the obsessive state is not normal.
• Fighting your obsessive condition. A person tries to hide his obsessive state from others, control it, study, adapt to it, but still cannot get rid of it on its own. That is why such people more often than others turn to psychologists, psychotherapists and even psychiatrists (despite the social fear of contacting a specialist of this kind) in order to receive appropriate help.

These three signs of an obsessive state distinguish it from diseases related to the so-called large psychiatry (for example, such as).

Obsessional State: Spheres of Obsession

According to the spheres of obsession, various obsessive states are distinguished:

• Intelligent.
• Emotional.
• Motor.

Intellectual obsessions.

Intellectual obsessions are also called obsessions or obsessions. The most common intellectual compulsions include:

• "Mental chewing gum" - doubts and reflections on any occasion and without it.
• Obsessive doubts are characterized by poor recording of events (“Did I turn off the iron?”, Etc.).
• Obsessive counting (arrhythmomania) is an obsessive state of counting objects, phenomena, people, etc. (for example, obsessive counting of passing cars, etc.).
• Obsessive representations.
• Obsessive reproduction in memory of names, dates, phone numbers, titles.
• Obsessive memories are often of indecent content.
• Obsessive fears - most often relate to the possible failure to perform a function (professional, sexual, etc.).
• Contrasting obsessive state - processes that sharply contrast with the moral and ethical attitudes of the individual (for example, blasphemous washing in church, thoughts of a good daughter about the possible violent death of her parents, etc.).

Emotional obsessions

Emotional obsessions are specific obsessive fears (phobias). For example, the fear of a mother that she might harm her child and even kill him. Also, everyday (cultural) obsessions - fear of black cats, fear of the number "13", etc. also belong to this type of obsessional states.

Motor obsessions

Movement compulsions are also called compulsions. These include:

• Obsessive tapping, shaking off, clicking.
• Obsessive hand washing.
• An obsessive tendency to arrange things in a certain order.
• Tics are stereotypically repetitive involuntary twitching of the facial muscles.

Obsessive-compulsive disorders

Obsessive states, especially those that exist for a long time and were subject to a long and unsuccessful internal struggle, can also be accompanied by:

• depression;
• asthenia;
• arrhythmias;
• insomnia;
• vague pain in the region of the heart;
• irritability;
• a change in character.

Obsessive states: what is their danger and how to diagnose the disease

Why is the obsessive state dangerous?

The obsessive state, as a rule, does not lead to dangerous consequences. So, a mother who is afraid to kill her child will never do it. But a person who insists on pedantic order in the house is capable of neuroticizing the rest of the family, which can even lead to the breakdown of the family. In addition, people with obsessive-compulsive disorder have limited opportunities to achieve success in society. Therefore, of course, obsessive states should be prevented, if possible, and, if necessary, treated.

How to diagnose an obsessive disorder

The diagnosis of an obsessive state is easy enough, since the patient is critical and is himself interested in getting rid of the obsessive state. Therefore, he easily talks about his condition, but on one condition - trust in a psychologist or psychotherapist, because each patient considers his obsessive state to be the most intimate and painful.

How to treat an obsessive-compulsive disorder.

Treatment of obsessive compulsions with psychotherapy and psychocorrection methods

In the treatment of obsessive states, psychocorrection and psychotherapy are in the first place, which allows the patient to feel liberation from the obsessive state, freedom of action and choice of the future.

Some of the most effective techniques have proven themselves:

• Regressive hypnosis.
• NLP (neurolinguistic programming).
• Self-hypnosis.
• Ericksonian hypnosis.

Psychotherapy and psychocorrection can be carried out without medical cover, since the patient is critical, and the occurrence of secondary disorders, although provoked by an obsessive state, usually does not interfere with treatment. Often it itself regresses as it cures from the obsessive state.

Medication support for obsessive-compulsive disorder

Drug treatment is used in the presence of concomitant symptoms, which, as residual effects, may continue to bother the patient:

• In case of irritability, valerian extract is prescribed 1-2 tablets 3 times a day, Corvalol, tincture of valerian, motherwort, peony root - 20-30 drops 2-4 times a day for 3-4 weeks, Fitosed, Novopasid.
• For depression - fluoxetine (Prozac), sertraline (Zoloft, Zolox), paroxetine (Seroxat, Paxil), citalopram (Tsipramil, Tsipralex). The dose is selected only individually.

Prevention of an obsessive state.

Life is arranged in such a way that traumatic situations can await us at every step. It's almost impossible to avoid them. For that, there is always the opportunity to immediately get rid of the obsessive state by contacting a psychologist or psychotherapist. And this is included in the area of ​​responsibility of the person himself for his psychological health.

One of the most common psychological disorders today is neurosis. This disease can bother you constantly or be episodic, but in any case, neurosis greatly complicates a person's life. If you do not seek qualified medical help in a timely manner, then this disorder can lead to the development of more complex mental diseases.

Neuroses are reversible psychogenic disorders that arise due to internal or external conflicts, emotional or mental stress, as well as under the influence of situations that can cause mental trauma in a person. A special place among neurotic disorders is occupied by obsessive-compulsive disorder. Many experts also refer to it as obsessive-compulsive disorder (OCD), but some doctors distinguish between the two.

Why it happens? The fact is that in domestic medicine for a long time obsessive-compulsive disorder and OCD were really considered different diagnoses. But the international classification of diseases ICD-10 used today does not contain such a disease as obsessive-compulsive disorder, in this list of diseases only obsessive-compulsive disorder is mentioned. That is why, recently, these two formulations have begun to be used as a definition of the same mental pathology.

A person in this state suffers from obsessive, interfering or frightening thoughts that arise involuntarily. The main difference between this disease and schizophrenia is that the patient is aware of his problems. He tries to get rid of the feeling of anxiety through obsessive and tedious actions. Only a qualified psychotherapist who has experience working with patients who suffer from this form of mental disorder can cure obsessive-compulsive disorder.

Reasons for development

Among the reasons for the development of obsessive-compulsive disorder are usually stressful situations and overwork, but obsessive-compulsive disorder does not occur in all people who find themselves in a difficult life situation. What actually provokes the development of obsessive-compulsive states has not yet been precisely established, but there are several hypotheses regarding the occurrence of OBD:

1. Hereditary and genetic factors. Researchers have identified a pattern between the propensity to develop obsessive-compulsive disorder and adverse heredity. Approximately one in five patients with OBD has relatives with mental disorders. The risk of developing this pathology increases in persons whose parents have abused alcoholic beverages, have suffered from a tuberculous form of meningitis, and also suffered from migraine or epilepsy attacks. In addition, obsessive compulsions can occur due to genetic mutations.
2. A fairly large number of people (about 75%) suffering from obsessive-compulsive disorder have other mental illnesses. Bipolar disorder, depression, anxiety disorder, phobias and obsessive compulsions, attention deficit hyperactivity disorder, and eating disorders are among the most likely companions of LHC.
3. Anatomical features can also provoke obsessive-compulsive disorder. Biological reasons also include a malfunction in some parts of the brain and autonomic nervous system. Scientists drew attention to the fact that in most cases, with obsessive-compulsive disorder, there is a pathological inertia in the excitation of the nervous system, accompanied by the lability of inhibition of the ongoing processes. OCD can occur in the presence of a variety of neurotransmitter dysfunctions. Disorders of the neurotic level arise due to a malfunction in the production and exchange of gamma aminobutyric acid, serotonin, dopamine and norepinephrine. There is also a version of the relationship between the development of obsessive-compulsive disorder and streptococcal infection. People who have had this infection have antibodies in the body that destroy not only harmful bacteria, but also the body's own tissues (PANDAS syndrome). As a result of these processes, the tissues of the basal ganglia can be disrupted, which can lead to the development of OCD.
4. The constitutional and typological factors include special character traits (anankastny). Most patients are prone to constant doubts, very circumspect and cautious. Such people are very worried about the details of what is happening, they are prone to perfectionism. Ananskasts are conscientious and very executive people who strive to scrupulously fulfill their obligations, but the desire for perfection very often interferes with completing the work begun on time. The desire to achieve high results in work does not allow the establishment of full-fledged friendly relations, and also very much interferes with personal life. In addition, people with such a temperament are very stubborn, they almost never compromise.

Treatment of obsessive-compulsive disorder should begin with identifying the causes of the development of the disorder. Only after this will a therapy regimen be drawn up and, if necessary, drug treatment will be prescribed.

Symptoms of the disorder

The doctor will be able to diagnose obsessive-compulsive disorder in a patient and prescribe appropriate treatment only if the main symptoms of the disorder have been observed for a long time (at least two weeks). OCD manifests itself as follows:

• the presence of obsessive thoughts. They can be regular or occur periodically, staying in the head for a long time. Moreover, all images and drives are very stereotyped. A person understands that they are absurd and ridiculous, but, nevertheless, perceives them as his own. The OCD patient also realizes that he cannot control this flow of thoughts, as well as control his own thinking. In the course of the thought process, a person suffering from obsessive-compulsive disorder periodically has at least one thought that he tries to resist. Someone's names and surnames, names of cities, planets, etc. can persistently come to mind. In the brain, a poem, a quote or a song can repeatedly scroll. Some patients constantly discuss topics that have nothing to do with reality. Most often, patients are disturbed by thoughts of panic fear of infectious diseases and pollution, painful loss or the predetermination of the future. Patients with obsessive-compulsive disorder may experience a pathological desire for purity, the need for a special order or symmetry;
• Another major symptom of obsessive-compulsive disorder is the desire to take action to reduce the intensity of anxious thoughts. This behavior is called compulsive, and the patient's regular and repeated actions are called compulsions. The patient's need to perform specific actions is a conditional "obligation". Compulsions rarely give moral pleasure to a sick person; such "ritual" actions can only alleviate the state of health for a short time. Among such obsessive actions, one can note the desire to count specific objects, commit immoral or illegal acts, repeatedly check the results of one's work, etc. The compulsion is the habit of squinting, sniffing, licking lips, winking, licking lips, or wrapping long strands of hair around a finger;
• doubts that constantly plague the patient can also indicate the presence of obsessive-compulsive disorder. A person in this state is not confident in himself and his own strengths, he doubts whether he has performed the necessary action (turned off the water, turned off the iron, gas, etc.). Sometimes doubts reach the height of absurdity. For example, a patient may repeatedly check whether the dishes are washed, and at the same time wash them each time;
• Another symptom of obsessive-compulsive disorder is that the patient has groundless fears devoid of logic. For example, a person may be terribly afraid to speak in public, he is afraid of the thought that he will definitely forget his speech. The patient may be afraid to visit public places, it seems to him that he will certainly be ridiculed there. Fears may include relationships with the opposite sex, inability to fall asleep, fulfillment of work obligations, and the like.

The most striking example of obsessive-compulsive disorder is the fear of getting dirty and getting a fatal disease after contact with microbes. In order to prevent this "terrible" infection, the patient tries in every possible way to avoid public places, he never eats in cafes or restaurants, does not touch the handles on the doors or handrails on the stairs. The home of such a person is practically sterile, since he carefully cleans it using specialized means. The same applies to personal hygiene, OCD forces a person to wash their hands for hours and treat their skin with a special antibacterial agent.

Obsessive-compulsive disorder is not a dangerous disorder, but it complicates the life of the individual so much that he himself begins to think about the question of how to cure obsessive-compulsive disorder.

Features of OCD treatment

The success of the treatment of obsessive-compulsive disorder depends on several factors, but the chances of a normal life will be higher if the treatment of the pathology is started as early as possible. Therefore, you should not ignore the first symptoms of the disease: if you notice that you are overcome by obsessive thoughts, then it is better to immediately contact a psychotherapist or psychiatrist.

Treatment of obsessive-compulsive disorder requires an integrated approach to solving the problem. Therapy is carried out in three directions: the impact of psychotherapy, drug treatment and hypnotherapy.

The most effective method of psychotherapeutic influence in the treatment of obsessive-compulsive disorder is cognitive-behavioral therapy. Its essence boils down to the fact that the patient, with the assistance of a psychotherapist, independently discovered his destructive thoughts, realized their absurdity and developed a new positive thinking pattern.

In psychotherapy sessions, the doctor tries to explain to the patient the difference between his adequate fears and thoughts that were inspired by neurosis. As a result, the patient not only gets rid of obsessive thoughts and actions, but also gains skills to prevent the recurrence of the disease. Cognitive thinking formed in the course of treatment makes it possible for a person in the future to independently cope with some mental problems and prevent their progression.

Another effective way to cure obsessive-compulsive disorder is the method of exposure and prevention of reactions. During the session, the patient is deliberately placed in conditions that cause psychological discomfort and a stream of obsessive thoughts. Previously, the therapist gives his client instructions on how to resist their need to perform compulsive actions. According to statistics, the use of this method allows you to achieve faster results, and remission in this case will be more stable.

Quite often, in the treatment of obsessive-compulsive disorder, various techniques of hypnotic influence are used. After the patient enters a hypnotic trance, the therapist is able to identify the circumstances that caused the development of obsessive-compulsive disorder. In just a few sessions of hypnosis, it is possible to achieve sufficiently high results. The patient's condition improves significantly, and the effect of the suggestion persists for a long time or for the whole life.

In addition, other methods of psychotherapy can be used:

• group. Communicating with people who have similar problems makes it possible for the sick person to realize that his situation is not unique. The positive experience of getting rid of obsessive-compulsive disorder is an additional incentive for treatment;
• Rational Behavioral Therapy allows you to change the way people think and behave. The basis of this therapy is the ABC model, which is also called the model of therapeutic change or ABC-theory of personality. A is the patient's own thoughts and feelings associated with current events, B is beliefs, but not religious or political (psychotherapists consider this a personal matter of the client) and views, and C is a consequence, the result of exposure to A and B. Each of these points are closely interconnected, in order to change the result (C), you need to make changes in your own thoughts (A) and realize the irrationality of beliefs (B), which led to irrational consequences;
• psychoanalysis. This method has been very popular in the past, but has recently been losing ground. First of all, this is due to the need for a large number of therapeutic sessions. In some cases, treatment for OCD can take several years. Modern progressive techniques allow you to achieve sustainable results in a shorter time frame.

Medication is rarely recommended for the treatment of obsessive-compulsive disorder. The decision is made after a comprehensive assessment of the patient's condition and the existing risks from drug therapy.

If there is a need to take medications, the doctor may prescribe to the patient a drug from the group of tricyclic antidepressants, antidepressants of the SSRI class, specific serotonergic and noradrenergic antidepressants, benzodiazepine tranquilizers or normotimics.

Atypical antipsychotics are usually not included in the treatment program for obsessive-compulsive disorder, since errors in the dosage of the drug can lead to the opposite results: the symptoms of obsessive-compulsive disorder may become more pronounced.

Complex therapy in the treatment of obsessive-compulsive disorder necessarily includes:

• elimination of the traumatic situation that caused the development of neurosis. It will also be necessary to prevent its re-development;
• it is necessary to develop a special educational strategy for children with a predisposition to the occurrence of compulsions and obsessions;
• carrying out preventive work with the patient's family. For the treatment to be successful, and its result to be long-term, it will be necessary to normalize the situation in the family;
• autogenous training. Meditation is very useful, during such exercises it is possible to clear the mind of disturbing thoughts that cause concern. Various muscle and respiratory relaxation techniques can be practiced;
• quitting alcohol and getting rid of other addictions;
• revision of the regime of the day. It is very important to have enough time for sleep and proper rest in order to normalize the mental state. You will need to normalize food. The daily diet should contain healthy foods that provide the body with a sufficient amount of beneficial trace elements and energy;
• Light therapy is an adjunct treatment for OCD. During the procedure, the rays of light stimulate the immunobiological activity of the body, which has a positive effect on most functional systems and allows you to get rid of some types of depression.

In addition, treatments such as acupuncture, massage, and reflexology can be beneficial. If the patient has concomitant somatic diseases, then efforts must also be made to heal them.

Obsessive-compulsive disorder is a pathology that is difficult to get rid of on your own. The patient, although he realizes the absurdity of his thoughts and actions, is still unable to change irrational thinking without special skills. Only an experienced psychotherapist can help get rid of this unpleasant mental disorder that greatly complicates life.

A mental disorder, which is based on obsessive thoughts, ideas and actions that arise in addition to the mind and will of a person. Obsessive thoughts often have a content alien to the patient, however, despite all efforts, he cannot get rid of them on his own. The diagnostic algorithm includes a thorough interrogation of the patient, his psychological testing, exclusion of organic pathology of the central nervous system using neuroimaging methods. The treatment uses a combination of drug therapy (antidepressants, tranquilizers) with psychotherapy methods ("thought stopping" method, autogenic training, cognitive-behavioral therapy).

General information

Probably, obsessive-compulsive disorder is a multifactorial pathology in which a hereditary predisposition is realized under the influence of various triggers. It is noted that people with increased suspiciousness, hypertrophied concern about how their actions look and what others will think of them, persons with great conceit and its downside - self-deprecation, are predisposed to the development of obsessive-compulsive disorder.

Symptoms and course of neurosis

The basis of the clinical picture of obsessive-compulsive disorder is formed by obsessions - irresistibly obsessive thoughts (ideas, fears, doubts, drives, memories) that cannot be “thrown out of my head” or ignored. At the same time, patients are quite critical of themselves and their condition. However, despite repeated attempts to overcome it, they do not succeed. Along with obsessions, compulsions arise, with the help of which patients try to reduce anxiety, distract themselves from annoying thoughts. In some cases, patients engage in compulsive activities covertly or mentally. This is accompanied by some distraction and slowness in the performance of their official or household duties.

The severity of symptoms can vary from mild, practically not affecting the patient's quality of life and his ability to work, to significant, leading to disability. With a mild severity, the acquaintances of a patient with obsessive-compulsive disorder may not even be aware of his existing disease, referring the quirks of his behavior to character traits. In severe, advanced cases, patients refuse to leave their home or even their room, for example, to avoid contamination or contamination.

Obsessive-compulsive disorder can proceed according to one of 3 options: with constant persistence of symptoms for months and years; with a remitting course, including periods of exacerbation, often provoked by overwork, illness, stress, an unfriendly family or work environment; with a steady progression, expressed in the complication of the obsessive syndrome, the appearance and aggravation of changes in character and behavior.

Types of obsessive states

Obsessive fear (fear of failure) is an agonizing fear of not being able to properly perform an action. For example, go out in front of the audience, remember a learned poem, have sexual intercourse, fall asleep. This also includes erythrophobia - the fear of blushing in front of strangers.

Obsessive doubts - uncertainty about the correctness of performing various actions. Patients suffering from obsessive doubts are constantly worried whether they turned off the tap with water, turned off the iron, whether they indicated the correct address in the letter, etc. Pushed by uncontrolled anxiety, such patients repeatedly check the performed action, sometimes reaching complete exhaustion.

Obsessive phobias - have the widest variation: from the fear of contracting various diseases (syphilophobia, carcinophobia, heart phobia, cardiophobia), fear of heights (hypsophobia), enclosed spaces (claustrophobia) and too open areas (agoraphobia) to fear of their loved ones and yourself someone's attention. Common phobias among OCD patients are fear of pain (algophobia), fear of death (thanatophobia), and fear of insects (insectophobia).

Obsessive thoughts - persistently "creeping" into the head names, lines from songs or phrases, surnames, as well as various thoughts that are opposite to the patient's life ideas (for example, blasphemous thoughts in a believing patient). In some cases, obsessive philosophizing is noted - empty endless reflections, for example, about why trees grow taller than people or what will happen if two-headed cows appear.

Obsessive recollections - recollections of some events that arise against the patient's wishes, which, as a rule, have an unpleasant coloration. This also includes perseverations (obsessive representations) - vivid sound or visual images (melodies, phrases, pictures) reflecting a traumatic situation that occurred in the past.

Obsessive actions are repeated many times against the will of the sick movement. For example, closing eyes, licking lips, correcting hair, grimacing, winking, scratching the back of the head, rearranging objects, etc. Some clinicians separately single out obsessive drives - an uncontrollable desire to count or read something, rearrange words, etc. this group also includes trichotillomania (hair pulling), dermatillomania (damage to one's own skin), and onychophagia (compulsive nail biting).

Diagnostics

Obsessive-compulsive disorder is diagnosed based on patient complaints, neurological examination findings, psychiatric examination and psychological testing. It is not uncommon for patients with psychosomatic obsessions to be treated ineffectively by a gastroenterologist, therapist or cardiologist for somatic pathology before being referred to a neurologist or psychiatrist.

Important for the diagnosis of OCD are obsessions and / or compulsions occurring every day, taking at least 1 hour a day and disrupting the patient's usual course of life. The patient's condition can be assessed using the Yale-Brown scale, psychological research of personality, pathopsychological testing. Unfortunately, in some cases, psychiatrists diagnose patients with OCD with schizophrenia, which entails inappropriate treatment, leading to the transition of neurosis to a progressive form.

Examination by a neurologist may reveal hyperhidrosis of the palms, signs of autonomic dysfunction, tremor of the fingers of outstretched arms, and a symmetrical increase in tendon reflexes. If there is a suspicion of cerebral pathology of organic origin (encephalitis, arachnoiditis, cerebral aneurysm), MRI, MSCT or CT of the brain are indicated.

Treatment

It is possible to effectively treat obsessive-compulsive disorder only by following the principles of an individual and integrated approach to therapy. It is advisable to combine drug and psychotherapeutic treatment, hypnotherapy.

The use of psychoanalytic methods in the treatment of obsessive-compulsive disorder is limited, since they can provoke outbursts of fear and anxiety, have a sexual connotation, and in many cases obsessive-compulsive disorder has a sexual accent.

Forecast and prevention

Complete recovery is rare. Adequate psychotherapy and medication support significantly reduce the manifestations of neurosis and improve the patient's quality of life. Under unfavorable external conditions (stress, serious illness, overwork), obsessive-compulsive disorder may arise again. However, in most cases, after 35-40 years, there is some smoothing of symptoms. In severe cases, obsessive-compulsive disorder affects the patient's ability to work, a third group of disability is possible.

Considering the character traits that predispose to the development of OCD, it can be noted that a simpler attitude towards oneself and one's needs, a life for the benefit of the people around, will be a good prevention of its development.

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Obsessive-compulsive disorder is an anxiety disorder characterized by burdened thoughts, fear, apprehension, anxiety, repetitive actions to reduce this anxiety, and a combination of obsessive obsessions and ideas.

Obsessive-compulsive disorder includes three forms of the course: the first, in which the symptoms persist for months or several years; the second remitting form, characterized by repeated episodes of weakening of the signs of the disease; the third steadily progressive form of the course. Complete recovery is rare. Closer to 35-40 years of age, painful manifestations are smoothed out.

In the 19th century, the term neurosis was widely used, which was referred to as obsessions. In 1827, Dominic Eskirol described one of the forms of obsessive-compulsive disorder, which he called the disease of doubt. He defined this disease between a disorder of intelligence and will. In 1858 I. M. Balinsky singled out a common feature among obsessions - alienation to consciousness. Further, I.P. Pavlov noted in his works the similarity of obsessions with delirium, since they are based on the pathological inertness of arousal, as well as the lability of inhibition.

Obsessive-compulsive disorder occurs less frequently than neurasthenia or hysterical neurosis. The incidence of the disease in men and women is almost the same. The disease is diagnosed by neurological manifestations: with outstretched hands, trembling of the fingers occurs, hyperhidrosis of the hands, revitalization of tendon and periosteal reflexes, and vegetative-vascular disorders are observed.

The causes of obsessive-compulsive disorder

Numerous psychological as well as biological factors lead to the causes of the development of obsessive-compulsive disorder. The severity of symptoms is assessed using the Yale-Brown scale.

Obsessive-compulsive disorder often occurs in individuals of the thinking type. The weakening of the body due to somatic and infectious diseases in combination with phobias provokes the appearance of neurosis, and people have obsessive thoughts, doubts, memories, actions, drives.

Obsessive-compulsive disorder symptoms

Symptoms of the disease include repetitive actions, rituals, cyclicality of diverse thoughts, constant checking of their actions, preoccupation with intimate thoughts, thoughts of violence, as well as religion, fear or desire to count numbers.

Symptoms of obsessive-compulsive disorder often frighten the immediate environment of patients, and the patients themselves are critical of themselves, but are not able to change their behavior or attitude to what is happening.

The actions of people suffering from obsessive-compulsive disorder are assessed as inadequate, affecting mental activity, and seem paranoid. The patients themselves admit that their actions are irrational, which further causes concern about this. The disease can appear at any age. A third of the patients claim that obsessive-compulsive disorder arose in childhood and now continues throughout their entire conscious life.

The term obsessive-compulsive disorder is applied to a meticulous person with perfectionistic traits, overly enthusiastic or fixated on something. The same symptoms are inherent in obsessive-compulsive disorder, autism. The disease can occur in patients with high intelligence. All patients are united by excessive attention to detail, careful planning, risk avoidance, a heightened sense of responsibility, as well as indecision with slow decision-making.

For a person suffering from this disease, all kinds of phobias are characteristic. These include carcinophobia (fear of getting cancer), lissophobia (obsessive fear of insanity), cardiophobia (fear of dying from heart disease), oxyphobia (fear of sharp objects), claustrophobia (fear of enclosed spaces), agoraphobia (fear of open spaces), acrophobia (fear heights), fear of pollution, fear of blushing and so on. For all these phenomena, the desire for obsessive states that arise contrary to the desire of a person is irresistible and strong. The sick person treats them critically, they are alien to him, he seeks to overcome them on his own, but this does not work. Patients suffer both from their fears, which have objective grounds, and act as a result of far-fetchedness, illusions. People are afraid of attacks on the street, fatal diseases, fear of unemployment, poverty, etc. Rarely, but the excruciating fear pushes them to commit suicide.

What is fear? Fear is a manifestation of a reaction to an imbalance between an imagined danger and perceived possibilities. Fear is expressed mentally; it is not objective. The sick person cannot move away from his phobia and surrenders to the power of fear. Fear torments you and you don't know what to do with it? The answer is on the surface. Do what you fear and the fear will subside.

Obsessive-compulsive disorder manifests itself in increased irritability, sleep disturbances, fatigue, and difficulty concentrating. Symptoms are expressed with varying intensity, and the patient's mood is often low and with a tinge of hopelessness, as well as a sense of his own inferiority.

Obsessive-compulsive disorder is capable of a chronic course with periods of exacerbations. Features of the course of obsessive-compulsive disorder are manifested in three types. The first involves a single episode of illness that lasts weeks or years. The second consists of relapses, including periods of full health. The third includes a continuous course, accompanied by a periodic increase in symptoms.

Obsessive-compulsive disorder in children

The disease in children has a reversible mental nature, in which the perception of the world is not distorted. Often, parents do not pay attention to obsessive-compulsive disorder in children, thinking that this state will go away on its own. The disease manifests itself in children as repetitive movements, tics, twitching of the shoulders, wrinkling of the forehead, grinning, sniffing, coughing, tapping, clapping. Often these symptoms are supplemented by a sense of fear that babies experience before the opportunity to stain their clothes, they are afraid of closed spaces, prickly objects.

During adolescence, fears change. This is being replaced by the fear of getting sick, of dying, the fear of speaking and answering at the blackboard. Sometimes children are disturbed by contrasting obsessions. They are characterized by immorality, blasphemy of thoughts, obsession with desires. The realization of such experiences is not carried out, and the sensations themselves deliver fear and anxiety. In these situations, parents should seek help from a psychotherapist. In the treatment of childhood obsessive-compulsive disorder, the method of play, fairy-tale therapy, is successfully used. Age and severity of the disease play an important role in prescribing treatment.

Obsessive-compulsive disorder treatment

Treatment is carried out only by an experienced doctor, after determining the type of disease. Therapy includes a complex, as well as a strictly individual approach, which is carried out taking into account both the clinical picture of the disease and the personal characteristics of the patient. Mild cases are treated with psychotherapeutic or restorative methods.

A good effect can be achieved with a simple workout that suppresses obsession. Provided that this does not give success, use the suggestion of hypnosis. Shown are sedatives, as well as tonic drugs, depending on the stage of the disease, as well as the characteristics of the clinical picture.

The initial stage of the course of obsessional neurosis in combination with phobias and anxiety is treated with tranquilizers of mild antidepressant action. All doses of drugs are selected individually for the state of neurotic disorders. If the obsessive-compulsive disorder after treatment weakens or disappears, then maintenance therapy is indicated for a duration of 6 months to one year. Psychotherapy for the patient is necessary along with the observance of a rest and sleep regimen.

Severe cases of neurosis, which occur with neurotic depression, are treated in hospitals. Medical institutions use antidepressants, hypoglycemic doses of insulin, antipsychotics in treatment. The recovery period is accompanied by the involvement of a person in the life of the team, as well as a shift in attention from obsessions to real life. If persistent, as well as isolated obsessions (fear of open space, fear of heights, fear of the dark) are preserved, the suppression of fear by the method of self-hypnosis is shown.

Obsessive-compulsive disorders with protracted courses require transferring patients to easier work. In case of complications, VKK refers the patient to VTEK. The commission can give III group of disability, as well as give recommendations that relate to working conditions, type of work.

How is obsessive-compulsive disorder treated?

Help for obsessive-compulsive disorders is carried out by folk non-drug methods. These methods include hyperventilation - intense breathing.

Obsessive-compulsive disorder leads either to suppression of appetite, or to its increase. In this case, it is very important to enrich your diet with foods containing vitamins B, E, magnesium, calcium. Indicated for use are juice, water, herbal teas (ginseng, wild oats, oats, linden, hop cones, valerian, chamomile). Self-massage (stroking techniques) is effective, as well as cognitive therapy, physical education, cranial osteopathy, aromatherapy.

Doctor of the PsychoMed Medical and Psychological Center

The information provided in this article is intended for informational purposes only and cannot replace professional advice and qualified medical assistance. At the slightest suspicion of the presence of obsessive-compulsive disorder, be sure to consult your doctor!

Article author: Maria Barnikova (psychiatrist)

Obsessive-compulsive disorder: causes, symptoms, treatment methods

21.04.2017

Maria Barnikova

Obsessive-compulsive disorder is a neurotic disorder. What are the symptoms of the disease? How to get rid of obsessions and compulsions?

Obsessive-compulsive disorder- a disorder of the neurotic level, which can be episodic or chronic, have a constant or progressive course. In the absence of adequate, timely and comprehensive treatment, there is a high risk of transformation of obsessive-compulsive disorder into a psychotic-level disease () - obsessive-compulsive disorder (OCD).

Obsessive-compulsive disorder: general information

The main symptoms of obsessive-compulsive disorder are those that are constantly present or that arise periodically, which have a frightening content and make it difficult for the patient to conduct a full-fledged activity. Such overwhelming fearful thoughts are called obsessions.

Along with obsessive thoughts, an individual's activity can be filled with meaningless and illogical compulsions called compulsions. Tiring, exhausting, meaningless actions play the role of a kind of "rescuer" that relieves the patient from overwhelming anxious thoughts.

Also, obsessive-compulsive neurosis is characterized by the emergence of obsessive memories in a person and an indomitable premonition of some kind of catastrophe in the future. In a patient with obsessive-compulsive disorder, the main emotional component is insurmountable and often reaching proportions. A person with this type of neurosis is distinguished by "strange" behavior, the senselessness of any repetitive actions, the obsessive repetition of certain actions.

To date, there are no precise statistics on the prevalence of obsessive-compulsive disorder. The incompleteness and inaccuracy of the picture of the disease explains the lack of a unified approach in psychiatry to understanding the forms of this disorder, the use of various diagnostic criteria, the existence of possible stidisimulation of symptoms of neurosis, the similarity of many signs of the disease with other mental illnesses.

According to the World Health Organization, the prevalence of obsessive-compulsive disorder and obsessive-compulsive disorder does not exceed 3% of the general human population. According to other studies, cases of this and OCD are recorded in 1 in 100 adults and in 1 in 500 children.

In most cases, in order to identify obsessive-compulsive disorder, carry out differential diagnostics with obsessive-compulsive disorder and other forms of mental disorders, assess the severity of the disease in modern medicine, the Yale-Brown scale is used - a questionnaire that provides the most accurate results. According to the data obtained, the doctor makes an assumption about the presence or absence of obsessive-compulsive disorder or OCD, determining the level of the existing threat to the patient's mental health.

As a rule, in most patients, obsessive-compulsive disorder debuts between the ages of 10 and 30... At the same time, the peak of the flourishing of the disease falls on the age category from 25 to 35 years old. Most often, with the problem of the existence of obsessive symptoms, people go to the doctor at the age of 30 to 35 years.

Obsessive-compulsive disorder is recorded in people of different social status, financial situation. However, obsessive-compulsive disorder most commonly affects low-income subjects. This pattern can be explained by the fact that people from the lower economic strata cannot always receive qualified medical care and do not apply to a medical institution in a timely manner.

Most often, the symptoms of obsessive-compulsive disorder are determined in people with a high level of education. Many patients with this neurosis are distinguished by excellent erudition and demonstrate a high level of intelligence. At the same time, it is the presence of obsessive thoughts and actions that is a serious obstacle to continuing their studies and fully fulfilling their work obligations. If a neurotic disorder has crossed the line of neuroses, transforming into OCD, the level of disability due to the disease reaches 75% of all patients.

About half of patients with obsessive-compulsive disorder are single people. They either never married or were divorced. This phenomenon can be explained by the fact that the obsessive symptoms of neurosis create serious problems not only for the patient himself, but also interfere with a full-fledged family life.

Also described are gender patterns in the development of obsessive-compulsive disorder. In the age group from 10 to 17 years, the majority of patients with OCD are males. In the period from 25 to 35 years, the dominant proportion of hospitalized patients are women. In the period from 35 to 65 years old, obsessive-compulsive disorder is most often diagnosed in men. Over the age of 65, the maximum number of cases of this form of neurosis was recorded among female representatives.

Obsessive-compulsive disorder: causes

At the moment, the specific provoking factor and causes of obsessive-compulsive disorder have not been established. Scientists have put forward several hypotheses about the origin of obsessive-compulsive disorder. Let's describe the most reasonable and proven versions.

According to the studies conducted, about 20% of patients with obsessive-compulsive disorder have an unfavorable heredity - in their family history there are cases of mental disorders. A high risk of developing symptoms of OCD is present in people whose parents have abused alcohol, and alcohol psychosis has arisen against the background of their intake. People, whose parents suffered from tuberculous meningitis, had epileptic seizures and migraine attacks, feel the full severity of obsessive-compulsive disorder. Genetic mutations in the hSERT gene located on chromosome 17 can also contribute to the onset of symptoms of obsessive-compulsive disorder.

About 75% of patients with obsessive-compulsive disorder have associated mental defects. Among the common companions of neurosis are bipolar disorder, depressive conditions, anxiety neurosis, phobic fears, eating disorders, attention deficit hyperactivity disorder. Gilles de la Tourette's syndrome has been diagnosed in many boys showing symptoms of obsessive-compulsive disorder.

The biological reasons for the development of obsessive-compulsive disorder include the anatomical features of the structure of the brain and failures in the processes controlled by the autonomic nervous system. According to some scientists, the emergence of obsessive-compulsive disorder is facilitated by the pathological inertness of the excitation of the nervous system in combination with the lability of inhibition of the ongoing processes.

One of the probable causes of obsessive-compulsive disorder is various disorders in the functioning of the neurotransmitter system. Disruption in the production and metabolism of serotonin, dopamine, norepinephrine and gamma aminobutyric acid can give rise to neurotic disorders.

Another biological version deserves attention, describing the relationship of obsessive-compulsive disorder with the presence of PANDAS syndrome in a patient, as a response to the presence of streptococcal infection in the body. This theory has strong evidence. As you know, in the process of fighting streptococcal infection, there is a high risk that the antibodies produced can not only destroy harmful bacteria, but also cause the destruction of the body's own tissues. With damage to the tissues of the basal ganglia, the development of symptoms of obsessive-compulsive disorder is quite likely.

The article also describes constitutional and typological factors that predetermine the development of neurotic disorders. So, most of the patients with obsessive-compulsive disorder have anankast character traits. Such persons are prone to constant doubts. They are very careful and discreet. The Anankastas are overly concerned with the details of what is happening. They are distinguished by perfectionism - the desire to do everything in an ideal way. Such a thirst for perfection prevents the perfectionist from completing the work begun on time. Anankastas are very conscientious and diligent people, scrupulously fulfilling their obligations. Their interest in high labor productivity interferes with the establishment of full-fledged friendships and harms personal relationships. They are particularly stubborn and do not know how to compromise. Most patients with obsessive-compulsive disorder are suspicious and impressionable people. A small fraction of them are capable of taking decisive action.

Obsessive-compulsive disorder: symptoms

According to the accepted criteria in psychiatry, the diagnosis of obsessive-compulsive disorder can be established if obsessions and / or compulsions have occurred in a patient for more than two weeks. At the same time, obsessive thoughts and "ritual" actions were the cause of a stressful state, worsened the patient's quality of life, changed the mode and volume of his activity.

Obsessive thoughts arise in an individual regularly or episodically, taking possession of his thinking for a long time. The main symptom of obsessive-compulsive disorder is precisely the obsession and stereotype of images and drives. Despite all the absurdity and absurdity of judgments, a person regards them as his own. The subject feels that he cannot control his reasoning and control the thought process. In the thinking of a patient with obsessive-compulsive disorder, there is at least one thought, which he tries to resist.

With obsessive thinking, a person can stubbornly come to mind some names and surnames, geographical names or names of distant planets. He can scroll the same poem in his head or repeat a certain quote many times. Often the patient's mind is occupied with "mental chewing gum": he ponders for a long time on some absurd topics that have nothing to do with his reality.

Common themes of obsessive thoughts are:

• panic fear of getting infected, getting sick with some kind of infectious disease;
• irrational fear of pollution - both of your own body and of surrounding objects;
• pathological desire for purity;
• painful need for symmetry and observance of a certain order in everything;
• frightening presentiments that in the future a person will definitely lose objects without which he cannot exist;
• various superstitions, belief in the predetermination of the future.

Another symptom of obsessive-compulsive disorder is the patient's desire to perform certain actions in order to reduce the intensity of unpleasant thoughts - compulsive behavior. Compulsions are defined as regularly and repetitive actions aimed at preventing unlikely events. This need to commit some specific act is a conditional "obligation". However, the need to perform such a "ritual" action does not always bring moral satisfaction to a person. Compulsions act only as a short-term improvement in well-being.

Obsessive actions include the need for a person to count some specific objects. The patient may have a craving for the accomplishment of some illegal or immoral act. Involuntary obsessive movements can also occur. Such compulsions include strange "habits": squinting eyes, licking lips, curling locks of hair, sniffing, winking.

Symptoms of obsessive-compulsive disorder also include doubts overwhelming a person. A sick person is not confident in himself, doubts whether some action has been performed, whether some process has been completed. A person suffering from obsessive-compulsive disorder can repeatedly check the performance of an act. For example: the patient checks several times whether the valve on the water supply system is closed, whether the light is off, whether the gas is turned off, whether the front door is locked. He can re-read his work over and over again, check the correctness of the calculations, verify the specified data. For some people, obsessive doubts are completely absurd. So the patient can recheck whether the dishes have been washed or whether the flowers have been watered, while again and again he will repeat the action already performed several times.

Obsessive-compulsive disorder symptoms also mean that an individual has illogical and unfounded fears. The subject may be agonizingly afraid of speaking in front of the public, being confident that he will definitely forget the words of his speech. He is afraid to take on some new work obligations, being convinced that he will not be able to fulfill them. Such a person is often afraid to be in society because of an abnormal fear of blushing or fear of being ridiculed. Some patients are convinced that they will never be able to fall asleep, and the evening before bedtime is filled with intense fears. Other subjects with OCD experience fear of the opposite sex. They are sure that they will not be able to show themselves in the intimate sphere and will definitely disgrace themselves in front of their partner.

A common example of obsessive-compulsive disorder is the fear of contamination. The patient constantly has obsessive thoughts that he will get sick with some dangerous disease due to contact with microbes. To prevent infection, a person begins to take various precautions: he thoroughly cleans the house, washes his hands for hours with soap, and treats the skin with antibacterial agents. He refuses not only to use, but also from touching non-individual objects, for example: the patient never eats in public places, does not touch handrails or doorknobs.

Obsessive-compulsive disorder: treatment

Each person should remember: the earlier the treatment of a neurotic disorder is started, the greater the chance of success of treatment measures. Therefore, at the first symptoms of neurosis, it is necessary to seek advice and treatment from a psychotherapist. For the treatment of obsessive-compulsive disorder, complex medical work is carried out, which includes psychotherapeutic effects, the use of pharmacological agents and hypnotherapy.

Psychotherapeutic treatment

How to get rid of obsessive-compulsive disorder? The basis of psychotherapeutic treatment is formed by the methods of cognitive-behavioral psychotherapy. This technique is based on the fact that the patient is aware of his problem and learns how to counteract the symptoms of the disease. In the course of treatment, the doctor explains to the client which of his fears are adequate and justified, and which thoughts are the result of neurosis.

As a result of psychotherapeutic treatment, the patient begins to control the course of his thoughts. The patient begins to draw a line between a real-life situation and a fantasy world.

Another effective method of treating obsessive-compulsive disorder is the technique of exposure and prevention of reactions. The exposition provides for the deliberate placement of the patient in an environment that causes psychological discomfort and contributes to the emergence of obsessive thoughts. In parallel with this, the client receives instructions on how to resist the need to perform compulsive actions. As psychotherapeutic practice shows, it is this method of treating obsessive-compulsive disorder that makes it possible to achieve stable long-term remission.

A variety of hypnosis techniques are also used in the treatment of symptoms of obsessive-compulsive disorder and obsessive-compulsive disorder. In a state of hypnotic trance, it is possible to establish the true cause that gave rise to the neurotic disorder. The conducted suggestion allows achieving a stable clinical improvement in the patient's condition, the effect of which lasts for several years or for life.

Also, the treatment of obsessive-compulsive disorder can be carried out using psychotherapy methods:

• group;
• rational-behavioral th;
• aversive;
• psychoanalytic.

Pharmacological treatment

For patients with obsessive-compulsive disorder, treatment is prescribed on an individual basis after assessing the existing risks from psychotropic therapy and determining the severity of the symptoms of the disorder. Most often, drug treatment involves the use of:

• tricyclic antidepressants such as clomipramine (Clomipraminum);
• SSRI antidepressants such as fluoxetine (Fluoxetinum);
• noradrenergic and specific serotonergic antidepressants such as Mirtazapine;
• normotimics, for example: topiramatum;
• benzodiazepine tranquilizers, for example: alprazolam (Alprazolam).

The inclusion of atypical antipsychotics, for example, risperidone (Risperidone), in the wrong doses, in the treatment program for obsessive-compulsive disorder, can have a completely opposite result, increasing the severity of symptoms of obsessive-compulsive disorder.

The OCD treatment program also includes:

• elimination and prevention of psycho-traumatic situations in all spheres of the patient's life;
• the correct educational strategy for children prone to the occurrence of obsessions and compulsions;
• normalization of the situation in the family, prevention of conflicts;
• autogenous training;
• getting rid of bad habits and maintaining a healthy lifestyle;
• choosing the right regime of work and rest;
• light therapy;
• treatment of chronic somatic pathologies.

Instead of a conclusion

The prognosis for the treatment of obsessive-compulsive disorder is favorable, but in the case of the transformation of the disease into obsessive-compulsive disorder, complete success in treatment is rarely achieved due to the persistence of symptoms and the existing tendency to chronicity and recurrence of the disease.

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Psychological stress