Obsessive syndrome: symptoms and treatment. What is obsessive-compulsive syndrome

Obsessive compulsive disorder (OCD) is a group of pathopsychological syndromes that manifests itself as obsessive thoughts and actions that prevent patients from leading full life. This condition is characterized by a person's inability to control his thoughts (ideas) or actions, which become habitual, stereotypical and constant fear and anxiety. Obsessive compulsive disorder is considered one of the most common mental disorders; according to some sources, every third adult suffers from obsessive thoughts or actions, and a severe disorder is observed in 1 child in a thousand.

The reasons for the development of obsessive-compulsive disorder in children and adults are still unclear. It has been proven that the occurrence of the disease is influenced by both physiological and psychological factors. It is impossible to say in advance exactly which factors can cause a disorder and which cannot, since each organism reacts individually to stimuli.

Risk factors for developing OCD are:

Obsessive compulsive disorder develops when a person develops a pattern of certain behavior. For example, having experienced fear or anxiety, the patient walked around the room or, in order to get rid of fear, turned on the light and checked to see if there was anyone in the room.

This reaction is fixed in the brain as a possible response to any dangerous situation, and in the future the patient cannot get rid of this behavior, continuing to perform certain rituals every day. Sometimes this behavior does not seem strange to others, but the patients themselves experience constant anxiety, which they are trying to get rid of with new rituals, which are gradually becoming more and more numerous.

What happens with obsessive-compulsive disorder?

The development of OCD is influenced by many factors; under their influence, the patient begins to constantly focus on certain thoughts and events, giving them excessive significance.

Obsessive thoughts arise from events or things that are of great value to a person, from his fears and experiences. From time to time, such thoughts or actions that cannot be dealt with appear in everyone - for example, while waiting and worrying about a loved one who stays late in the evening or the habit of constantly checking the keys to the apartment.

But with OCD, patients do not try to cope with the influx of thoughts, because they consider them too important, and their behavior is the only correct and possible in such a situation.

Certain rituals and behavior patterns help them feel safe and “cope” with anxiety, but gradually, they become more and more and the patient falls into vicious circle– any unfulfilled or untimely ritual causes even more severe anxiety, and in order to get rid of it, you need to perform some other ritual.

Rituals and habits can be very different, from harmless - “knock on wood so as not to jinx it” or spit over your left shoulder if a black cat crossed the road” to complex, multi-component ones: in order to prevent bad things from happening, you must definitely avoid of blue color, and if you see a blue object, you must return home, change clothes and leave the house only in the dark.

People suffering from neurosis are characterized by an exaggeration of danger and “obsession” with it; any event in life turns into a problem or even a disaster that a person is not able to cope with. This supports constant feeling anxiety and tension, interfering with the patient’s normal life.

Symptoms

The main symptoms of obsessive-phobic disorder are obsessive thoughts and compulsive actions (rituals). These two combinations give a huge amount various options clinical picture diseases.

You can suspect OCD and make a diagnosis based on the following signs:

1. Rituals are one of the most characteristic signs of OCD. Rituals are repetitive activities whose main purpose is to calm anxiety or to try to “avoid” something scary. Patients themselves realize the wrongness and abnormality of such actions, but cannot cope with these impulses. For some, this becomes the only way to calm down, while others believe that this is the only way to avoid various misfortunes. Rituals can be very different: from the habit of arranging all objects by size, to daily cleaning throughout the house with disinfectants, even stranger habits can occur: for example, reading the same page in a book every day before going to bed, turning off and then turning on the lights in the room 10 times, and so on.
2. Obsessive rumination is the second characteristic sign of the disease. Patients think about the same event for hours, “chew” it in their brain, not finding the strength to interrupt this flow of thoughts. “Mental chewing gum” can be associated with the need to perform some action: call someone, talk, do something, or perform an ordinary, everyday action that healthy man does it without any thought. Such thoughts can also concern relationships and unfinished actions: is the light turned off, is there a thief breaking into the house, and so on.
3. Anxiety – with obsessive compulsive disorder, patients always have a feeling of anxiety. It can arise due to small, everyday situations (a child was late for 10 minutes) or because of “global” ones that are in no way controllable - terrorist attacks, environmental deterioration, and so on.
4. Obsessive thoughts – negative thoughts or desires to harm other people may occur in certain situations or occur periodically. Patients try to control such thoughts, but there is always a risk that they will do something similar.
5. or obsessive states - can be sensual and figurative. Sensual obsessions are sensations that one’s own thoughts, feelings and desires are imposed by someone, “not one’s own.” Imposed images can relate to any imaginary situations: patients “see” themselves committing some act, usually illegal or aggressive, or vice versa, unreal images seem to them to be real, to have already happened.
6. Obsessive impulses are an unexpected desire to perform some action that may be inappropriate or even dangerous. Sometimes in this way the patient tries to cope with obsessive thoughts or anxiety by doing strange, often destructive or dangerous things.
7. Obsessive drives - the patient feels an irresistible desire to do something, regardless of whether it is feasible, whether such actions are allowed, and so on. The attraction can be quite harmless: the desire to eat something, or completely unacceptable: to kill someone, commit arson, and so on. But in any case, the patient’s inability to cope with his feelings causes great discomfort and becomes another reason for anxiety and concern.
8. - a very characteristic symptom of obsessive disorder. Fears and phobias can be of very different types; nosophobia (obsessive fear of a serious or fatal illness), fear of heights, open or closed spaces, and fear of pollution are common. Various rituals help to temporarily cope with fear, but then it only intensifies.

With severe OCD, the patient may experience all the symptoms at the same time, but most often there is increased anxiety, obsessive thoughts and rituals. Sometimes they are accompanied by obsessions: aggressive thoughts and behavior, as well as phobias.

OCD in children

Unfortunately, today the number of children suffering from such a pathology as obsessive-compulsive disorder continues to increase. It is quite difficult to diagnose, especially in children of primary school age, and manifestations of the disease are often mistaken for attention deficit hyperactivity disorder, depression, conduct disorder or autism. This is due to the smaller number of characteristic symptoms that the child demonstrates and the fact that he cannot and does not know how to accurately characterize and describe his condition.

Children with OCD also suffer from obsessive thoughts and anxiety, but they can only articulate their condition at an older age; young children can be very restless, overly irritable, aggressive and hyperactive.

Anxiety and fears are manifested by the fear of being left without parents, alone, fear of strangers, new rooms, situations and even clothes.

The most characteristic feature obsessive compulsive disorders in childhood rituals are considered. This can be repeated repetition of the same actions that seem senseless to adults, excessive neatness and disgust (after any contamination, hands need to be washed for a long time with soap), attachment to the same things or sequence of events (a lullaby before bed, an obligatory glass of milk for breakfast ).

Moreover, the child categorically refuses to replace old thing to a new one, change something in the ritual or abandon it. Attempts by parents or others to “break” the ritual are perceived extremely aggressively; children with OCD cannot be switched to something else or distracted from performing actions.

At an older age, severe fears or phobias may appear, as well as anxiety and obsessive movements. Young children with this disorder are usually considered hyperactive or have neurological problems.

Diagnosing obsessive-phobic disorder in children is very difficult, since the clinical picture, due to age-related characteristics, is unclear and it is difficult to make a differential diagnosis with other diseases.

Treatment

How is obsessive compulsive disorder treated? great effort on the part of the patient and the doctor. Until recently, this disease was considered extremely resistant to treatment and doctors, first of all, tried to cope with the most pronounced symptoms of the disease, without trying to rid the patient of the disorder itself. Today, thanks to fairly effective and safe medications and new methods of psychotherapy, it is possible to stabilize the condition of a patient with OCD in most cases.

For this use:

• drug therapy: antidepressants, antipsychotics, anti-anxiety and sedatives;
• psychotherapy: prevention method, 4-step therapy, thought stopping method and cognitive behavioral therapy, as adjuvant therapy family psychotherapy, personal and other methods can be used;
• treatment at home - this disease requires medication and psychotherapeutic treatment, but if the patient does not fight his disorder independently, at home, the effect of treatment will be minimal.

Drug therapy

Antidepressants are used for treatment: Fluvoxamine, Paroxetine, Clomipramine; atypical antipsychotics: Olanzapine, Lamotrigine; anxiolytics: Clonazepam, Buspirone; mood stabilizers: lithium salts and others. All these drugs have contraindications and side effects, so they should be used only as indicated and under the supervision of a physician.

Treatment for OCD begins with a 2-3 month course of antidepressants; they help cope with anxiety, worries, normalize the mood and general condition of the patient. After or simultaneously with taking antidepressants, psychotherapy is started. It is very important to monitor the use of antidepressants, especially at the initial stage of treatment, when there is no visible effectiveness from taking the drugs, and the patient’s psyche continues to remain depressed. Only after 2-3 weeks of use do the first pronounced changes in a person’s mood and well-being appear, after which it becomes much easier to control the treatment.

In addition to antidepressants, sedatives and hypnotics are used, as well as antipsychotics and normotics - these drugs are used only for the treatment of concomitant disorders. Neuroleptics are indicated for pronounced aggressive intentions, thoughts or actions, and mood stabilizers are indicated for decreased mood, fears and phobias. The drugs are prescribed for 10-30 days, depending on the severity of symptoms.

Psychotherapy

The main goal of psychotherapy for OCD is to make the patient aware of his problem and ways to deal with anxiety and obsessive thoughts and actions.

“4 Steps” therapy is based on replacing or simplifying rituals that help patients relieve anxiety. Patients must be clearly aware of what and when they provoke attacks of compulsions and control their actions.

The “Thought Stopping” method teaches the patient the ability to stop and “look” at his actions and thoughts “from the outside.” This helps you realize the absurdity and fallacy of your fears and misconceptions and teaches you how to cope with them.

Treatment at home

The help and support of the patient’s relatives and friends is very important for successful treatment. They must understand the causes and manifestations of the disease and help him cope with panic attacks and anxiety.

The patient himself learns to control his thoughts and actions, avoiding situations in which obsessions may appear. This includes giving up bad habits, reducing exposure to stressors, relaxation and meditation techniques, and so on.

Treatment of OCD can take a long time, and both the patient and his family need to tune in to long-term therapy - it takes from 2 to 6 months, and sometimes more, to stabilize the condition. And in order to exclude the possibility of relapse of the disease, you need to periodically visit your doctor and repeat the course of medication and psychotherapy.

Obsessive compulsive disorder is an illness whose causes are rarely on the surface. This syndrome is characterized by the presence of intrusive, persistent thoughts (obsessions), to which the person responds with corresponding actions (compulsions).

Obsessive Compulsive Disorder: Overview

Obsessive compulsive is deciphered as follows. Obsession (translated from Latin obsessio - “siege”) - desire or thought, which pops up in my brain all the time. This thought is difficult to control or get rid of, which causes extreme stress.

In obsessive compulsive disorder, the most common intrusive thoughts (obsessions) are:

Almost everyone has experienced such intrusive thoughts. But for people with obsessive compulsive disorder, the level of anxiety from these thoughts is off the charts. And in order to relieve anxiety, a person is often forced perform “protective” actions- compulsions (translated from Latin compello - “to force”).

Compulsions with this disease are a bit like rituals. These are actions that people, in response to an obsession, repeat over and over again to reduce the possibility of harm. Compulsions can be physical (for example, constantly checking whether the door is closed) or mental (for example, saying a phrase in your head).

With OCD, compulsions of mental rituals (special prayers or words that are repeated in a certain order), constant checks (for example, gas valves), and counting are common.

The most common is considered fear of virus infection combined with obsessive cleaning and washing. Out of fear of infection, a person can go to great lengths: he avoids shaking hands, does not touch toilet seats, or door handles. Typically, with obsessive compulsive syndrome, the patient stops washing his hands not when they are already clean, but when, in the end, he feels “relief.”

Avoidance behavior is a core part of obsessive compulsive disorder, which includes:

• the need to perform obsessive actions;
• attempts to avoid situations that cause anxiety.

Obsessive compulsive neurosis is usually accompanied by depression, guilt and shame. In human relationships, illness creates chaos and can affect performance. According to WHO, obsessive compulsive disorder is among the top ten diseases that lead to loss of ability to work. A person with obsessive-compulsive disorder syndrome does not seek help from doctors because he is afraid, embarrassed, or does not know that his illness can be treated, including in a non-drug manner.

Causes of obsessive compulsive syndrome

Despite numerous studies devoted to obsessive compulsive syndrome, it is still impossible to say for sure what is the main cause of OCD. Behind this state Both psychological and physiological reasons may be responsible.

Genetics

Research has shown that obsessive compulsive disorder can be passed down through generations. The study of the problem showed that this disease is moderately hereditary, but no gene has been identified as causing this condition. But a lot of attention deserve SLC1A1 and hSERT genes, they might play a role in OCD syndrome:

• The hSERT gene is its main task, assembly into nerve fibers"spent" serotonin. There are studies that support hSERT mutations in some people with OCD. As a result of such mutations, the gene works very quickly and collects all the serotonin even before the nerve “hears” the next impulse.
• SLC1A1 - This gene is similar to hSERT, but its task is to collect another neurotransmitter - glutamate.

Neurological diseases

Brain imaging techniques have enabled scientists to study activity of individual parts of the brain. It has been revealed that the activity of certain areas of the brain in OCD syndrome has specific activity. The obsessive compulsive disorder syndromes involved are:

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

Brain scan findings in people with obsessive compulsive disorder. The circuit, which includes the areas described above, regulates behavioral factors such as bodily secretions, sexuality and aggression. The chain activates appropriate behavior, for example, after contact with something unpleasant, washing your hands thoroughly. Normally, after the action, the desire decreases, that is, the person finishes washing his hands and begins to perform another activity.

But in people with obsessive compulsive disorder the brain experiences certain complications with the circuit turned off, it creates communication problems. Compulsions and obsessions continue, leading to repetition of an action.

Autoimmune reaction

Obsessive compulsive disorder can result from autoimmune diseases. Certain cases of rapid development of OCD in children may be a consequence of streptococcal bacteria, which cause dysfunction and inflammation of the basal ganglia.

Another study suggested that episodic OCD occurs not due to streptococcal bacteria, but more due to the prevention of antibiotics prescribed to treat the disease.

Psychological Causes of OCD

Taking into account the basic law of behavioral psychology, repetition of a certain behavioral action makes it easier to reproduce in the future.

Patients with obsessive compulsive disorder do nothing but try to avoid things that can activate fear, perform “rituals” or “fight” thoughts to reduce feelings of anxiety. These actions temporarily reduce fear, but in a paradoxical way, according to the law described above, they increase the likelihood of obsessive behavior in the future. It turns out that The main cause of OCD is avoidance.. Instead of coping with fear, it is avoided, which can lead to disastrous consequences.

People most susceptible to developing OCD are those who are under stress: they suffer from overwork, end relationships, start new job. For example, a person who calmly used the public toilet at work all the time, in a stressful state, unexpectedly begins to “wind up”, saying that the toilet seat is dirty and you can catch an illness. Then, by association, fear begins to transfer to other similar objects: public showers, sinks, etc.

When a person begins to avoid public toilets or perform various cleansing rituals (cleaning door handles, seats, followed by thorough hand washing) instead of enduring fear, then this may develop into a phobia.

Distress, environment

Psychological trauma and stress activate OCD syndrome in people who tend to develop this condition. Studies have shown that obsessive-compulsive neurosis in 55-75% of cases appeared due to the adverse effects of the environment.

Statistics prove the fact that many people with symptoms of obsessive-compulsive disorder have experienced traumatic or stressful event. These events can also worsen an existing disorder. Here is a list of the most traumatic environmental causes:

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

Cognitive causes of obsessive compulsive disorder

Cognitive theory explains the appearance of OCD syndrome by the inability to correctly interpret thoughts. Many people have intrusive or unwanted thoughts several times a day, but all people who suffer from the disorder significantly exaggerate the importance of such thoughts.

Obsessions in young mothers. For example, a woman who is raising a baby, due to fatigue, may from time to time be visited by thoughts of harming her child. Many, naturally, brush aside these obsessions and do not notice them. People who suffer from the disorder exaggerate the importance of thoughts and take them as a threat: “What if I’m actually capable of this?!”

The woman thinks that she may be a threat to the baby, and this causes anxiety and other negative emotions in her, such as feelings of shame, guilt or disgust.

Fear of one's thoughts sometimes leads to attempts to neutralize the negative emotions that arise from obsessions, for example, by avoiding situations that trigger those thoughts, or by engaging in "rituals" of prayer or excessive purification.

Scientists suggest that people with the disorder give exaggerated meaning to thoughts due to false prejudices that were received in childhood. Among them:

Causes of progression of obsessive-compulsive disorder

For effective treatment of the disorder, knowledge of the causes that caused the disease is not so important. It is much more important to know the mechanisms that support OCD. This is the key to overcoming the disorder.

Compulsive rituals and avoidance

OCD is supported by the following circle: anxiety, obsession and the response to this anxiety.

Constantly, when a person avoids an action or situation, his behavior is “fixed” in the brain in the form of a corresponding neural circuit. The next time in the same situation, he will begin to act in the same way, and accordingly, he will again miss the chance to reduce the activity of neurosis.

Compulsions also become entrenched. A person feels less anxious when he has checked whether the iron is turned off. Accordingly, he will begin to act in the same way in the future.

Impulsive actions and avoidances initially “work”: the person believes that he has prevented harm, and this stops the feeling of anxiety. But in the long term, this creates even more fear and anxiety, as it feeds the obsession.

“Magical” thinking and exaggeration of one’s capabilities

The OCD patient greatly exaggerates his ability to influence the world and his capabilities. He confident in his power prevent or cause negative events through thought. “Magical” thinking implies the belief that performing certain rituals or actions will cause something unwanted (reminiscent of superstition).

This allows a person to feel the illusion of comfort, as if he has a huge influence on the control and events of what is happening. Most often, a person, wanting to feel calmer, constantly performs rituals, this leads to the progression of OCD.

Perfectionism

Certain types of OCD involve the belief that everything needs to be done perfectly, that there is always perfect solution, and what sales a small mistake will have significant consequences. This is often found in patients diagnosed with OCD who strive for order, and most often in those people who suffer from anorexia nervosa.

Intolerance of uncertainty and overestimation of danger

Also very important aspect- overestimation of the danger of the situation and underestimation of the ability to cope with it. Most people who suffer from OCD believe that they must know for sure that bad things will not happen. For these people, OCD is a kind of absolute insurance. They believe that if they try hard, perform more rituals and take good insurance, they will have more certainty. In fact, trying too hard only leads to increased feelings of uncertainty and more doubt.

Treatment of obsessive compulsive disorder

Research has proven that psychotherapy significantly helps 70% of people diagnosed with OCD. There are two main ways to treat the disorder: psychotherapy and medications. However, they can be used simultaneously.

But still, non-drug therapy is preferable, since OCD can be easily corrected without drugs. Psychotherapy has no side effects on the body and has a more lasting effect. Medicines may be prescribed as a treatment when the neurosis is complicated, or as a short-term measure to relieve symptoms before starting psychiatric treatment.

For the treatment of OCD EMDR therapy is used, cognitive behavioral therapy (CBT), hypnosis and strategic brief psychotherapy.

The method of confrontation with simultaneous suppression of anxious emotions was recognized as the first effective psychological method of treating OCD. Its meaning lies in a carefully dosed confrontation with obsessive thoughts and fears, but without typical reaction avoidance. As a result, a person gets used to it over time, and fears gradually disappear.

But not everyone has the strength to go through this treatment, so this method has been refined with CBT, which focuses on changing the response to impulses (the behavioral part), as well as changing the meaning of the intrusive urges and thoughts that arise (the cognitive part).

Any of the above psychotherapeutic treatments for the disorder allows break the cycle of anxiety, obsessions and avoidance reactions. And it makes no difference whether you and the psychotherapist first focus on analyzing the meanings that the patient attaches to events and thoughts with further elaboration of alternative reactions to them. Or the focus is on reducing the level of discomfort from working through obsessions. Or it is the restoration of the ability to unconsciously filter obsessive thoughts before they reach the conscious level.

This treatment reduces the anxiety that OCD typically causes. The therapy methods are assimilated by the person, after which his urge to act inappropriately to the situation and anxiety disappear. Obsessive compulsive disorder is not a mental illness, since it does not lead to a change in personality, it is a neurotic disorder that is reversible with proper treatment.

Every person at least once in his life has experienced a “visit” of unpleasant thoughts that frightened him, leading him to a terrible state. Fortunately, for the most part, a person can not concentrate his attention on them and, easily brushing them aside, move on with his life, enjoying life. But, unfortunately, there are people who cannot do this. They cannot let go of an unpleasant thought, but begin to dig around and look for the reason for the appearance of such thoughts and fears. Such people come up with specific actions for themselves, performing which they can calm down for a while. This phenomenon is called OCD.

And in today’s article we will talk about such a personality disorder as OCD (Obsessive-Compulsive Disorder).

Expanding the term we get to the essence

Obsessions are thoughts, images and even impulses that frighten the patient and do not let him go. Compulsions are specific actions that a person performs in order to eliminate these thoughts and calm down.

In a patient, this condition may progress, and in this case the person has to commit more compulsions in order to calm down.

OCD itself can be chronic or episodic. More importantly, this condition causes real inconvenience to a person, affecting all areas of his life.

Top common obsessive thoughts

A lot of research has been conducted on this issue, which has helped to identify which obsessive thoughts are most often found in people.

Of course, in reality there are a lot of obsessions, different people Those suffering from this disorder are visited by a variety of thoughts and fears. But above we have listed the most common ones today.

How does the disease manifest itself?

The most characteristic symptoms of this disease are the following:

• When a thought appears in the patient, he is perceived not as the voice of another from the outside, but as his own.
• The patient himself understands that this is not normal and makes efforts to resist them: he fights these thoughts, tries to switch his attention to other things, but all to no avail.
• A person constantly experiences feelings of guilt and fear because his fantasies and thoughts can come true.
• Obsessions are permanent and can be repeated very often.
• After all, this tension leads a person to loss of strength, and subsequently the person becomes inactive and fearful, closing off from the outside world.

Unfortunately, not knowing or not fully understanding the complexity of this disorder, others do not understand that the person has a real problem. For many people who do not know about obsessive-compulsive disorder, these symptoms can only cause laughter or misunderstanding. However, OCD is a serious personality disorder that affects all areas of a person's life.

Pure OCD

In this disorder, there is a predominance of either compulsion or obsession. However, pure OCD can also occur. In this case, the person understands that he has this disorder. Understands that there are intrusive thoughts that do not correspond to one’s values ​​and beliefs. But they are confident that they do not have compulsive manifestations, in other words, they do not perform any rituals to free themselves from frightening thoughts.

In fact, this is not entirely true, because in this version of OCD a person may not knock on wood, may not pull pens and all that, but at the same time he can for a long time, sometimes spend hours convincing yourself that you don’t need to pay attention to these thoughts or fears.

And they themselves do certain actions. These actions may not be visible to others, but still, even in this type of obsessive-compulsive disorder, a person gets rid of emotional stress thanks to certain actions: this could be a quiet prayer, counting to 10, shaking the head, stepping from one foot to the other and the like.

All this may go unnoticed by others, and even by the patients themselves. However, no matter what the type of OCD, it is still accompanied by some kind of compulsions: it does not matter whether these actions are conscious or unconscious.

What causes OCD?

Just like any other problem, disease or disorder. and OCD has reasons for its manifestation. And to understand the full picture of the problems, you need to start by studying exactly the cause.

To date, researchers of this problem have come to the conclusion that obsessive-compulsive disorder is caused by a combination of three factors: social, psychological and biological.

Thanks to the latest technologies, scientists can already study the anatomy and physiology of the human brain. And studies of the brains of OCD patients have shown that there are some significant differences in the way the brains work in these people. Basically, there are differences in different regions, such as the anterior frontal lobe, thalamus and striatum of the anterior cingulate cortex.

Studies have also shown that patients have certain abnormalities that are associated with nerve impulses between neuron synapses.

In addition, a mutation of genes that are responsible for the transfer of serotonin and glutamate was identified. All these anomalies lead to the fact that a person processes neurotransmitters before he is able to transmit an impulse to the next neuron.

Most scientists, when talking about the causes of OCD, insist on genetics. Since more than 90% of patients with this disorder also have sick relatives. Although this may be controversial, since in these cases the child, living with a mother who has OCD, may simply take this disorder for granted and apply it in his life.

Group A streptococcal infection can also be cited as a cause.

As for the psychological reasons, experts in this field assure that people who are predisposed to OCD have a peculiarity in their thinking:

• Overcontrol - such people believe that they have the power to control everything, including their own thoughts.
• Super-responsibility - such people are confident that every person is responsible not only for their actions, but also for their thoughts.
• Materiality of thoughts - the entire psychology of such people is built on the belief that thought is material. They firmly believe that if a person can imagine something, then it will happen. It is for this reason that they believe that they are capable of bringing trouble upon themselves.
• Perfectionists - those with OCD - are the most ardent representatives of perfectionism; they are confident that a person should not make mistakes and should be perfect in everything.

This disorder is often found in those people who were raised in strict families, where parents controlled all the child’s steps and set high standards and goals. And the child wants in vain to meet these requirements.

And in this case: that is, if a person has peculiarities of thinking (mentioned above) and supercontrol of parents in childhood, the appearance of obsessive-compulsive disorder is only a matter of time. And just one, the slightest push, a stressful situation (divorce, death of a loved one, moving, job loss, etc.), fatigue, prolonged stress, or the use of large quantities of psychotropic substances can cause OCD to appear.

Nature of the disorder

This disorder is mostly cyclical in nature, and the patient’s actions themselves occur in cycles. At first, a person has a thought that frightens him. Then, as this thought grows, he begins to feel shame, guilt, and anxiety. Afterwards, the person, not wanting this, concentrates his attention more and more on the thought that frightens him. And all this time, tension, anxiety and a feeling of fear are growing.

Naturally, in such conditions, the human psyche cannot remain in a helpless state for long, and ultimately he finds how to calm down: by doing certain actions and rituals. After performing stereotypical actions, a person feels relief for some time.

But this is only for a short time, since the person understands that something is wrong with him and these sensations force him to return to strange and frightening thoughts again and again. And then the whole cycle begins to repeat itself again.

Many people naively believe that these ritual actions of patients are harmless, but in fact, over time, the patient begins to become dependent on these actions. It's like drugs, the more you try, the harder it is to quit. In fact, ritual actions increasingly perpetuate this disorder and lead the person to avoid certain situations that cause obsession.

As a result, it turns out that a person avoids dangerous moments and begins to convince himself that he has no problems. And this leads to the fact that he does not take measures for treatment, which ultimately worsens the situation even more.

Meanwhile, the problem is getting worse, since the patient hears reproaches from his relatives, they take him for a madman and begin to forbid him to do the rituals that are familiar and soothing to the patient. In these cases, the patient cannot calm down and all this leads the person to various difficult situations.

Although, in some cases, it also happens that relatives encourage these rituals, which ultimately leads to the patient beginning to believe in their necessity.

How to diagnose and treat this disease?

Diagnosing OCD in a person is a difficult task for a specialist, since its symptoms are very similar to those of schizophrenia.

It is for this reason that in most cases a differential diagnosis is made (especially in cases where the patient’s obsessive thoughts are too unusual, and the manifestations of compulsion are clearly eccentric).
For diagnosis, it is also important to understand how the patient perceives incoming thoughts: as his own or as imposed from the outside.

We must remember one more important nuance: depression itself is often accompanied by OCD.
And in order for a specialist to be able to determine the level of severity of this disorder, an OCD test or the Yale-Brown scale is used. The scale has two parts, each with 5 questions. The first part of the questions helps to understand the frequency of occurrence of obsessive thoughts and determines whether they correspond to OCD, and the second part of the questions makes it possible to analyze the patient’s compulsions.

In cases where this disorder is not so severe, a person is able to cope with the disease himself. To do this, it will be enough not to get hung up on these thoughts and turn your attention to other things. You can, for example, start reading, or watch a good and interesting film, call a friend, etc.

If you have a desire or need to perform a ritual action, try to delay performing it for 5 minutes, and then gradually increase the time and reduce the performance of these actions more and more. This will make it possible to understand that you yourself can calm down without any stereotypical actions.

And in cases where a person has this disorder of moderate severity or higher, then the help of a specialist is needed: a psychiatrist, psychologist or psychotherapist.

In the most severe cases, the psychiatrist prescribes drug treatment. But, unfortunately, medications do not always help treat this disorder, and their effect is not permanent. So, after the course of drugs ends, the disorder returns again.

It is for this reason that psychotherapy has become widespread. Thanks to her, about 75% of OCD patients have recovered to date. The psychotherapist’s tools can be very different: cognitive behavioral psychotherapy, exposure or hypnosis. What is more important is that they all have good help and help achieve good results.

The best results are obtained using the exposure technique. Its essence is that the patient is “forced” to face his fears in situations where he controls the situation. For example, a person who is afraid of germs is “forced” to poke the elevator button with his finger and not immediately run to wash his hands. And so the requirements become more complicated each time, and as a result the person understands that it is not so dangerous and it becomes habitual for him to do things that previously frightened him.

One last thing

It is important to understand and accept the fact that OCD is as serious a personality disorder as any other disorder. That is why the attitude and understanding of family and friends is very important for patients. Otherwise, hearing ridicule, curses and not receiving understanding, a person may close down even more, and this will lead to an increase in tension, which will bring a bunch of new problems.

To do this, we recommend that you do not seek help from a psychologist alone. Family therapy will help family members understand not only the patient, but also understand the causes of the disease. Thanks to this therapy, relatives will understand how to behave correctly with the patient and how to help them.

It is also important for every person to understand that in order to prevent obsessive-compulsive syndrome, you need to follow simple preventive tips:

• Don't get overtired:
• Don't forget about rest;
• Apply techniques to combat stress;
• Resolve intrapersonal conflicts in a timely manner.

Remember, OCD is not mental illness, and a neurotic disorder does not lead a person to personal changes. The most important thing is that it is reversible and with the right approach you can easily overcome OCD. Be healthy and enjoy life.

Obsessive-compulsive mental disorder (also called obsessive-compulsive disorder) can significantly worsen the quality of life. Despite this, many of those who notice alarming symptoms, do not rush to see a doctor, explaining this with prejudices, a sense of false shame and other reasons.

Obsessive-compulsive disorder: what is it in simple words

Obsessive-compulsive disorder (OCD) is a neurotic pathology that is characterized by the appearance of restless thoughts that provoke the performance of actions that have the meaning of a ritual for the patient. In this way, a person manages to reduce the level of anxiety for some time.

Symptoms of OCD include:

• obsessions - obsessive thoughts, images or impulses to action that the patient receives in the form of stereotypes;
• compulsions - repeated actions caused by worries and fears. They serve as “magical” rituals that can protect from harm or prevent an undesirable event.

Psychologists consider a striking example of OCD:

• nosophobia - pathological fear of incurable conditions;
• mania to constantly wash your hands for fear of catching an infection.

It is noteworthy that people suffering from OCD, as a rule, have a high intellectual level, are punctual, conscientious and neat.

Causes

The reasons for the development of OCD have not been precisely established, but there are various hypotheses about this.

Symptoms and treatment of Bipolar affective disorder:

1. Biological. She considers the following as causative factors:
   • brain pathologies, including those resulting from birth injuries;
   • functional anatomical anomalies;
   • features of work vegetative department CNS;
   • hormonal disorders.
2. Genetic, which does not exclude the development of OCD if present hereditary predisposition.
3. Psychological theories, including:
   • psychoanalytic, which explains obsessive states by saying that they are a tool for reducing anxiety in cases where it, together with aggression, is directed at another person;
   • exogenous-psychotraumatic, which as a cause puts forward a theory about the impact of strong stressful situations related to family, work, various types of sexual relationships.
4. Sociological theories explain OCD by saying that it is a pathological reaction of the body to traumatic situations.

Mechanism of disease formation

As mentioned above, there are different explanations for the formation of obsessive-compulsive disorder. Currently, the neurotransmitter theory, which is part of the biological one, is considered a priority. Its essence is that the cause of OCD lies in incorrect communications between individual parts of the cerebral cortex and a complex of subcortical neural nodes.

The interaction of these structures is ensured by serotonin. Scientists have concluded that in obsessive-compulsive disorder, there is a deficiency of this hormone caused by increased reuptake, which interferes with the transmission of impulses to the next neuron.

To summarize, we can state that the pathogenesis of OCD is quite complex and has not been sufficiently studied.

OCD in men, women and children – differences in manifestation

Obsessive-compulsive disorder affects many people, with approximately the same number of men and women. As for age indicators, it is believed that symptoms appear more often in adults, but there is information that up to 4% of children and adolescents suffer from OCD to one degree or another. Among older people there are also a considerable number of those who suffer from obsessive disorders. The statistics provided contain information about the number of people who sought help.

Manifestations of pathology in men and women have much in common, in particular:

• always manifests itself first with obsessive thoughts;
• a restless stream of consciousness creates anxiety;
• against the backdrop of fears, actions are born that relieve nervous tension and, in the patient’s opinion, can prevent terrible consequences.

For men, the source of anxiety is:

• work activity;
• career and business development;
• the desire to preserve and increase what has been acquired.

For example, a man is worried that he may be fired from his job and left without a livelihood. Against the background of anxiety, anxiety is born, and therefore a person begins to compulsively: pray or perform other rituals (actions), which, as it seems to him, will miraculously help avoid troubles.

Women's Anxieties to a greater extent due to:

• worry about the health of family members;
• fear of the possibility of divorce;
• pathological fear of loneliness.

There is a special thing - postpartum OCD, when the mother worries about the health and life of her newborn baby so much that it takes on the character of a pathology. She is tormented by the thought that he might:

• suddenly fall ill and die;
• fall and get injured;
• stop breathing in your sleep.

This leads to the fact that a significant part of the time is devoted to experiences and behavior dictated by OCD.

Obsessive-compulsive disorder in older people is associated with such phenomena as:

• loneliness, without prospects to change anything;
• inactive lifestyle;
• worries about the health and well-being of younger relatives;
• deterioration in quality of life;
• development of ailments leading to physical limitations.

Elderly people stop sleeping at night and start calling their grandchildren and children frequently to make sure they are alive and well. Inexplicable rituals are born along the way - for everything to go well, you need to:

• take a swim;
• rearrange things in the closet;
• swap flowers on the windowsill;
• perform other actions.

In children it occurs, for the most part, due to genetic reasons or because of problems at school, at home, among friends. Children often suffer due to:

• poor academic performance;
• quarrels and loneliness;
• violent acts of a physical and psychological nature.

Like the adults, in the background increased anxiety they begin to perform certain rituals.

Types and types of obsessive-compulsive disorder and their distinctive features

It has been noted that OCD can occur in a chronic, progressive or episodic form:

1. A chronic condition indicates that the disorder is constantly present, stable, and unchanging.
2. A progressive condition means that the patient is experiencing a chronic process, the symptoms of which intensify, which is dangerous.
3. Episodic is characterized by the fact that symptoms appear from time to time. There are cyclic, conditional and mixed types of episodic forms of the disorder, with:
   • cyclical states depend on the body’s biorhythms;
   • conditional ones manifest themselves under the influence of traumatic circumstances, which include a sharp change in the usual lifestyle, the impact of psycho-emotional stress, various pathologies of the body;
   • mixed represent a combination of biorhythmic and conditional factors.

Depending on the degree of predominance of the main symptoms, several types of OCD are classified:

1. Mixed, including both compulsions and obsessions;
2. “Pure” types are obsessive and compulsive.

It is noteworthy that in single-component types, upon closer examination, one way or another, the influence of the pair component can be traced.

For example, a person leisurely placing objects on a table in a certain order (compulsion). He performs these actions in order to suppress the feeling of anxiety (obsession) that inevitably manifests itself from the contemplation of disorder.

Compulsions can be expressed:

• external actions (counting stripes on trousers, rearranging small objects, frequent hand washing, and so on);

Obsessions are present in the form of:

• annoying thoughts (for example, about one’s own professional incompetence);
• groundless fears;
• doubts about the impeccability of one’s own actions and reasoning;
• obsessive anxiety about personal relationships;
• exciting memories relating to the distant past;
• pathological fear of doing something wrong or discovering signs (character, appearance, lifestyle) that are condemned and ridiculed in society;
• obsessive feeling of physical discomfort.
• a feeling of anxiety that occurs suddenly and prompts you to perform a certain action.

Signs and symptoms

Symptoms of obsessive-compulsive disorder include:

• a person worries about order, small, unimportant details, imaginary dangers so much that many truly important moments in life fade into the background;
• perfectionism does not allow you to complete the work you started due to endless rework caused by doubts and worries about insufficient quality;
• all the time and attention is devoted to working for the sake of high results. At the same time, a person sacrifices rest, friendship, interesting leisure, although objectively “the game is not worth the candle,” that is, the sacrifices are not comparable to the reward for the results of labor;
• those suffering from OCD are distinguished by a pathologically high level of consciousness and responsibility, are meticulous and completely inflexible in matters of morality and ethics;
• a person experiences real suffering when it is necessary to throw away damaged and unnecessary things;
• Difficulties arise whenever it comes to the need to share at least a small part of one’s powers with other people. If this happens, it is only on the condition that the work will be carried out according to already existing rules;
• People with OCD are strong-willed and stubborn. In addition, they are extremely economical and reluctant to spend money, because in the future there may be difficulties, tragedies and disasters that will require financial expenses,

If someone has discovered 4 or more of the signs listed above in themselves or a loved one, there is a possibility that these are symptoms of the development of obsessive-compulsive personality disorder.

Treatment options

Treatment for obsessive-compulsive disorder includes medication and psychotherapy as essential elements.

Psychotherapy

It involves the use of such treatment methods as:

1. Cognitive-behavioral correction, which was developed by the American psychiatrist D. Schwartz. The technique gives the patient the opportunity to resist the influence of the disorder by changing the order of ritual actions, simplifying them, in order to gradually reduce them to a minimum. The method is based on a person’s conscious attitude towards his mental problem and gradual resistance to its symptoms.
2. “4 Steps” is another technique developed by the same specialist in the field of psychiatry. Its action is based on what the doctor explains to the patient:
   • which of his fears are justified and which are provoked by the influence of OCD and therefore make no sense;
   • how, if found in a particular situation, a healthy person would act;
   • How can you stop obsessive thoughts?
3. Exposure and prevention are one of the most effective forms of behavior correction for OCD sufferers. In this case, exposure consists of immersing the patient in conditions that provoke discomfort due to obsessions. The therapist instructs how to resist urges to perform compulsive actions, forming a warning for a pathological response. According to statistics, the vast majority of those who have undergone such treatment achieve lasting improvement in their condition. The effect of psychotherapy can last for many months.

Other types of psychocorrection are also used in the treatment of OCD:

• group and family,
• rational and aversive:
• other types.

Drug therapy with psychotropic drugs

Antidepressants have shown maximum effectiveness for OCD. When anxiety increases in the first stages of treatment, they are supplemented with tranquilizers. In chronic cases of OCD, when serotonin reuptake inhibitor antidepressants are ineffective, atypical antipsychotic drugs are increasingly prescribed.

It is impossible and unacceptable to treat the disease at home.

How to live with OCD and is it possible to get rid of it completely?

There is no universal answer to this question, since it all depends on:

• severity of the disorder;
• characteristics of a particular person;
• presence of motivation to overcome the problem.

The latter is extremely important, since it would be wrong to accept the situation and adapt to the standards of the disorder. In order for life to be long, happy, rich and interesting, you must recognize the problem and take measures to solve it. Of course, it is better to consult a doctor immediately. Many people try to cope with the disease on their own, but in the absence of special knowledge and skills, this can lead to wasted time and increasing symptoms.

To change your life for the better, it is important:

• Get as much information as possible about obsessive-compulsive disorder. New knowledge will provide an understanding of where obsessive states come from and how to manage them;
• be open to positive changes, no matter how unrealistic they may seem;
• understand that the healing process requires time, persistence and patience;
• communicate with other people suffering from OCD. There are similar communities on the Internet. They are useful not only as an opportunity to talk, but also as a chance to receive new, useful information.

OCD, which lasts for years, is exhausting, takes a lot of energy and time, brings discomfort into life, but has been successfully treated for a long time.

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

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

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

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

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

The discovery that intensive serotonin reuptake inhibition (SSRI) was the key to effectively treating OCD was the first step in the revolution and stimulated clinical researches, which have shown the effectiveness of such selective inhibitors.

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

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

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

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

CLINICAL PICTURE

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

Basic clinical manifestations OCD:

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

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

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

Obsessive rituals include both mental activity (for example, repeating counting in a special way, or repeating certain words) and repetitive but meaningless behavior (for example, washing your hands twenty or more times a day). Some of them have an understandable connection with previous obsessive thoughts, for example, repeated hand washing with thoughts of infection. Other rituals (for example, regularly laying out clothes in a particular pattern) complex system before putting it on) do not have such a connection. Some patients feel an irresistible urge to repeat such actions a certain number of times; if this fails, they are forced to start all over again. Patients are invariably aware that their rituals are illogical and usually try to hide them. Some fear that such symptoms are a sign of incipient madness. Both obsessive thoughts and rituals inevitably lead to problems in daily activities.

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

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

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

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

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

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

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

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

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

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

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) is an unjustified antipathy to a certain, often driven away by the patient, to a loved one, cynical, unworthy thoughts and ideas in relation to respected people, among religious persons - in relation to saints or church ministers.

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

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

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

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

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

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

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

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

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

Course of obsessive-compulsive disorder.

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

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

DIFFERENTIAL DIAGNOSIS

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

Genetic factors

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

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

TREATMENT: BASIC METHODS AND APPROACHES

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

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

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

Drug therapy

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

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

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

Psychotherapy

Behavioral psychotherapy

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

Social rehabilitation

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

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