Obsessive compulsive disorder
Light evidence of obsessive compulsive disorder can occur in 30% of adults and a maximum of 15% of adolescents and children. Clinically confirmed cases are no more than 1%.
The appearance of the first symptoms can be attributed to the age of 10 to 30 years. Usually people of 25-35 years old seek medical help.
In pathology, there are two components: obsession (obsession) and compulsion (compulsion). Obsession is associated with the emergence of obsessive, constantly recurring emotions and thoughts. It can be provoked by coughing, sneezing or touching another person on the door handle. Healthy will note to himself that someone sneezed and gives further. The patient is obsessed with what happened.
Obsessive thoughts fill his whole being, generate anxiety and fear. This happens due to the fact that some object, a person becomes important and valuable for him. The environment at the same time seems too dangerous.
Compulses are actions that a person must perform to protect them from moments that provoke obsessive thoughts or fears. Actions can be a response to what happened. In some cases, they are of a preventive nature, i.e. they are the result of some idea, idea, fantasy.
Compulsion can be not only motor, but also mental. It consists in the constant repetition of the same phrase, for example, a conspiracy aimed at protecting the child from the disease.
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Obsession and compulsion component form an attack of OCD. Basically, we can talk about the cyclical nature of pathology: the appearance of obsessive thought leads to filling it with value and the emergence of fear, which, in turn, causes certain protective actions. Upon completion of these movements, a period of tranquility begins. After some time, the cycle starts again.
Types of OCD
With the predominant presence of obsessive thoughts and ideas speak of intellectual obsessive-compulsive disorder. The predominance of obsessive movements indicates motor pathology. Emotional disorder is associated with the presence of constant fears, turning into phobias. Mixed syndrome is talked about when obsessive movements, thoughts, or fears are detected. Despite the fact that all three components are part of the disorder, the separation by the predominance of one of them is important for the choice of treatment.
The frequency of symptoms allows you to isolate pathology with a seizure that occurred only once, with regularly occurring incidents and a constant course. In the latter case, it is impossible to single out periods of health and pathology.
The nature of obsession affects the characteristics of the disease:
- Symmetry. All items must be placed in a specific order. The patient checks all the time as they are set, corrects them, rearranges. Another type is the tendency to constantly check whether the devices are turned off.
- Beliefs. These may be all subservient beliefs of a sexual or religious nature.
- Fear. Constant fear of getting infected, getting sick leads to obsessive actions in the form of cleaning the room, washing hands, using a napkin when touching something.
- Accumulation. Often there is an uncontrollable passion to accumulate something, including things that are absolutely unnecessary for a person.
There is no clear and unambiguous reason why obsessive-compulsive disorders are formed. Allocate hypotheses, most of which seem logical and reasonable. They are united in groups: biological, psychological and social.
One of the famous theories is neurotransmitter. The basic idea is that with obsessive-compulsive disorder in the neuron there is too much seizure of serotonin. The latter is a neurotransmitter. He is involved in the transmission of nerve impulses. As a result, the impulse cannot reach the next cell. This hypothesis is proved by the fact that, taking antidepressants, the patient feels better.
Another neurotransmitter hypothesis is associated with an excess of dopamine and dependence on it. The ability to solve a situation involving obsession or emotion leads to “pleasure” and increased dopamine production.
The hypothesis associated with PANDAS syndrome is based on the idea that antibodies produced in the body to fight streptococcal infection, for some reason, infect the tissues of the basal nuclei of the brain.
Genetic theory is associated with a mutation of the hSERT gene responsible for serotonin transfer.
The nature of obsessive-compulsive disorder was considered by psychologists in various fields. So, Z. Freud associated it mainly with the unfavorable passage of the anal stage of development. The feces at that moment seemed to be something valuable, which ultimately led to a passion for accumulation, accuracy and pedantry. He linked the obsession directly with the system of prohibitions, rituals and the “omnipotence of thought.” Compulsion, from his point of view, is associated with a return to the experienced trauma.
From the point of view of followers of behavioral psychology, the disorder arises from fear and the desire to get rid of it. For this, repetitive actions and rituals are developed.
Cognitive psychology emphasizes mental activity and the fear of invented meaning. It arises because of the feeling of hyper-responsibility, the tendency to overestimate the danger, perfectionism and the belief that thoughts can be executed.
The hypothesis of this group connects the emergence of pathology with the traumatic circumstances of the environment: violence, the death of loved ones, a change of residence, changes in work.
The following symptoms indicate obsessive compulsive disorder:
- the appearance of repeated thoughts or fears;
- monotonous actions;
- high level of anxiety;
- panic attacks;
- appetite disorders.
Adults in some cases realize the groundlessness of their fears, thoughts, senselessness of actions, but they cannot do anything with themselves. The patient loses control over his thoughts and actions.
In children, the violation is extremely rare. It appears more often after 10 years. Associated with the fear of losing anything. The child, afraid of losing his family, is inclined to constantly clarify whether his mom or dad loves. Fears of losing himself, so firmly holding parents by the hand. The loss of any subject in school or the fear of it causes the child to recheck the contents of the satchel, to wake up at night.
Obsessive compulsive disorder can be accompanied by nightmares, tearfulness, moodiness, dejection, loss of appetite.
The diagnosis is determined by a psychiatrist. The main diagnostic methods is the conversation and testing. During the conversation, the doctor identifies the characteristics associated with the manifestation of significant symptoms. So, thoughts should belong to the patient, they are not a product of delirium or hallucinations, and the patient understands this. In addition to obsessional, he has such ideas that he can resist. Thoughts and actions are not perceived by them as something pleasant.
Testing is conducted on the basis of the Yale-Brown obsessive-scale. Half of its points assess how obsessive ideas are expressed, the other half helps to analyze the severity of actions. The scale is filled during the interview based on the symptoms of the last week. Analyzes the level of psychological discomfort, the duration of symptoms during the day, the impact on the patient’s life, the ability to resist the symptoms and exercise control over them.
The test identifies 5 different degrees of disorder, from subclinical to extremely severe.
The disease is differentiated from depressive disorders. If there are symptoms of schizophrenia, organic disorders, neurological syndromes, obsession is considered a part of these diseases.
The main methods of treatment of obsessive-compulsive disorder is psychotherapy, the use of drugs, physiotherapy.
Treat the disease using hypnosis, cognitive-behavioral, aversive methods of psychoanalysis.
The main goal of the cognitive-behavioral method is to help the patient in the awareness of the problem and resistance to disease. The patient may be placed in an artificially created stress situation, and during the session the doctor and the patient try to cope with it. The psychotherapist comments on the fears and the value that the patient puts in his thoughts, stops his attention to actions, helps to change the ritual. It is important that a person learns to identify which of his fears really make sense.
According to researchers, the compulsive part of the syndrome responds better to therapy. The effect of the treatment lasts for several years. In some patients, anxiety levels increase during treatment. It passes over time, but for many it is an important reason for choosing other therapies.
Hypnosis allows you to save the patient from obsessive thoughts, actions, discomfort, fears. In some cases, the recommended use of self-hypnosis.
In the framework of psychoanalysis, the doctor and the patient discover the causes of the experiences and rituals, work out ways to get rid of them.
The aversive method aims to challenge the patient to discomfort, unpleasant associations when performing obsessive actions.
Psychotherapeutic methods are used individually and in a group. In some cases, especially when working with children, family therapy is recommended. Its goal is to establish trust, increase the value of the individual.
Treatment of obsessive-compulsive disorder in severely recommended with the use of drugs. They complement, but do not cancel the methods of psychotherapy. The following groups of drugs are used:
- Tranquilizers. They reduce stress, anxiety, reduce panic. Phenazepam, Alprazolam, Clonazepam is used.
- MAO inhibitors. Drugs in this group contribute to the reduction of depressive feelings. These include Nialamide, Fenelzin, Befol.
- Atypical antipsychotics. Medications are effective for serotonin uptake disorders. Appoint Clozapine, risperidone.
- Selective serotonin reuptake inhibitors. These drugs prevent the breakdown of serotonin. The neurotransmitter accumulates in the receptors and has a longer lasting effect. The group includes Fluoxetine, Naphazodone, Serenate.
- Mood stabilizers. Drugs are aimed at stabilizing mood. This class includes Normotiv, Topiramate, lithium carbonate.
It is recommended to take various water treatments. This is a warm bath with a cold compress on the head for 20 minutes. They are taken up to 3 times a week. Useful rubbing towel soaked in cold water, dousing. It is recommended to swim in the sea or river.
Obsessive compulsive disorder is a chronic pathology. Usually the use of any treatment stops and softens its manifestations. It is possible to cure the disease in a mild or moderate degree, however, further aggravation is possible in some emotionally difficult situations.
A severe disorder is difficult to treat. Probably the occurrence of relapses.
Lack of treatment can lead to impaired performance, the emergence of suicidal intentions (up to 1% of patients commit suicide), some physical problems (frequent hand washing leads to skin damage).
Primary prevention includes preventing the occurrence of traumatic factors, including conflicts at home, at school, at work. If we are talking about a child, it is important to avoid imposing thoughts on his inferiority, instilling fear, guilt.
It is recommended to include in the diet bananas, tomatoes, figs, milk, dark chocolate. These products contain tryptophan, from which serotonin is formed. It is important to take vitamins, get enough sleep, avoid taking alcohol, nicotine, drugs. The room should be as much light as possible.
Obsessive-compulsive disorder, even to a slight degree, cannot be ignored. The condition of such a patient may deteriorate over time, which leads to serious disturbances in the emotional sphere, the inability to adapt to society. Psychotherapeutic and medical methods allow a person to return to normal life.