Obsessive compulsive disorder is a mental disorder based on obsessive thoughts, ideas and actions that arise in addition to the mind and will of a person. Obsessive thoughts often have a content alien to the patient, however, despite all efforts, he cannot get rid of them on his own. The diagnostic algorithm includes a thorough interview of the patient, his psychological testing, the exclusion of organic pathology of the central nervous system using neuroimaging methods. The treatment uses a combination of drug therapy (antidepressants, tranquilizers) with psychotherapy methods (the method of “stopping thoughts”, autogenic training, cognitive behavioral therapy).
General information
Obsessive compulsive disorder was first described in 1827. Domenic Esquirol, who gave him the name “the disease of doubt”. Then the main feature of the obsessions haunting the patient with this type of neurosis was determined – their alienness to the patient’s consciousness. Currently, 2 main components of the obsessive compulsive disorder clinic have been identified: obsessions (obsessive thoughts) and compulsions (obsessive actions). In this regard, in practical neurology and psychiatry, the disease is also known as obsessive compulsive disorder (OCD).
Obsessive compulsive disorder is not as common as hysterical neurosis or neurasthenia. According to various sources, it affects from 2 to 5% of the population of developed countries. The disease has no gender predisposition: it is equally often observed in persons of both sexes. It should be noted that isolated obsessions (for example, fear of heights or fear of insects) are also observed in healthy people, but they are not as uncontrolled and irresistible as in patients with neurosis.
Causes
According to modern researchers, obsessive compulsive disorder is based on metabolic disorders of neurotransmitters such as norepinephrine and serotonin. The result is a pathological change in thought processes and an increase in anxiety. In turn, disorders in the work of neurotransmitter systems can be caused by hereditary and acquired factors. In the first case, we are talking about inherited abnormalities in the genes responsible for the synthesis of substances that are part of neurotransmitter systems and affect their functioning. In the second case, among the trigger factors of OCD are various external influences that destabilize the work of the central nervous system: chronic stress, acute psychotrauma, TBI and other severe injuries, infectious diseases (viral hepatitis, infectious mononucleosis, measles), chronic somatic pathology (chronic pancreatitis, gastroduodenitis, pyelonephritis, hyperthyroidism).
Obsessive compulsive disorder is probably a multifactorial pathology in which a hereditary predisposition is realized under the influence of various triggers. It is noted that people with increased suspiciousness, hypertrophied concern about how their actions look and what others will think about them, people with great self—conceit and its downside – self-deprecation are predisposed to the development of obsessive-compulsive neurosis.
Obsessive compulsive disorder symptoms
Obsessions are the basis of the clinical picture of obsessive compulsive neurosis – irresistibly obsessive thoughts (ideas, fears, doubts, drives, memories) that cannot be “thrown out of your head” or ignored. At the same time, patients are quite critical of themselves and their condition. However, despite repeated attempts to overcome it, they do not achieve success. Along with obsessions, compulsions occur, with the help of which patients try to reduce anxiety, distract themselves from annoying thoughts. In some cases, patients perform compulsive actions covertly or mentally. This is accompanied by some distraction and slowness in the performance of their official or household duties.
The severity of symptoms can vary from mild, practically not affecting the quality of life of the patient and his ability to work, to significant, leading to disability. With mild severity, acquaintances of a patient with obsessive compulsive disorder may not even guess about the disease that exists in him, referring the quirks of his behavior to the peculiarities of his character. In severe neglected cases, patients refuse to leave the house or even their room, for example, to avoid infection or contamination.
Obsessive-compulsive neurosis can occur in one of 3 variants: with the constant persistence of symptoms for months and years; with a remitting course, including periods of exacerbation, often provoked by overwork, illness, stress, an unfriendly family or work environment; with steady progression, expressed in the complication of the obsessive syndrome, the appearance and aggravation of changes in character and behavior.
Kinds
Obsessive fears (fear of failure) — a painful fear that it will not be possible to properly perform this or that action. For example, to go out in front of the public, recall a learned poem, perform sexual intercourse, fall asleep. This also includes erythrophobia — the fear of blushing in front of strangers.
Obsessive doubts — uncertainty about the correctness of performing various actions. Patients suffering from obsessive doubts constantly worry whether they have closed the water tap, turned off the iron, whether they have correctly indicated the address in the letter, etc. Pushed by uncontrolled anxiety, such patients repeatedly check the action performed, sometimes reaching complete exhaustion.
Obsessive phobias have the widest variation: from fear of getting sick with various diseases (syphilophobia, carcinophobia, infarctophobia, cardiophobia), fear of heights (hypsophobia), confined spaces (claustrophobia) and too open areas (agoraphobia) to fear for your loved ones and fear of attracting someone’s attention. Common phobias among OCD patients are fear of pain (algophobia), fear of death (thanatophobia), fear of insects (insectophobia).
Obsessive thoughts are names that persistently “climb” into the head, lines from songs or phrases, surnames, as well as various thoughts that are opposite to the patient’s life ideas (for example, blasphemous thoughts in a believing patient). In some cases, obsessive wisdom is noted — empty endless reflections, for example, about why trees grow taller than people or what will happen if two-headed cows appear.
Obsessive memories are memories of certain events that arise contrary to the patient’s desire, which, as a rule, have an unpleasant color. This can also include perseverations (obsessive representations) — vivid sound or visual images (melodies, phrases, paintings) reflecting a traumatic situation that occurred in the past.
Obsessive actions are movements that are repeated many times against the will of the patient. For example, closing your eyes, licking your lips, correcting your hairstyle, grimacing, winking, scratching the back of your head, rearranging objects, etc. Some clinicians separately distinguish obsessive compulsions — an uncontrollable desire to count or read something, rearranging words, etc. This group also includes trichotillomania (pulling out hair), dermatillomania (damage to one’s own skin) and onychophagia (obsessive nail biting).
Diagnostics
Obsessive compulsive disorder is diagnosed based on patient complaints, neurological examination data, psychiatric examination and psychological testing. It is not uncommon for patients with psychosomatic obsessions to be treated unsuccessfully by a gastroenterologist, therapist or cardiologist for somatic pathology before being referred to a neurologist or psychiatrist.
Obsessions and/or compulsions that occur daily and take at least 1 hour per day and disrupt the patient’s habitual course of life are significant for the diagnosis of OCD. The patient’s condition can be assessed using the Yale-Brown scale, psychological personality research, and pathopsychological testing. Unfortunately, in some cases, psychiatrists diagnose patients with OCD with schizophrenia, which entails improper treatment, leading to the transition of neurosis into a progressive form.
A neurologist’s examination can reveal hyperhidrosis of the palms, signs of autonomic dysfunction, tremor of the fingers of outstretched hands, symmetrical increase in tendon reflexes. If cerebral pathology of organic origin is suspected (intracerebral tumor, encephalitis, arachnoiditis, cerebral vascular aneurysm), MRI, MSCT or CT of the brain is indicated.
Obsessive compulsive disorder treatment
Obsessive compulsive disorder can be effectively treated only by following the principles of an individual and integrated approach to therapy. It is advisable to combine medical and psychotherapeutic treatment, hypnotherapy.
Drug therapy is based on the use of antidepressants (imipramine, amitriptyline, clomipramine, St. John’s wort herb extract). The best effect is provided by third-generation drugs, the effect of which is to inhibit the reuptake of serotonin (citalopram, fluoxetine, paroxetine, sertraline). With the predominance of anxiety, tranquilizers (diazepam, clonazepam) are prescribed, with a chronic course — atypical psychotropic drugs (quetiapine). Pharmacotherapy of severe cases of obsessive compulsive disorder is carried out in a psychiatric hospital.
Of the methods of psychotherapeutic influence, cognitive behavioral therapy has proven itself well in the treatment of OCD. According to her, the psychotherapist first identifies the obsessions and phobias that exist in the patient, and then gives him the installation to overcome his worries by becoming face to face with them. The method of exposure has become widespread, when a patient under the supervision of a psychotherapist is faced with a disturbing situation to make sure that nothing terrible will follow. For example, a patient with a fear of getting infected with germs who constantly washes his hands is prescribed not to wash his hands in order to make sure that no disease occurs at the same time.
Part of complex psychotherapy can be the method of “stopping thoughts”, consisting of 5 steps. The first step is to determine the list of obsessions and psychotherapeutic work on each of them. Step 2 is to teach the patient the ability to switch to some positive thoughts when obsessions occur (remember a favorite song or imagine a beautiful landscape). In step 3, the patient learns to stop the influx of obsession by saying the command “stop” aloud. Doing the same thing, but saying “stop” only mentally is the task of step 4. The last step is the patient’s ability to find positive aspects in emerging negative obsessions. For example, if you are afraid of drowning, imagine yourself in a life jacket next to a boat.
Along with these techniques, individual psychotherapy, autogenic training, and hypnosis treatment are additionally used. Fairy tale therapy and game methods are effective in children.
The use of psychoanalysis methods in the treatment of obsessive compulsive disorder is limited, since they can provoke outbursts of fear and anxiety, have sexual overtones, and in many cases obsessive compulsive disorder has a sexual accent.
Prognosis and prevention
Full recovery is noted quite rarely. Adequate psychotherapy and medical support significantly reduce the manifestations of neurosis and improve the quality of life of the patient. Under unfavorable external conditions (stress, severe illness, fatigue), obsessive-compulsive neurosis may occur again. However, in most cases, after 35-40 years, there is some smoothing of symptoms. In severe cases, obsessive compulsive disorder affects the patient’s ability to work, the 3rd disability group is possible.
Given the character traits that predispose to the development of OCD, it can be noted that a good prevention of its development will be a simpler attitude to yourself and your needs, life with benefits for people around you.
