Obsessive compulsive disorder

[Teacher]

In Russia, the diagnosis of obsessive-compulsive disorder (OCD) and other disorders from its group has always caused a lot of controversy and controversy, and often people suffering from this disorder undeservedly received the stigmatizing diagnosis of schizophrenia and did not have access to modern methods of treatment.

Previously, obsessive-compulsive disorder was classified as an anxiety disorder, but now it is increasingly being singled out as a separate group of diseases that have similar neurobiological, phenomenological, psychopathological features, as well as comparable approaches to therapy. In the latest revision of the American DSM-5 classification of mental disorders, the obsessive-compulsive disorder group has taken its place alongside anxiety and stress-related disorders. It included categories such as OCD (obsessive-compulsive disorder), body dysmorphic disorder, trichotillomania (compulsive hair-pulling), and excoriation disorder.

Obsessions, anxiety, compulsions
Obsessive-compulsive disorder has several symptoms.

Obsessions are obsessive thoughts, desires, doubts, or images that trigger anxiety. For example, obsessive fear of contracting a dangerous infection or inappropriate thoughts of a sexual, religious nature, fear of looking ridiculous or being dangerous to other people. The more a person tries not to think about it, to get distracted and stop worrying, the more often he comes back to these thoughts and images again and again, they more and more flood the consciousness and cause expressed anxiety.

A person suffering from obsessions is trying to cope with this condition, to do something to prevent an imaginary danger to himself or others, and also to reduce his own anxiety, discomfort, and feel relief. These actions are called compulsions, and sometimes they become excessive and even pretentious. For example, people who have an obsessive fear of pollution can wipe all surfaces of the apartment with alcohol, wash their hands many times a day, or go outside only with gloves. Those who are afraid of their own taboo thoughts, for example, about sex or religion, actively avoid sexual relations or visiting religious places.

But if a collision with a frightening stimulus is still inevitable, then compulsions (they are also called rituals) help neutralize the danger. Rituals can be incomprehensible actions for people around them: for example, a person needs to turn around several times, knock on wood, do something at certain hours and days of the week. The belief that by observing certain rituals we can influence reality is called magical thinking in psychology. In everyday life, we regularly encounter it in the form of superstition.

Sometimes obsessive actions (compulsions) are not associated with negative emotions. Such manifestations include, for example, compulsive counting, singing, or a desire not to step on the joints of tiles on the sidewalk.

With any obsessive-compulsive disorder, there is a triad: obsessive thoughts - obsessions, the anxiety they cause, and actions aimed at reducing anxiety - compulsions. The relief that results from these actions is usually temporary. In the long term, compulsions do not help, but only support the problem and maladjust the person.

With OCD, a person spends a lot of time on obsessive thoughts and compulsive actions. Everyday life, relationships with loved ones begin to suffer. It is not possible to find time for important things, since the symptoms of the disorder take more and more time - up to several hours a day, and in some cases even the whole day. The symptoms of obsessive-compulsive disorder significantly reduce the ability to work: in patients aged 15 to 44, the World Health Organization lists OCD as one of the twenty most commonly disabling diseases.

Different forms of OCD
There are various types of obsessive-compulsive disorder. Some people have more obsessions, others have compulsions. For example, trichotillomania - compulsive pulling of hair from the head - manifests itself only in compulsions, and the obsessive part is either absent or not recognized.

Obsessive thoughts and compulsive actions are different for everyone, but there are typical themes of anxiety that are most common among people with OCD. For example, many forms of OCD are associated with a sense of increased responsibility for oneself or others. A typical fear is the fear of contamination or contamination. Touching dirty surfaces, objects that have been on the street, in contact with the floor, with shoes, a person fears that he may get dirty or contract a dangerous disease, and his compulsive actions are aimed at trying to cleanse his hands, body, clothes after colliding with the outside world.

There is also the concept of "mental mud", when a person feels dirty and compulsively seeks to cleanse himself when morally unacceptable and unpleasant thoughts appear. Often taboo, “blasphemous” thoughts are associated with this type of OCD. A deeply religious person comes to mind an obscene scene of a religious nature, and a person of high moral behavior may have an obsessive thought that he is committing obscene acts in a public place. In such cases, mental rituals may appear: for example, immediately after a "bad" thought to think about something good.

Ideas related to order, symmetry, and the ideal performance of actions or rituals are common. A person has an obsessive thought that it is necessary to arrange clothes in a closet in a strict order, sort them by color or other characteristics, ideally park the car, leave things in strictly allocated places, and if this is not done, then something bad may happen ...

Another typical manifestation is an obsessive fear of harming others. Obsessive-compulsive disorder often occurs in young mothers in the early postpartum period in the form of fear of harming their child: "What if I drop the baby, take a knife or throw it out the window?" The mother may compulsively hide all sharp objects, distrust herself and ask only her husband to swing, bathe, and swaddle the child.

Obsessive thoughts aren't always upset
Can obsessive thoughts normally occur? Canadian scientists conducted a multicenter study in 14 countries [1]. Healthy people were asked whether they had ever had obsessive thoughts or thoughts, the content of which seemed strange and unacceptable to them. The results of this study showed that normally 80% of people have such thoughts periodically, more often during stressful periods.

Why does not a single obsessive thought that occurs to most people become a disorder? Most of us do not rate obsessions as scary or abnormal: a strange thought came, twisted and left. With obsessive-compulsive disorder, an obsessive thought is followed by anxiety or even fear, and then an obsessive desire to get rid of it arises - a compulsion, then again a thought and again a compulsion. The vicious circle repeats itself many times and leads to maladjustment. That is, people who have OCD fear intrusive thoughts, in contrast to people without OCD who treat strange ideas like “brain spam” that just comes to mind from time to time.

It often happens that during life, some obsessive experiences replace others. For example, at the age of 20, a person was worried about the fear of infection, and at the age of 25, the idea of causing harm was disturbed. As overall stress levels rise, OCD symptoms increase, and as overall stress levels decrease, OCD symptoms decrease. However, there are observations that show that during times of severe turmoil, such as wars or disasters, OCD symptoms may have temporarily ceased. Extreme stress can be an antidote, but only temporary.

Statistics
There is no specific group of people who are more likely to have OCD. Obsessive-compulsive disorder can affect both adults and adolescents and children. The most common age of diagnosis is about 19–20 years, but there are cases of diagnosis even after 35 years. It is believed that approximately 1.2% of the US adult population has obsessive-compulsive disorder, with women diagnosed with obsessive-compulsive disorder more often than men: 1.8% versus 0.5%. More than half of patients hide symptoms of obsessive-compulsive disorder. On average, 12-14 years elapse between the onset of obsessive-compulsive disorder and the visit to a doctor.

Genetics and biology of OCD
There are studies that support a genetic predisposition to developing OCD. This is a polygenic disease: we cannot identify one gene that is responsible for the disorder. For now, we can say for sure that if a parent has OCD, the likelihood of a child or adolescent having OCD is higher than the average population. How much higher is unknown. We are talking about increased risks, and not the absolute inheritance of a genetic predisposition.

Biological determinants show that people with OCD have more anxious brains. Their limbic system is more reactive. The frontal cortex, which is responsible for the cognitive regulation of emotions, responds more slowly to emotional outbursts. We are not talking about structural features, but about the features of the functioning of the brain of people with OCD. At the same time, numerous studies of the structure of the brain of patients with OCD and possible neuropsychological abnormalities did not reveal any pathologies in the anatomical structure of the brain. There is also evidence that people who experience physical or sexual abuse or trauma during childhood are at higher risk of developing OCD. In a number of cases, it has been shown that people who have a strep infection during childhood are at risk of developing OCD or OCD-like symptoms.

Combination with other diseases
Obsessive-compulsive disorder is a separate disorder and is not a symptom of another disease. This is very important, especially in the Russian context. A number of psychiatrists of the Soviet psychiatric school believed that obsessive-compulsive disorder does not exist, and its manifestations are symptoms of schizophrenia. In this regard, a large number of people suffering from obsessive-compulsive disorder undeservedly received a difficult, stigmatizing diagnosis. Now all over the world OCD is isolated as a separate disease, it has its own diagnostic criteria, symptoms and strategies for effective treatment. It is very important that people receive the correct diagnosis and timely effective treatment.

People with OCD may have comorbid (coexisting) disorders. For example, against the background of obsessive-compulsive disorder, panic disorder may develop or separate panic attacks may occur. Or, a person with OCD may develop depression due to a long illness. A person can be so immersed in his experiences that he stops going out on the street, communicating with the people around him. He understands that this is not normal, but he cannot do anything. This mode of life inevitably leads to the formation of secondary depression.

Medication and psychotherapy
There are several approaches to treating OCD. The most famous is drug treatment. It is carried out according to a clear protocol generally accepted in the world: they start with the drugs of the first choice, and if the drug does not work in the maximum doses, the second drug is prescribed and its effectiveness is assessed for a certain time, and so on until the result is achieved.

The main group of drugs for the treatment of OCD is selective serotonin reuptake inhibitors. These drugs are generally used at higher dosages than are used to treat depression. The effectiveness of treatment is assessed after 8-12 weeks, which is significantly later than the standard for anxiety or depressive disorders (6 weeks). If serotonin reuptake inhibitors do not work, another drug, the tricyclic antidepressant, clomipramine, has been shown to be very effective in treating OCD in many studies. Atypical antipsychotics may also be used in combination with antidepressants. With the right therapy, the symptoms can become significantly less intense or even stop altogether.

In addition, psychotherapeutic treatment is widely used for OCD. Here cognitive-behavioral psychotherapy has proven to be effective. The psychotherapy process involves discussing the idea that people often suffer from anxiety when they perceive situations as more dangerous than they really are. Effective cognitive work helps a person formulate an alternative, less threatening interpretation of what is happening, which matches his life experience and the views of others. Subsequently, cognitive behavioral therapists use exposure and response prevention techniques to test these new interpretations. For example, a person with fear of infection, who is afraid to touch surfaces in public places, together with a therapist voluntarily holds his hand on such a surface for 10 seconds. At this moment, he has a strong anxiety, an acute desire to realize the compulsion - to remove his hand and go to wipe it with alcohol. Together with the therapist, the patient plans that he will not react in this way, will hold it for 10 seconds and will not go to wash his hand. With a repeated repetition of such actions, anxiety is much less tenfold than the first, and if this is done a sufficient number of times, anxiety can generally be reduced. Much modern research suggests that psychotherapy is a more effective treatment than pharmacotherapy, with fewer relapses. With a repeated repetition of such actions, anxiety is much less tenfold than the first, and if this is done a sufficient number of times, anxiety can generally be reduced. Much modern research suggests that psychotherapy is a more effective treatment than pharmacotherapy, with fewer relapses. With a repeated repetition of such actions, anxiety is much less tenfold than the first, and if this is done a sufficient number of times, anxiety can generally be reduced. Much modern research suggests that psychotherapy is a more effective treatment than pharmacotherapy, with fewer relapses.

With very severe or long-term current disorders, medication or psychotherapy alone does not give the desired result. Then a combination of drug and psychotherapeutic treatment will be effective.

OCD research
To date, a lot of research has been done on obsessive-compulsive disorder. We have a rough understanding of the biological background and psychological functioning of people with OCD. We know how to treat this disorder, but this knowledge is not enough. All the same, there are cases in which we are unable to help the patient with known methods, and we do not really understand why this happens. New technological solutions are now being developed for the treatment of resistant cases. For this, the method of deep brain stimulation (deep brain stimulation) is used. An electrode is inserted into the brain, which stimulates the brain in a specific area and reduces the symptoms of OCD. Because it is an invasive treatment and its long-term effects are poorly understood,

Through psychological research, we know that obsessive-compulsive disorders can manifest themselves in specific ways in different cultures, for example, if there are bad omens in the culture, compulsions can develop in response to these omens (“black cat crossed the road”) ... We know that family context can influence the course of obsessive-compulsive disorder. Indulging the obsessions and compulsions of a sick family member, unfortunately, contributes not to recovery, but to the consolidation of the disorder. The influence of social, cultural, family factors on the course of this disorder is now very interesting for science.

Research is underway that is trying to investigate the link between OCD and autism spectrum disorders. It was noted that some correlations exist, but causal relationships have not yet been established. We still know very little about the genetics and biology of this disorder. By knowing more about OCD, we can be more effective in treating this disease, which is difficult for patients and their families.

I think I have OCD. When is it time to see a psychotherapist?
If you notice all of the following symptoms in yourself, you should contact a psychotherapist. If a specialist confirms the diagnosis, you will receive help.

- Strange, unpleasant, disturbing thoughts often come to mind. You don't want to think about it, but thoughts continue to come outside of your desire.

- Anxious thoughts take more than one hour a day in aggregate.

- Thoughts begin to seriously interfere, causing severe anxiety or anxiety.

- Because of obsessive thoughts, you have to skip important things, cancel plans. It takes a lot of time to deal with disturbing ideas, ordinary life begins to fade into the background.

Many patients with obsessive-compulsive disorder are very shy about their thoughts, they think they are stupid, strange or dangerous. They feel embarrassed and try to talk less about them, because often even those close to them can laugh and say: “Listen, this is some kind of stupidity” and not take their experiences seriously.

Why is it important to see a specialist as soon as possible? The earlier treatment is started, the more likely it will be easier to help the patient. With an early start of treatment, a person can be helped exclusively psychotherapeutically, without the use of psychopharmacological agents.

It is also important to know when to see a psychotherapist. If you have a ridiculous thought, an annoying song stuck, or you have been thinking about something for several days and cannot get the thought out of your head, you do not need to panic. Think about research: 80% of people may experience obsessive thoughts at some point in their lives. This is fine. So-called brain spam comes to our minds and is not a sign of a disorder. You should be concerned when you see these thoughts taking too long and causing your life to begin to negatively transform.

OCD and falling in love
It is believed that falling in love resembles the symptoms of OCD. Indeed, falling in love is a mental fixation on one object. From the point of view of the power with which falling in love captures our thoughts, there really is a similarity. But at the same time, unlike OCD, falling in love is pleasant, as a rule, you do not want to get rid of it. Falling in love is more likely to help a person, make him more efficient and productive, in contrast to OCD, which can seriously disrupt the quality of life. These are different phenomena, and falling in love is a normal, healthy state of a person, and not at all an obsessive-compulsive disorder.