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prominent role among mental illness play syndromes (complexes of symptoms), united in the group of obsessive-compulsive disorder (OCD), which received its name from the Latin terms obsessio and compulsio.

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

Compulsions (lat. compello - I force). 1. Obsessive drives, a kind of obsessive phenomena (obsessions). Characterized by irresistible attraction that arises contrary to the mind, will, feelings. Often they are unacceptable to the patient, contrary to his moral and ethical properties. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the sick as wrong and painfully experienced by them, especially since their very appearance, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsions is also used in more broad sense to denote any obsessions in the motor sphere, including obsessive rituals.

Currently, almost all obsessive-compulsive disorders are united in the International Classification of Diseases under the concept of "obsessive-compulsive disorder".

OKR concepts have undergone a fundamental reappraisal over the past 15 years. During this time, the clinical and epidemiological significance of OCD has been completely revised. If it was previously thought that this is a rare condition observed in a small number of people, now it is known that OCD is common and causes a high percentage of morbidity, which requires the urgent attention of psychiatrists around the world. Parallel to this, our understanding of the etiology of OCD has broadened: the vaguely formulated psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm that explores the neurotransmitter disorders that underlie OCD. And most importantly, pharmacological interventions specifically targeting serotonergic neurotransmission have revolutionized the prospects for recovery for millions of OCD patients worldwide.

The discovery that intense serotonin reuptake inhibition (SSRI) was the key to effective OCD treatment was the first step in the revolution and spurred clinical researches, which have shown the effectiveness of such selective inhibitors.

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

In a broad sense, the core of OCD is the syndrome of obsession, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, memories that arise in addition to the desire of patients, but with awareness of their pain and a critical attitude towards them. Despite the understanding of the unnaturalness, illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessional impulses or ideas are recognized as alien to the personality, but as if coming from within. Obsessions can be the performance of rituals designed to alleviate anxiety, such as washing hands to combat "pollution" and to prevent "infection". Attempts to drive away unwelcome thoughts or urges can lead to severe internal struggle, accompanied by intense anxiety.

Obsessions in the 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 an indicator of 1.5% (meaning "fresh" cases of diseases) or 2-3%, if episodes of exacerbations observed throughout life are taken into account. Those suffering from obsessive-compulsive disorder make up 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-compulsive disorders 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 an obsessive fear of death. Mentions of obsessions are found in the writings of F. Pinel (1829). I. Balinsky proposed the term "obsessive ideas", which took root in Russian psychiatric literature. In 1871, Westphal introduced the term "agoraphobia", which denoted the fear of being in public places. M. Legrand de Sol, analyzing the features 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 ridiculous fears of" touch "to surrounding objects, motor rituals are added, the implementation of which is subject to the whole life of patients. However, only at the turn of the XIX-XX centuries. researchers were able to more or less clearly describe the clinical picture and give syndromic characteristics of obsessive-compulsive disorders. The onset of the disease usually occurs in adolescence and adolescence. The maximum of clinically defined manifestations of obsessive-compulsive disorder is observed in the age range of 10-25 years.

The main clinical manifestations of OCD:

Obsessive thoughts are painful, arising against the will, but recognized by the patient as their own, ideas, beliefs, images, which in a stereotypical form forcibly invade the patient's consciousness and which he tries to resist in some way. It is this combination inner feeling compulsive impulse and efforts to resist it characterizes obsessional symptoms, but of these two components, the degree of effort applied is more variable. Obsessional thoughts can take the form individual words, phrases or poetic lines; they are usually unpleasant to the patient and may be obscene, blasphemous, or even shocking.

Obsessional imagery is vividly presented scenes, often violent or disgusting, including, for example, sexual perversion.

Obsessional impulses are urges to do things that are usually destructive, dangerous, or shameful; for example, jumping into the road in front of a moving car, injuring a child, or shouting obscene words while in society.

Obsessional rituals involve both mental activities (for example, repeating counting in some particular way, or repeating certain words), and repetitive but meaningless actions (for example, washing hands twenty or more times a day). Some of them have an understandable connection with the obsessive thoughts that preceded them, for example, repeated washing of hands - with thoughts of infection. Other rituals (for example, regularly laying out clothes according to some complex system before putting it on) have no such connection. Some patients feel an irresistible urge to repeat such actions a certain number of times; if that 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 the onset of insanity. Both obsessive thoughts and rituals inevitably lead to problems in daily activities.

Obsessive rumination (“mental chewing gum”) is an internal debate in which the arguments for and against even the simplest everyday actions are endlessly revised. Some obsessive doubts relate to actions that may have been incorrectly performed or not completed, such as turning off the gas stove faucet or locking the door; others concern actions that could harm other people (for example, the possibility of driving past a cyclist in a car, knocking him down). Sometimes doubts are possible violation religious prescriptions and rituals - "remorse".

Compulsive actions are repetitive stereotypical actions, sometimes acquiring the character of protective rituals. The latter are aimed at preventing any objectively unlikely events that are dangerous for the patient or his relatives.

In addition to the above, in a number of obsessive-compulsive disorders, a number of outlined symptom complexes stand out, and among them are obsessive doubts, contrasting obsessions, obsessive fears- phobias (from Greek phobos).

Obsessive thoughts and compulsive rituals may intensify 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 kept. Since patients often avoid such situations, there may be a superficial resemblance to the characteristic avoidance pattern found in phobic anxiety disorder. Anxiety is an important component of obsessive-compulsive disorders. Some rituals reduce anxiety, while after others it increases. Obsessions often develop as part of depression. In some patients, this appears to be a psychologically understandable response to obsessive-compulsive symptoms, but in other patients, recurrent episodes of depressive mood occur independently.

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

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

Obsessive doubts - persistently arising contrary to logic and reason, uncertainty about the correctness of committed and committed actions. The content of doubts is different: obsessive everyday fears (whether the door is locked, whether windows or water taps are closed tightly enough, whether gas and electricity are turned off), doubts related to official activities (whether this or that document is written correctly, whether the addresses on business papers, whether inaccurate figures are indicated, whether the orders are formulated or executed correctly), etc. Despite repeated checks committed action, doubts, as a rule, do not disappear, causing psychological discomfort in the sufferer of this kind of obsession.

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

Obsessive inclinations are urges to commit one or another tough or extremely dangerous action, accompanied by a feeling of horror, fear, confusion with the inability to get rid of it. The patient is seized, for example, by the desire to throw himself under a passing train or push a loved one under it, 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 referred to as mastering, appear in the form of implausible, sometimes absurd situations that patients take for real. An example of obsessive ideas is the patient's conviction that the 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, 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 delusions.

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) - unjustified antipathy to a certain, often close person, driven away by the patient from himself, cynical, unworthy thoughts and ideas regarding respected people, in religious persons - in relation to saints or ministers of the church .

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

Obsessive fears, or phobias, include an obsessive and senseless fear of heights, big streets, open or confined spaces, large crowds of people, fear of sudden death, fear of falling ill with one or another incurable disease. Some patients may develop a wide variety of phobias, sometimes acquiring the character of fear of everything (panphobia). And finally, an obsessive fear of the emergence of fears (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 the fear of the development of malignant tumors. At the peak of anxiety, patients sometimes lose their critical attitude to their condition - they turn to doctors of the appropriate profile, require examination and treatment. The implementation of hypochondriacal phobias occurs both in connection with psycho- and somatogenic (general non-mental illnesses) provocations, and spontaneously. As a rule, hypochondriacal neurosis develops as a result, accompanied by frequent visits to doctors and unreasonable medication.

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

Obsessive fears are often accompanied by the development of rituals - actions that have the meaning of "magic" spells that are performed, despite the critical attitude of the patient to obsession, in order to protect against one or another imaginary misfortune: before starting any important business, the patient must perform some 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 relatives are not aware of the existence of such disorders. Rituals, combined with obsessions, are a fairly stable system that usually exists for many years and even decades.

Obsessions of affectively neutral content - obsessive philosophizing, obsessive counting, recalling 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 harming oneself and others. Psychopathological formations of this group refer mainly to figurative obsessions with pronounced affective saturation and ideas that take possession of the consciousness of patients. They are distinguished by a sense of alienation, the absolute lack of motivation of the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions and complain of an irresistible desire to add endings to the remarks they have just heard, giving an unpleasant or threatening meaning to what has been said, to repeat after those around them, but with a touch of irony or malice, 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, injuring themselves or their loved ones. In the latter cases, obsessions are often combined with object phobias (fear of sharp objects - knives, forks, axes, etc.). The contrast group also partially includes obsessions of sexual content (obsessions of the type of forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals).

Obsessions of pollution (mysophobia). This group of obsessions includes both the fear of pollution (by earth, dust, urine, feces and other impurities), as well as the fear of penetration into the body of harmful and toxic substances(cement, fertilizer, toxic waste), small items (glass shards, needles, specific species dust), microorganisms. In some cases, the fear of contamination may be limited, remaining for many years at a preclinical level, manifesting itself only in some features of personal hygiene (frequent change of linen, repeated washing of hands) or housekeeping (thorough handling of food, daily washing of floors). , "taboo" on pets). This kind of monophobia does not significantly affect the quality of life and is evaluated by others as habits (exaggerated cleanliness, excessive disgust). Clinically manifested variants of mysophobia belong to the group of severe obsessions. In these cases, gradually becoming more complex protective rituals come to the fore: avoiding sources of pollution and touching "unclean" objects, processing things that could get dirty, a certain sequence in the use of detergents and towels, which allows you to maintain "sterility" in the bathroom. Staying outside the apartment is also furnished with a series of protective measures: going out into the street in special clothing that covers the body as much as possible, special processing of wearable items upon returning home. In the later stages of the disease, patients, avoiding pollution, not only do not go out, 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 come near them. Mysophobia is also related to the fear of contracting a disease, which does not belong to the categories of hypochondriacal phobias, since it is not determined by fears that a person suffering from OCD has a particular disease. In the foreground is the fear of a threat from the outside: the 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 can shake their heads (as if checking whether the hat fits well), make hand movements (as if discarding interfering hair), blink their eyes (as if getting rid of a mote). Along with obsessive tics, pathological habitual actions (biting lips, grinding teeth, spitting, etc.) are often observed, which differ from obsessive actions proper in the absence of a subjectively painful sense of persistence and experience them as alien, painful. Neurotic states characterized only by obsessive tics usually have a favorable prognosis. Appearing most often in preschool and junior school age, tics usually subside by the end of puberty. However, such disorders can also be more persistent, persist for many years and only partially change in manifestations.

The course of obsessive-compulsive disorder.

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

More severe and complex OCDs, such as phobias of contamination, pollution, sharp objects, contrasting performances, multiple rituals, on the other hand, may become persistent, resistant to treatment, or show a tendency to recur with disorders that persist despite active therapy. 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 there are obsessions and rituals. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when the obsessive thoughts are unusual in content (eg, mixed sexual and blasphemous themes) or the rituals are exceptionally eccentric. The development of a sluggish schizophrenic process cannot be ruled out with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity(inconsistency of thinking and actions), monotony of emotional manifestations. Protracted obsessive states complex structure must be distinguished from the manifestations of paroxysmal schizophrenia. Unlike neurotic obsessive states, they are usually accompanied by a sharply increasing anxiety, a significant expansion and systematization of the range of obsessive associations that acquire the character of obsessions of "special significance": previously indifferent objects, events, random remarks of others remind patients of the content of phobias, offensive thoughts and thereby acquire in their view a special, menacing significance. In such cases, it is necessary to consult a psychiatrist in order to exclude schizophrenia. It can also be difficult to differentiate between OCD and conditions with a predominance of generalized disorders, known as Gilles de la Tourette's syndrome. 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. In these cases, this syndrome can be excluded by the coarseness of movement disorders characteristic of it and more complex in structure and more severe mental disorders.

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 figure is low, it is higher than in the general population. While the evidence for a hereditary predisposition to OCD is still uncertain, psychasthenic personality traits can be largely explained by genetic factors.

Approximately two-thirds of OCD patients improve within a year, more often by the end of this period. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of improvement in health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic personality with severe symptoms of the disease, or if there are continuous stressful events in the life of the patient. Severe cases can be extremely persistent; for example, a study of hospitalized patients with OCD found that three-quarters of them remained symptom-free 13 to 20 years later.

TREATMENT: BASIC METHODS AND APPROACHES

Despite the fact that OCD is a complex group of symptom complexes, the principles of treatment for them are the same. The most reliable and effective method of treating OCD is considered to be drug therapy, during which a strictly individual approach to each patient should be shown, 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-treatment. If any disorders similar to mental ones appear, it is necessary, first of all, to contact the specialists of the psycho-neurological dispensary at the place of residence or other psychiatric medical institutions to establish the correct diagnosis and prescribe competent adequate treatment. At the same time, it should be remembered that at present a visit to a psychiatrist does not threaten any negative consequences- the infamous "registration" was canceled more than 10 years ago and replaced by the concepts of consultative and medical care and dispensary observation.

When treating, it must be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods remissions (improvement). The apparent suffering of the patient often seems to call for vigorous effective treatment, but the natural course of the condition must be kept in mind in order to avoid the typical error of over-intensive therapy. It is also important to consider that OCD is often accompanied by depression, effective treatment which often leads to the alleviation of obsessional symptoms.

Treatment of OCD begins with an explanation to the patient of the symptoms and, if necessary, with reassurance that they are the initial manifestation of insanity (a common cause for concern for patients with obsessions). Those suffering from certain obsessions 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 it by excessive indulgence in the morbid fantasies of the patients.

Drug therapy

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

Any comorbid depressive disorder is treated with antidepressants at an adequate dose. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessional symptoms, but the results of controlled clinical trial showed that the effect of the use of this drug is insignificant and manifests itself only in patients with distinct depressive symptoms.

In cases where obsessive-phobic symptoms are observed within schizophrenia, intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect. In some cases, it is advisable to connect 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 a 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 the systematic observance of 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 the method of preventing a reaction with placing the patient in conditions that aggravate these rituals. Significant but not complete improvement can be expected in about two-thirds of patients with moderately heavy rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts also recede. In panphobia, predominantly behavioral techniques are used to reduce sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases where ritualized phobias predominate, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for obsessive thoughts that are not accompanied by rituals. Thought-stopping has been used by some experts 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 may improve, regardless of which particular treatment methods were used. Until recovery, patients can benefit from supportive conversations that provide continued 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 in order to correct behavioral disorders and improve family relationships. If marital problems aggravate the 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, need both medical and social and 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 on an outpatient basis, as well as taking measures to restore social ties, professional skills, family relationships. Social rehabilitation is a set of programs for teaching OCD patients how to rationally behave both at home and in a hospital setting. Rehabilitation focuses on teaching social skills correct interaction with other people, professional education as well as skills needed in everyday life. Psychotherapy helps patients, especially those who experience a sense of their own inferiority, treat themselves better and correctly, master ways to solve everyday problems, and gain confidence in their strength.

All of these methods, when used judiciously, can increase the effectiveness of drug therapy, but are not capable of completely replacing drugs. It should be noted that explanatory psychotherapy does not always help, and some patients with OCD even worsen because such procedures encourage them to think painfully and unproductively about the subjects discussed in the course of treatment. Unfortunately, science still does not know how to cure mental illness once and for all. OCD often has a tendency to recur, which requires long-term prophylactic medication.

Approximately 4 million people with obsessive-compulsive disorder (OCD). Many of them have never been to a psychotherapist and do not know that they are sick. OCD generates automatic obsessive thoughts (sometimes frightening, sometimes shameful), from which only rituals - compulsions - save. However, rituals eliminate obsessive thoughts only for a while, so the patient is forced to repeat them over and over again.

The Village talked to Muscovites who live with the disease about their daily struggles, treatment methods and society's attitude towards mentally ill people.

Anastasia Povarina

21 years old, student

Strange rituals appeared in the tenth grade. I attribute their appearance to stress before passing the exam. At that time, I began to knock on objects before leaving the house, step over all the cracks in the street, shift objects until I began to consider their position to be correct. It seemed to me that the objects were not in the right place, and this gave rise to a feeling of anxiety, which disappeared only when all the objects were in the right place. The right place can be anything, I just have to feel where it is.

I used to think that my rituals are a revelation that helps me get out of trouble, but in my first year at university, I read in a magazine “ Big city» material about people with obsessive-compulsive disorder and realized that my behavior is not unique.

After school, I entered the Higher School of Economics. University is a new place, new people and circumstances, and for me such things are always stressful. Because of this, in the first year of university, I had a lot of new rituals - compulsions. I went around certain hatches, walked only in a certain place on the road, and also stroked the walls. It seemed to me that people offend the walls, touching them with elbows and bags, so I stroked them.

At the sight of every church, I was baptized - I think this is also a compulsion. I think that any religion is built on an obsessive-compulsive mechanism. You come to church with an experience - an obsession, and you are offered a certain number of rituals to overcome this obsession. If you are afraid that your relatives will get sick, pray, drink holy water, and everything will pass. I believe that my belief in God was not very sincere - in fact, I was just trying to give my rituals a generally accepted form. That is, then I didn’t just stroke the walls like crazy, but prayed along with millions of people, so I thought that everything was fine with me.

Another big obsession of mine is the fear of getting sick and, as a result, a passion for cleanliness. I wash my hands in every establishment, I always carry antiseptics with me, and at home I wipe things with chlorhexidine. Frequent hand washing is the most common form of obsessive-compulsive disorder. The disease has so subdued me that I cannot refuse rituals. If I don’t touch all the toys and figurines in the apartment before leaving the house, I will feel panic. This process usually takes 20 minutes, and I often end up late for university because of it.

Often I have terrible thoughts that something bad is about to happen, like my family will get sick, I will fail my exams, or someone will die. In such cases, I definitely need to look out any window and throw negative thoughts into it. If there are no windows in the room, I feel panic, I have to throw off my thoughts at the doors, at the ceiling and at the ventilation shafts.

It seemed to me that people offend walls by touching them with their elbows and bags, so I stroked them

I convinced myself that OCD is not such a terrible disease, that many people live much worse, and against the background of their diseases, my rituals look simply ridiculous. I did not go to the doctor until the summer of 2016. Then I broke up with a guy, and against this background, I developed depression. I felt so bad that I went to a psycho-neurological dispensary. The doctor prescribed me antidepressants and antipsychotics.

Thanks to the medication, my sleep was restored and state of mind However, the rituals remained. In the fall, I entered my fourth year of university, and due to stress, I began to new depression. I didn't leave the house because I was afraid something bad would happen to me, like the person in front of me would turn around and shoot me or my subway train would derail.

This time, in addition to the pills, I was assigned a visit to the day hospital, which is a small room in the building of the neuropsychiatric dispensary. Day hospital is Kindergarten for adults, the same people come there every day, they communicate with doctors and among themselves, undergo various trainings, do exercises, walk, listen and read lectures to each other. A positive atmosphere reigns there, everyone is happy for each other and there are no indifferent doctors who, like in a clinic, can be rude. In the hospital, everyone takes care of you and praises you for every painted house.

I went there every day for a month from nine in the morning until one in the afternoon, after which I went to classes at the university. the main objective visits to the hospital - the establishment of pharmacotherapy. Every day I told the doctor about my state of health, about the past day. About how certain medicines affect me. Based on my stories, the doctor decided which antidepressants and how much to prescribe for me.

I am still on the antidepressants and antipsychotics that I was prescribed at the time. Medications help me regulate my mood by reducing the amount of stress that obsessions cause. With rituals, too, it becomes easier. I no longer open and close the door nine times, do not touch all the corners and toys in the apartment before leaving, do not cross myself and do not touch the walls.

However, I could not refuse some rituals, for example, obsession with the number 9. I always go around the entire station and go through the ninth turnstile in the subway, I go only on the ninth step of the escalator (usually I let all the people in front of me, waiting for my step), I love ninth tables, I try to get the ninth locker in the pool and buy the ninth seat in the train car. I want to get rid of this ritual by force of will. When I pass through not the ninth turnstile, I am proud of myself. But sometimes I can deceive myself - for example, go through the third turnstile: this is not the ninth turnstile, but nine is three times itself.

Friends know about my illness and treat it with understanding: they remind me about the pills and support me. But my mother did not recognize my illness for a long time. She had this position: someone does not eat meat, someone does not like black, and I go around all the cracks in the road. Mom believed that everyone has their own quirks, and denied my illness. She changed her mind last fall when I fell into a deep depression. Then my mother realized that my illness was serious and gave me great support. I wouldn't have made it without her.

Mom believes that the fact of OCD should remain private, that it is not worth talking about it publicly, so she tried to dissuade me from interviewing.

In our society, it is believed that only patients who rush at people with knives go to psychotherapists. But it's not. People with mental disorders many, they all live among us, and most of them are not dangerous to society. Because of such an attitude many sick people self-medicate and run their illnesses. Therefore, I believe that it is necessary to overcome the denial and stigmatization of the problem. You don't have to be afraid of your mental problems you just need to go to the doctor.

Alexander Mekhnetsov

26 years old, design engineer

I was born in a small provincial town, graduated from high school there, and then moved to Vologda. I moved to Moscow in September last year. My childhood was not easy: my father drank, often quarreled with my mother, and, of course, I saw it all. I remember that I was always afraid to screw up and do something wrong, so I constantly double-checked that everything was in order.

The symptoms of obsessive-compulsive disorder began to manifest in the fifth grade - primarily in the constant washing of hands. It was as if I was flying somewhere and did not control myself when I washed my hands. I constantly felt like my hands were dirty, and I washed them again and again. It was important for me to repeat washing a certain number of times. I developed a passion for the number 3, and I did everything three times. Or the number of repetitions had to be a multiple of three. Before leaving the house, I checked for a long time whether the gas pipe was closed, constantly opened and closed the doors, pulled their handles. I have never adhered to Orthodoxy, but, most likely, my love for the number 3 is connected with the Holy Trinity.

I understood that something was wrong with me, and my parents noticed it, but they did nothing about it. The disease progressed, its peak was in the eighth grade, then I lived like hell. I began to spend a lot of time performing rituals: I constantly checked whether I had taken everything to school, before leaving the classroom, I alternately looked at the desk and under it at least three times. I was also worried about the arrangement of objects on the table. I touched each item three times, and they all had to be in perfect position.

Another compulsions concerned the road to school and back. I went around all the hatches, followed a strictly defined path and constantly looked to see if I had dropped anything. For example, the sidewalk I was walking on ended, which means I need to turn around and look into the distance in search of a possibly fallen thing. Then I turned back and looked at the road in front of me for a long time. Then he looked back again, and so on. I could stand outside and turn my head for 20 minutes. Of course, I was embarrassed that everyone was looking at me, but I could not stop. If I failed to complete the ritual to the end, I fell into a stupor and could not do anything further.

I was not the most popular student in school, so when my classmates noticed my strange behavior, they began to spread rot at me. At the same time, I realized that I was not like other people, and from this I closed myself even more. From all this, I became a terrible social phobe.

It always seemed to me that my hands were dirty, and I washed them over and over again. I was important repeat washing a certain number of times

The compulsions disappeared in the 11th grade, unexpectedly and by themselves. I don’t know what it is connected with, I only remember that I wanted to become a normal person, like everyone else, but I don’t remember that I somehow struggled with the disease. In that year, all the rituals disappeared from my life, but obsessive thoughts remained with me, in a different way - mental chewing gum.

I constantly thought about some everyday things and scrolled through the same thoughts for hours. Some patients with obsessive-compulsive disorder think about something bad or embarrassing, but I just remembered the recent moments of my life: I wondered if I had forgotten something, and I replayed the actions I had done over and over again. For example, I scattered sugar, and then in my head I modeled past situation: I remembered how I approached the closet, how I opened its door, took a sugar bowl and so on. In other words, I was trying to understand why I spilled the sugar. Such thoughts took a lot of time and effort. Because of them, I had a fog in my head: I could not read normally, do my homework and generally concentrate for a long time.

AT school time I did not have a constant opportunity to go online, and it was only at the age of 22 that I first found information about obsessive thoughts on Google. I came across an article about OCD and realized that it was written about me. Nobody diagnosed me then, but I understood everything without doctors. After the institute, I got a job, and I began to have a depression that lasted a year and a half. I continued to go to work, but I was extremely passive and did not want anything. To get rid of depression, I decided to go to the open department of neurosis and borderline disorders of the psychiatric hospital in Vologda.

At the time of hospitalization, I did not talk about the disease, I did not tell anyone about it at all, because I was afraid of condemnation. However, when they put me in the department, I told him everything at the first appointment with the psychotherapist. That doctor was the first person I told about the illness. After this conversation, it became much easier for me: I was no longer shy about talking about obsessive-compulsive disorder.

I spent a month in a day hospital, drank a six-month course of antidepressants, but obsessive thoughts did not go away. In the provinces, the doctors don't know how to treat my disease, and they stuff everyone with the same drugs.
In the hospital, I rested and talked with doctors, but I can’t say that the treatment helped me, I didn’t feel any difference in my state of health. By the way, during the treatment, I found out that one of my cervical vertebrae was pinched, and because of this, blood does not flow well to the brain. This may be a physiological explanation for the disease and poor functioning of my brain in general.

At one of the appointments, the doctor told me: "Find a girl, and everything will be fine with you." I was skeptical about his words. No, of course, it’s good to find a girl, but on the other hand, I thought - what kind of girl needs such a guy? Although, maybe the doctor was right, because not so long ago I started dating a girl, and I really got better. She gives me hope for a cure, thanks to her I became more open and decided to move to Moscow. Sometimes obsessive thoughts go away and I even forget that I am sick. For example, I recently lived for three weeks as normal person. However, I still do not know how to completely get rid of intrusive thoughts.

Now my life is hard work, I work on myself every day and I know all my inner demons. Of course, I dream that one day I will live a normal life.

I don't want to see a doctor in Moscow. I'm not ready to dig into myself again. In addition, I am afraid that if I start thinking about it a lot, then I will get worse and the compulsions will return. Moreover, the doctor is not a magician: what if he makes a wrong diagnosis or sends me to a closed hospital department, where they will stuff me with medicines? And I don't have time to go to the doctors either.

For 15 years, I have gone through several stages of relationship with the disease. At first I felt denial and anger - these emotions are absolutely useless and did not help me in any way. Then came the bargaining stage, where I tried to compromise with my frustration. I agreed to perform some rituals, but others did not disappear, so this tactic did not work either.

Then I fell into depression, which eventually turned into a feeling of guilt and self-pity, but now I realized that I don’t have to feel sorry for myself, because the disease sees my weaknesses and puts pressure on them. Do not consider yourself poor and unhappy - this only makes you weaker.

Right now I feel like I'm in the last stage, the stage of acceptance. I understand that life flows like water and in order to fully live, you need to go with the flow and let go of the disease. There is no one-size-fits-all cure for OCD - it all depends on the person's desire to be cured and their belief in a brighter future.

Evgeny Chataev

26 years old, student

I think everyone on the planet has OCD in one form or another. I have had the disease throughout my life. As a child, I loved to bite my nails, avoid the joints between the tiles on the road and repeat my last words in a whisper. And I didn’t even notice that I was repeating the words, my friends told me about it. This behavior is typical of many children, and usually with age it disappears, but it was different for me. Up until 2011 I lived as a common person but then things slowly started to change.

Then I met a girl, and we often spent time in my room. We often spilled tea, put our feet on the table and scattered crumbs, but after a while I realized that I could no longer behave like this. I started obsessing over cleanliness and after a while I stopped even putting the cup on the table in the room, because it could leave a mark.

At the same time, an important fad appeared in my head, which is still there. It sounds like this: “If I want to do some kind of activity, then everything around me should be clean.” And the whole house should be clean. Before I did my homework or sat down to watch a series, I carefully cleaned the apartment and did it in a strictly defined order: first the kitchen, then the toilet, the corridor, then one room and another. If the order was disturbed, I experienced strong feeling discomfort. Soon, cleaning became the only way to start working or studying. Without her, I felt uneasy and thought only that the apartment was dirty.

I decided to look into the motives of my passion for cleanliness and realized that the basis is a sense of guilt towards myself. I began to demand more discipline from myself than before, and in case of non-compliance with my requirements, I had to clean up. If I didn’t do my homework, spent time incompetently, smoked or drank, then as a punishment I had to clean the whole house. I thought that this was the only way I could return to my previous “high” level. It doesn’t matter if the apartment is clean or not, I still cleaned because I messed up. At the peak of my illness, I cleaned five times a week, and each cleaning took two to three hours.

Over time, the area of ​​​​my cleaning increased, as well as the number of details that were worth paying attention to. For example, I adjusted jars in the kitchen so that they stood at a certain angle to sunlight. I also checked the arrangement of applications on the phone, launched each of them, checked SMS messages, deleted unnecessary ones, and so on. All the folders on my computer also had to be put in order. In addition, I went to VKontakte: I checked the wall, audio recordings, videos, messages, photos and constantly deleted unnecessary ones. I loved only even numbers and believed that everywhere there should be a beautiful number, like 21,500 messages, and not a disgusting 21,501.

After cleaning, I analyzed the entire process: I remembered in what order and what I did, did I forget anything. I had to mentally say every little thing, and it took half an hour. If I was distracted at that moment, I had to start over. Sometimes debriefing brought me to tears, because I was sure that I had forgotten something, but I could not remember what it was.
As a result, the recitation of the performed rituals itself became a ritual.

After several months of cleaning, I decided that I would clean on one specific day - on Sundays. This led to the fact that if I accidentally committed any violation, it was followed by violations quite conscious. For example, I could forget myself and accidentally eat for computer desk, and then consciously went into all serious trouble: he smoked in the apartment, made a mess and walked for a long time. By the way, only in these moments I really liked to live. Thus, I could live freely all week, knowing that on Sunday I would clean up anyway.

When I planned the cleaning, I understood that it would be important for me and big event, about as New Year. I always thought that after cleaning I would start a new one, right life. If for some reason I did not clean up on time, then the next day was a nightmare for me. I thought only about the mess at home and could not concentrate: even at work I was shaking because the house was not cleaned. In such cases, I canceled all plans for Monday and cleaned out.

So I lived until 2012, not considering my rituals as something serious, but at some point my behavior became even more strange. Once I was walking down the street and missed the chewing gum in the trash can. After that, I couldn't help but think about this chewing gum and decided that the most important thing was to get to the subway, because leaving the subway to pick up gum is completely absurd. As a result, I entered the subway, went down the escalator, but could not stand it and still went back to the trash can. At that moment, I realized that I was completely sick and since I was doing such a game, I could afford other things that would make me feel better.

For example, it became important for me to keep track of which foot I enter the entrance from. It often happened that I entered the entrance, went up to my door and felt discomfort from the fact that I did not notice which foot I entered from. Then I left the entrance and entered again, but I was so absorbed in the thought of tracking which foot I entered from, that I simply could not concentrate and missed this moment again and again.

I only liked even numbers and believed that everywhere there should be a beautiful number, for example, 21,500 messages, and not disgusting 21,501

In addition, I began to hold my breath while turning off the computer or phone. It seemed to me that this gives the action purity. Even in my life, for some reason, I felt uncomfortable with the numbers 4 and 6. If I dined at McDonald's and these numbers were in the order number, then I did not pick up the food and just left. Although in the company I behaved normally: I still don’t want to look like a fool.

I began to have thoughts that one of my friends would die. Basically, these thoughts concerned my mother. I think if I was a homophobe, I would be afraid of becoming gay, but something else scared me: sex with the elderly. I looked at some granny and thought: “Oh, no, no, no, not that.” I'm not a pervert, but these thoughts were unstoppable, so I tried not to make eye contact with the grandmothers. For a while, I was rescued by a mantra that I spoke to myself. Something like “Enough! You are a free man, breathe deeply."

Another important point- it is ideal to close the front door to the apartment. I had to concentrate as much as possible on the process of closing the door and feel satisfaction from this. One day in 2013, I closed the door for about an hour. Mom noticed this and began to ask me what I was doing. It was the worst thing that could happen to me, because when you do things like this, you have to be in a vacuum, no one has to interfere with you. And then they not only interfered with me, but also put pressure on me. I remember that I stood all sweaty and asked my mother not to distract me. I put the brakes on the conversation that followed, and my mother did not delve into my quirks too much.

However, that day I seriously thought about my problems. At night, I began to search the Internet for information about neuroses and found an article about OCD in which every line was about me. I was shocked and relieved at the same time. Of course, I considered going to the doctor, but after I learned about the existence of OCD, it became easier to relate to my rituals. It seemed to me that this is not such a serious disease. I always thought that my illness was illusory and I could deal with it myself.

On the Internet, in various forums and in thematic groups, it is advised to fight OCD with willpower: "Rebuff your rituals, try not to do them." I remember thinking, “Great, challenge accepted.” But it quickly became clear that it was impossible to fight. I need to work and study, and in order to do this, I should not have any psychological struggle inside. It is much easier to succumb to the disease, perform the rituals and live peacefully on.

The last time OCD hit its peak was during a difficult breakup with a girlfriend early last summer. However, after parting, the disease receded for two months! I fondly remember the time when I did not perform a single ritual and felt free. This life is nothing compared to my previous life with rituals and cleaning.

In the fall, the disease began to return, but I realized that it was pointless to fight it. I decided to love myself in any manifestation and accepted the disease. OCD has a serious effect on you only as long as you treat it negatively. No need to be angry either at yourself or at the disease, you don’t need to get hung up on the fact that this is a problem. It's just one of those must-have things that take time, like brushing your teeth.

Gradually rituals began to evaporate by themselves. Now I don't leave an order if it has a 4 or 6 in it, my cleanings aren't as thorough as they used to be, and I no longer check to see if I've done everything. Once every three months, I open and close the front door, but I do this not out of a painful feeling, but for fun. I stand above the rituals and can postpone them for a convenient time for me. They have become like a sweet habit for me, although I admit that if a serious one arises stressful situation the disease may return.

Obsessive Compulsive Disorder (OCD) is one of the most common psychological illness. A severe disorder is characterized by the presence of disturbing thoughts (obsessions) in a person, provoking the appearance of constantly repeating certain ritual actions (compulsions).

Obsessive thoughts conflict with the subconscious of the patient, causing him depression and anxiety. And manipulation rituals designed to stop anxiety do not bring the expected effect. Is it possible to help the patient, why does such a condition develop, turning a person's life into a painful nightmare?

Obsessive-compulsive disorder causes suspiciousness and phobias in people

Every person has experienced this type of syndrome in their life. People call it " obsession". Such state-ideas fall into three general groups:

1. Emotional. Or pathological fears that develop into a phobia.
2. Intelligent. Some thoughts, fantastic ideas. This includes intrusive disturbing memories.
3. Motor. This kind of OCD is manifested in the unconscious repetition of some movements (wiping the nose, earlobes, frequent washing of the body, hands).

Doctors refer to this disorder as a neurosis. The name of the disease is "obsessive-compulsive disorder" English origin. In translation, it sounds like "obsession with an idea under duress." Translation very accurately defines the essence of the disease.

OCD has a negative impact on a person's standard of living. In many countries, a person with such a diagnosis is even considered disabled.

OCD is "an obsession with an idea under duress"

People encountered obsessive-compulsive disorders back in the dark Middle Ages (at that time this condition was called obsession), and in the 4th century it was ranked as melancholy. OCD has been periodically written down as paranoia, schizophrenia, manic psychosis, psychopathy. Modern doctors refer pathology to neurotic conditions.

Obsessive Compulsive Syndrome is amazing and unpredictable. It is quite common (according to statistics, up to 3% of people suffer from it). Representatives of all ages are subject to it, regardless of gender and level of social status. Studying the features of this disorder for a long time, scientists made curious conclusions:

• it is noted that people suffering from OCD have suspiciousness and increased anxiety;
• obsessive states and attempts to get rid of them with the help of ritual actions can occur periodically or torment the patient for whole days;
• the disease adversely affects a person's ability to work and perceive new information(according to observations, only 25-30% of OCD patients can work productively);
• in patients, personal life also suffers: half of people diagnosed with obsessive-compulsive disorder do not create families, and in the case of illness, every second couple breaks up;
• OCD is more likely to attack people who don't have higher education, but representatives of the world of the intelligentsia and people with a high level of intelligence are extremely rare with such a pathology.

How to recognize the syndrome

How to understand that a person suffers from OCD, and is not subject to ordinary fears or is not depressed and protracted? To understand that a person is sick and needs help, pay attention to the typical symptoms of obsessive-compulsive disorder:

obsessive thoughts. Anxious thoughts that relentlessly follow the patient are more often related to fear of disease, germs, death, possible injury, loss of money. From such thoughts, the OCD sufferer becomes panic-stricken, unable to cope with them.

Components of obsessive-compulsive disorder

Constant anxiety. Being captive to obsessive thoughts, people with obsessive-compulsive disorder experience internal struggle with your own state. Subconscious "eternal" anxiety gives rise to a chronic feeling that something terrible is about to happen. It is difficult to bring such patients out of a state of anxiety.

Repetition of movements. One of the striking manifestations of the syndrome is the constant repetition of certain movements (compulsions). Obsessive actions are rich in variety. The patient may:

• count all the steps of the stairs;
• scratching and twitching certain parts of the body;
• wash your hands constantly for fear of contracting a disease;
• synchronously arrange / lay out objects, things in the closet;
• repeatedly return back to once again check whether household appliances are turned off, the light, whether the front door is closed.

Often, impulsive-compulsive disorder requires patients to create their own system of checks, some kind of individual ritual of leaving the house, going to bed, eating. Such a system is sometimes very complex and confusing. If something in it is violated, a person begins to carry it out again and again.

The whole ritual is carried out deliberately slowly, as if the patient is delaying time in fear that his system will not help, and internal fears will remain.

Attacks of the disease often occur when a person is in the middle of a large crowd. He instantly wakes up disgust, fear of illness and nervousness from a sense of danger. Therefore, such people deliberately avoid communication and walks in crowded places.

Causes of pathology

The first causes of obsessive-compulsive disorder usually appear between the ages of 10 and 30. By the age of 35-40, the syndrome is already fully formed and the patient has a pronounced clinical picture illness.

Frequent couples (thought-ritual) in OCD

But why doesn't obsessional neurosis come to all people? What must happen for the syndrome to develop? According to experts, the most common culprit of OCD is idiosyncrasy mental makeup of a person.

Provoking factors (a kind of trigger) doctors divided into two levels.

Biological provocateurs

chief biological factor, causing obsessive-compulsive states, becomes stress. A stressful situation never goes unnoticed, especially for people predisposed to OCD.

In susceptible individuals, obsessive-compulsive disorder can even cause overwork at work and frequent conflicts with relatives and colleagues. Other common biological causes include:

• heredity;
• traumatic brain injury;
• alcohol and drug addiction;
• violation of brain activity;
• diseases and disorders of the central nervous system;
• difficult childbirth, trauma (for a child);
• complications after severe infections affecting the brain (after meningitis, encephalitis);
• a metabolic disorder (metabolism), accompanied by a drop in the level of the hormones dopamine and serotonin.

Social and psychological reasons

• family severe tragedies;
• severe psychological trauma of childhood;
• parental long-term overprotection of the child;
• long work, accompanied by nervous overload;
• strict puritanical, religious education, built on prohibitions and taboos.

An important role is played by the psychological state of the parents themselves. When a child constantly observes manifestations of fear, phobias, complexes from their side, he himself becomes like them. The problems of loved ones seem to be “drawn in” by the baby.

When to See a Doctor

Many people who suffer from OCD often do not even understand or accept the problem. And if they notice strange behavior behind themselves, they do not appreciate the seriousness of the situation.

According to psychologists, a person suffering from OCD should definitely undergo a full diagnosis and be taken for treatment. Especially when obsessive states begin to interfere with the life of both the individual and others.

It is imperative to normalize the condition, because the OCD disease strongly and negatively affects the well-being and condition of the patient, causing:

• depression;
• alcoholism;
• isolation;
• thoughts of suicide;
• rapid fatigue;
• mood swings;
• a drop in the quality of life;
• growing conflict;
• disorder from the gastrointestinal tract;
• constant irritability;
• difficulty making decisions;
• drop in concentration;
• abuse of sleeping pills.

Diagnosis of the disorder

To confirm or refute the mental disorder of OCD, a person should consult a psychiatrist. The physician, after a psychodiagnostic conversation, will differentiate the presence of pathology from similar mental disorders.

Diagnosis of obsessive-compulsive disorder

The psychiatrist takes into account the presence and duration of compulsions and obsessions:

1. Compulsive states (obsessions) acquire a medical background due to their stability, regular repetitions and importunity. Such thoughts are accompanied by feelings of anxiety and fear.
2. Compulsions (obsessive actions) arouse the interest of a psychiatrist if, at the end of them, a person experiences a feeling of weakness and fatigue.

Attacks of obsessive-compulsive disorder should last for an hour, accompanied by difficulties in communicating with others. To accurately identify the syndrome, doctors use a special Yale-Brown scale.

Treatment of obsessive-compulsive disorder

Doctors are unanimously inclined to believe that it is impossible to cope with obsessive-compulsive disorder on your own. Any attempt to take control of your own mind and defeat OCD leads to a worsening of the condition. And the pathology is "driven" into the crust of the subconscious, destroying the patient's psyche even more.

Mild illness

The treatment of OCD in the initial and mild stages requires constant outpatient monitoring. In the process of conducting a course of psychotherapy, the doctor identifies the causes that provoked obsessive-compulsive disorder.

The main goal of treatment consists of establishing a trusting relationship between a sick person and his close environment (relatives, friends).

Treatment of OCD, including combinations of methods psychological correction, may vary depending on the effectiveness of the sessions.

Treatment for Complicated OCD

If the syndrome passes in more complex stages, is accompanied by an obsessive phobia of the patient before the possibility of contracting diseases, fears of certain objects, treatment is complicated. Specific medications enter the fight for health (in addition to psychological corrective sessions).

Clinical Therapy for OCD

Medicines are selected strictly individually, taking into account the state of health and concomitant diseases of a person. The following groups of medicines are used in the treatment:

• anxiolytics (tranquilizers that relieve anxiety, stress, panic conditions);
• MAO inhibitors (psychoenergizing and antidepressant medications);
• atypical neuroleptics (antipsychotics, new class drugs that relieve symptoms of depression);
• serotonergic antidepressants (psychotropic drugs used in the treatment of severe depression);
• antidepressants of the SSRI category (modern third-generation antidepressants that block the production of the hormone serotonin);
• beta-blockers (drugs, their action is aimed at normalizing cardiac activity, problems with which are observed during attacks of ORG).

Prognosis of the disorder

OCD is a chronic disease. Not typical for this syndrome. full recovery, and the success of therapy depends on the timely and early start of treatment:

1. With a mild form of the syndrome, recession (stopping of manifestations) is observed after 6-12 months from the start of therapy. Patients may have some manifestations of the disorder. They are expressed in mild form and do not interfere with normal life.
2. In more severe cases, improvement becomes noticeable 1-5 years after the start of treatment. In 70% of cases, obsessive-compulsive disorder is clinically cured (the main symptoms of the pathology are removed).

Severe, advanced OCD is difficult to treat and prone to relapse. The aggravation of the syndrome occurs after the withdrawal of medications, against the background of new stresses and chronic fatigue. Cases of complete cure of OCD are very rare, but they are diagnosed.

With adequate treatment, the patient is guaranteed stabilization of unpleasant symptoms and relief of the vivid manifestation of the syndrome. The main thing is not to be afraid to talk about the problem and start therapy as early as possible. Then the treatment of neurosis will have a much greater chance of complete success.

alarm condition, fear of trouble, repeated washing of hands are just a few signs of a dangerous obsessive-compulsive disorder. The fault line between normal and obsessive states can turn into an abyss if OCD is not diagnosed in time (from Latin obsessive - obsession with an idea, siege, and compulsive - coercion).

What is obsessive-compulsive disorder

The desire to check something all the time, the feeling of anxiety, fear have varying degrees of severity. It is possible to speak about the presence of a disorder if obsessions (from Latin obsessio - “representations with a negative coloring”) appear with a certain frequency, provoking the occurrence of stereotypical actions called compulsions. What is OCD in Psychiatry? Scientific definitions come down to the interpretation that it is a neurosis, a syndrome of obsessive-compulsive disorders caused by neurotic or mental disorders.

Oppositional defiant disorder, which is characterized by fear, obsession, and depressed mood, lasts for an extended period of time. This specificity of obsessive-compulsive malaise makes the diagnosis difficult and simple at the same time, but a certain criterion is taken into account. According to the accepted classification according to Snezhnevsky, based on the characteristics of the course, the disorder is characterized by:

• a single attack lasting from a week to several years;
• cases of relapse of a compulsive state, between which periods of complete recovery are fixed;
• continuous dynamics of development with periodic intensification of symptoms.

Contrasting obsessions

Among the obsessive thoughts that occur with compulsive malaise, alien true desires the personality itself. The fear of doing something that a person is not able to do by virtue of character or upbringing, for example, blaspheming during a religious service, or a person thinks that he can harm his loved ones - these are signs of contrast obsession. Fear of harm in obsessive-compulsive disorder leads to a studious avoidance of the subject that caused such thoughts.

obsessive actions

At this stage, obsessive disorder may be characterized as a need to perform some action that brings relief. Often mindless and irrational compulsions (compulsions) take one form or another, and such wide variation makes it difficult to make a diagnosis. The emergence of actions is preceded by negative thoughts, impulsive actions.

Some of the most common signs of obsessive-compulsive disorder are:

• frequent washing of hands, taking a shower, often with the use of antibacterial agents - this causes fear of pollution;
• behavior when fear of infection forces a person to avoid contact with doorknobs, toilet bowls, sinks, money as potentially dangerous peddlers of dirt;
• repeated (compulsive) checking of switches, sockets, door locks, when the disease of doubt crosses the line between thoughts and the need to act.

Obsessive-phobic disorders

Fear, albeit unfounded, provokes the appearance of obsessive thoughts, actions that reach the point of absurdity. Anxiety, in which an obsessive-phobic disorder reaches such proportions, is treatable, and rational therapy is the four-step method of Jeffrey Schwartz or the study of a traumatic event, experience (aversive therapy). Among the phobias in obsessive-compulsive disorder, the most famous is claustrophobia (fear of closed spaces).

obsessive rituals

When negative thoughts or feelings arise, but the patient's compulsive ailment is far from the diagnosis - bipolar affective disorder, one has to look for a way to neutralize the obsessive syndrome. The psyche forms some obsessive rituals, which are expressed by meaningless actions or the need to perform repetitive compulsive actions similar to superstition. Such rituals the person himself may consider illogical, but an anxiety disorder forces him to repeat everything all over again.

Obsessive Compulsive Disorder - Symptoms

Obsessive thoughts or actions that are perceived as wrong or painful can be harmful to physical health. Symptoms of obsessive-compulsive disorder can be solitary, have an uneven severity, but if you ignore the syndrome, the condition will worsen. Obsessive-compulsive neurosis can be accompanied by apathy, depression, so you need to know the signs by which you can diagnose OCD (OCD):

• the emergence of unreasonable fear of infection, fear of pollution or trouble;
• repeated obsessive actions;
• compulsive actions (defensive actions);
• excessive desire to maintain order and symmetry, obsession with cleanliness, pedantry;
• "stuck" on thoughts.

Obsessive Compulsive Disorder in Children

It is less common than in adults, and when diagnosed, compulsive disorder is more often detected in adolescents, and only a small percentage are children of 7 years of age. Gender does not affect the appearance or development of the syndrome, while obsessive-compulsive disorder in children does not differ from the main manifestations of neurosis in adults. If parents manage to notice signs of OCD, then it is necessary to contact a psychotherapist to select a treatment plan using medications and behavioral, group therapy.

Obsessive Compulsive Disorder - Causes

Comprehensive study syndrome, many studies have not been able to give a clear answer to the question of the nature of obsessive-compulsive disorders. Psychological factors (stress, problems, fatigue) or physiological (chemical imbalance in nerve cells) can affect a person’s well-being.

If we dwell on the factors in more detail, then causes of OCD look like this:

1. stressful situation or traumatic event;
2. autoimmune reaction (a consequence of streptococcal infection);
3. genetics (Tourette syndrome);
4. violation of brain biochemistry (decrease in the activity of glutamate, serotonin).

Obsessive Compulsive Disorder - Treatment

An almost complete recovery is not excluded, but long-term therapy will be required to get rid of obsessive-compulsive neurosis. How to treat OCD? Treatment of obsessive-compulsive disorder is carried out in a complex with sequential or parallel application techniques. Compulsive personality disorder in severe OCD requires drug treatment or biological therapy, and for mild - use the following methods. This is:

• Psychotherapy. Psychoanalytic psychotherapy helps to cope with some aspects of compulsive disorder: correcting behavior during stress (exposure and warning method), training in relaxation techniques. Psychoeducational therapy for obsessive-compulsive disorder should be aimed at deciphering actions, thoughts, identifying the causes, for which sometimes prescribed family therapy.
• Lifestyle correction. Mandatory revision of the diet, especially if there is a compulsive eating disorder, getting rid of bad habits, social or professional adaptation.
• Physiotherapy at home. Hardening at any time of the year, swimming in sea ​​water, warm baths average duration and subsequent rubdown.

Medical treatment for OCD

A mandatory item in complex therapy, requiring a careful approach from a specialist. The success of medical treatment of OCD is associated with the correct choice of drugs, duration of administration and dosage when symptoms worsen. Pharmacotherapy provides for the possibility of prescribing drugs of one group or another, and the most common example that can be used by a psychotherapist to recover a patient is:

• antidepressants (paroxetine, sertraline, citalopram, escitalopram, fluvoxamine, fluoxetine);
• atypical antipsychotics (risperidone);
• normotimics (Normotim, Lithium carbonate);
• tranquilizers (diazepam, clonazepam).

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