An obsessive-compulsive personality should be distinguished from a person with OCD, i.e. which one obsessive compulsive disorder (compulsive disorder).

Because in the first, somewhat obsessive and ritualistic thinking and behavior may look like an anxious and suspicious trait of character and temperament, and especially not interfere with himself and those around him, close people.

The second has overly obsessive OCD symptoms, such as fear of infection and frequent washing hands - can significantly interfere with a person, both in personal and in public life. That, too, can negatively affect the immediate environment.

However, it should be remembered that the first can easily become the second.

obsessive-compulsive personality

The obsessive-compulsive personality type is characterized by the following features:

• Them keywords: "Control" and "Must"
• Perfectionism (striving for perfection)
• Consider themselves responsible for themselves and others
• Others for them are frivolous, irresponsible and incompetent
• Beliefs: “I must manage the situation”, “I must only do everything right”, “I know what is best ....”, “You must do it my way”, “People and yourself need to be criticized to prevent mistakes” ...
• Catastrophic thoughts that the situation will get out of hand
• They control the behavior of others by excessive control, or by disapproval and punishment (up to the use of force and enslavement).
• Prone to regret, disappointment, punishment of themselves and others.
• Often experiencing anxiety, with failures can become depressed

Obsessive Compulsive Disorder - Symptoms

Obsessive Compulsive Personality Disorder (OCD) is characterized by: symptoms:

• Repetitive obsessive thoughts and forced actions that interfere with a normal life
• Repetitive obsessive, ritualistic behavior (or imagination) to relieve anxiety and distress caused by obsessive thoughts
• A person with OCD may or may not be aware of the meaninglessness of their thoughts and behaviors.
• Thoughts and rituals take up a lot of time and interfere with normal functioning, causing psychological discomfort, including the immediate environment
• Impossibility of independent, volitional control and opposition to automatic thoughts and ritual behavior

OCD related symptoms:
Depressive disorder, anxiety and panic disorder, social phobias, eating disorders (anorexia, bulimia)…

The listed accompanying symptoms may be similar to OCD, therefore, a differential diagnosis is made, distinguishing other personality disorders.

obsessional disorder

Persistent (frequent) obsessive thoughts are ideas, images, beliefs, and ruminations that cause anxiety and distress and constitute obsessive personality disorder.

The most common obsessive thoughts are fear of infection, pollution or poisoning, harm to others, doubts about closing the door, turning off household appliances ... and so on.

Compulsive disorder

Obsessive behavior, or ritual behavior (ritual can be mental) is a stereotyped behavior by which a person with a compulsive disorder tries to relieve anxiety or relieve distress.

The most common ritual behaviors are washing hands and/or objects, counting aloud or to oneself, and checking the correctness of one's actions...etc.

Obsessive Compulsive Disorder - Treatment

For the treatment of obsessive-compulsive disorder, drug therapy and psychotherapy are used, in particular, cognitive behavioral therapy, exposure therapy and psychoanalysis.

Usually, with a very pronounced OCD and with little motivation for a person to get rid of it, they use drug treatment, in the form of taking antidepressants and serotonin reuptake inhibitors, non-selective serotonergic drugs and placebo pills. (effect, usually short-lived, besides, pharmacology is not harmless)

For OCD sufferers long time, and usually strongly motivated to cure, the best option there will be a psychotherapeutic intervention without medication (medication, in some difficult cases, can be used at the beginning of psychotherapy).

However, those wishing to get rid of obsessive-compulsive disorder and its accompanying emotional and psychological problems should be aware that psychotherapeutic intervention is time-consuming, not fast and expensive.

But those who have the desire, after a month of intensive psychotherapy, will be able to improve their condition to normal. In the future, to avoid relapses and to consolidate the results, supportive therapeutic meetings may be necessary.

A significant role among mental illnesses is played by 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 are 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 states are combined into International Classification 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 treatment for OCD was the first step in a revolution and spurred clinical research that showed the efficacy 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". Trying to push 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", denoting the fear of being in 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 (such as counting in a particular way, or repeating certain words) and repetitive but meaningless acts (such as 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 in some complex system before putting them on) do not have such a 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 stands out whole line outlined symptom complexes and among them are obsessive doubts, contrasting obsessions, obsessive fears - phobias (from the 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 reaction 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, an obsessive feeling of antipathy, an 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 are mixed up , whether inaccurate figures are indicated, whether orders are correctly formulated or executed), etc. Despite repeated verification of the committed action, doubts, as a rule, do not disappear, causing psychological discomfort in a person suffering from 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 him under it. loved one kill a 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 of obsession, they acquire the character of overvalued formations (dominant ideas that do not correspond to their true value), and sometimes delirium.

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) is an 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, large streets, open or confined spaces, large crowds of people, the fear of sudden death, the 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 contrasting 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 contamination (by earth, dust, urine, feces and other impurities), as well as the fear of penetration into the body of harmful and toxic substances (cement, fertilizers, toxic waste), small objects (glass fragments, 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 pollution, 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 - the fear of a threat from the outside: the fear of penetration into the body of pathogenic bacteria. Hence the development of appropriate protective actions.

A special place in a number of obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, unlike organically conditioned 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 the lips, grinding the teeth, spitting, etc.), which differ from the actual obsessive actions 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 primary 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 full recovery are relatively rare. However, in many patients, especially with the development and preservation 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 on certain modes of transport, or public speaking, cease to feel defective and work along with 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, and multiple rituals, on the contrary, 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), and the uniformity 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 patient's life. 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 individual approach to each patient, taking into account the characteristics of the manifestation of OCD, age, gender, the presence of burdened by 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 of remission (improvement). The apparent suffering of the patient often seems to call for energetic and effective treatment, but the natural course of this condition must be remembered in order to avoid typical mistake consisting in excessively 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 more than one to two months, small doses of tricyclic antidepressants or small antipsychotics sometimes help. 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 obsessive 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 in 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 intra-family relations. If marital problems exacerbate 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 rational behavior both at home and in hospital settings. Rehabilitation is aimed at teaching social skills to properly interact with other people, vocational training, as well as skills necessary in everyday life. Psychotherapy helps patients, especially those who feel own inferiority treat yourself better and correctly, master ways of solving everyday problems gain faith in your own 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.

Obsessive-compulsive disorder (OCD) is a mental illness characterized by obsessive thoughts, doubts, and constant double-checking of actions taken.

Obsessive-compulsive disorder is not as serious a pathology as schizophrenia or depression, but this mental disorder can significantly impair a person's quality of life, contribute to a decrease in self-esteem, and even worsen the patient's social status.

Causes

Obsessive-compulsive disorder can develop due to the interaction of a number of factors. First of all, it is a hereditary predisposition. A person can be inherited certain personality traits, a model of behavior in psychotraumatic conditions.

The development of this mental disorder can be caused by sudden mental trauma (a life-threatening situation, the death of a loved one, disaster) or a long stay in stressful conditions, when the human psyche is "exhausted". Examples of such a situation are an uninteresting, hated job for a person, from which he cannot quit (lives in small village where no other work can be found).

Symptoms of the disease

The first manifestations of obsessive-compulsive disorder appear in adolescence or early childhood. adulthood. At this time, obsessions arise, which are regarded by patients as something absurd, illogical.

The main obsessions characteristic of OCD are obsessive thoughts and compulsive actions.

Now let's take a closer look at each individual symptom.

obsessive thoughts

obsessive thoughts- painful thoughts, images and desires that arise against the will of a person, again and again come to his mind, and which he tries to resist. Such thoughts themselves “swarm” in the head, do not give a person peace of mind, he would be happy to switch to something else, but again and again obsessive thoughts arise in his mind.

We are all different, so each of us has our own obsessive thoughts. However, all obsessive thoughts can be divided into obsessive doubts, obsessive fears of contamination or contamination, and contrast obsessions. So, let's talk about each of these groups separately.

obsessive doubts

Obsessive doubts arose, probably, in each of us. Have I done everything? Did you make the right decision? Did I close the door? Did I turn off the gas? Did you write everything in the answer to the ticket during the entrance exam? Familiar thoughts, right?

Obsessive doubts can be related to everyday issues (is the door closed, is the gas turned off), with official activities (a bank employee will doubt whether he correctly indicated the account to which he transferred the money, the teacher - whether he gave the correct grade to the student). To make sure that everything is done, a person will again and again check gas, electricity, water, the number of the current account. And even if everything is done carefully, then after a while doubts may return again (what if the tap was not completely closed, and I didn’t see it; what if I still mixed up the numbers in the account number?)

If such thoughts sometimes arise - it's okay, it happens to almost everyone. But if you are forced to check many times whether the gas is turned off, the light is still not sure that everything is turned off, in this case it is better to visit a psychiatrist. You may have obsessive-compulsive personality disorder. By the way, here's a little anecdote on the subject.

The appearance of various obsessions, especially obsessive doubts, is characteristic of such a personality disorder as.

Contrasting obsessions

Contrasting obsessions can also occur with obsessive-compulsive disorder. These are vivid ideas that arise in the imagination of a person, unpleasant in meaning, blasphemous thoughts.

Contrasting obsessions include an absolutely groundless fear of harming oneself or others. It may also be a desire to continue someone's remark with an ironic, offensive statement. This group of obsessions can include obsessive representations of sexual content - obsessions of the type of forbidden representations of sexual acts with animals, representatives of the same sex.

Obsessions of pollution

Obsessions of pollution are also called mysophobia. They can be manifested by fear of getting dirty with earth, feces, urine, fear of penetration into the body of microorganisms, harmful substances.

Sometimes the fear of pollution is not very pronounced. At the same time, a person for many years only washes his hands too hard or several times a day without apparent reason mop the floor. Such phobias do not significantly affect the quality of human life, and others are regarded only as increased cleanliness.

Much worse if pollution obsessions get more complicated. At the same time, there appear various activities, rituals designed to prevent pollution. Such a person will avoid touching objects that may have been contaminated. He will go out into the street only in special clothes, supposedly protecting him from pollution. He will also wash his hands in a certain sequence and in no case violates it (otherwise he will consider that his hands were dirty). In the later stages of the disease, some people even refuse to go outside, so as not to get dirty there, not to pick up some kind of infection.

Another manifestation of mysophobia is the fear of contracting some kind of disease. Most often, patients are afraid that pathogenic microorganisms will enter their body from the outside by some means. in an unusual way(for example, due to contact with old things that once belonged to a sick person).

obsessive actions

Compulsive actions- stereotypically repetitive, obsessive behavior. In some cases, obsessive actions take the form of protective rituals: by performing certain actions under certain conditions, a person tries to protect himself from something. It is these compulsions that are most often found in OCD.

Among obsessive actions, especially in childhood and adolescence, tics predominate. They differ from tics in organic brain diseases in that they are much more complex movements that have lost their original meaning. For example, compulsive actions can include hand movements, as if throwing back long hair (although a person has been walking with a short haircut for a long time) or attempts to blink their eyes hard, as if a speck has got into the eye. The performance of these movements is accompanied by a painful sense of persistence, a person understands the meaninglessness of these movements, but performs them anyway.

Many of us have bad habits- someone bites his lips, someone twists the ring, someone else periodically spits. However, these actions are not accompanied by a sense of obsession.

If you diligently take care of yourself, you can get rid of such habits. Or if someone from outside pays attention that a person is biting his lips at that moment, then this person will stop doing it, and his mental state will not be disturbed.

In the presence of obsessive thoughts and actions that are becoming more and more absurd, it must be borne in mind that similar symptoms can also be observed with. It is also characterized by the progression of emotional impoverishment, the loss of habitual interests.

Treatment of the disorder

Antidepressants (anafranil, imipramine, amitriptyline, fluvoxamine) can be used to treat obsessive-compulsive disorder. With contrast obsessions, the antidepressant sertraline (Zoloft) has the best effect.

Tranquilizers (hydroxyzine, alprazolam, diazepam, clonazepam) may also be given for short-term treatment of OCD.

At obsessive fear pollution, accompanied by a complex system of protective rituals, neuroleptics (sonapax, truxal, ridazine) can be used.

In most cases, effective treatment of OCD is impossible without the use of psychotherapy. Its goal is to reduce a person’s self-control, to teach him to relax. One of the methods of psychotherapeutic treatment is the purposeful and consistent contact of a person with things that he avoids. This is done so that the patient learns to consciously control his emotions in such situations.

Obsessive-compulsive disorder is a pathological condition that has a clear onset and is reversible with proper treatment. This syndrome is considered under the rubric of borderline mental disorders. Obsessive-compulsive disorder (OCD) is distinguished from the pathology of the neurotic level by a greater severity, frequency of occurrence and intensity of obsessions.

To date, information on the prevalence of the disease cannot be called reliable and accurate. The inconsistency of the data can be explained by the fact that a lot of people suffering from obsessions do not go to the psychiatric service. Therefore, in clinical practice, in terms of frequency, obsessive-compulsive disorder ranks after anxiety-phobic disorders and conversion disorders. However, conducted anonymous sociological surveys show that over 3% of respondents suffer from obsessions and compulsions in varying degrees of severity.

First episode of obsessive-compulsive disorder most often occurs between 25 and 35 years of age. Neurosis is fixed in people with different levels of education, financial situation and social status. In most cases, the occurrence of obsessions is determined in unmarried women and single men. Often, OCD affects individuals with a high IQ, whose professional duties involve active mental activity. Residents of large industrial cities are more susceptible to the disease. Among the population countryside disorder is extremely rare.

Most people with OCD have symptoms that are chronic, with obsessions occurring regularly or constantly. Manifestations of obsessive-compulsive disorder may be sluggish and perceived by the patient as tolerable phenomena. Or, as the disease develops, the symptoms become aggravated at a rapid pace, preventing a person from having a normal existence. Depending on the severity and rate of development of symptoms, obsessive-compulsive disorder either partially impedes the patient's full-fledged activity, or completely prevents interaction in society. In a severe course of OCD, the patient becomes a hostage to the obsessions that overcome him. In some cases, the patient completely loses the ability to control the process of thinking and cannot control his behavior.

For obsessive compulsive disorder two leading symptoms are characteristic - obsessive thoughts and compulsive actions. Obsessions and compulsions arise spontaneously, are of an obsessive and irresistible nature, and cannot be independently eliminated either by an effort of will or by conscious personal work. The individual evaluates the obsessions that overcome him as alien, illogical, inexplicable, irrational, absurd phenomena.

• It is customary to call obsessions those thoughts that come to mind involuntarily, in addition to the desire of the subject, intrusive, relentless, oppressive, languishing, frightening or threatening thoughts. Obsessive thinking includes persistent ideas, images, desires, desires, doubts, fears. A person tries with all his might to resist regularly appearing obsessive thoughts. However, attempts to distract and switch the course of thinking do not give the desired result. Intrusive ideas still cover the entire spectrum of the subject's thoughts. No other ideas, except annoying thoughts, arise in the mind of a person.
• Compulsions are debilitating and exhausting actions that are regularly and repeatedly repeated in an unchangeable constant form. Standardly performed processes and manipulations are a kind of protective and protective rituals. The persistent repetition of compulsive actions is designed to prevent the onset of any frightening circumstances for the object. However, according to an objective assessment, such circumstances simply cannot occur or are unlikely situations.

In obsessive-compulsive disorder, the patient may have both obsessions and compulsions at the same time. Also, exclusively obsessive thoughts without subsequent ritual actions can be observed. Or a person may suffer from an oppressive feeling of having to carry out compulsive actions and perform them repeatedly.

In the vast majority of cases, obsessive-compulsive disorder has a clear, pronounced start. Only in isolated cases is a gradual slow increase in symptoms possible. The manifestation of pathology almost always coincides with the period of a person's stay in severe stressful condition. The debut of OCD is possible as a result of the sudden action of extreme stressful situations. Or the first episode of the disorder is the result of a prolonged chronic stress. It should be pointed out that the trigger mechanism for obsessive-compulsive disorder is not only stress in its understanding, as a traumatic situation. The onset of the disease often coincides with stress caused by physical ill health and severe somatic illness.

Obsessive-compulsive disorder: pathogenesis

Most often, a person pays attention to the existence of obsessions and compulsions after he has experienced a serious life drama. It also becomes noticeable to those around him that after the tragedy that happened, the person began to behave differently and, as it were, is in his own world of reflection. Despite the fact that the symptoms of obsessive-compulsive disorder become pronounced precisely after extreme circumstances in the life of the subject, it acts only as a trigger for the visible manifestation of the pathology. A traumatic situation is not directly cause of OCD, it only provokes the fastest aggravation of the disease.

Reason 1. Genetic theory

The predisposition to pathological reactions is laid down at the gene level. It has been established that the majority of patients with obsessive-compulsive disorder have defects in the gene responsible for the transport of the neurotransmitter serotonin. More than half of the examined individuals had mutations in the seventeenth chromosome in the SLC6A4 gene, a serotonin transporter.

The appearance of obsessions is recorded in persons whose parents have a history of episodes of neurotic and psychotic disorders. Obsessions and compulsions can occur in people whose close relatives have suffered from alcohol or drug addiction.

Scientists also suggest that excessive anxiety is also transmitted from descendants to ancestors. Many cases have been recorded when grandparents, parents and children had similar or performed similar ritual actions.

Reason 2. Features of higher nervous activity

The development of obsessive-compulsive disorder is also influenced by the individual properties of the nervous system, which are due to innate qualities and life experiences. Most OCD patients have a weak nervous system. The nerve cells of such people are not able to fully function under prolonged stress. In many patients, an imbalance in the processes of excitation and inhibition is determined. Another trait found in such individuals is inertia. nervous processes. That is why sanguine people are rarely found among patients with obsessive-compulsive disorder.

Reason 3. Constitutional and typological aspects of personality

At risk are anancaste personalities. They are characterized by an increased tendency to doubt. These pedantic persons are absorbed in the study of details. These are suspicious and impressionable people. They strive to do their best and suffer from perfectionism. Every day they scrupulously think over the events of their lives, endlessly analyze their actions.

Such subjects are not able to make an unambiguous decision even when all the conditions exist for right choice. Anancasts are not able to displace obsessive doubts, which provokes the emergence of a strong one before the future. They cannot resist the emerging illogical desire to double-check the work done. To avoid failure or mistakes, anancasts begin to use saving rituals.

Reason 4. The influence of neurotransmitters

Doctors suggest that a malfunction in serotonin metabolism plays a role in the development of obsessive-compulsive disorder. In the central nervous system, this neurotransmitter optimizes the interaction of individual neurons. Violations of serotonin metabolism do not allow for a qualitative exchange of information between nerve cells.

Reason 5. PANDAS syndrome

Nowadays, there is a lot of evidence for the hypothesis put forward about the connection between obsessive-compulsive disorder and infection of the patient's body with group A beta-hemolytic streptococcus. These cases are designated by the English term

PANDAS. The essence of this autoimmune syndrome is such that if there is a streptococcal infection in the body, the immune system is activated and, trying to destroy microbes, mistakenly affects nerve tissues.

Obsessive-compulsive disorder: clinical picture

The leading symptoms of obsessive-compulsive disorder are obsessive thoughts and compulsive actions. The criteria for making a diagnosis of OCD is the severity and intensity of the symptoms. Obsessions and compulsions occur in a person regularly or are present constantly. The symptoms of the disorder make it impossible for the subject to fully function and interact in society.

Despite the many faces and variety of obsessive thoughts and ritual actions, all the symptoms of obsessive-compulsive disorder can be divided into several classes.

Group 1. Unremovable doubts

In this situation, a person is overcome by obsessive doubts about whether some action has been performed or not. He is haunted by the need to conduct a second check, which, from his point of view, can prevent disastrous consequences. Even repeated checks do not give the subject confidence that the case was completed and completed.

Pathological doubts of the patient may relate to traditional household chores, which, as a rule, are performed automatically. Such a person will check several times: whether the gas valve is closed, whether the water tap is closed, whether the front door is locked. He returns several times to the scene of action, touches these objects with his hands. However, as soon as he leaves his home, doubts overcome him with greater force.

Painful doubts can also affect professional duties. The patient is confused whether he has completed the required task or not. He is not sure that he wrote the document and sent it to e-mail. He doubts if all the details are in the weekly report. He rereads, skims, rechecks over and over again. However, leaving workplace, obsessive doubts arise again.

It is worth pointing out that obsessive thoughts and compulsive actions resemble a vicious circle that a person cannot break through the efforts of the will. The patient understands that his doubts are groundless. He knows he has never made the same mistake in his life. However, he cannot "persuade" his mind not to retest.

Only a sudden "insight" can break the vicious circle. This is the situation when a person's mind clears up, the symptoms of obsessive-compulsive disorder subside for a while, and the person experiences release from obsessions. However, a person cannot bring the moment of “enlightenment” closer by an effort of will.

Group 2. Immoral obsessions

This group of obsessions is represented obsessions indecent, immoral, illegal, blasphemous content. A person begins to be overcome by an indomitable need to commit an obscene act. At the same time, the person has a conflict between her existing moral standards and an indomitable desire for antisocial action.

The subject may be overcome by a thirst to offend and humiliate someone, to be nasty and rude to someone. A respectable individual may be pursued by some absurd undertaking, which is a loose immoral act. He may begin to blaspheme God and speak unflatteringly about the church. He may be overcome by the idea of ​​indulging in sexual debauchery. He may be tempted to commit a hooligan act.

However, a patient with obsessive-compulsive disorder fully understands that such an obsessive need is unnatural, indecent, illegal. He tries to drive away such thoughts from himself, but the more he makes an effort, the more intense his obsessions.

Group 3. Overwhelming feelings about pollution

The symptoms of obsessive-compulsive disorder also affect the topic. The patient may be pathologically afraid of contracting some difficult-to-diagnose and incurable disease. In such a situation, it performs protective actions to exclude contact with microbes. He takes strange precautions, afraid of viruses.

Obsessions are also manifested by an abnormal fear of pollution. Patients with obsessive-compulsive disorder may fear that they will be soiled with dirt. They are terribly afraid of house dust, so they are engaged in cleaning for days on end. Such subjects are very careful about what they eat and drink, as they are convinced that they can be poisoned by low-quality food.

In obsessive-compulsive disorder, common themes of obsessions are the patient's thoughts about polluting his own home. Such subjects are not satisfied with standard apartment cleaning methods. They vacuum the carpets several times, wash the floor using disinfectants, and wipe the surfaces of the furniture using cleaning products. For some patients, cleaning the home takes the entire period of wakefulness, they arrange a break for themselves only during the night's sleep.

Group 4. Obsessive actions

Compulsions are actions, behaviors and behavior in general that a person with obsessive-compulsive disorder uses to overcome intrusive thoughts. Compulsive acts are performed by the subject as a ritual designed to protect against some potential catastrophe. Compulsions are performed regularly and often, while the person cannot refuse or suspend them.

There are a great many types of compulsions, since they reflect the subject's obsessive thinking in a particular area. The most common forms of protective and preventive actions are:

• activities carried out due to existing superstitions and prejudices, for example: fear of the evil eye and a warning method - regular washing with "holy" water;
• stereotypical, mechanically performed movements, ex: pulling one's own hair out of one's head;
• deprived common sense and the need to perform any process, for example: combing hair for five hours;
• excessive personal hygiene, for example: taking a shower ten times a day;
• uncontrollable need to recalculate all surrounding objects, for example: counting the number of dumplings in a serving;
• an uncontrollable desire to place all objects symmetrically to each other, the desire to arrange things in a strictly established sequence, for example: arranging shoe units in parallel;
• craving for collecting, collecting, hoarding, when the hobby goes from the category of a hobby to a pathology, for example: keeping at home all the newspapers bought in the last ten years.

Obsessive Compulsive Disorder: Treatment Methods

The treatment regimen for obsessive-compulsive disorder is selected for each patient individually, depending on the severity of the symptoms and the severity of the existing obsessions. In most cases, it is possible to help a person by treating on an outpatient basis. However, some patients with severe OCD need to be admitted to an inpatient facility because there is a risk that obsessive thoughts will require actions that can cause real harm to the person and their environment.

The classical method of treating obsessive-compulsive disorder provides for the consistent implementation of activities that can be divided into four groups:

• pharmacological therapy;
• psychotherapeutic impact;
• use of hypnosis techniques;
• implementation of preventive measures.

Medical treatment

The use of medicines has the following goals: to strengthen nervous system the patient, minimize feelings and anxieties, help take control of their own thinking and behavior, eliminate existing depression and despair. Treatment for OCD begins with two weeks of benzodiazepines. In parallel with tranquilizers, the patient is recommended to take antidepressants from the SSRI class for six months. To get rid of the symptoms of the disorder, it is advisable to prescribe atypical antipsychotics to the patient. In some cases, the use of mood stabilizers may be required.

Psychotherapeutic treatment

Modern psychotherapy has in its arsenal a variety of proven and effective methods for getting rid of obsessive-compulsive disorder. Often OCD treatment carried out using the cognitive-behavioral method. This technique provides assistance to the client in detecting the destructive components of thinking and the subsequent acquisition functional image thinking. During psychotherapeutic sessions, the patient acquires the skills to control his thoughts, which makes it possible to control his own behavior.

Another psychotherapeutic treatment option that shows good results in the treatment of obsessive-compulsive disorder is exposure and reaction prevention. Placing the patient in artificially created frightening conditions, accompanied by a clear and understandable step-by-step instruction on how to prevent compulsions, gradually alleviates and eliminates the symptoms of obsessive-compulsive disorder.

Hypnosis treatment

Many people who suffer from obsessive-compulsive disorder indicate that when they give in to their obsessive ideas and commit compulsive actions, it is as if they are in a trance state. That is, they concentrate within themselves, so the fruits of their imagination become more real than objectively existing reality. That is why it is advisable to act on obsessions in a state of trance, immersion into which occurs during a hypnosis session.

A break occurs during a hypnosis session association between overpowering obsessions and the need to use a stereotypical model of behavior. Hypnosis techniques help the patient to be convinced of the inappropriateness, absurdity and alienness of the emerging obsessive thoughts. As a result of hypnosis, he no longer needs to perform certain rituals. He acquires a mind free from prejudices and takes control of his own behavior.

Preventive actions

To prevent recurrence of obsessive-compulsive disorder, it is recommended:

• take a contrast shower in the morning;
• in the evening, take baths with the addition of relaxing natural oils or soothing herbal formulations;
• ensuring a good night's sleep;
• daily walks before bed;
• being outdoors for at least two hours a day;
• active exercise stress, mobile sports;
• compiling a healthy menu, excluding from the diet products that have stimulating properties;
• refusal of alcoholic beverages;
• exclusion of smoking;
• creating a favorable atmosphere at home, eliminating stressful situations;
• normalization of work schedule;
• performing breathing exercises.

Despite the persistent course of obsessive-compulsive disorder, the disease is treatable, provided that the patient fully complies with all medical recommendations.

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