Definition and main features of obsessive-compulsive disorder, criteria for the diagnosis. Pharmacological and psychotherapeutic principles of the treatment of this disease. Obsessive-compulsive disorder (OCD) is a mental illness that is accompanied by obsessive thoughts (obsessions) and stereotyped actions (compulsions). They are cyclical and cause anxiety, anxiety and even fear in a person.
Description and mechanism of development of obsessive-compulsive disorder
This disease is a set of sometimes meaningless, sometimes completely unnecessary stereotypes or rituals that are caused by obsessive thoughts. At the same time, a person is fully aware and understands the irrationality of his ideas and actions, but is unable to resist them.
The emerging obsession is usually associated with anxiety about the correctness of their actions, decisions, arrangement of objects or their health. Such ideas are impossible to get rid of, and over time they become a priority, crowding out others, perhaps more important. For example, if this happens at work, a person's ability to work falls and he cannot even think about anything else.
Obsession causes constant anxiety for something, paralyzing the rest of thinking, its intensity increases and requires some action. Suppose a person does not remember whether he has closed his car or apartment, and he is anxious - what if he has forgotten? This thought becomes obsessive and does not allow you to think about anything else.
The obsession requires you to take action - go and see if you have closed your car or your house. The person goes, checks and comes back, but a new thought arises that he has not checked thoroughly enough. The second, more severe obsession requires repeated action (compulsion). Thus, a vicious circle is created, which constantly leads to an aggravation of the anxiety state.
Such actions are perceived by the person himself critically, he may even be ashamed of them, but he cannot do anything about it. No matter how long the resistance lasts, the obsession will still dominate.
The main causes of obsessive-compulsive disorder
Currently, more than 3% of the population, according to various sources, suffers from obsessive-compulsive disorder. This figure fluctuates depending on the country and nation.
It is known that the risk of developing OCD in close relatives is much higher than in the population. This leads to certain conclusions that there is an inherited propensity to this disorder.
Obsessive-compulsive disorder can occur in anxious, thoughtful individuals. They are prone to forming obsessions and have a hard time experiencing some doubts.
The biological factor is also of great importance. A difficult perinatal period with trauma or asphyxiation during childbirth increases the chances of developing obsessive-compulsive disorder. In some patients, organic changes may even be observed, which are recorded using MRI or CT.
In all other cases, they talk about psychogenic factors that are present in our life. Stress, nervous strain, overwork are able to provoke a pathological reaction of the psyche. Some theories view obsessions and compulsions as a defense of the mind against excessive anxiety, fear, or aggression. The body tries to occupy itself with something at a time when it is covered by anxiety.
Symptoms of developing obsessive-compulsive disorder
Regardless of the cause of obsessive-compulsive disorder, symptoms develop according to the same principle, but stereotyped movements may differ, as well as obsessions and thoughts.
OCD can manifest with the following types of symptoms:
- Obsessive thoughts … They arise regardless of the desire of the person himself, but are recognized by him as his beliefs, ideas and even images. They constantly invade consciousness and repeat themselves stereotypically, dominating others. A person cannot resist such a thing. Examples of such thoughts can be individual words, phrases, poems. Sometimes their content is obscene and contradictory to the character of the person himself.
- Obsessive impulses … An irresistible desire to immediately take any action that is meaningless and sometimes shocking. For example, a person suddenly has a strong desire to swear or call someone in a public place. He cannot control this impulse, no matter how hard he tries. Often these actions are carried out by people whose upbringing does not allow them to do this, but, nevertheless, obsessions force them.
- Obsessive reflections … The person begins to think about any ridiculous situations, gives arguments and rejects them, getting stuck in this internal discussion. It can be doubts about rituals performed or not performed, when trying to resist the inner need for these actions.
- Obsessive images … A vivid presentation of violent scenes, perversions and other impressive pictures that do not at all correspond to upbringing, religious prejudices.
- Obsessive doubts … Various kinds of uncertainty about the correctness or completeness of certain actions, constantly emerging in memory and interfering with normal life. Symptoms persist even after doubts can be dispelled and the person is convinced of their groundlessness.
- Obsessive phobias … Fears that arise without a reason and are meaningless in their essence. Their nature is represented by dozens of possible variants that are observed in OCD. It can be hypochondriacal phobias, manifested in the fear of catching a terrible infection or being seriously ill.
- Pollution obsessions (misophobia) … A person is constantly wary of getting dirty, penetration of poisons, small needles or other things into the body. They are manifested by special rituals that are needed to protect oneself. Also, special attention is paid to hygiene, constant checking of cleanliness. Such people often avoid physical contact, and some are even afraid to leave the room.
To make a diagnosis of obsessive-compulsive disorder, certain conditions must be met. First, obsessive and / or compulsive symptoms must be present for at least 2 weeks. They must cause distress and disrupt human activity, and also meet the following requirements:
- Obsessive thoughts, ideas should be regarded as their own, and not external;
- There is at least one thought or action that the patient tries to resist;
- Performing an action is not satisfying;
- Thoughts or ideas are periodically stereotyped.
Important! OCD symptoms can have a significant impact on a person's life. He can isolate himself from the outside world, lose his previous connections, family, work.
Features of the treatment of obsessive-compulsive disorder
Despite the rather extensive group of symptoms that form obsessive-compulsive disorder, the disease lends itself well to correction. A timely visit to a specialist will help save valuable time and quickly prescribe the right therapy. Treatment of obsessive-compulsive disorder must begin with a detailed explanation of the person's symptoms. It should be said that this problem is by no means a sign of some kind of terrible mental illness, provided the correct therapeutic approach is used, the manifestations are eliminated.
Psychotherapeutic correction
This method is widespread among the treatment of diseases of the neurotic spectrum. With the help of words, an experienced professional will be able to establish the correct diagnosis, formulate the main causes of the disorder and develop leverage to get rid of this disease.
One of the most important aspects of psychotherapeutic care is the establishment of a relationship of trust between the patient and the doctor. Each of them is obliged to responsibly treat the sessions and conversations, which are conducted with one common goal - to help the patient recover from OCD. In order for the therapy to be effective and fully contribute to the improvement of a person's condition, it is necessary to fully comply with all the recommendations and prescriptions of the doctor.
In the arsenal of psychotherapeutic tools, there are a lot of individual and group methods that are suitable for correcting obsessive states and help to form a new model of responding to emerging obsessive thoughts, images and other elements.
The most common and effective psychotherapeutic methods are successfully used in practice, both in conjunction with pharmacotherapy, and separately from it. Psychological support is also important during the rehabilitation period with a preventive purpose. Most often, these patients are treated by specialists in cognitive-behavioral therapy.
This method has a sufficient number of programs developed specifically for this disorder:
- Exposure prevention reactions … It is a relatively new section of psychotherapeutic assistance, which has established schemes and scales for assessing the patient's condition. Based on the mutual preparation of an individual plan for responding to the symptoms of obsessive-cognitive disorder. The sheer number of tools for diagnosing disease symptoms allows us to compile a specific list of the signs of OCD that bother a person. It is used in exposure psychotherapy. During a conversation, starting with the smallest manifestations, the patient is exposed to fears, whether it be a virus infection or an unplugged iron. With the help of a doctor, he tries to form a protective reaction and prevent the manifestation of the symptom. In addition, the specificity of this type of therapy is based on the repetition of these psychological exercises at home without the participation of a specialist. If the patient learns to independently resist the manifestation of such symptoms, such treatment can be called successful.
- Imaginary representations … This method is used to treat OCD with an anxiety component present. Its purpose is to reduce the intensity of the reaction to unwanted obsessive thoughts. For the patient, short stories are selected, recorded in audio format, which contain elements of the obsessive thoughts of a particular person. By squandering them over and over again, the doctor provokes the patient to experience the situations that he is afraid of. After several such courses, a person gets used to hearing them and presenting unwanted pictures, trying not to react so sharply to the situation outside the psychotherapist's office. In other words, every time his imagination tries to paint a picture of fear, and he learns to properly defend himself against its influence.
- Conscious behavioral psychotherapy … This type of treatment is based on a logical explanation of the symptoms that appear. The goal of a psychotherapist is to teach a person to perceive manifestations of obsessive-compulsive disorder as separate sensations. The patient needs to block out painful thoughts that cause discomfort, fear, and even inconvenience. Subjective perception of your own experiences will help to deactualize your symptoms and reduce their intensity. Roughly speaking, the whole spectrum of discomfort that develops with OCD is not the main problem. Most of all, irritability is caused by unsuccessful attempts to cope with the disease. It is they who create the main pathogenic mechanism of OCD. If the obsessions are correctly perceived, the symptoms will soon lose their strength.
In addition to cognitive behavioral therapy, there are several other methods that are used for this disease. Hypno-suggestive therapy is an effective means of influencing a person's perception of their own feelings. It ensures the correct setting of priority feelings and can significantly reduce the manifestations of obsessive-compulsive disorder.
A person is immersed in a state of hypnosis, focusing on the voice of a specialist who is engaged in this practice. With the help of suggestion, it is possible to lay in the conscious and unconscious sphere of the person's mental activity the correct scheme for responding to obsessions. After a course of such therapy, the patient always notices significant improvements, reacts much more easily to provoking factors and is able to be critical of internal urges to any convulsive actions.
In some cases, a significant effect can be achieved with the help of group psychotherapy methods. Usually, the appearance of symptoms, obsessive thoughts that constantly bother a person, causes significant discomfort, and it is not at all easy for some to share this. Finding that others have similar problems makes it much easier to deal with your own.
Drug treatment
The main treatment for OCD at the moment is pharmacotherapy. The selection of doses and the selection of an individual drug is carried out by a psychiatrist, taking into account the characteristics of each individual. It also takes into account the presence of comorbidities, gender, age and course of obsessive-compulsive disorder.
Depending on the framework within which obsessional compulsion syndrome is considered, different therapeutic approaches are used. The prevailing symptoms, the presence of concomitant depressive manifestations are also taken into account.
The following groups of drugs are used to treat OCD:
- Antidepressants … Usually, medications with serotonergic action are used. With their help, you can eliminate the accompanying depressive symptoms and improve overall well-being.
- Anxiolytics (tranquilizers) … They are used for fear, anxiety, anxiety conditions, which are often observed in the clinical picture of OCD. Preference is given to drugs of the diazepine series.
- Antipsychotics … In some cases, it is advisable to involve representatives of this group of drugs. Ritualized compulsions respond well to treatment with atypical antipsychotics.
If obsessive symptoms occur within schizophrenia, typical antipsychotics should be used. High doses of serotonergic antidepressants can effectively relieve obsessive-phobic manifestations.
In any case, only a qualified doctor knows how to treat obsessive-compulsive disorder correctly, so self-medication will not only not bring the expected results, but can also aggravate the situation. How to treat obsessive-compulsive disorder - watch the video:
Treating OCD has been challenging for a long time. With the advent of new psychotherapeutic methods, the development of pharmacological drugs that allow a softer and more accurate effect on certain symptoms, the treatment of this disease today can be called quite successful. The key to the effective impact of absolutely all means of the medical arsenal is a trusting contact between the patient and the psychotherapist or psychiatrist. Only by joining forces can such a problem be overcome.
