Broken record: what is obsessive-compulsive disorder. Socio-public and psychological factors. Total correctness and organization

Living with obsessive-compulsive disorder (OCD) is not easy. With this disease, there intrusive thoughts causing great anxiety. To get rid of anxiety, a person suffering from OCD is often forced to certain rituals.

In the classification of mental illness, OCD is classified as an anxiety disorder, and anxiety is familiar to almost everyone. But this does not mean that any healthy person understands what an OCD sufferer has to experience. Headaches are also familiar to everyone, but this does not mean that we all know what migraine sufferers feel.

Symptoms of OCD can interfere with a person's ability to work, live, and relate to others.

“The brain is designed in such a way that it always warns us of the dangers that threaten survival. But in OCD patients, this brain system does not work properly. As a result, they are often overwhelmed by a tsunami of unpleasant experiences and are unable to focus on anything else,” explains psychologist Stephen Philipson, clinical director of the Center for Cognitive Behavioral Therapy in New York.

OCD is not associated with any one particular fear. Some obsessions are well known - for example, patients may constantly wash their hands or check to see if the stove is turned on. But OCD can also manifest as hoarding, hypochondria, or the fear of harming someone. A fairly common type of OCD, in which patients are tormented by a paralyzing fear about their sexual orientation.

As with any other mental illness, only professional doctor can make a diagnosis. But there are still a few symptoms that experts say can indicate the presence of OCD.

1. They bargain with themselves.

OCD sufferers often believe that if they check the stove again or search the Internet for symptoms of the illness they claim to be suffering from, they will finally be able to calm down. But OCD is often deceptive.

“Biochemical associations arise in the brain with the object of fear. The repetition of obsessive rituals further convinces the brain that the danger is indeed real, and thus completes the vicious circle.

2. They feel an obsessive need to perform certain rituals.

Would you agree to stop doing the usual rituals (for example, not checking 20 times a day if Entrance door) if you were paid $10 or $100 or some other significant amount for you? If your anxiety is so easily bribed, then most likely you are just more afraid of robbers than usual, but you do not have OCD.

For a person suffering from this disorder, the performance of rituals seems to be a matter of life and death, and survival can hardly be valued in money.

3. It is very difficult to convince them that their fears are unfounded.

OCD sufferers are familiar with the verbal construction “Yes, but...” (“Yes, the last three tests showed that I do not have this or that disease, but how do I know that the samples were not mixed up in the laboratory?”).

Since it is rarely possible to be absolutely sure of something, no amount of belief helps the patient overcome these thoughts, and he continues to be tormented by anxiety.

4. They usually remember when the symptoms started.

“Not everyone with OCD can tell exactly when the disorder first appeared, but most do remember,” Philipson says. At first it just appears causeless anxiety, which then takes shape in a more specific fear - for example, that you, while preparing dinner, will suddenly stab someone with a knife. For most people, these experiences pass without consequences. But OCD sufferers seem to be falling into an abyss.

“At such moments, panic makes an alliance with a certain idea. And it’s not easy to end it, like any unhappy marriage,” Philipson says.

5. They are consumed by anxiety.

Almost all the fears that torment OCD sufferers have some basis. Fires do happen, and hands are really full of bacteria. It's all about the intensity of the fear.

If you are able to live a normal life despite the constant uncertainty associated with these risk factors, you most likely do not have OCD (or a very mild case). Problems begin when anxiety completely consumes you, preventing you from functioning normally.

If the patient is afraid of pollution, the first exercise for him will be to touch the doorknob and not wash his hands afterwards.

Fortunately, OCD can be adjusted. Important role Medications play a role in therapy, including some types of antidepressants, but psychotherapy – especially cognitive behavioral therapy (CBT) – is equally effective.

Within the framework of the CPT there is effective method OCD treatment- the so-called exposure with the prevention of reactions. In the course of treatment, the patient, under the supervision of a therapist, is specially placed in situations that cause all greater fear, while he needs to resist the desire to perform the usual ritual.

For example, if the patient is afraid of pollution and constantly washes his hands, the first exercise for him will be to touch the doorknob and not wash his hands after that. In the following exercises, the perceived danger is increased - for example, you will need to touch the handrail on the bus, then the faucet in the public toilet, and so on. As a result, fear gradually begins to subside.

The love of order and cleanliness is part of the life of most people. But sometimes these habits cross the fine line that separates the normal state of the psyche from its pathology. Such people suffer from Obsessive Compulsive Disorder or OCD for short. This pathology is also called obsessive-compulsive disorder-this is mental illness. What are the causes of this pathology? What methods of treatment are offered by doctors, we will consider further in the article?

OKR: definition of the term

Obsessive-compulsive disorder (compulsive disorder) refers to a symptomatic group, the name of which comes from two Latin words: obsession and compulsio. The first word is translated from Latin as an environment or blocking, and the second as “I compel”.

Obsessive desires, which are a type of obsessive states (obsessions), are characterized by the appearance of irresistible obsessive drives that appear in the patient's brain, regardless of the emotions, will and intellect of the sick person. The patient himself often perceives the essence of his obsessive drives as morally or religiously unacceptable.

Compulsions (what distinguishes them from impulsive drives) never become a reality, they never materialize. The patient himself considers his desires to be wrong, impure or contrary to his nature - and therefore it is very hard to experience. In turn, the fact of the appearance of unnatural desires provokes the emergence of obsessive feeling fear.

The term compulsions often means obsessive movements or rituals performed by a person from day to day.

Domestic psychiatrists define obsessive-compulsive states as pathological phenomena of the psyche, the essence of which is approximately as follows: certain psychopathological phenomena arise in the patient's mind, which are invariably accompanied by a sense of coercion. Obsessive states are characterized by the appearance of desires and aspirations that contradict will and reason, which a person is clearly aware of, but does not accept and does not want to realize.

The above obsessive desires and thoughts are deeply alien to the psyche of a particular person, but he himself is not able to neutralize them. This situation provokes the occurrence of depression in the patient, unbearable anxiety, an increase in emotionality contrary to any logic.

The complex of symptoms listed above does not affect the patient's intellect, does not reduce the productivity of his thinking, in general, being rather defects of the subconscious than consciousness. However, the appearance of such symptoms significantly reduces a person's working capacity and negatively affects the effectiveness of his mental activity.

All the time while a person is subject to the considered mental pathology, a stably critical assessment is held to emerging obsessive thoughts and ideas.

What are obsessive states?

• Phobias (intellectual-affective);
• Compulsions (motor);
• Affectively indifferent (abstract).

Most of clinical cases combine a number of obsessive phenomena. Quite often, the allocation of abstract, or affectively indifferent obsessions (which include, for example, arrhythmomania), turns out to be irrelevant to the real picture of the disease. Qualitative analysis of psychogenesis neurotic state usually allows you to see the basis of pathology in depression.

Causes of obsessive-compulsive disorder

The most common causes of obsessive-compulsive disorder are genetically determined features of the psychoasthenic personality structure, as well as severe problems in the family circle.

The simplest obsessive-compulsive states, along with psychogenic causes, have cryptogenic causes, hiding the reason for the onset of pathology. Most often, obsessions affect people with a psychoasthenic mindset. In such cases, obsessive fears are most important.

Other factors in the onset of obsessive-compulsive disorders:

• Neurosis-like states in sluggish schizophrenia.
• Epilepsy.
• endogenous depression.
• The period of recovery after somatic diseases and craniocerebral injuries.
• Nosophobic or hypochondriacal-phobic syndrome.

Most scientists of this phenomenon believe that the genesis of OCD is a kind of sad play in which leading role either mental trauma or stimuli play conditioned reflexes, coinciding with causing fear factors, and therefore become pathogenic. Summarizing the above, it is worth noting that obsessive states in general provoke situations of contradiction between environment and people's ideas about it. However, quite often obsessions affect psychoasthenic personalities or people with an extremely contradictory character.

Today, all of the above obsessive states are integrated into International Classification Diseases under the name "OCD (obsessive compulsive syndrome)".

OCD is repeatedly diagnosed and has high percent morbidity, therefore, if symptoms occur, it is urgent to involve psychiatrists in the treatment of pathology.

To date, experts have significantly expanded their understanding of the etiology of the disease. The most important factor is the direction of therapy of obsessive-compulsive disorders towards serotonergic neurotransmission. This discovery is a revolution in the treatment of the disease in question, it makes it possible to cure millions of patients around the world.

How is it possible to replenish the deficiency of serotonin in the body? Tryptophan, an amino acid found only in food, can help in this matter. Once in the body, tryptophan is converted into serotonin. Data transformation process chemical elements causes a state of mental relaxation in a person, turning into a feeling of emotional stability and well-being. Further transformation of serotonin converts it into, which helps to normalize The biological clock organism.

The discovery of intense serotonin reuptake inhibition (SSRI) is the first step towards the most effective therapy obsessive-compulsive disorders. This fact was the first step in the revolutionary transformations in the course of clinical research, during which scientists noted the effectiveness of selective inhibitors.

History of OCD Therapy

Obsessive conditions and their treatment have been of interest to scientists since the 17th century. The first mention of studies of this pathology dates back to 1617. The year 1621 is marked by the work of E. Barton, in which the researcher described obsessive fear dying. In 1829, the works of F. Pinel were published, which were important for further breakthroughs in the study of the topic. The term "obsessive ideas" was introduced into Russian psychiatry by I. Balinsky. In 1871, Westphal first voiced the name "agoraphobia", meaning the fear of being in human society.

M. Legrand de Sol in 1875, examining the dynamics of the development of the incidence of obsessive-compulsive disorders, combined with insanity such as "fluctuations plus sensory delirium", determined that the course of this kind of disease is aggravated: symptomatic picture the substitution of obsessive hesitation by the fear of touching surrounding things and furnishings is gradually supplemented by movement rituals, which then accompany patients throughout their lives.

OCD Symptoms

The main symptoms of a disease called "obsessive-compulsive disorder" are constantly appearing thoughts and aspirations (obsession), as well as motor rituals (compulsion), which the ill person cannot neutralize on their own.

The core of any clinical picture of OCD is a compulsion syndrome, which is a combination of fears, doubts, feelings and memories that arise regardless of the patient's desire and contradict his picture of the world. The patient is aware of the incorrectness of the thoughts and feelings that have arisen, and is extremely critical of them. Realizing that the ideas, feelings and desires that arise in their brain are illogical and unnatural, the sick are absolutely powerless in trying to overcome them. The whole complex of obsessive ideas and aspirations is perceived by a person as something that comes from within, but contradicts his very personality.

Quite often, obsessions in patients are converted into compulsory execution some rituals to ease anxiety states(for example, unreasonable frequent washing hands or change of underwear to prevent an almost mythical infection most dangerous disease, or wearing a gauze bandage for the same reason). By attempting to drive away obsessive urges, the patient introduces himself into a state of internal contradiction, which significantly increases the level of anxiety. That is why the above pathological conditions included in the group of neurotic disorders.

The incidence of OCD among the population of developed countries is extremely high. People affected by obsessive-compulsive disorder, according to statistics, make up about 1% of patients in psychiatric hospitals. Moreover, this pathology is equally characteristic of both men and women of all ages.

This disorder is characterized by the inexplicable logical occurrence of painful thoughts that the patient passes off as images and ideas produced by his consciousness. These kinds of thoughts enter the mind of a person by force, but he tries his best to resist them.

It is the feeling of internal compulsive conviction, combined with a burning desire to counteract it, that speaks of the development of OCD. Sometimes obsessive thoughts take the form of single lines or phrases. For the patient, they have a connotation of indecency or even be unnatural or blasphemous.

What exactly are the images caused by obsessive ideas and aspirations? Usually these are incredibly lively, voluminous scenes of violence or sexual perversions that cause fear or disgust in the patient.

Obsessional impulses are thoughts that drive a person to do potentially dangerous, shameful, or destructive actions. For example, jumping onto the roadway in front of a moving car or loudly shouting an obscene phrase in a polite society.

Obsessional rituals are compulsively repetitive actions that the patient performs to drown out impulses of anxiety and fear. For example, it can be repeated washing of hands (up to several dozen times), repetition of certain phrases or words, as well as other actions that make no sense. A certain percentage of those who become ill are subject to persistent obsessive thoughts about imminent infection with a serious illness.

Quite often, obsessional rituals involve constantly laying out the wardrobe in a complex system. Also, patients may experience an irresistible desire to repeat ritual actions a certain number of times. If this fails, the cycle repeats from the beginning.

The patients themselves, recognizing the illogicality of their actions, suffer greatly from this and try with all their might to hide their habits. Some even consider their rituals to be symptoms of delusion. That is why obsessive thoughts and rituals make it unbearable everyday life sick.

Obsessive thoughts are something similar to the patient's endless dialogue with himself. Its theme may be the simplest everyday action, but deliberation drags on for a long time. Subject to obsessive thoughts, people endlessly weigh the pros and cons, unable to make a decision. It's about about actions that may be incorrectly performed (for example, turning on the microwave or computer), or not completed, and may also pose a danger to the sick person or other people.

Obsessive thoughts and compulsive rituals can become stronger in an environment where the patient is surrounded by objects and phenomena that provoke such thoughts. For example, in the kitchen, where there are forks and knives, thoughts and harm to yourself or others may be amplified. In this case, the symptoms of OCD are similar to those of a phobic anxiety disorder. In general, anxiety plays a significant role in clinical picture OCD: Some thoughts and actions make it muted, others make it grow.

Obsessive, or obsessive states can be figurative-sensory (with the development of a painful effect) or be affectively neutral in nature. Sensual obsessive states commonly include compulsive aversion, remembering, imagining, hesitating and acting, unnatural cravings, and the fear of doing simple, mundane acts.

• Obsessive doubts are the infirmity of the patient in his own actions and decisions, not based on reason and logic. At home, it may be concerns about closed door, a barred window, an iron or stove turned off, a closed tap, and so on. At work, obsession can force a person to double-check the correctness of writing reports and other documents, addresses and numbers ten times. It is important that a lot of checks do not make doubts disappear, but only add anxiety to a person.
• Obsessive memories are pictures of terrible or shameful events that have happened to him all the time, which a person tries to forget, but cannot in any way.
• Obsessions are "inward impulses" to commit dangerous or violent acts. The sufferers themselves are aware of the wrongness of these impulses, but cannot free themselves from them. Obsessions can take the form of a desire to brutally kill a partner or child, push a friend under a car, and so on.
• Obsessional representations can take many forms. Sometimes sick people see very clearly the result of the realization of their obsessive desires (they see in the colors of the cruelty that they dreamed about; moreover, they see them already perfect). Sometimes OCD sufferers substitute reality with invented absurd situations (the person is sure that his dead relative buried while still alive).

OCD Therapy

Complete relief from obsessive-compulsive disorder symptoms medical practice observed extremely rarely. It seems more realistic to stabilize the symptoms and alleviate the patient's condition by improving the quality of his life.

In the process of diagnosing OCD, it is extremely difficult to distinguish between Tourette syndrome or schizophrenia. That is why the diagnosis of OCD should be made by a qualified psychiatrist.

The first thing to do to stabilize the condition of an OCD patient is to relieve him of all possible stresses. Further applied drug therapy aimed at serotonergic neurotransmission.

Medication for obsessive compulsive disorder is the most reliable way to reduce OCD symptoms and improve the patient's life. Therefore, at the slightest suspicion, it is necessary to visit a psychiatrist, and refrain from self-treatment - this can cause even more harm to health.

Subject to obsessive ideas and thoughts, people often involve family members and relatives in their rituals. The latter in this case must be firm, without losing sympathy.

What medications do people with obsessive-compulsive disorder take?

• Serotonergic antidepressants;
• Small antipsychotics;
• Anxiolytics;
• MAO inhibitors;
• beta blockers;
• triazole benzodiazepines.

The basis of the treatment of the disorder in question is atypical antipsychotics(olanzapine, resperidone, cretiapine) together with antidepressants (tianeptine, moclobemide) and benzodiazepine derivatives (clonazepam, alprazolam).

The main thing in successful therapy of the pathology under consideration is the establishment of contact with the patient and his firm belief in the possibility of recovery. It is also important that a person overcome their prejudice against psychotropic drugs. In this case, all moral support and faith in a successful outcome of treatment are required from the relatives of the sick person.

Videos on obsessive compulsive disorder

Obsessive-compulsive disorder is a syndrome whose causes rarely lie on the surface. It is characterized by the presence of obsessive thoughts (obsessions), to which a person responds with certain actions (compulsions).

Obsession (lat. obsessio - "siege") - a thought or desire that constantly pops up in the mind. This thought is difficult to control or get rid of, and it causes a lot of stress.

Common obsessions (obsessions) with OCD are:

• fear of infection (from dirt, viruses, microbes, biological fluids, excreta or chemicals);
• fears about possible dangers (external, for example, the fear of being robbed and internal, for example, the fear of losing control and harming someone close to you);
• excessive concern for precision, order, or symmetry;
• sexual thoughts or images.

Almost everyone has experienced these intrusive thoughts. However, for a person with OCD, the level of anxiety from such thoughts goes through the roof. And to avoid too strong anxiety, a person is often forced to resort to some "protective" actions - compulsions (Latin compello - "to force").

Compulsions in OCD are somewhat ritualistic. These are actions that a person repeats over and over again in response to an obsession in order to reduce the risk of harm. The compulsion can be physical (like repeatedly checking to see if the door is locked) or mental (like saying a certain phrase in your mind). For example, it can be the pronunciation of a special phrase to "protect relatives from death" (this is called "neutralization").

Common in OCD are compulsions in the form of endless checks (for example, gas taps), mental rituals (special words or prayers repeated in in due course), check.

The most common is the fear of germs in combination with compulsive washing and cleaning. Because of the fear of getting infected, people go to great lengths: do not touch the door handles, toilet seats, avoid shaking hands. What is characteristic of the syndrome OCD man he stops washing his hands not when they are clean, but when he finally feels “released” or “as it should be”.

Avoidance behavior - central part OKR, it includes:

1. desire to avoid situations evocative anxiety;
2. the need to perform coercive actions.

Obsessive-compulsive disorder can cause many problems, and is usually accompanied by shame, guilt, and depression. The disease creates chaos in human relationships and affects performance. According to the WHO, OCD is one of the top ten diseases leading to disability. People with OCD do not seek professional help because they are embarrassed, afraid or do not know that their condition is treatable, incl. non-drug.

What Causes OCD

Despite many studies on OCD, it is still not clear what is the main cause of the disorder. This condition may be responsible for physiological factors(chemical imbalance in nerve cells), as well as psychological ones. Let's consider them in detail.

Genetics

Research has shown that OCD can be passed down through the generations to close relatives, in the form of a greater tendency to develop painful obsessions.

A study of the problem in adult twins has shown that the disorder is moderately hereditary, but no gene has been identified as causing the condition. However special attention deserve genes that could play a role in the development of OCD: hSERT and SLC1A1.

The task of the hSERT gene is to collect "waste" serotonin in nerve fibers. Recall that the neurotransmitter serotonin is necessary for the transmission of impulses in neurons. There are studies that support unusual hSERT mutations in some patients with obsessive-compulsive disorder. As a result of these mutations, the gene starts to work too fast, collecting all the serotonin before the next nerve "hears" the signal.

SLC1A1 is another gene that may be involved in OCD. This gene is similar to hSERT, but its job is to transport another neurotransmitter, glutamate.

autoimmune reaction

Some cases of rapid onset of OCD in children can be a consequence of Group A streptococcal infection, which causes inflammation and dysfunction of the basal ganglia. These cases are grouped into clinical conditions called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection).

Another study suggested that the episodic occurrence of OCD is not due to streptococcal infection, but rather to prophylactic antibiotics given to treat infections. OCD conditions may also be associated with immunological reactions to other pathogens.

neurological problems

Brain imaging techniques have allowed researchers to study activity specific areas brain. The activity of some parts of the brain in OCD sufferers has been shown to be unusually active. Involved in OCD symptoms are:

• orbitofrontal cortex;
• anterior cingulate gyrus;
• striatum;
• thalamus;
• caudate nucleus;
• basal ganglia.

The circuit that includes the above areas regulates primitive behavioral aspects such as aggression, sexuality and bodily secretions. Activation of the circuit triggers the appropriate behavior, such as thoroughly washing hands after contact with something unpleasant. Normally, after the necessary act, the desire decreases, that is, the person stops washing his hands and moves on to another activity.

However, in patients diagnosed with OCD, the brain has some difficulty turning off and ignoring the urges from the circuit, which creates communication problems in these areas of the brain. The obsessions and compulsions continue, leading to the repetition of certain behaviors.

The nature of this problem is not yet clear, but it is probably associated with a violation of the biochemistry of the brain, which we talked about earlier (decreased activity of serotonin and glutamate).

Causes of OCD in terms of behavioral psychology

According to one of the fundamental laws of behavioral psychology, the repetition of a particular behavioral act makes it easier to reproduce it in the future.

People with OCD do nothing but try to avoid things that trigger fear, "fight" thoughts, or perform "rituals" to reduce anxiety. Such actions temporarily reduce fear, but paradoxically, according to the law voiced above, increase the likelihood of occurrence of obsessive behavior in the future.

It turns out that avoidance is the cause of obsessive-compulsive disorder. Avoiding the object of fear, instead of enduring it, can lead to sad consequences.

The most susceptible to the occurrence of pathology are people who are in stressful condition: start new job, end relationships, suffer from overwork. For example, a person who has always calmly used public latrines, suddenly, in a state of stress, begins to “twist” himself, saying that the toilet seat is dirty and there is a danger of catching the disease ... Further, by association, fear can spread to other similar objects: public sinks, showers, etc.

If a person avoids public toilets or begins to perform complex cleansing rituals (cleaning the seat, door handles, followed by a thorough hand washing procedure) instead of coping with fear, then this may result in the development of a real phobia.

Cognitive Causes of OCD

The behavioral theory described above explains the occurrence of pathology by "wrong" behavior, while the cognitive theory explains the occurrence of OCD by the inability to correctly interpret one's thoughts.

Most people have unwanted or intrusive thoughts several times a day, but all those suffering from the disorder greatly exaggerate the importance of these thoughts.

For example, in the background of fatigue, a woman who is raising a child may periodically have thoughts about harming her baby. The majority, of course, dismisses such obsessions, ignores them. People with OCD exaggerate the importance of thoughts and react to them as a threat: “What if I really am capable of this ?!”

A woman begins to think that she can become a threat to the child, and this causes her anxiety and other negative emotions, such as disgust, guilt and shame.

Fear of one's own thoughts can lead to attempts to neutralize negative feelings arising from obsessions, such as avoiding thought-provoking situations or engaging in "rituals" of excessive self-cleansing or prayer.

As we noted earlier, repetitive avoidance behaviors can get stuck, tend to repeat themselves. It turns out that the cause of obsessive-compulsive disorder is the interpretation of obsessive thoughts as catastrophic and true.

Researchers suggest that OCD sufferers place exaggerated importance on thoughts due to false beliefs acquired during childhood. Among them:

• exaggerated responsibility: the belief that a person is solely responsible for the safety of others or the harm caused to them;
• belief in the materiality of thoughts: the belief that negative thoughts can "come true" or affect other people and must be controlled;
• exaggerated sense of danger: a tendency to overestimate the likelihood of danger;
• exaggerated perfectionism: the belief that everything should be perfect and mistakes are unacceptable.

Environment, distress

Stress and psychological trauma can trigger the process of OCD in people who have a tendency to develop given state. Studies of adult twins have shown that obsessive-compulsive neurosis in 53-73% of cases arose due to the adverse effects of the environment.

Statistics confirm the fact that the majority of people with OCD symptoms experienced a stressful or traumatic life event just before the onset of the disease. Such events may also cause exacerbation of already existing manifestations of the disorder. Here is a list of the most traumatic environmental factors:

• mistreatment and violence;
• change of housing;
• disease;
• death of a family member or friend;
• changes or problems at school or at work;
• relationship problems.

What contributes to the progression of OCD

For effective treatment of obsessive-compulsive disorder, knowing the causes of the pathology is not so important. It is much more important to understand the mechanisms that support OCD. That is the key to overcoming the problem.

Avoidance and compulsive rituals

Obsessive-compulsive disorder is maintained in a vicious circle: obsession, anxiety, and response to anxiety.

Whenever a person avoids a situation or action, their behavior is “reinforced” in the form of a corresponding neural circuit in the brain. The next time in a similar situation, he will act in a similar way, which means he will again miss the chance to reduce the intensity of his neurosis.

Compulsions are also fixed. The person feels less anxious after checking to see if the lights are off. Therefore, it will continue to do the same in the future.

Avoidance and impulsive actions initially "work": the patient thinks that he has prevented harm, and this stops the feeling of anxiety. But in the long run, they will create even more anxiety and fear because they feed the obsession.

Exaggeration of one's abilities and "magical" thinking

A person with OCD overexaggerates their abilities and ability to influence the world. He believes in his power to cause or prevent bad events with his mind. "Magical" thinking involves the belief that the performance of certain special actions, rituals, will prevent something undesirable (similar to superstition).

This allows a person to feel the illusion of comfort, as if he has more influence on events and control over what is happening. As a rule, the patient, wanting to feel calmer, performs rituals more and more often, which leads to the progression of neurosis.

Over-concentration on thoughts

This refers to the degree of importance a person attaches to intrusive thoughts or images. It is important to understand here that obsessive thoughts and doubts - often absurd and opposite to what a person wants or does - appear in everyone! In the 1970s, researchers conducted experiments in which they asked people with and without OCD to list their obsessive thoughts. No difference was found between the thoughts that were recorded by both groups of subjects - with and without the disease.

The actual content of obsessive thoughts comes from the person's values: the things that are most important to him. Thoughts represent the most deepest fears personality. So, for example, any mother always worries about the health of the child, because he is the most great value in life, and she would be in despair if something bad happened to him. This is why intrusive thoughts about harming the baby are so common among mothers.

The difference is that people with obsessive-compulsive disorder have more painful thoughts than others. But this is due to the too great importance that patients attribute to these thoughts. It's no secret: the more attention you pay to your obsessive thoughts, the worse they seem. Healthy people may simply ignore obsessions and not focus their attention on them.

Overestimation of danger and intolerance to uncertainty

Another important aspect is overestimating the danger of the situation and underestimating one's ability to cope with it. Many OCD patients feel they need to know for sure that bad things won't happen. For them, OCD is a kind of absolute insurance policy. They think that if they try hard and do more rituals and better insurance, they will get more certainty. In fact, trying harder only leads to more doubt and more uncertainty.

perfectionism

Some varieties of OCD involve the belief that there is always a perfect solution, that everything should be done perfectly, and that the slightest mistake will have serious consequences. This is common in people with OCD who strive for order, and is especially common in those who suffer from anorexia nervosa.

looping

As they say, fear has big eyes. There are typical ways to “wind up” yourself, to increase anxiety with your own hands:

• "Everything is terrible!" - refers to the tendency to describe something as "terrible", "nightmarish" or "the end of the world". It only makes the event seem more frightening.
• "Catastrophe!" - means expecting a catastrophe as the only possible outcome. The thought that something catastrophic is bound to happen if it is not prevented.
• Low tolerance for disappointment - when any excitement is perceived as "unbearable" or "intolerant".

In OCD, a person first involuntarily plunges himself into a state of extreme anxiety due to his obsessions, then tries to escape from them by suppressing them or performing compulsive actions. As we already know, it is this behavior that increases the frequency of occurrence of obsessions.

Treatment for OCD

Studies show that psychotherapy significantly helps 75% of patients with obsessive-compulsive disorder. There are two main ways to treat neurosis: drugs and psychotherapy. They can also be used together.

However, non-drug treatment is preferable because OCD responds well without medication. Psychotherapy does not provide side effects on the body and has a more stable effect. Medications may be recommended as a treatment if the neurosis is severe, or as a short-term measure to relieve symptoms while you are just beginning psychotherapy.

For the treatment of obsessive-compulsive disorder, cognitive behavioral therapy (CBT), short-term strategic psychotherapy, as well as is used.

Exposure - controlled confrontation with fear - is also used in the treatment of OCD.

First effective psychological method The fight against OCD was recognized as a technique of confrontation with parallel suppression of the anxious reaction. Its essence consists in a carefully dosed collision with fears and obsessive thoughts, but without the usual avoidance reaction. As a result, the patient gradually gets used to them, and fears begin to fade away.

However, not everyone feels able to go through such treatment, so the technique has been perfected with CBT, which focuses on changing the meaning of obsessive thoughts and urges (the cognitive part) as well as changing the response to the urge (behavioral part).

Obsessive Compulsive Disorder: Causes

What is OCD, how it manifests itself, who is prone to obsessive-compulsive disorder and why, what accompanies OCD. The reasons

Hello! Usually in articles I try to give useful advice, but this one will be more educational in nature, in order to generally understand what people are facing. We will analyze how the disorder most often manifests itself, who is most prone to it. This will give you some idea of ​​what to pay attention to and where to start moving towards recovery.

What is OCD (obsession and compulsion)

So, what is obsessive compulsive disorder, and in particular, obsessive-compulsive disorder (OCD)?

Obsession – obsession, recurring annoying, unwanted thought. People are disturbed by repetitive thoughts and thought-images. For example, about possible mistakes, omissions, inappropriate behavior, the possibility of infection, loss of control, etc.

Compulsion- this is a compulsive behavior that, as a person seems to be forced to do, in order to prevent something bad, that is, actions aimed at avoiding a perceived danger.

Obsessive-compulsive disorder was not so long ago considered a disease, but now in the international medical classification(ICD-10) OCD is classified as a neurotic disorder, which is successfully and permanently amenable to getting rid of modern psychotherapeutic methods, in particular, CBT (cognitive behavioral therapy), founded by the famous psychotherapist Aaron Beck (although, in my opinion and experience, this method lacks some important points).

This is a very viscous, tenacious and heavy state that is able to absorb almost all the time, filling it with meaningless actions and repetitive thoughts and images. Against this background, people begin to experience difficulties in communication, in everyday affairs, study and work.

Obsessive-compulsive disorder is divided into two forms:

1. obsessions when a person has only obsessive thoughts and images, whether they are contrasting (single) or numerous thoughts replacing each other for various reasons that he is afraid of, trying to get rid of and distract from them.
2. Obsessions-compulsions when there are obsessive thoughts and actions (rituals). If a person is unable to control his anxious thoughts and feelings, he can try to do something, apply some actions to extinguish anxiety and get rid of annoying thoughts and fears.

Over time, these actions themselves become obsessive and seem to stick to the human psyche, then an overwhelming feeling arises to continue performing rituals, and in the future, even if a person decides not to do them, it simply does not work out.

Compulsive disorder is compulsive behavior.

Most often, rituals are associated with rechecking, washing, cleaning, counting, symmetry, hoarding, and, at times, the need to confess.

Such actions include, for example, counting windows, turning lights off and on, constantly checking doors, stoves, arranging things in a specific order, frequently washing hands (apartments), and so on.

There are also many who use mental rituals associated with the pronunciation of certain words, self-persuasion, or building images according to a specific scheme. People do such rituals because it seems to them that if everything is done exactly (as it should be), then terrible thoughts will let them go, and in the first times of application, it really helps them.

As I wrote earlier, the main cause of obsessive-compulsive disorder is the harmful beliefs of people, which are often acquired in childhood, and then everything is fixed by emotional addiction.

Such beliefs and beliefs primarily include:

The thought is material - when unwanted thoughts come to mind, there is a fear that they will come true, for example, "what if I harm someone if I think about it."

The perfectionist belief that everything has to be perfect, you can't make mistakes.

Suspiciousness - belief in amulets and evil eye, a tendency to exaggerate (catastrophize) any more or less possible danger.

Hyper-responsibility (I have to control everything) - when a person believes that he is responsible not only for himself, but also for the appearance of thoughts and images in his head, as well as for the actions of other people.

Beliefs associated with an internal assessment of any phenomena and situations: “good - bad”, “right - wrong” and others.

Manifestations of obsessive-compulsive disorder.

So, let's look at all the most common manifestations of OCD in life.

1.Constant hand washing

Obsessive thoughts and desire to wash hands (bathroom, apartment) often (for a long time), use protective hygiene products everywhere, wear gloves for fear of infection (pollution).

Real example. One woman in her childhood was frightened by an anxious mother out of good intention - to warn her daughter - with worms. As a result, fear stuck in the child's psyche so much that, having matured, the woman learned everything possible about worms: from the stages of reproduction, how and where you can catch it, to the symptoms of infection. She tried to protect herself from slightest possibility get infected. However, knowledge did not help her to pick up the infection and, on the contrary, the fear escalated and grew into a constant and disturbing suspicion.

Note that the risk of infection in modern life with frequent examinations, hygiene and good conditions life is small, however, it is this fear as a risk to life, and not other possible threats, even more likely, that has become constant and main for a woman.

This may also include an obsession with cleaning around the house, where fear of germs or a disturbing feeling of “uncleanness” manifests itself.

In general, you can teach a child to be afraid of everything, even God, if you bring him up in religion and often say: "Don't do this and that, otherwise God will punish you." It often happens that children are taught to live in fear, shame and before God (life, people), and not in freedom and love for God and the whole world (universe).

3. Obsessive check of actions (control)

It is also a common manifestation of obsessive-compulsive disorder. Here, people repeatedly check whether the doors are locked, whether the stove is turned off, etc. Such repeated checks, to convince themselves that everything is in order, arise because of anxiety for the safety of oneself or loved ones.

And often a person is driven by an anxious feeling that I did something wrong, missed it, didn’t finish it and don’t control it, the thought may arise: “what if I did something terrible, but I don’t remember and don’t know how to check it.” Background (chronic) anxiety simply suppresses the will of a person.

4. Obsessive counting

Some people with obsessive-compulsive disorder count everything that catches their eye: how many times they turned off the lights, the number of steps or blue (red) cars passing by, etc. The main reasons for this behavior are superstitions (suspiciousness) associated with fear that if I don’t exactly do or count exactly a specific number of times, then something bad may happen. This also includes - an attempt to distract from some disturbing, annoying thoughts.

People "accordingly", without realizing it, pursue the main goal - to extinguish the pressing anxiety, but in their minds it seems to them that by doing the ritual they will protect themselves from any consequences. Most are aware that all this is unlikely to help them in any way, but trying not to do the ritual, the anxiety intensifies, and they again begin to count, wash their hands, turn the lights on and off, etc.

5.Total correctness and organization

The same is a common form of obsessive-compulsive disorder. People with this obsession are able to bring organization and order to perfection. For example, in the kitchen everything should be symmetrical and on the shelves, otherwise I feel internal, emotional discomfort. The same is true in any business or even eating.

In a state of severe anxiety, a person ceases to take into account the interests of others, like other negative emotions, they exacerbate a person’s egoism, therefore, close people also get it.

6. Obsessive-compulsive dissatisfaction with their appearance

Dysmorphophobia, when a person believes that he has some kind of serious external flaw(ugliness) - also refer to obsessive-compulsive disorder.

People, for example, can look for hours until they like their facial expression or some part of their body, as if their life directly depends on it, and only after liking themselves can they calm down a little.

In another case, it is the avoidance of looking in the mirror for fear of seeing one's "flaws".

7. Conviction of wrongness and feeling of incompleteness.

It happens that some people are crushed by a feeling of incompleteness, when it seems that something is not good enough or something has not been completed, in such a situation they can shift things from place to place many times until, finally, they are satisfied with the result.

And believers (although not only them) very often encounter the “wrongness” and “obscenity” of their thoughts. Something comes to their mind, in their opinion, obscene (blasphemous), and they are absolutely convinced that it is a sin to think (imagine) like that, I should not have such people. And as soon as they start thinking like that, the problem immediately grows. Others may even develop fear associated with words, such as black, devil, blood.

8. Compulsive overeating (briefly)

The most common causes of compulsive overeating are psychological factors associated with society, when a person is ashamed of his figure, experiences negative emotions, and food, often sweet, unconsciously tries to extinguish unpleasant feelings, and this works to a certain extent, but affects the appearance.

Psychological (personal) problems - depression, anxiety, boredom, dissatisfaction with some areas of your life, insecurity, constant nervousness and an inability to control one's emotions often lead to compulsive overeating.

Sincerely, Andrey Russkikh

Don't part with hand sanitizer? Is your wardrobe laid out in a closet "on the shelves" in every sense? These habits may simply be a reflection of character or beliefs, but sometimes they cross an invisible line and turn into obsessive-compulsive disorder (OCD, scientifically speaking) that affects almost 1% of Americans.

How to distinguish a habit from a medical diagnosis that requires the help of a specialist? The task is not easy, according to Professor Jeff Zymansky. But some symptoms speak openly about the problem.

Frequent hand washing

An obsessive urge to wash hands or use hand sanitizer is common among OCD sufferers, so much so that they have even been categorized as “cleaners.” main reason compulsive washing hands is the fear of bacteria, less often - the desire to protect others from their own "impurity".

When to seek help: If you can't get rid of germs even after washing your hands, you're afraid you didn't wash them thoroughly enough, or you might have caught AIDS from a supermarket cart, chances are you're one of the washers. Another clear sign- the ritual of washing: you think that you must lather and rinse your hands five times, while lathering each individual nail.

Obsession with cleaning

People with OCD and a passion for handwashing often fall into another extreme: they are obsessed with cleaning the house. The cause of this obsessive state also lies in germophobia or the feeling of being "unclean". Although cleaning relieves the fear of germs, the effect does not last long, and the need for new cleaning becomes stronger than before.

When to seek help: If you spend several hours daily cleaning your home, chances are you have obsessive-compulsive disorder. If satisfaction from cleaning occurs in 1 hour, it will be more difficult to make a diagnosis.

Obsessive Action Check

If you need to make sure that the stove is turned off and the front door is closed 3-4, or even 20 times, this is another common (about 30%) manifestation of obsessive-compulsive disorder syndrome. Like other compulsions, repeated checks arise out of fear for one's own safety or a deep sense of irresponsibility.

When to seek help: It's perfectly reasonable to double-check something important. But if compulsive checks get in the way of your life (you start being late for work, for example) or take on a ritualistic form that you can't break, you may be a victim of OCD.

Unexplained craving to count

Some people with obsessive-compulsive disorder place a great deal of importance on counting and counting everything they see: the number of stairs, the number of red cars passing by, and so on. Often the reason for counting is superstition, the fear of failure if some action is not performed a certain “magical” number of times.

When to seek help:“It all depends on the context,” Szymanski explains. Does this behavior make sense for you? You can count the steps from the door to the car, for example, out of boredom. But if you can’t get rid of the numbers in your head and continuous counting, it’s time to contact a specialist.”

Total organization

People with obsessive-compulsive disorder are able to perfect the art of organization. Things on the table should lie evenly, clearly and symmetrically. Is always.

When to seek help: If you want your desk to be clean, tidy, and organized, it may be easier for you to work, and you do it out of a completely normal need for order. People with OCD, on the other hand, may not need it, but still organize the surrounding reality, which otherwise begins to scare them.

Fear of Trouble

Everyone has anxious thoughts about a possible unpleasant incident or violence. And the more we try not to think about them, the more insistently they appear in the head, but in people with OCD, fear reaches an extreme, and the troubles that have happened cause too strong a reaction.

When to seek help: It is important to establish a boundary between periodic unpleasant thoughts and fears and excessive experiences. OCD is possible if you avoid, for example, walking in the park for fear of being robbed, or calling several times a day dear person to inquire about his safety.

Intrusive thoughts of a sexual nature

As well as thoughts of violence, obsessive-compulsive disorder often has obsessive thoughts about obscene behavior or taboo desires. OCD sufferers may unwittingly imagine that they are hitting on co-workers or strangers, or begin to doubt their sexual orientation.

When to seek help:“Most people will tell you: No, I don't want to do this at all and it doesn't reflect my inner convictions at all,” Szymanski comments. “But a person with OCD will say differently: These thoughts are disgusting, they don’t come to anyone but me, and what will they think of me now ?!” If a person's behavior changes because of these thoughts: he begins to avoid acquaintances with gay or people who appear in his fantasies - this is already an alarming sign.

Unhealthy Relationship Analysis

People with OCD are known for their obsessive tendency to analyze relationships with friends, colleagues, partners, and family members. For example, they can worry and analyze for a particularly long time whether the incorrect phrase they said became the reason for the detachment of a colleague or a misunderstanding - a reason to part with a loved one. This state can extremely increase the sense of responsibility and the complexity of perceiving unclear situations.

When to seek help: Breaking up with a loved one can “loop” in your head, which is normal, but if these thoughts increase like a snowball over time, developing into a complete undermining of self-confidence and a negative attitude towards yourself, it is worth seeking help.

Finding support

People with obsessive-compulsive disorder often try to alleviate their support from friends and loved ones. If, for example, they are afraid to goof off at a party, then they ask their friends to “rehearse” a possible situation in advance, and more than once.

When to seek help: Asking friends for help is a perfectly normal part of friendship, but if you find yourself asking the same question on a regular basis - or your friends tell you - it could be a sign of OCD. Worse than that, getting approval and support from loved ones can worsen the manifestation of this obsessive condition. It's time to turn to professionals.

Dissatisfaction with your appearance

Dysmorphophobia - the conviction that there is some kind of flaw in one's appearance, often accompanies OCD, and makes people obsessively evaluate their body parts that seem ugly to them - nose, skin, hair (by the way, unlike malnutrition, dysmorphophobes do not focus their attention on weight or diets).

When to seek help: It is quite normal not to be delighted with some part of your body. Another thing is when you spend hours at the mirror looking at and criticizing this place.