Compulsive thinking. Medications for the treatment of OCD

Living with obsessive-compulsive disorder (OCD) is not easy. With this disease, intrusive thoughts arise, causing severe 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 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, there is just an unreasonable 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. Medications play an important role in therapy, including some types of antidepressants, but psychotherapy, especially cognitive behavioral therapy (CBT), is equally effective.

Within CBT, there is an effective treatment for OCD called reaction-avoidance exposure. In the course of treatment, the patient, under the supervision of a therapist, is specifically placed in situations that cause increasing fear, while he must not succumb to 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 amplified - for example, you will need to touch the handrail on the bus, then the tap in public toilet etc. As a result, fear gradually begins to subside.

Mild evidence of obsessive-compulsive disorder may occur in up to 30% of adults and up to 15% of adolescents and children. Clinically confirmed cases account for no more than 1%.

The appearance of the first symptoms is usually attributed to the age of 10 to 30 years. Usually people aged 25-35 seek medical help.

In pathology, two components are distinguished: obsession (compulsion) and compulsion (compulsion). Obsession is associated with the occurrence of obsessive, constantly recurring emotions and thoughts. It can be provoked by coughing, sneezing, or another person touching the doorknob. A healthy person will note to himself that someone sneezed and move on. The patient is obsessed with what happened.

Obsessive thoughts fill his entire being, give rise to anxiety and fear. This happens due to the fact that some object, a person becomes important and valuable for him. The environment, however, appears too dangerous.

Compulsions are actions that a person is forced to perform to protect themselves from the moments that provoke obsessive thoughts or fears. Actions can be a response to what happened. In some cases, they are of a preventive nature, that is, they are the result of some idea, idea, fantasy.

Compulsion can be not only motor, but also mental. It consists in the constant repetition of the same phrase, for example, a conspiracy aimed at protecting a child from illness.

The obsession and compulsion of the component form an OCD attack. In principle, we can talk about the cyclic nature of pathology: the appearance of an obsessive thought leads to its filling with meaning and the emergence of fear, which, in turn, causes certain protective actions. At the end of these movements, a period of calm begins. After a while, the cycle restarts.

With predominant availability intrusive thoughts and representations speak of intellectual obsessive-compulsive disorder. The predominance of obsessive movements indicates motor pathology. Emotional disorder is associated with the presence of constant fears, turning into phobias. A mixed syndrome is said to be when obsessive movements, thoughts, or fears are detected. Despite the fact that all three components are part of the disorder, the division according to the predominance of one of them is important for the choice of treatment.

The frequency of symptom manifestation makes it possible to distinguish pathology with an attack that occurred only once, regularly occurring incidents and a constant course. In the latter case, it is impossible to single out periods of health and pathology.

The nature of obsession affects the characteristics of the disease:

1. Symmetry. All items must be arranged in a certain order. The patient checks all the time how they are placed, corrects them, rearranges them. Another type is the tendency to constantly check to see if appliances are turned off.
2. Beliefs. It can be all subjugating beliefs of a sexual or religious nature.
3. Fear. Constant fear of getting infected, getting sick leads to the appearance obsessions in the form of cleaning the room, washing hands, using a napkin when touching something.
4. Accumulation. Often there is an uncontrollable passion to accumulate something, including things that are absolutely unnecessary for a person.

Causes

There is no clear and unambiguous reason why obsessive-compulsive disorders are formed today. Allocate hypotheses, most of which seem logical and reasonable. They are combined into groups: biological, psychological and social.

Biological

One of the well-known theories is neurotransmitter. The basic idea is that in OCD there is too much uptake of serotonin in the neuron. The latter is a neurotransmitter. It is involved in the transmission of nerve impulses. As a result, the impulse cannot reach the next cell. This hypothesis is proved by the fact that taking antidepressants, the patient feels better.

Another neurotransmitter hypothesis is associated with an excess of dopamine and dependence on it. The ability to resolve the situation associated with an obsessive thought or emotion leads to “pleasure” and increased production of dopamine.

The hypothesis associated with PANDAS syndrome is based on the idea that antibodies produced in the body to fight streptococcal infection, for some reason, affect the tissues of the basal ganglia of the brain.

genetic theory associated with a mutation in the hSERT gene responsible for the transfer of serotonin.

Psychological

The nature of obsessive-compulsive disorder was considered by psychologists of various directions. So, Z. Freud associated it mainly with the unsuccessful passage of the anal stage of development. Feces at that moment seemed to be something valuable, which eventually led to a passion for accumulation, accuracy and pedantry. He connected obsession directly with the system of prohibitions, rituals and "omnipotence of thought." Compulsion, from his point of view, is associated with a return to the trauma experienced.

From the point of view of the followers of behavioral psychology, the disorder arises from fear and the desire to get rid of it. For this, repetitive actions, rituals are developed.

Cognitive psychology emphasizes mental activity and fear of imaginary meaning. It arises from a sense of hyper-responsibility, a tendency to overestimate danger, perfectionism and the belief that thoughts can be fulfilled.

Social

The hypothesis of this group connects the appearance of pathology with traumatic environmental circumstances: violence, death of loved ones, change of residence, changes at work.

Symptoms

The following symptoms indicate obsessive-compulsive disorder:

• the appearance of recurring thoughts or fears;
• monotonous actions;
• anxiety;
• high level of anxiety;
• panic attacks;
• phobias;
• appetite disorders.

Adults in some cases are aware of the groundlessness of their fears, thoughts, senselessness of actions, but they cannot do anything with themselves. The patient loses control over his thoughts and actions.

In children, the disorder is extremely rare. It usually occurs after 10 years of age. Associated with the fear of losing something. A child, afraid of losing his family, tends to constantly clarify whether his mother or father loves him. He is afraid of getting lost himself, so he holds his parents tightly by the hand. The loss of any subject at school or the fear of it makes the child double-check the contents of the satchel, wake up at night.

Obsessive-compulsive disorder can be accompanied by nightmares, tearfulness, moodiness, dejection, and decreased appetite.

Diagnostics

The diagnosis is determined by a psychiatrist. The main diagnostic methods are conversation and tests. During the conversation, the doctor identifies characteristics associated with the manifestation of significant symptoms. So, thoughts should belong to the patient, they are not the product of delusions or hallucinations, and the patient understands this. In addition to the obsessive ones, he has ideas that he can resist. Thoughts and actions are not perceived by him as something pleasant.

Testing is based on the Yale-Brown obsessive-compulsive scale. Half of its items assess how pronounced obsessions are, the other half help analyze the severity of actions. The scale is completed at the time of the interview based on the occurrence of symptoms over the past week. The level of psychological discomfort, the duration of manifestation of symptoms during the day, the impact on the patient's life, the ability to resist symptoms and exercise control over them are analyzed.

The test determines 5 different degrees of disorder - from subclinical to extremely severe.

The disease is distinguished from depressive disorders. In the presence of symptoms of schizophrenia, organic disorders, neurological syndromes, obsession is considered part of these diseases.

Treatment

Psychotherapy is the main treatment for obsessive-compulsive disorder. medicines, physiotherapy.

Psychotherapy

The disease can be treated using hypnosis, cognitive-behavioral, aversive methods of psychoanalysis.

The main goal of the cognitive-behavioral method is to help the patient in understanding the problem and resisting diseases. The patient can be placed in an artificially created stress situation, and during the session, the doctor and the patient try to cope with it. The psychotherapist comments on the fears and the meaning that the patient puts into his thoughts, stops his attention on actions, helps to change the ritual. It is important that a person learns to isolate which of his fears really make sense.

According to the researchers, the compulsive part of the syndrome lends itself better to therapy. The effect of the treatment lasts for several years. Some patients experience increased levels of anxiety during treatment. It resolves over time, but for many it is an important reason for choosing other therapies.

Hypnosis allows you to save the patient from obsessive thoughts, actions, discomfort, fears. In some cases, the use of self-hypnosis is recommended.

Within the framework of psychoanalysis, the doctor and the patient discover the causes of experiences and rituals, work out ways to get rid of them.

The aversive method is aimed at causing the patient discomfort, unpleasant associations when performing obsessive actions.

Psychotherapeutic methods are used individually and in a group. In some cases, especially when working with children, family therapy is recommended. Its purpose is to establish trust, increase the value of the individual.

Medicines

Treatment of severe obsessive-compulsive disorder is recommended with the use of drugs. They complement, but do not cancel the methods of psychotherapy. The following groups of drugs are used:

1. Tranquilizers. They reduce stress, anxiety, reduce panic. Phenazepam, Alprazolam, Clonazepam are used.
2. MAO inhibitors. Drugs in this group help to reduce depressive sensations. These include Nialamid, Fenelzin, Befol.
3. Atypical neuroleptics. Medications are effective for disorders of serotonin uptake. Assign Clozapine, Risperidone.
4. Selective serotonin reuptake inhibitors. These drugs prevent the destruction of serotonin. The neurotransmitter accumulates in receptors and has a longer effect. The group includes Fluoxetine, Nafazodone, Serenata.
5. Normotimics. Medicines are aimed at stabilizing mood. This class includes Normotim, Topiramate, lithium carbonate.

Physiotherapy

It is recommended to take various water procedures. These are warm baths with a cold compress applied to the head for 20 minutes. They are taken up to 3 times a week. Useful wiping with a towel dipped in cold water, dousing. Swimming in the sea or river is recommended.

Forecast

Obsessive-compulsive disorder is a chronic pathology. Usually, the use of any treatment stops and softens its manifestations. The disease can be cured in a mild to moderate degree, but in the future, in some emotionally difficult situations, an exacerbation is possible.

A severe disorder is difficult to treat. Likely to relapse.

Lack of treatment can lead to impaired performance, the appearance of suicidal intentions (up to 1% of patients commit suicide), some physical problems ( frequent washing hands leads to skin damage).

Prevention

Primary prevention includes preventing the occurrence of traumatic factors, including conflicts at home, at school, at work. If a we are talking about a child, it is important to avoid imposing on him thoughts about his inferiority, instilling fears, guilt.

It is recommended to include bananas, tomatoes, figs, milk, dark chocolate in the diet. These foods contain tryptophan, from which serotonin is formed. It is important to take vitamins, get enough sleep, avoid alcohol, nicotine, drugs. The rooms should have as much light as possible.

Obsessive-compulsive disorder, even in a mild degree, cannot be ignored. The condition of such a patient may worsen over time, which leads to severe disorders in the emotional sphere, the inability to adapt in society. Psychotherapeutic and drug methods allow a person to return to normal life.

It is impossible to make a diagnosis of OCD based on one or two facts. It is important to understand whether a person suffers from mental disorders or is simply frightened or upset. Unpleasant thoughts, excitement, anxiety are also inherent in absolutely healthy people.

What is Obsessive Compulsive Disorder?

Psychiatrists classify OCD as an obsessive-compulsive disorder. Healthy man able to brush aside doubts and disturbing thoughts. The one who suffers from obsessive-compulsive disorder does not have such an opportunity. Disturbing ideas torment him, forcing him to think them over and over again. Such thoughts in OCD are impossible to control or get rid of them, which causes a lot of stress. To cope with anxiety, a person has to perform certain rituals.

Thus, obsessive-compulsive disorder (OCD, obsessive-compulsive disorder, obsessive compulsive) includes two phases: obsessions - disturbing, obsessive thoughts; and compulsions - special actions that help to drive them away for a while.

In a mild form, the diagnosis of OCD almost does not cause inconvenience to a person, does not interfere with working capacity. But over time, the number of compulsions and obsessions increases, and the disease becomes chronic. And for a person diagnosed with OCD, the abundance of disturbing thoughts and the rituals that follow will make it difficult to maintain a social and personal life.

What obsessive thoughts do people diagnosed with OCD most often suffer from?

Examples of possible compulsions:

• Fear of infections. A constant desire to wash your hands or wipe with a disinfectant. Wearing gloves. Wipe surfaces that come into contact. Taking a shower many times a day.
• Painful passion for symmetry and order. The requirement that everything should be in its place, in order. Correction of even slightly asymmetric structures. strong emotional stress in violation of order, symmetry.
• Fear of harm. A person diagnosed with OCD tries not to be alone or alone with a person whom, according to the obsession, he can harm. Hides potentially dangerous objects: kitchen knives, soldering irons, hammers, axes.
• Control of possible dangers. Carrying with you protective equipment(bricks, gas cartridges) for fear of being robbed. Or checking several times gas valves, sockets where electrical appliances are connected.
• Trying to foresee everything. Constant rechecking of pockets, briefcase, bag - are all the things that you might need in place.
• superstition. A person diagnosed with OCD can cast a spell, wear happy clothes to important meetings, look in the mirror if they forgot something at home. In a single version, objects and words of luck can increase self-esteem. But if they don't work, the OCD sufferer increases the number of compulsions to pathological levels.
• Mental violations of religious doctrines. After thinking something that seems blasphemous to him, a person diagnosed with OCD spends his nights in prayer or gives the church everything to the last penny.
• Erotic thoughts which seem unacceptable. Fearing to do something indecent or rude, the patient refuses intimacy to a loved one.

It would seem that illiterate people should be so superstitious or suspicious. However, as Wikipedia assures, patients who are diagnosed with OCD in the majority have a high level of intelligence. The wiki also states: as a separate disease in psychiatry, OCD was identified in 1905, but the ancient Greeks and Romans suffered from the disease.

Did you know that little children are also diagnosed with OCD? They, too, may suffer from compulsive disorders. In their case, the fear of getting lost, the fear of being abandoned by their parents, of forgetting something important for school are more common.

Symptoms of obsessive-compulsive disorder:

The compulsive syndrome is somewhat reminiscent of a religious ritual. This response to an obsessive thought can be physical (checking gas valves or decontaminating hands) or mental (casting spells). Also possible with a diagnosis of OCD avoidance behavior - attempts to get away from an alarming situation.

Characteristic signs of OCD that should be considered when making a diagnosis:

• The patient realizes that obsessions are generated by him. He does not suffer from otherworldly voices.
• A person tries to fight back obsessive thoughts, but to no avail.
• Obsessions frighten the patient, cause feelings of guilt and shame. In serious cases, a person diagnosed with OCD refuses social activity, may lose his job and family.
• The state of "obsession" often recurs.

Such a disorder is more likely to affect people who want to control everything, or those who could not survive childhood psychological trauma. Less often, the provoking factor of OCD is physical influences, head injuries.

Some psychiatrists divide this neurosis into two subtypes:

With the diagnosis of "OFR", patients recognize the presence of thoughts of an obsessive nature. But they are sure that the rituals are not performed. This is not always true. Possible hidden compulsive behavior. Patients themselves may not be aware of the ritual: some kind of convulsive movement - shaking the head, leg, snapping fingers.

What causes OCD?

In the world, three out of 100 adults and two out of 500 children are diagnosed with obsessive-compulsive disorder.

The diagnosis of OCD requires mandatory therapy. Scientists can only talk about risk factors for the syndrome. But it is impossible to immediately identify the diagnosis of OCD and eliminate the cause, thereby alleviating the patient's condition.

What physiological factors can trigger compulsive disorder?

• Heredity - the disease can be transmitted through the generation. If one of the grandparents had a diagnosis of OCD, the risk of getting sick increases.
• neurological diseases. More often, their cause is a metabolic disorder that causes problems in the functioning of neurons.
• Consequences of infectious and autoimmune diseases, head injuries.

According to psychiatric research, a decrease in the level of serotonin, norepinephrine, or dopamine in brain tissues can also lead to the diagnosis of OCD.

Behavioral psychology assumes that any repeated action is easier to reproduce later. This law explains the reason for the progression of an OCD diagnosis and the likelihood of further manifestation of obsessive behavior.

Most susceptible to the development of neurosis are people who are in a state of stress and depression - when moving, new beginnings, loss of loved ones, overwork. Two-thirds of patients diagnosed with OCD experience some form of stress.

Other causes of the psychological nature of the disorder are more often related to childhood trauma. This upbringing was unnecessarily tough - religious, paramilitary. Or family relationships caused serious psychological trauma, which responded in adulthood with a diagnosis of OCD.

People who are impressionable and prone to exaggeration are more at risk of developing OCD.

An example would be a young mother who, amid fatigue and stress, begins to be afraid of harming her baby. This results in the diagnosis of OCD: pathological cleanliness, endless checks of devices, various prayers and spells.

Why do more people have this diagnosis and why does the disease progress?

With compulsive disorders, anxiety always occurs first.. It is replaced by an obsessive thought, then the anxiety is fixed. A person remembers an action that temporarily reduces the activity of a neurosis. But the next obsessional state will require more than one repetition of the ritual. The results will be deplorable: loss of time, existence in severe stress mode, loss social qualities personality to the point of refusing to interact with other people.

What causes an exacerbation of obsessive-compulsive disorder:

• Incorrect self-esteem and magical realism. A person suffering from OCD exaggerates their own capabilities and influence on the surrounding reality. He is sure that he can prevent any negative situation with the help of spells, prayers, magical rituals. Temporarily they give the illusion of comfort, but then they require more and more repetitions.
• perfectionism. Some types of OCD require a perfect match certain rules. Man presents ideal condition life, which must be achieved at any cost. And minor errors or asymmetries will lead to pathological consequences. Often this type of compulsive disorder goes hand in hand with anorexia nervosa.
• Attempts to take everything under control and reassessment of danger. A person suffering from obsessive-compulsive disorder feels compelled to anticipate any danger. Even the one that in reality can not be. And compulsions in this case become a kind of insurance. Sick thinks: 25 checks closed door will ensure that thieves will not enter the house. But repeated repetitions only increase the feeling of anxiety and uncertainty.

Avoiding the situation or ritual will only make OCD worse. After all, attempts not to get into a dangerous situation lead to constant thinking about how best to do it and to a feeling of one's own abnormality. Relatives are also capable of worsening the situation, forbidding rituals, mocking the sick, calling them crazy.

However, the diagnosis of OCD does not apply to mental illness - this ailment does not change personality traits. But it can ruin the life of the patient thoroughly.

Treatment for obsessive-compulsive disorder:

Obsession at home is treated if the disease has not gone too far and the diagnosis is made on time. Analyze your condition - can you cope with the problem on your own.

1. Accept the diagnosis of OCD as part of your psyche.
2. Make a list of the signs of OCD that you see in yourself.
3. Read all relevant psychological literature on the diagnosis and treatment of OCD, and make a plan to get rid of the disease.
4. Seek help from family and friends. People are biased in diagnosing, so your "worry" list OCD symptoms someone needs to check.
5. Accept the unreality of your fears. This should always be remembered when you are drawn to perform a ritual. One of simple ways get rid of anxiety - imagine what will happen if fear is realized. Will you stay alive? So what are the rituals for?
6. Support yourself with praise and even nice prizes and gifts. Encouragement will reinforce the thought: you are stronger than anxiety, able to overcome them.

Additionally, to get rid of the diagnosis of OCD, you can use breathing exercises and folk medicine. Sedative decoctions and tinctures based on motherwort, mint, peony, lemon balm, valerian will help. For OCD, you can use aroma oils such as: lavender, orange, bergamot, rose, ylang-ylang.

If you cannot cope with the OCD diagnosis on your own, you need to consult a doctor and this is necessary so as not to aggravate your situation.

Which doctor should be consulted?

With the help of a psychotherapist, psychotherapy without additional medication leads to a cure for OCD in 70 cases out of 100. If the disorder is corrected without medication, the effect will be more persistent, and side effects- none.

How to treat OCD without drugs? The following techniques will help:

• Cognitive Behavioral Therapy.
• hypnotic effect.
• EMDR therapy.
• Strategic short-term psychotherapy.

Each of these OCD treatments aims to get out of the wheel of anxiety, obsessions, and avoidance. Attention may be focused on reducing the discomfort of obsessive moments, on counteracting negative thoughts, or on changing the response to the urge to repeat the ritual. Group therapy is useful - it will make it clear that you are not the only person diagnosed with OCD in the universe and not at all crazy.

Physiotherapy - massage, swimming, relaxing baths - will help reduce anxiety.

Medications for the diagnosis of OCD are prescribed if psychotherapeutic methods do not help. These include serotonin reuptake antidepressants, atypical antipsychotics. With physiological causes of the disease, special drugs are prescribed to help cure them. They combine psychotherapy with taking medications for the diagnosis of OCD in cases where it is necessary to quickly remove an acute condition.

In order to prevent obsessive-compulsive disorder syndrome, we recommend:

1. You can include regular medical examinations.
2. Taking vitamins.
3. Maximum avoidance of stressful situations and overwork.
4. Relaxing practices - yoga, qigong, meditation.

An accurate diagnosis of OCD can only be made by specialists in the field of psychiatry.

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What is obsessive-compulsive disorder? We will analyze the causes of occurrence, diagnosis and treatment methods in the article of Dr. Bachilo E.V., a psychiatrist with an experience of 9 years.

Definition of disease. Causes of the disease

Obsessive Compulsive Disorder (OCD)- a mental disorder, which is characterized by the presence in the clinical picture of obsessive thoughts (obsessions) and obsessive actions (compulsions).

Data on the prevalence of OCD is highly conflicting. According to some reports, the prevalence varies between 1-3%. There are no exact data regarding the causes of obsessive-compulsive disorder. However, there are several groups of hypotheses of etiological factors.

Symptoms of obsessive-compulsive disorder

As noted above, the main symptoms of the disease manifest themselves in the form of obsessive thoughts and compulsive actions. These obsessions are perceived by patients as something psychologically incomprehensible, alien, irrational.

obsessive thoughts- These are painful ideas, images or attractions that arise independently of the will. They constantly come to the mind of a person in a stereotypical form, and he tries to resist them. Recurrent obsessions - unfinished, endlessly considered alternatives that are associated with an inability to make any ordinary decision necessary in Everyday life.

Compulsive actions- these are stereotypical, repetitive actions, which sometimes take on the character of rituals that perform a protective function and relieve excessive anxiety. A significant proportion of compulsions involve cleaning up contamination (compulsive handwashing in a number of cases) as well as rechecking to ensure that a potentially dangerous situation does not occur. Note that usually the basis of such behavior is the fear of danger, which is “expected” by the person himself or which he can cause to another.

To the most common manifestations of OCD include:

1. mysophobia (when there is an obsessive fear of pollution with the ensuing consequences and human behavior);
2. “gathering” (in the case when people are afraid to throw something away, experiencing anxiety and fear that it may be needed in the future);
3. obsessive thoughts of a religious nature;
4. obsessive doubts (when a person constantly has doubts about whether he turned off the iron, gas, light, whether the water taps are closed);
5. obsessive counting or anything related to numbers (adding numbers, repeating numbers a certain number of times, etc.);
6. obsessive thoughts about "symmetry" (may appear in clothing, the location of interior items, etc.).

Note that the manifestations described above are permanent and painful for this person character.

The pathogenesis of obsessive-compulsive disorder

As noted above, there are different approaches to explaining obsessive-compulsive disorder. To date, the most common and recognized neurotransmitter theory. The essence of this theory is that there is a connection between obsessive-compulsive disorder and communication disorders between certain areas of the cerebral cortex and the basal ganglia.

The designated structures interact through serotonin. So, scientists believe that in OCD there is an insufficient level of serotonin due to increased reuptake (by neurons), which prevents the transmission of an impulse to the next neuron. In general, it must be said that the pathogenesis of this disorder is quite complex and not fully understood.

Classification and stages of development of obsessive-compulsive disorder

Obsessive thoughts (obsessions) can be expressed in different ways: arrhythmia, obsessive reproductions, onomatomania.

• "Mental chewing gum" expressed in the irresistible desire of patients to pose and ponder questions that have no solution.
• arrhythmia or, in other words, obsessive counting, is expressed in the recounting of objects that, as a rule, fall into the field of view of a person.
• Obsessive reproductions are manifested in the fact that the patient develops a painful need to remember something that, in general, has no personal significance at the moment.
• Onomatomania- an obsessive desire to remember names, terms, titles and any other words.

As part of obsessive-compulsive disorders, there may be various options compulsions. They can be in the form of simple symbolic actions. The latter is expressed in the fact that patients form certain "prohibitions" (taboos) on the performance of any actions. So, for example, the patient counts the steps in order to find out whether he will fail or succeed. Or the patient should only walk on the right side of the street and only open the door right hand. Another option would be stereotypical acts of self-harm: pulling hair out of one's own body, pulling hair out and eating it, plucking one's own eyelashes for morbid reasons. However, it should be noted that in a number of cases (as, for example, in the last one), a clear and deep differential diagnosis with other mental disorders, which is carried out by a doctor, is necessary. There may also be compulsions that occur episodically, are not motivated in any way and frighten patients, and which are usually not realized because they meet with active opposition from the person. Obsessive impulses arise suddenly, unexpectedly, in situations where adequate impulses can also arise.

Complications of obsessive-compulsive disorder

Complications of the course of obsessive-compulsive disorder are associated with the addition of other mental disorders. For example, with obsessions that cannot be corrected for a long time, depressive disorders, anxiety disorders, and suicidal thoughts may occur. This is due to the fact that a person cannot get rid of OCD. Also, there are frequent cases of abuse of tranquilizers, alcohol, and other psychoactive substances, which, of course, will aggravate the course. It is impossible not to say about the low quality of life of patients with severe obsessions. They interfere with normal social functioning, reduce performance, and disrupt communication functions.

Diagnosis of obsessive-compulsive disorder

The diagnosis of OCD is currently based on the International Classification of Diseases 10th Revision (ICD-10). Below we will consider what signs are characteristic and necessary for the diagnosis of Obsessive-Compulsive Disorder.

In ICD-10, there are the following diagnoses, denoting the disorder we are considering:

1. OKR. Predominantly intrusive thoughts or ruminations;
2. OKR. Predominantly compulsive actions;
3. OKR. Mixed intrusive thoughts and actions;
4. Other obsessive-compulsive disorders;
5. Unspecified obsessive-compulsive disorder.

The general diagnostic criteria for making a diagnosis are:

• the presence of obsessive thoughts and / or actions;
• they must be observed most of the days over a period of at least two weeks;
• obsessions/compulsions must be a source of distress for the person;
• the thought of implementing an action should be unpleasant for a person;
• thoughts, ideas and impulses should be unpleasantly repetitive;
• compulsive actions should not necessarily correspond to specific thoughts or fears, but should be aimed at relieving a person of spontaneously arising feelings of tension, anxiety and / or internal discomfort.

So, the diagnosis of OCD. Predominantly obsessive thoughts or reflections” is exhibited in the case of the presence of only designated thoughts; thoughts must take the form of ideas, mental images, or impulses to action, almost always unpleasant for the particular subject.

Diagnosis OCD. Predominantly compulsive actions” is exhibited in case of predominance of compulsions; behavior is based on fear, and a compulsive action (actually a ritual) is a symbolic and futile attempt to prevent danger, while it can take a large number of time, several hours a day.

The mixed form is exhibited when obsessions and compulsions are expressed in the same way.

The diagnoses discussed above are made on the basis of an in-depth clinical interview, examination of the patient and anamnesis. It should be noted that scientifically proven laboratory studies aimed exclusively at identifying OCD do not exist in routine practice today. One of the valid psychodiagnostic tools for identifying obsessive-compulsive disorders is the Yale-Brown scale. This is professional tool, which is used by specialists to determine the severity of symptoms, regardless of the form of obsessive thoughts or actions.

Treatment of obsessive-compulsive disorder

In terms of the treatment of obsessive-compulsive disorders, we will proceed from the principles of evidence-based medicine. Treatment based on these principles is the most proven, effective and safe. In general, the treatment of the disorders in question is carried out with antidepressant drugs. If the diagnosis is made for the first time, it is best to use antidepressant monotherapy. If this option is ineffective, you can resort to drugs from other groups. In any case, therapy should be carried out under close medical supervision. Usually treatment is carried out on an outpatient basis, in complicated cases - in a hospital.

We also note that one of the methods of therapy is psychotherapy. Currently, cognitive behavioral therapy and its various directions have proven effectiveness. To date, it has been proven that cognitive psychotherapy is comparable in effectiveness with medicines and superior to placebo in mild obsessive-compulsive disorder. It is also noted that psychotherapy can be used to enhance the effect of drug therapy, especially in cases of difficult-to-treat disorders. In OCD therapy, both individual forms of work and work in a group, as well as family psychotherapy are used. It should be said that the therapy of the disorder in question should be carried out for a long time, for at least 1 year. Despite the fact that improvement occurs much earlier (within 8-12 weeks and earlier), it is absolutely impossible to stop therapy.

Therapy for OCD in children and adolescents generally follows that of adults. Non-pharmacological methods are mainly based on psychosocial interventions, the use of family psychoeducation and psychotherapy. Cognitive behavioral therapy is used, including exposure and response prevention, which is considered the most effective methods. The latter consists in purposeful and consistent contact of a person with OCD with stimuli avoided by him and a conscious delay in the occurrence of pathological reactions in this case.

Forecast. Prevention

As mentioned above, the most characteristic of obsessive-compulsive disorder is the chronization of the process. It is worth noting that a long-term stable condition is possible in a number of individuals with this disorder, especially in patients who have any one type of manifestation of obsessions (for example, arithmomania). In this case, symptom relief is noted, as well as good social adaptation.

Mild manifestations of OCD usually occur on an outpatient basis. In most cases, improvement occurs around the end of the first year. Severe cases of obsessive-compulsive disorders, which have numerous obsessions, rituals, complication of phobias in their structure, can be quite persistent, resistant to therapy, and tend to relapse. This can be facilitated by the repetition or the emergence of new psycho-traumatic situations, overwork, general weakening of the body, insufficient sleep, mental overload.

There is no specific prevention for OCD because the exact cause has not been established. Therefore, recommendations for prevention are sufficient general character. OCD prevention is divided into primary and secondary.

To primary prevention include interventions to prevent the development of OCD symptoms. To do this, it is recommended to profilatize psychotraumatic situations in the family and at work, to give Special attention raising a child.

Secondary prevention aims to actually prevent the recurrence of symptoms of obsessive-compulsive disorder. To do this, use a number of methods:

Of particular note as preventive measure periodic consultations and / or examination by a doctor. This may be a preventive examination, which children with adolescence pass annually to control their mental state. Also, these are periodic consultations with a doctor for people who have previously suffered from obsessive-compulsive disorder. The doctor will help to identify deviations in a timely manner, if any, and prescribe therapy, which will help to more effectively cope with the disorder and prevent its occurrence later.

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