Obsessive Compulsive Disorder (OCD)
OCD (OBSESSIVE COMPULSIVE DISORDER) , SICKNESS, OR “THE HABIT OF REPEATING”?
People suffering from OCD are considered to be disabled in some countries. Most of them spend a lot of time pointlessly because of compulsions. Obsessions are often expressed by obsessive thoughts and phobias, which also negatively affects the quality of life of the patient.
From the14 to the 16 centuries in Europe it was claimed that people exposed to blasphemous, sexual character or other obsessive thoughts were possessed by the devil. Based on this reason, the treatment included the expulsion of “evil” from the “possessed” person by means of exorcism. In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts that manifest as symptoms. Freud described the clinical history of a typical case of “touch phobia”, which began in early childhood, when a person had a strong desire to touch objects. In response, people have developed an “external prohibition” against this kind of touch. However,” this prohibition did not succeed in eliminating “the desire to touch; all he could do was suppress the desire and”make it involuntary.
As begins disease
According to medical statistics, obsessive-compulsive disorder is formed in the period from 10 to 30 years. No matter when its first symptoms appeared, patients turn to the doctor between 27 and 35 years. This means that from the moment of the disease development to the beginning of treatment it takes several years.
At the initial stage, the symptoms of the disease appear in the form of obsessive States (actions) and various phobias (obsessive thoughts). During this period, a person may still be aware of their irrationality. It is visited by unpleasant or frightening thoughts, but if the majority can easily dismiss them, for some it’s impossible. People with OCD ponder why they have such a thought, coming back to it again and again. Get rid of it, they can only perform certain actions.
Obsessions — frightening thoughts, images or impulses that do not leave the person.
Compulsions-certain actions that help to eliminate obsessive thoughts and reduce anxiety.
The condition can progress, forcing a person to perform more and more compulsions, have a chronic or episodic form.
Over time, in the absence of medical and psychological assistance, the disorder escalates. The patient loses the ability to adequately assess their fears. In advanced cases, treatment involves hospitalization with the use of serious drugs.
Clinic obsessive-compulsive disorder has attracted the attention of researchers since the 17 century.
The first of them began in 1617, and in 1621 E. Barton described an obsessive fear of death. Research in the field of obsession is described by F. Pinel (1829), And I. Balinsky introduced the term “obsessions”, which entered the Russian psychiatric literature. Since 1871 Westphalian introduced the term “agoraphobia”, which refers to the fear of being in public places.
In 1875, M. Legrand de Sol, analyzing the dynamics of obsessive-compulsive disorder in the forms of insanity doubt, along with delirium touch found that gradually increasing complexity of the clinical picture, in which obsessive doubts are replaced by fear of touching objects in the environment, as well as joining motor rituals, which obeys the life of the sick
Clinical manifestations of OCD :
Obsessive-compulsive disorder has specific symptoms:
– thoughts should be perceived as one’s own, not as a voice from above or another person’s;
– the patient resists these thoughts, tries unsuccessfully to switch to others.
– the idea that what is presented can happen scares a person, makes him feel ashamed and guilty, causes tension and loss of activity;
-an obsession is often repeated.
Most frequent obsessions and corresponding compulsions:
– Fear of Contracting disease or fear of germs. In order to prevent this, a person tries to wash his hands as often as possible or take a shower, wash clothes, wash thoroughly all surfaces with which he comes in contact. This can take a lot of hours every day.
– Fear of harming yourself or your loved ones. The patient tries not to be alone or with the person to whom, he believes, can harm. Hides potentially dangerous things, such as knives, ropes, heavy objects.
– Fear that the right things will not appear. A person checks his pockets and bags repeatedly, whether he has forgotten to put documents, Essentials or medicines.
-Order and symmetry. He must be in a room where everything is in its place and subject to certain rules. They take great care to ensure that even small objects had melted in a certain order, for example, the exposed height or symmetrical. And if someone has touched or incorrectly put the folder on the table, the person experiences emotional stress.
-Superstitions. The person may be afraid that he’s not lucky, if he does not perform a certain ritual. So sick of OCD, leaving the house had to wear “happy” shoes, twice to look in the mirror and show her tongue to jiggle the doorknob seventeen times. If something unpleasant happened, he increased the number of actions.
Scientists still can not list the main factors that contribute to the emergence of mental illness. However, there are a large number of theories. According to one of them, among the biological factors, obsessive-compulsive disorder causes have the following:
* metabolic disorders of neurotransmitters (primarily serotonin and dopamine, as well as norepinephrine and GABA.
* head injuries and injuries;
* hereditary predisposition (obsessive-compulsive disorders found in about 5-7% of parents with these disorders)
* complicated course of infectious diseases of the brain (especially in death)
* deviations at the level of the autonomic nervous system.
The cycle of OCD.
Actions of a person with obsessive-compulsive disorder have a cyclical nature.
1. First, there is a certain thought that scares and makes you feel ashamed and guilty for it.
2.Then there is a concentration on this thought against the will. As a result, there is mental tension and growing anxiety.
3.The human psyche finds a way to calm down, performing stereotypical actions that he thinks will save him. Thus, there is a short-term relief.
4.But the feeling of abnormality due to the thoughts won’t leave him and again he returned to her. The cycle gets a new round.
It is noted that OCD can occur in a chronic, progressive or episodic form:
1. Chronic condition indicates that the disorder is present constantly, is stable and unchanged.
2. Progressive condition means that the patient is going through a chronic process, the symptoms of which are increased, which is dangerous.
3. Sporadic is different because the signs appear from time to time. Distinguish cyclic, conditional and mixed types of the episodic form of disorder, thus:
– cyclic States depend on biorhythms of the organism;
– conditional appear under the influence of traumatic circumstances, which include a sharp change in the usual way of life, the impact of psycho-emotional stress, various pathologies of the body;
– mixed represent a combination of biorhythmic and conditional factors.
That affects the development of neurosis.
The more often a patient resorts to ritual actions, the more he / she becomes dependent on them. It’s like a drug. Reinforce the disorder and avoidance of situations or actions that cause obsessions. A person, trying not to face a potentially dangerous situation, still thinks about it and is convinced of his abnormality. The situation can aggravate and the behavior of loved ones who suffer the disorder are called crazy or forbidden to perform the ritual. After all, if he is crazy, then he can really carry out the actions that he is so afraid of. And the imposition of a ban on compulsions leads to an increase in anxiety. But sometimes the opposite situation, when the relatives are involved in the performance of the ritual, thereby affirming its necessity.
In people with OCD, other conditions may be diagnosed, along with or instead of OCD, such as the above obsessive-compulsive personality disorder, clinical depression, bipolar disorder, General anxiety disorder, neuropsychiatric anorexia, social phobia, neuropsychological bulimia, Tourette’s syndrome, Asperger’s syndrome, hyperactivity disorder with attention deficit, dermatitis (skin compression), bodily injury dysmorphic disorder and trichotillomania (hair pulling). In 2009 depression among OCD sufferers was reported to be partly a warning, as the risk of suicide was high; more than 50 per cent of patients showed suicidal tendencies and 15 per cent attempted suicide. Subjects with OCD are also affected by owl syndrome to a much greater extent than the General population. Moreover, severe symptoms of OCD necessarily accompanied by a more restless sleep. The decrease in total sleep time and its effectiveness is observed in patients with OCD, while there is a delay in the onset and end of sleep, as well as an increase in the prevalence of “owl” syndrome. With regard to behavior , some studies demonstrate the link between drug addiction and disorder equally. For example, there is an increased risk of drug dependence among people with anxiety disorder (possibly as a way to cope with an increased level of anxiety), but drug dependence among patients with OCD can act as a type of compulsive behavior rather than as a mechanism to overcome anxiety. Depression is also common among OCD sufferers. One explanation for the increased risk of depression among OCD sufferers was made by Minec, Watson, and Clark (1998), who explained that people with OCD (or any other anxiety disorder) can be suppressed due to uncontrolled perception. Some subjects showing signs of OCD do not necessarily have OCD. Behaviours that appear (or appear) to be Intrusive or compulsive can also be attributed to many other conditions, including obsessive-compulsive personality disorder, autism spectrum disorders, disorders in which perseverance is a possible characteristic (ADHD, PTSD, physical disabilities or habits), or subclinical disorders. Some OCD sufferers exhibit features commonly associated with Tourette’s syndrome, such as compulsive actions that may resemble motor tics; this disorder apply the concept of “associated with tics OCD” or “OCD Tourette’s”.
Way of treatment
Therapy obsessive-compulsive disorder includes medication and psychotherapy as the must-have items
It involves the use of therapeutic techniques such as:
1. Cognitive behavioral correction. The technique gives the patient the opportunity to resist the influence of disorder, changing the order of ritual actions, simplifying them to gradually reduce to a minimum. The method is based on the conscious attitude of a person to his / her mental problem and gradual resistance to its features.
2. “4 steps” is another technique. Her action is based on what the doctor explains to the patient:
– which of his fears are justified, and which are provoked by the influence of OCD, and therefore do not make sense;
– how, once in a particular situation, would act a healthy person;
– how to stop obsessive thoughts.
3. Exposure and prevention — one of the most effective forms of behavior correction in patients with OCD. At the same time, the exposition consists in immersing the patient in conditions that provoke discomfort in connection with obsessions. The doctor instructs how to resist the urge to perform compulsive actions, forming a warning of a pathological response. According to statistics, the vast majority of those treated achieve steady improvement. The effect of psychotherapy can last for many months.
In the treatment of OCD, other types of psychocorrection are also used:
- group and family,
- rational ;
- aversive (the General name of the group of therapeutic methods based on the use of unpleasant stimuli causing the client’s aversion, disgust, extremely unpleasant, painful sensations)
Antidepressants showed maximum efficiency in OCD. When anxiety increases at the first stages of treatment, they are supplemented with tranquilizers. In the chronic case of OCD, when antidepressants from a number of serotonin reuptake inhibitors are ineffective, atypical antipsychotics are increasingly prescribed.