Can you grow out of ocd

Does Childhood OCD Go Away? — Child Counseling in Davidson

If your child has OCD, you may worry at times about what the future holds. It seems like such an unfair burden for a young child to deal with. Maybe you’ve wondered whether your child’s OCD symptoms will eventually fade away, so she will be free to live life without constant worry. If you have, you aren’t alone.

“Does childhood OCD ever go away?” is one of the most common questions I hear from parents, especially at the beginning of therapy. And it’s totally understandable! OCD symptoms can be debilitating and time consuming. Handwashing, repeated checking, asking for reassurance, or long rituals are exhausting not just for the child, but for the whole family. Nobody wants a child be stuck with those symptoms forever!

I can’t predict what the outcome may be for your child, but I do know that therapy can lead to big, positive changes in the lives of kids with OCD. Today, I am digging into the research to see how common it is for childhood OCD symptoms to completely resolve. I’ll also take a look at what we can do to help all kids with OCD start feeling better.

How Common is Childhood OCD?

Childhood OCD is more common than you might think. While we may talk more about forms of anxiety and depression affecting kids, OCD also often starts early in life. Most studies estimate that 1-3% of kids have OCD, although their symptoms might fly under the radar for a long time. This is because because they can be hard to spot.

OCD most often starts when a person is a child or teen. Pretty much everyone with OCD starts getting symptoms before age 25. For childhood-onset OCD, the average age of onset is around 10 years old. It is common for boys to start noticing symptoms a little earlier, while girls might not develop OCD symptoms until later.

Some people may not get treatment for OCD until they reach the late teen or adult years, but their problems often began years earlier, during childhood.

You Can’t Outgrow Childhood OCD Without Help

Looking at the research, one thing that is really clear is that OCD is not likely to go away on its own. It’s not something that a child is likely to just outgrow or forget about. Kids with OCD need specialized therapy. The right counseling can help them learn how to deal with the intrusive thoughts that cause their anxiety and push them to repeat actions over and over.

OCD symptoms tend to ebb and flow over time: sometimes they’re better, sometimes they’re worse. Stress often plays a part in how bothersome OCD symptoms are. Some studies suggest that a small number of people might be able to “outgrow” their OCD without therapy: about 1 in 5. However, it can be a little tricky to tell if someone has really gotten rid of their OCD, or if they’re just in a low-stress time of life when it isn’t noticeable. It’s possible for symptoms to go away entirely when stress is low, only to return again during a more difficult time.

There’s also a risk that a child’s OCD could get worse without treatment. This can lead to small inconveniences, like chapped skin from too much handwashing, or major life impairments, like difficulty getting out of the house. Children with OCD are at an increased risk of also having other mental health problems, like anxiety and depression. Later in life, people with untreated mental health problems sometimes turn to unhealthy coping mechanisms like drugs and alcohol if they don’t have other good ways to deal with their symptoms.

The good news is that most people with OCD feel better after therapy. About 70% of people who get specialized treatment for OCD will improve, and usually they improve by a lot. The great news is that kids often get better results from OCD therapy than adults do. Catching symptoms early and getting help quickly leads to fewer symptoms later in life. Most kids will still have some leftover symptoms after therapy, but a small number of kids might see their OCD go away.

Sometimes, OCD Goes Away Completely (But Not Always)

Different experts have different opinions on whether or not it’s possible for OCD to completely go away. I don’t think I can argue with the experts! It’s not entirely clear whether people get cured of their OCD, or if they just go into remission from OCD. “Cured” means the symptoms are gone forever, while “remission” means the symptoms go away for a while, but may come back later.

Being the nerd that I am, I’ve looked over a handful of studies looking at the likelihood of OCD symptoms going away after therapy. It seems like it is possible for some people, and there are a few factors that increase a person’s odds. Kids whose symptoms start when they are young have better chances of remission than teens or adults. So do people whose symptoms are milder, and who are able to get therapy quickly. Finally, people who do not have other mental health problems alongside their OCD fare better than people who are also dealing with anxiety or other conditions.

Depending on the study you look at, you’ll see researchers estimating that anywhere from 32% to 70% of people go into remission after therapy, meaning that their symptoms are gone for a long time, or have gotten so mild that they aren’t getting in the way of things. However, this is different than being cured: there’s no guarantee that the symptoms might come back. The number of kids who are cured is much smaller and open to debate. Some experts guess that 20% of kids with childhood OCD are cured, while others think OCD never completely goes away.

You Can’t Always Cure OCD…And That’s OK!

As we just talked about in the last section, there’s a big difference between remission and cure. With good treatment, many kids with OCD will go for long stretches without problems. However, expecting your child to never have another OCD thought ever again for the rest of her life probably isn’t realistic. While some kids may fully outgrow their OCD, many won’t. Most experts consider OCD to be a chronic condition that, once you have it, sticks around for the long term.

That may be demoralizing to hear. The words “chronic illness” can sound very hopeless, especially if your child is struggling intensely right now. But just because OCD can be a lifetime diagnosis doesn’t mean it’s a life sentence. You may remember from earlier in this post that OCD affects 1-3% of people. That’s a pretty solid number! There are lots of kids and adults out there who are thriving, enjoying life, and just so happen to have OCD.

Help is Available for Childhood OCD in Charlotte, NC

OCD doesn’t have to run your child’s life. If you are tired of repeated worries and rituals taking up your family’s time, therapy can help. In counseling, kids can learn that OCD is just a way that some people’s brains think—and they have control over which thoughts they listen to and which they don’t. A skilled therapist can help a child gradually “talk back” to their worries and face their fears. Eventually, OCD stops being such an overwhelming urge and turns into background noise.

I’m a therapist based in Davidson, NC, just outside of Charlotte. I’m also someone who had childhood OCD! Everybody’s symptoms are different, but I remember what it felt like to be spending so much time every day dealing with worries I didn’t want to have. I love helping other kids manage their OCD fears so they can get back to enjoying childhood.

Cognitive Behavioral Therapy is a great option for OCD, and younger kids often benefit from play therapy, too. Is Davidson, NC a long commute for you? We can work together online if you live anywhere in North Carolina, New York, or Florida.

Want to learn more? Email me to ask a question or request an appointment.

Can OCD Go Away? | PCH Treatment Center

Does Obsessive-Compulsive Disorder Ever Go Away?

Following an obsessive-compulsive disorder (OCD) diagnosis, one of the most common questions clients ask us is, “Does OCD go away?” and understandably so. With the pathologizing that comes with labeling individuals as obsessive-compulsive and even being told they have a “disorder,” many clients seek OCD treatment with the mentality that they have a problem they need to “fix” or get rid of before returning to “normal.”

One of the first steps to treatment is helping clients understand that an obsessive-compulsive cognitive style generally does not go away. The way you think is part of who you are, so asking, “Does OCD go away?” is typically not productive for treatment or healing. The stigmatizing of obsessive-compulsive tendencies negates the possibility that these traits can actually be adaptive, rather than maladaptive, behaviors in specific contexts. For example, obsessive-compulsive characteristics are productive in detail-oriented professions in the healthcare, accounting, and engineering fields.

At PCH, we prefer to frame the question as, “Can the disruptions that obsessive-compulsive behaviors cause in your life go away?” because the answer is absolutely. By framing the issue around the behavior rather than the individual, we focus on holistic treatment that accounts for the positive and negative tendencies, so you can focus on healing yourself and growing as an individual.

So while the “obsessive-compulsive” component of an individual’s personality may never “go away,” the “disorder” aspect of compulsive thoughts can be managed through proper treatment.

Do I Really Have OCD?

Along with, “Can OCD go away?” many of our clients also ask, “Do I really have OCD?” It’s not rare for clients to question whether their OCD diagnosis is correct, and even after starting treatment they may still experience thoughts of doubt. When doubts take the form of intrusive or repetitive thoughts, the patterns generally confirm that OCD is the correct diagnosis. OCD is colloquially referred to as the “doubting disease” for a reason, and even an OCD diagnosis can become the focus of obsessive-compulsive doubting.

At PCH, we understand the doubts you may be experiencing, and that’s why we prefer to focus on the individual rather than the diagnosis. If you find yourself questioning whether you have OCD in circular thought patterns after a diagnosis, don’t be surprised. Those thoughts are common and often provide concrete verification that an obsessive-compulsive cognitive style is interfering with your daily well-being.

Did My OCD Go Away?

Obsessive-compulsive symptoms generally wax and wane over time. Because of this, many individuals diagnosed with OCD may suspect that their OCD comes and goes or even goes away—only to return. However, as mentioned above, obsessive-compulsive traits never truly go away. Instead, they require ongoing management.

General life stress is often the main factor for the worsening or subsiding of obsessive-compulsive symptoms. During times of high stress, an individual will experience a worsening of obsessive-compulsive behaviors while during times of reduced stress, an individual may return to a baseline or even think their OCD has gone away altogether.

While symptoms of an obsessive-compulsive thought style may fluctuate in intensity over time based on stress levels, a chronic or deteriorating course is common if you choose not to engage in appropriate treatment.

What Happens If OCD Goes Untreated?

That leads into another frequently asked question about OCD: What happens when OCD is left untreated? Current research shows that genetic and biological factors may make a person more vulnerable to developing OCD, while learning and environmental factors may influence the particular type of OCD a person has.

Many people diagnosed with OCD report that a life event triggered their OCD symptoms, including traumatic experiences, drug use, or even random interactions that planted a seed of doubt in the mind and will not go away. Others may not be able to identify a particular life event, but the situation for untreated OCD remains the same. Without appropriate treatment, obsessive-compulsive symptoms become chronic and may even grow worse over time.

If you or someone you care about has been struggling with an OCD diagnosis, the team at PCH Treatment Center is here to help. Reach out today, and we’ll help you uncover the next steps on the road to healing.

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Obsessive-compulsive disorder

A prominent role among mental illnesses is played by syndromes (complexes of symptoms), united in the group of obsessive-compulsive disorder (OCD), which received its name from the Latin terms obsessio and compulsio.

Obsession (lat. obsessio - taxation, siege, blockade).

Compulsions (lat. compello - I force). 1. Obsessive drives, a kind of obsessive phenomena (obsessions). Characterized by irresistible attraction that arises contrary to the mind, will, feelings. Often they are unacceptable to the patient, contrary to his moral and ethical properties. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the patient as wrong and painfully experienced by them, especially since their very appearance, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsions is also used in a broader sense to refer to any obsessions in the motor sphere, including obsessive rituals.

In domestic psychiatry, obsessive states were understood as psychopathological phenomena, characterized by the fact that phenomena of a certain content repeatedly appear in the mind of the patient, accompanied by a painful feeling of coercion [Zinoviev PM, 193I]. For N.s. characteristic involuntary, even against the will, the emergence of obsessions with clear consciousness. Although the obsessions are alien, extraneous in relation to the patient's psyche, the patient is not able to get rid of them. They are closely related to the emotional sphere, accompanied by depressive reactions, anxiety. Being symptomatic, according to S.L. Sukhanov [1912], "parasitic", they do not affect the course of intellectual activity in general, remain alien to thinking, do not lead to a decrease in its level, although they worsen the efficiency and productivity of the patient's mental activity. Throughout the course of the disease, a critical attitude is maintained towards obsessions. N.s. conditionally divided into obsessions in the intellectual-affective (phobia) and motor (compulsions) spheres, but most often several of their types are combined in the structure of the disease of obsessions. The isolation of obsessions that are abstract, affectively indifferent, indifferent in their content, for example, arrhythmomania, is rarely justified; An analysis of the psychogenesis of a neurosis often makes it possible to see a pronounced affective (depressive) background at the basis of the obsessive account. Along with elementary obsessions, the connection of which with psychogeny is obvious, there are “cryptogenic” ones, when the cause of painful experiences is hidden [Svyadoshch L.M., 1959]. N.s. are observed mainly in individuals with a psychasthenic character. This is where apprehensions are especially characteristic. In addition, N.S. occur within the framework of neurosis-like states with sluggish schizophrenia, endogenous depressions, epilepsy, the consequences of a traumatic brain injury, somatic diseases, mainly hypochondria-phobic or nosophobic syndrome. Some researchers distinguish the so-called. "Neurosis of obsessive states", which is characterized by the predominance of obsessive states in the clinical picture - memories that reproduce a psychogenic traumatic situation, thoughts, fears, actions. In genesis play a role: mental trauma; conditioned reflex stimuli that have become pathogenic due to their coincidence with others that previously caused a feeling of fear; situations that have become psychogenic due to the confrontation of opposing tendencies [Svyadoshch A. M., 1982]. It should be noted that these same authors emphasize that N.s.c. occurs with various character traits, but most often in psychasthenic personalities.

Currently, almost all obsessive-compulsive disorders are united in the International Classification of Diseases under the concept of "obsessive-compulsive disorder".

OKR concepts have undergone a fundamental reassessment over the past 15 years. During this time, the clinical and epidemiological significance of OCD has been completely revised. If it was previously thought that this is a rare condition observed in a small number of people, now it is known that OCD is common and causes a high percentage of morbidity, which requires the urgent attention of psychiatrists around the world. Parallel to this, our understanding of the etiology of OCD has broadened: the vaguely formulated psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm that explores the neurotransmitter disorders that underlie OCD. And most importantly, pharmacological interventions specifically targeting serotonergic neurotransmission have revolutionized the prospects for recovery for millions of OCD patients worldwide.

The discovery that intense serotonin reuptake inhibition (SSRI) was the key to effective treatment for OCD was the first step in a revolution and spurred clinical research that showed the efficacy of such selective inhibitors.

As described in ICD-10, the main features of OCD are repetitive intrusive (obsessive) thoughts and compulsive actions (rituals).

In a broad sense, the core of OCD is the syndrome of obsession, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, memories that arise in addition to the desire of patients, but with awareness of their pain and a critical attitude towards them. Despite the understanding of the unnaturalness, illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessional impulses or ideas are recognized as alien to the personality, but as if coming from within. Obsessions can be the performance of rituals designed to alleviate anxiety, such as washing hands to combat "pollution" and to prevent "infection". Attempts to drive away unwelcome thoughts or urges can lead to severe internal struggle, accompanied by intense anxiety.

Obsessions in the ICD-10 are included in the group of neurotic disorders.

The prevalence of OCD in the population is quite high. According to some data, it is determined by an indicator of 1.5% (meaning "fresh" cases of diseases) or 2-3%, if episodes of exacerbations observed throughout life are taken into account. Those suffering from obsessive-compulsive disorder make up 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally.

CLINICAL PICTURE

The problem of obsessive-compulsive disorders attracted the attention of clinicians already at the beginning of the 17th century. They were first described by Platter in 1617. In 1621 E. Barton described an obsessive fear of death. Mentions of obsessions are found in the writings of F. Pinel (1829). I. Balinsky proposed the term "obsessive ideas", which took root in Russian psychiatric literature. In 1871, Westphal coined the term "agoraphobia" to refer to the fear of being in public places. M. Legrand de Sol [1875], analyzing the features of the dynamics of OCD in the form of "insanity of doubt with delusions of touch, points to a gradually becoming more complicated clinical picture - obsessive doubts are replaced by ridiculous fears of" touch "to surrounding objects, motor rituals join, the fulfillment of which is subject to the whole life sick. However, only at the turn of the XIX-XX centuries. researchers were able to more or less clearly describe the clinical picture and give syndromic characteristics of obsessive-compulsive disorders. The onset of the disease usually occurs in adolescence and adolescence. The maximum of clinically defined manifestations of obsessive-compulsive disorder is observed in the age range of 10-25 years.

Main clinical manifestations of OCD:

Obsessional thoughts - painful, arising against the will, but recognized by the patient as their own, ideas, beliefs, images, which in a stereotyped form forcibly invade the patient's consciousness and which he tries to resist in some way. It is this combination of an inner sense of compulsive urge and efforts to resist it that characterizes obsessional symptoms, but of the two, the degree of effort exerted is the more variable. Obsessive thoughts may take the form of single words, phrases, or lines of poetry; they are usually unpleasant to the patient and may be obscene, blasphemous, or even shocking.

Obsessional imagery is vivid scenes, often violent or disgusting, including, for example, sexual perversion.

Obsessional impulses are urges to do things that are usually destructive, dangerous or shameful; for example, jumping into the road in front of a moving car, injuring a child, or shouting obscene words while in society.

Obsessional rituals include both mental activities (eg, counting repeatedly in a particular way, or repeating certain words) and repetitive but meaningless acts (eg, washing hands twenty or more times a day). Some of them have an understandable connection with the obsessive thoughts that preceded them, for example, repeated washing of hands - with thoughts of infection. Other rituals (for example, regularly laying out clothes in some complex system before putting them on) do not have such a connection. Some patients feel an irresistible urge to repeat such actions a certain number of times; if that fails, they are forced to start all over again. Patients are invariably aware that their rituals are illogical and usually try to hide them. Some fear that such symptoms are a sign of the onset of insanity. Both obsessive thoughts and rituals inevitably lead to problems in daily activities.

Obsessive rumination (“mental chewing gum”) is an internal debate in which the arguments for and against even the simplest everyday actions are endlessly revised. Some obsessive doubts relate to actions that may have been incorrectly performed or not completed, such as turning off the gas stove faucet or locking the door; others concern actions that could harm other people (for example, the possibility of driving past a cyclist in a car, knocking him down). Sometimes doubts are associated with a possible violation of religious prescriptions and rituals - “remorse of conscience”.

Compulsive actions - repetitive stereotypical actions, sometimes acquiring the character of protective rituals. The latter are aimed at preventing any objectively unlikely events that are dangerous for the patient or his relatives.

In addition to the above, in a number of obsessive-compulsive disorders, a number of well-defined symptom complexes stand out, and among them are obsessive doubts, contrasting obsessions, obsessive fears - phobias (from the Greek. phobos).

Obsessive thoughts and compulsive rituals may intensify in certain situations; for example, obsessive thoughts about harming other people often become more persistent in the kitchen or some other place where knives are kept. Since patients often avoid such situations, there may be a superficial resemblance to the characteristic avoidance pattern found in phobic anxiety disorder. Anxiety is an important component of obsessive-compulsive disorders. Some rituals reduce anxiety, while after others it increases. Obsessions often develop as part of depression. In some patients, this appears to be a psychologically understandable reaction to obsessive-compulsive symptoms, but in other patients, recurrent episodes of depressive mood occur independently.

Obsessions (obsessions) are divided into figurative or sensual, accompanied by the development of affect (often painful) and obsessions of affectively neutral content.

Sensual obsessions include obsessive doubts, memories, ideas, drives, actions, fears, an obsessive feeling of antipathy, an obsessive fear of habitual actions.

Obsessive doubts - intrusively arising contrary to logic and reason, uncertainty about the correctness of committed and committed actions. The content of doubts is different: obsessive everyday fears (whether the door is locked, whether windows or water taps are closed tightly enough, whether gas and electricity are turned off), doubts related to official activities (whether this or that document is written correctly, whether the addresses on business papers are mixed up , whether inaccurate figures are indicated, whether orders are correctly formulated or executed), etc. Despite repeated verification of the committed action, doubts, as a rule, do not disappear, causing psychological discomfort in the person suffering from this kind of obsession.

Obsessive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a sense of shame, repentance. They dominate the mind of the patient, despite the efforts and efforts not to think about them.

Obsessive impulses - urges to commit one or another tough or extremely dangerous action, accompanied by a feeling of horror, fear, confusion with the inability to get rid of it. The patient is seized, for example, by the desire to throw himself under a passing train or push a loved one under it, to kill his wife or child in an extremely cruel way. At the same time, patients are painfully afraid that this or that action will be implemented.

Manifestations of obsessive ideas can be different. In some cases, this is a vivid "vision" of the results of obsessive drives, when patients imagine the result of a cruel act committed. In other cases, obsessive ideas, often referred to as mastering, appear in the form of implausible, sometimes absurd situations that patients take for real. An example of obsessive ideas is the patient's conviction that the buried relative was alive, and the patient painfully imagines and experiences the suffering of the deceased in the grave. At the height of obsessive ideas, the consciousness of their absurdity, implausibility disappears and, on the contrary, confidence in their reality appears. As a result, obsessions acquire the character of overvalued formations (dominant ideas that do not correspond to their true meaning), and sometimes delusions.

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) - unjustified, driven away by the patient from himself antipathy towards a certain, often close person, cynical, unworthy thoughts and ideas in relation to respected people, in religious persons - in relation to saints or ministers churches.

Obsessive acts are acts done against the wishes of the sick, despite efforts made to restrain them. Some of the obsessive actions burden the patients until they are realized, others are not noticed by the patients themselves. Obsessive actions are painful for patients, especially in those cases when they become the object of attention of others.

Obsessive fears, or phobias, include an obsessive and senseless fear of heights, large streets, open or confined spaces, large crowds of people, the fear of sudden death, the fear of falling ill with one or another incurable disease. Some patients may develop a wide variety of phobias, sometimes acquiring the character of fear of everything (panphobia). And finally, an obsessive fear of the emergence of fears (phobophobia) is possible.

Hypochondriacal phobias (nosophobia) - an obsessive fear of some serious illness. Most often, cardio-, stroke-, syphilo- and AIDS phobias are observed, as well as the fear of the development of malignant tumors. At the peak of anxiety, patients sometimes lose their critical attitude to their condition - they turn to doctors of the appropriate profile, require examination and treatment. The implementation of hypochondriacal phobias occurs both in connection with psycho- and somatogenic (general non-mental illnesses) provocations, and spontaneously. As a rule, hypochondriacal neurosis develops as a result, accompanied by frequent visits to doctors and unreasonable medication.

Specific (isolated) phobias - obsessive fears limited to a strictly defined situation - fear of heights, nausea, thunderstorms, pets, treatment at the dentist, etc. Since contact with situations that cause fear is accompanied by intense anxiety, the patients tend to avoid them.

Obsessive fears are often accompanied by the development of rituals - actions that have the meaning of "magic" spells that are performed, despite the critical attitude of the patient to obsession, in order to protect against one or another imaginary misfortune: before starting any important business, the patient must perform some that specific action to eliminate the possibility of failure. Rituals can, for example, be expressed in snapping fingers, playing a melody to the patient or repeating certain phrases, etc. In these cases, even relatives are not aware of the existence of such disorders. Rituals, combined with obsessions, are a fairly stable system that usually exists for many years and even decades.

Obsessions of affectively neutral content - obsessive sophistication, obsessive counting, recalling neutral events, terms, formulations, etc. Despite their neutral content, they burden the patient, interfere with his intellectual activity.

Contrasting obsessions ("aggressive obsessions") - blasphemous, blasphemous thoughts, fear of harming oneself and others. Psychopathological formations of this group refer mainly to figurative obsessions with pronounced affective saturation and ideas that take possession of the consciousness of patients. They are distinguished by a sense of alienation, the absolute lack of motivation of the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions and complain of an irresistible desire to add endings to the replicas they have just heard, giving an unpleasant or threatening meaning to what has been said, to repeat after those around them, but with a touch of irony or malice, phrases of religious content, to shout out cynical words that contradict their own attitudes and generally accepted morality. , they may experience fear of losing control of themselves and possibly committing dangerous or ridiculous actions, injuring themselves or their loved ones. In the latter cases, obsessions are often combined with object phobias (fear of sharp objects - knives, forks, axes, etc. ). The contrasting group also partially includes obsessions of sexual content (obsessions of the type of forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals).

Obsessions of pollution (mysophobia). This group of obsessions includes both the fear of pollution (earth, dust, urine, feces and other impurities), as well as the fear of penetration into the body of harmful and toxic substances (cement, fertilizers, toxic waste), small objects (glass fragments, needles, specific types of dust), microorganisms. In some cases, the fear of contamination can be limited, remain at the preclinical level for many years, manifesting itself only in some features of personal hygiene (frequent change of linen, repeated washing of hands) or in housekeeping (thorough handling of food, daily washing of floors). , "taboo" on pets). This kind of monophobia does not significantly affect the quality of life and is evaluated by others as habits (exaggerated cleanliness, excessive disgust). Clinically manifested variants of mysophobia belong to the group of severe obsessions. In these cases, gradually becoming more complex protective rituals come to the fore: avoiding sources of pollution and touching "unclean" objects, processing things that could get dirty, a certain sequence in the use of detergents and towels, which allows you to maintain "sterility" in the bathroom. Stay outside the apartment is also furnished with a series of protective measures: going out into the street in special clothing that covers the body as much as possible, special processing of wearable items upon returning home. In the later stages of the disease, patients, avoiding pollution, not only do not go out, but do not even leave their own room. In order to avoid contacts and contacts that are dangerous in terms of contamination, patients do not allow even their closest relatives to come near them. Mysophobia is also related to the fear of contracting a disease, which does not belong to the categories of hypochondriacal phobias, since it is not determined by fears that a person suffering from OCD has a particular disease. In the foreground is the fear of a threat from the outside: the fear of pathogenic bacteria entering the body. Hence the development of appropriate protective actions.

A special place in the series of obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, unlike organically conditioned involuntary movements, are much more complex motor acts that have lost their original meaning. Tics sometimes give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures. Patients suffering from tics can shake their heads (as if checking whether the hat fits well), make hand movements (as if discarding interfering hair), blink their eyes (as if getting rid of a mote). Along with obsessive tics, pathological habitual actions (lip biting, gnashing of teeth, spitting, etc.) are often observed, which differ from obsessive actions proper in the absence of a subjectively painful sense of persistence and experience them as alien, painful. Neurotic states characterized only by obsessive tics usually have a favorable prognosis. Appearing most often in preschool and primary school age, tics usually subside by the end of puberty. However, such disorders can also be more persistent, persist for many years and only partially change in manifestations.

The course of obsessive-compulsive disorder.

Unfortunately, chronization must be indicated as the most characteristic trend in the OCD dynamics. Cases of episodic manifestations of the disease and complete recovery are relatively rare. However, in many patients, especially with the development and preservation of one type of manifestation (agoraphobia, obsessive counting, ritual handwashing, etc.), a long-term stabilization of the condition is possible. In these cases, there is a gradual (usually in the second half of life) mitigation of psychopathological symptoms and social readaptation. For example, patients who experienced fear of traveling on certain types of transport, or public speaking, cease to feel flawed and work along with healthy people. In mild forms of OCD, the disease usually proceeds favorably (on an outpatient basis). The reverse development of symptoms occurs after 1 year - 5 years from the moment of manifestation.

More severe and complex OCDs such as phobias of infection, pollution, sharp objects, contrasting performances, multiple rituals, on the other hand, may become persistent, resistant to treatment, or show a tendency to recur with disorders that persist despite active therapy. Further negative dynamics of these conditions indicates a gradual complication of the clinical picture of the disease as a whole.

DIFFERENTIAL DIAGNOSIS

It is important to distinguish OCD from other disorders that involve compulsions and rituals. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when the obsessive thoughts are unusual in content (eg, mixed sexual and blasphemous themes) or the rituals are exceptionally eccentric. The development of a sluggish schizophrenic process cannot be ruled out with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity (inconsistency of thinking and actions), and the uniformity of emotional manifestations. Prolonged obsessional states of a complex structure must be distinguished from the manifestations of paroxysmal schizophrenia. Unlike neurotic obsessive states, they are usually accompanied by a sharply increasing anxiety, a significant expansion and systematization of the circle of obsessive associations, which acquire the character of obsessions of "special significance": previously indifferent objects, events, random remarks of others remind patients of the content of phobias, offensive thoughts and thereby acquire in their view a special, menacing significance. In such cases, it is necessary to consult a psychiatrist in order to exclude schizophrenia. It can also be difficult to differentiate between OCD and conditions with a predominance of generalized disorders, known as Gilles de la Tourette's syndrome. Tics in such cases are localized in the face, neck, upper and lower extremities and are accompanied by grimaces, opening the mouth, sticking out the tongue, and intense gesticulation. In these cases, this syndrome can be excluded by the coarseness of movement disorders characteristic of it and more complex in structure and more severe mental disorders.

Genetic factors

Speaking about hereditary predisposition to OCD, it should be noted that obsessive-compulsive disorders are found in approximately 5-7% of parents of patients with such disorders. Although this figure is low, it is higher than in the general population. While the evidence for a hereditary predisposition to OCD is still uncertain, psychasthenic personality traits can be largely explained by genetic factors.

FORECAST

Approximately two-thirds of OCD patients improve within a year, more often by the end of this period. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of improvement in health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic personality with severe symptoms of the disease, or if there are continuous stressful events in the patient's life. Severe cases can be extremely persistent; for example, a study of hospitalized patients with OCD found that three-quarters of them remained symptom-free 13 to 20 years later.

TREATMENT: BASIC METHODS AND APPROACHES

Despite the fact that OCD is a complex group of symptom complexes, the principles of treatment for them are the same. The most reliable and effective method of treating OCD is considered to be drug therapy, during which a strictly individual approach to each patient should be manifested, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of other diseases. In this regard, we must warn patients and their relatives against self-treatment. If any disorders similar to mental ones appear, it is necessary, first of all, to contact the specialists of the psycho-neurological dispensary at the place of residence or other psychiatric medical institutions to establish the correct diagnosis and prescribe competent adequate treatment. At the same time, it should be remembered that at present a visit to a psychiatrist does not threaten with any negative consequences - the infamous "accounting" was canceled more than 10 years ago and replaced by the concepts of consultative and medical care and dispensary observation.

When treating, it must be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement). The apparent suffering of the patient often seems to call for vigorous effective treatment, but the natural course of the condition must be kept in mind in order to avoid the typical error of over-intensive therapy. It is also important to consider that OCD is often accompanied by depression, the effective treatment of which often leads to an alleviation of obsessional symptoms.

The treatment of OCD begins with an explanation of the symptoms to the patient and, if necessary, with reassurance that they are the initial manifestation of insanity (a common concern for patients with obsessions). Those suffering from certain obsessions often involve other family members in their rituals, so relatives need to treat the patient firmly, but sympathetically, mitigating the symptoms as much as possible, and not aggravating it by excessive indulgence in the sick fantasies of patients.

Drug therapy

The following therapeutic approaches exist for the currently identified types of OCD. Of the pharmacological drugs for OCD, serotonergic antidepressants, anxiolytics (mainly benzodiazepine), beta-blockers (to stop autonomic manifestations), MAO inhibitors (reversible) and triazole benzodiazepines (alprazolam) are most often used. Anxiolytic drugs provide some short-term relief of symptoms, but should not be given for more than a few weeks at a time. If anxiolytic treatment is required for more than one to two months, small doses of tricyclic antidepressants or small antipsychotics sometimes help. The main link in the treatment regimen for OCD, overlapping with negative symptoms or ritualized obsessions, are atypical antipsychotics - risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants or other antidepressants - moclobemide, tianeptine, or with high-potency benzodiazepine derivatives ( alprazolam, clonazepam, bromazepam).

Any comorbid depressive disorder is treated with antidepressants at an adequate dose. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms, but the results of a controlled clinical trial showed that the effect of this drug is insignificant and occurs only in patients with distinct depressive symptoms.

In cases where obsessive-phobic symptoms are observed within the framework of schizophrenia, intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect. In some cases, it is advisable to connect traditional antipsychotics (small doses of haloperidol, trifluoperazine, fluanxol) and parenteral administration of benzodiazepine derivatives.

Psychotherapy

Behavioral psychotherapy

One of the main tasks of the specialist in the treatment of OCD is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the "harm" caused by psychotropic drugs, to convey his conviction in the effectiveness of treatment, subject to the systematic observance of the prescribed prescriptions. The patient's faith in the possibility of healing must be supported in every possible way by the relatives of the OCD sufferer. If the patient has rituals, it must be remembered that improvement usually occurs when using a combination of the method of preventing a reaction with placing the patient in conditions that aggravate these rituals. Significant but not complete improvement can be expected in about two-thirds of patients with moderately heavy rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts also recede. In panphobia, predominantly behavioral techniques are used to reduce sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases where ritualized phobias predominate, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for obsessive thoughts that are not accompanied by rituals. Thought-stopping has been used by some experts for many years, but its specific effect has not been convincingly proven.

Social rehabilitation

We have already noted that obsessive-compulsive disorder has a fluctuating (fluctuating) course and over time the patient's condition may improve regardless of which particular methods of treatment were used. Until recovery, patients can benefit from supportive conversations that provide continued hope for recovery. Psychotherapy in the complex of treatment and rehabilitation measures for patients with OCD is aimed at both correcting avoidant behavior and reducing sensitivity to phobic situations (behavioral therapy), as well as family psychotherapy to correct behavioral disorders and improve family relationships. If marital problems exacerbate symptoms, joint interviews with the spouse are indicated. Patients with panphobia (at the stage of the active course of the disease), due to the intensity and pathological persistence of symptoms, need both medical and social and labor rehabilitation. In this regard, it is important to determine adequate terms of treatment - long-term (at least 2 months) therapy in a hospital with subsequent continuation of the course on an outpatient basis, as well as taking measures to restore social ties, professional skills, family relationships. Social rehabilitation is a set of programs for teaching OCD patients how to behave rationally both at home and in a hospital setting. Rehabilitation is aimed at teaching social skills to properly interact with other people, vocational training, as well as skills necessary in everyday life. Psychotherapy helps patients, especially those who experience a sense of their own inferiority, treat themselves better and correctly, master ways to solve everyday problems, and gain confidence in their strength.

All of these methods, when used judiciously, can increase the effectiveness of drug therapy, but are not capable of completely replacing drugs. It should be noted that explanatory psychotherapy does not always help, and some patients with OCD even worsen because such procedures encourage them to think painfully and unproductively about the subjects discussed in the course of treatment. Unfortunately, science still does not know how to cure mental illness once and for all. OCD often has a tendency to recur, which requires long-term prophylactic medication.

Obsessive Compulsive Disorder (OCD): what it is, symptoms, treatment, advice from a doctor Some people develop symptoms during adolescence, although they are usually diagnosed in adults. Obsessive-compulsive disorder can significantly interfere with a fulfilling life, but treatment can help keep it under control.

Let's figure out together with experts what are the causes of OCD, what therapeutic and drug methods are used by doctors, and how to behave relatives of a person who has been diagnosed with this disorder.

Contents

What it is
Signs and symptoms
Causes
Diagnosis
How to treat
Advice for relatives

What is obsessive-compulsive disorder?

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Obsessive-compulsive disorder is a common chronic and long-term condition in which a person has uncontrollable repetitive, obsessive thoughts (ideas) and/or actions (behaviors) [1]. OCD is diagnosed in 1.3% of the world's population [2].

Many people confuse OCD with nail biting or negative thinking. Both can be a sign of the disease, but other diagnostic criteria must be taken into account. The obsession is often that a person considers certain numbers or colors to be "good" or "bad". It happens that the habit with OCD is washing your hands repeatedly after touching something that is considered dirty, infected, dangerous. Although the person does not want to think or do it, he is unable to stop [3].

Vladimir BelovMedical psychologist, child psychologist, consultant suicidologist, leading specialist of the Semeynaya clinic network

“Obsessive Compulsive Disorder is a neuropsychological disorder that always includes two components:

obsessions - constant thoughts or impulses, intrusive and unacceptable, causing anxiety;
compulsions are rituals that are built into the thoughts of a person, he considers it necessary to perform them in response to an obsession.

The most common connection between these components is that compulsions are actions whose purpose is to neutralize or reduce the distress caused by obsessions. Rituals include such processes as endless washing of hands, double-checking one's own actions or the state of some objects. For some people, these are specific prayers, rituals when going to work, when returning to an apartment, while waiting for transport.

Signs and symptoms of obsessive-compulsive disorder

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Obsessions - involuntary thoughts and ideas: "I shook hands with a person and now I can get infected with something. " This rumination in itself is perfectly normal, but the person with OCD will wash their hands again and again, unable to get rid of it. This is already a compulsion - an obsessive behavior, an individual unstoppable ritual. In the short term, it reduces anxiety, but the thought returns and the action must be repeated. A person feels that he must do it, while he cannot stop. Everyone has recurring habits or thoughts that recur frequently. But in the case of OCD they are:

present daily;
are uncontrollable;
are not enjoyable;
affect work and social life.

It's not unusual to wonder if the curling iron is unplugged. It’s worth worrying if this thought haunts you every day, makes you return home halfway from work and check (more than once, even if you just made sure that the device is not turned on). Obsessive-compulsive disorder comes in many forms, but most cases fall into at least one of the four main categories. The symptoms of OCD are rooted in the person's obsessive behavior. For example, he:

Checks if the door is locked, if the iron and oven are switched off.
Unreasonably suspects undiagnosed health conditions such as pregnancy or schizophrenia.
Afraid of germs, things that can be dirty, constantly cleaning.
Strives for excessive symmetry and order, feels the need to arrange things in a certain way: by size, colors or alphabet.
Cannot drive obsessive thoughts and ideas away from himself. Some of them can be violent or disturbing.

Anastasia AfanasyevaPsychiatrist, psychotherapist, clinical director of the psychological platform Alter

“Intrusive thoughts can occur as part of a variety of disorders, from psychosis to anxiety. To understand what disease these thoughts can be associated with, experts look at how a person treats them. For example, a person in psychosis may not even have a shadow of doubt and discomfort from the fact that the obsessive thought “you can harm your child” is spinning in his head. A person with OCD cannot have this, he will be frightened by such thoughts, and he will try to do everything to prevent this from happening, for example, remove all sharp objects away from him or not approach the child. Discomfort and the feeling that these thoughts are "inadequate", "wrong" will be an important identifying factor that this is OCD.

People without disorders can also have obsessive thoughts, but normally we quickly cope with them and they do not disturb life, forcing us to rebuild it for ourselves: the thought appeared - the person brushed it off and moved on.

Causes of OCD

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Doctors do not give a specific explanation of the causes of the onset and development of OCD. It is most often diagnosed in adolescence and adulthood, with women 1.6 times more likely than men [4]. The factors for the development of the disease include:

Genetics. If you have OCD in your next of kin—father, mother, brother, and sister—the chances are high that you have it too.
Structure and function of the brain. In the brain of OCD sufferers, increased activity is recorded in the region of the cortico-striatal-thalamo-cortical loop [5].
Environment. High levels of stress, increased anxiety can also be a trigger for the development of obsessive-compulsive disorder.
Concomitant diseases. OCD is often diagnosed in parallel with eating disorders and depression [6].
Traumatic events. The disorder can be the result of difficult circumstances experienced: psychological and sexual abuse, physical trauma, loss of loved ones.
Infections. Occasionally, OCD is found in children who have had a streptococcal infection. This is called pediatric autoimmune neuropsychiatric disorders.

There is a hypothesis that disturbing deviations developed and persisted in the course of evolution [7]. When people did not have access to modern advances in medicine and hygiene, those who had less contact with a possible source of infection and were constantly on the alert, assessing possible risks and double-checking the safety of food and housing, survived.

Obsessive Compulsive Disorder Diagnostics

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All people from time to time find themselves in stressful situations, many people find it helpful to put things in order at home or in the closet, everyone at least once caught himself thinking that he had not turned off the coffee maker in a hurry to a meeting. It doesn't mean you have OCD. Only a doctor can make an accurate diagnosis. Contact a specialist if the above symptoms directly affect your relationship with yourself and others, steal time, do not allow you to relax and enjoy life.

In society, the attitude towards OCD is often superficial and not serious. It is often perceived as a funny feature of a person. But the worsening symptoms cannot be controlled by willpower alone. OCD can be expressed in varying degrees of obsession, and for many it really does not interfere (and may help maintain cleanliness and keep processes under control), but for others it poses a real threat to normal life [8].

There are specialized tests for obsessive-compulsive disorder. Try to answer several questions in the format "often", "rarely", "never", "always":

Do you experience obsessive thoughts about possible tragic events, death, serious illnesses, fires, accidents?
Are you concerned about the possibility of contamination with germs and chemicals?
Do you unnecessarily re-read emails or text messages before or after sending them?
Are you obsessed with keeping everything in order (cataloging books, perfect stacks of clothes in the closet, pencils arranged by size on the table)?
Do you repeat routines such as opening a door, putting on your shoes, or getting into bed over and over again until you feel like you've done it "right"?
Do you have recurring inappropriate thoughts (often of a religious, violent, or sexual nature) that seem intrusive and out of control?
Do you feel the need to constantly seek confirmation of what you have said or done?
Do you follow ritualized washing, cleaning or grooming habits (eg washing your hands five times in a row)?
Do you avoid certain colors or numbers because you consider them "unlucky"?
Do you check your trash before throwing it away to make sure it's clean?
Do you worry about doing something out of a senseless urge, like pushing a stranger or hitting a loved one?
Do you check oven handles, door locks and car brakes over and over again in a short period of time?

If most of the thoughts and situations described appear suspiciously often in your daily life, you should consult a general practitioner. He will conduct a physical examination and order blood tests to make sure that the symptoms are not caused by something else. If OCD is suspected, work with a therapist or psychiatrist to talk about life circumstances, feelings, thoughts, and habits.

How to treat obsessive-compulsive disorder

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There is no specific drug that can completely eliminate the symptoms of OCD. But medication support and additional psychological techniques for working on oneself help to work through this problem and keep it under control.

Psychotherapy

Cognitive Behavioral Therapy allows you to change your thinking patterns. Anastasia Afanasyeva believes that one of the most important techniques when working with OCD is distancing, exposing and challenging thoughts: “Distancing is a group of techniques in which we teach a person with OCD to notice intrusive thoughts, realize their ineffectiveness and switch from thinking about them to current ones. affairs. It is important here not to try to start controlling and “not thinking” these thoughts, as this is unrealistic and causes even more anxiety. Instead, for example, we can imagine that thoughts are like an annoying radio broadcast that cannot be turned off, but is not worth listening to.

Exposure is the conscious exposure to uncomfortable situations in order to gradually learn to endure stress and stop using rituals that reduce anxiety in the moment, such as double-checking, washing hands, avoiding sharp objects.

Challenging and checking the reality of thoughts helps to understand that often a thought is just a thought and not every thought that comes to mind is worth believing. To assess how true this idea is, you can write it down on a piece of paper and give facts for and against its correctness.

Relaxation

Anxiety and obsessive thoughts are inevitably associated with tension in the body. Available meditation techniques, as well as massage and yoga classes, help to consciously look at the circumstances and cope with stress.

Anastasia Afanasyeva:

“In general, working with anxiety disorders always involves homework, as people learn to cope with their anxiety not only in the psychologist's office, but also in situations that arise in everyday life. Mostly it's working with thoughts and changing behavioral strategies that support OCD or reduce anxiety for only a short time.

The most common treatment for OCD involves individual sessions with a psychotherapist. There are practically no therapy protocols with proven efficacy for groups.”

Medicines

When taking drugs, you can achieve a stable remission. The timing of drug treatment will be determined by the attending physician. Do not stop taking antidepressants at the first sign of improvement.

Vladimir Belov:

“First of all, we need the work of both a psychiatrist and a medical psychologist / psychotherapist. Because, on the one hand, cognitive-behavioral therapy is used, which is quite effective and has a lot of scientific evidence: exposure and prevention of reactions and rituals. This program goes on for several months and is combined with drugs. First of all, these are antidepressants - selective serotonin reuptake inhibitors and atypical antipsychotic drugs. Much depends on the condition of the patient and the severity of the process in which he is.

What to do for relatives of an OCD patient

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People who live near a person with OCD often find themselves in difficult conditions. They want to help by interrupting the compulsive manifestations of a loved one, which can create an even more stressful situation for him. But it is also not worth closing your eyes to the disease. Psychologists advise updating it, pronouncing the problem. Develop the emotional intelligence of a loved one: let's understand that he can safely talk to you about any of his feelings. Emphasize that you are always ready to listen and help: “I am with you, we will deal with this problem together.”

Anastasia Afanasyeva:

“If someone close to you suffers from OCD, then one of the important tasks you face is to stay out of the anxiety maintenance cycle. For example, one should not encourage the desire for excessive cleanliness, endless washing of clothes, washing hands, constant fruitless visits to doctors, one should not participate in rechecking any facts. You need to understand that this does not help a loved one cope with anxiety, but reinforces a non-working pattern of behavior and serves as proof that such behavior and thoughts are justified.

Forums, support groups for people with OCD

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The best option is to contact a trusted doctor and treat according to his recommendations. In addition to medicines and work with a specialist, the fulfillment of independent tasks plays an important role. It is important for people with OCD to talk about the problem and see the support of others. Like-minded forums often help. You can join thematic groups on social networks or contact volunteers:

Anxiety and Depression Association of America (ADAA) - mental health resources, including conferences of the International OCD Foundation. There are online support groups for those with the disorder.
OCD Peers - Virtual support groups (6-10 members) using a HIPAA compliant platform. Video conferences with group mentor, open discussions and agenda. All groups are paid.
7 cups - on the platform you can find a volunteer who will be in touch and ready to listen to the problem. This is not a qualified professional, but sometimes speaking out to an attentive listener is just as important as working through a problem with a licensed psychotherapist.
Support Groups - A free resource with several hundred support groups on a variety of topics, including those for OCD sufferers. Groups are moderated to avoid bullying and inappropriate user reactions.
HealthUnlocked - literally "health unlocked" - a resource with forums to support people with various diseases. The ROC topic is moderated not only by the portal administrators, but also by representatives of the International ROC Foundation.
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