Clean disorder ocd

Understanding OCD and Cleaning

You like your kitchen sink to shine, and your stove can never be clean enough. Does that mean you have obsessive-compulsive disorder (OCD)?

Answering that question requires a deeper look into what OCD is — and why some people with OCD are compelled to clean.

The relationship between OCD and cleaning hinges on obsession (recurrent, intrusive thoughts) and compulsion (repeated behaviors or actions).

Obsessions and compulsions intertwine in OCD, and they can drive an overwhelming desire to repeatedly clean things.

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is an authoritative guide to psychological conditions. It describes OCD as a disorder that causes people to experience distressing thoughts and mental images that won’t go away.

In response to these unwanted thoughts, people with OCD may feel an intense urge to repeat certain actions. The actions may be physical behaviors (such as arranging objects in a particular order) or mental ones (like praying in a particular way).

Some people feel that completing these actions will neutralize a threat, make an obsessive thought stop, or relieve the anxiety that unwanted thoughts create.

DSM-5 emphasizes that compulsive acts can take up a lot of time. They can disrupt a person’s social, academic, or professional life. The need to precisely perform rituals and compulsive acts can cause serious anxiety.

OCD, then, is much more than a desire to work or live in a clean environment or a preference for neatness. It involves a sometimes debilitating and distressing need to clean and reclean specific areas or items.

Although DSM-5 doesn’t list subtypes of OCD, some researchers group obsessions and compulsions into “symptom dimensions.” These clusters of symptoms share similar anxieties and behavior patterns.

Here’s a brief look at the symptom dimensions as currently described in scientific literature:

Contamination and cleaning

Some people have an extreme fear of becoming contaminated by germs, bodily fluids, or other substances — including abstract contaminants like evil or bad luck. People may even fear that they’re contaminating others.

An obsession with contamination can lead to a cleaning compulsion. People may believe that by cleaning objects or spaces in a specific order or with a particular frequency, they can avoid or recover from contamination or infection.

Symmetry and ordering

Some people become preoccupied with arranging objects in a certain order, often because of a kind of magical thinking or magical ideation. For example, individuals with OCD may think, “If I don’t line up my toiletries exactly this far apart, someone is going to harm me today, or if I clean my sink five times this morning, my brother won’t get sick today.”

Researchers have found that people with symmetry obsession and an ordering compulsion often have trouble expressing anger in healthy ways and may have a personal history of trauma.

Doubt about harm and checking

Some people have intrusive thoughts and fears about harming others or being harmed themselves. An excessive dread of being responsible for harm can lead to compulsive checking behaviors — for example, repeatedly making sure you’ve turned off the stove or an iron.

People affected by checking compulsions describe a feeling of incompleteness unless they perform certain rituals or behaviors. Other common compulsions include repeating mantras, prayers, or safety words to ward off danger or reduce anxiety.

Similar to symmetry and order compulsions, checking compulsions have been associated with anger and trauma.

Unacceptable thoughts and mental rituals

Some people experience frequent intrusive thoughts about things that violate their own sense of morality and goodness. Often, these unwanted thoughts involve sex, violence, or religious images.

Although people with this symptom cluster generally have no history of violence, they spend a lot of time and energy trying to suppress or erase these thoughts. Trying to squelch the thoughts can lead to even more anxiety, which tends to produce more unwanted thoughts — resulting in an unhealthy cycle.

Two of these symptom dimensions have a clear link to cleaning tasks: contamination and cleaning as well as symmetry and ordering.

You can’t prevent OCD, though doctors say an early diagnosis and intervention may mean you spend less time dealing with the difficulties this disorder can present.

About 2 percent of the general population has OCD. The disorder tends to appear at an earlier age in males. By midlife, though, more women than men have symptoms of OCD.

Here’s what we know about the risk factors, causes, and triggers of this disorder.

Genetics

Researchers continue to explore the influence of genetics on whether someone develops OCD.

As of now, scientists know that if your parent or sibling has OCD, you’re more likely to develop the condition. Some studies have found that the symptom dimensions involving OCD cleaning and ordering are especially likely to run in families.

Brain structure

Researchers are finding differences in the brain structures of people with OCD, along with differences in how their brain functions.

For example, one 2017 study found that in people with OCD, there’s greater connectivity and activity in parts of the brain associated with habit formation and in parts that process emotions — especially fear.

Brain scans also reveal differences in estrogen receptors and in the amount of white and gray matter in the brains of people with the contamination and cleaning symptom dimensions.

Understanding differences in brain structures is important because it may point to new directions for treating the condition.

Environment

Behavioral researchers have long known that stress and trauma are associated with a higher risk of developing OCD.

For example, 2015 study involving 22,084 Swedish twins indicates that two kinds of childhood trauma are particularly likely to lead to symptoms of OCD: abuse and family disruption.

OCD symptoms include not only obsessions and compulsions, but significant anxiety as well. You may feel stressed in circumstances where you feel out of control or uncertain.

If you have OCD and contamination or cleaning are important to you, you may notice that you:

feel disgust or fear over certain objects or substances, including dirt, illness, body secretions, trash, or chemicals
believe you or others can be contaminated by magical or spiritual means — such as by saying certain names or numbers
have a strong urge to wash your hands or shower frequently
use a very specific process or ritual for washing yourself or your surroundings
change clothes several times a day
avoid places or people that may have been infected
conduct precise decontaminating rituals
refuse to allow others into your safe spaces
damage your skin or body through excessive cleaning

If you have OCD and it’s important for you to keep things symmetrical or arranged in a precise order, you may notice that you:

experience serious anxiety if certain things are not arranged “just right”
feel an urge to repeat what happens to one side of your body on the other side of your body
fear that if something is unbalanced or uneven, a catastrophe could happen
perform touching or tapping rituals
count things habitually

A doctor, psychologist, or psychiatrist can diagnose your condition by interviewing you about your thought and behavior patterns or by asking you about symptoms listed in DSM-5.

A physical examination could help your doctor determine whether an underlying health condition is causing your symptoms.

OCD is well researched. Doctors, psychiatrists, and psychologists have found a number of treatments that can decrease your symptoms and improve your daily functioning.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is an effective treatment for many people dealing with OCD.

In a CBT session, you meet with a therapist who can help you decrease your anxiety by identifying thought patterns that distort your view of reality and cause stress. Your therapist can then help you learn to restructure these thoughts in productive ways.

Studies have shown that CBT strengthens connections throughout your brain, especially in areas that deal with your ability to control your thinking and balance your emotions.

Online therapy options

Read our review of the best online therapy options to find the right fit for you.

Exposure and response prevention

Exposure and response prevention (ERP) is another type of therapy known to be effective in treating OCD.

In ERP, you and your therapist work together to identify external and internal triggers that cause you stress and make you want to behave compulsively.

You also describe your obsessive thoughts and your compulsive behaviors to your therapist. You explain what you fear will happen if you don’t follow through with a behavior or rituals.

Your therapist then helps you practice gradually facing stressful situations — both in your imagination and in real life — without using your compulsions.

Medication

Your doctor may prescribe an antidepressant to reduce your OCD symptoms. Some of the more common medications prescribed for OCD are:

Anafranil
Fluvoxamine
Paxil
Prozac
Zoloft

If you take one of these medications to treat OCD, it’s important to talk to your doctor before you change your dose.

You shouldn’t stop taking your medication suddenly, because in some cases it can cause:

a relapse of your symptoms
serious changes in your mood
an increased risk of suicidal thoughts

Deep brain stimulation

Your doctor may recommend deep brain stimulation (DBS) if more conservative treatment methods aren’t working for you.

During DBS, doctors implant electrodes in targeted areas of your brain. The electrodes produce electrical pulses that may help change your thoughts and behaviors.

Transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) is another approach to consider if other treatments aren’t helping you.

During TMS, a doctor places an electromagnetic coil on your head. Magnetic fields interact with nerve cells in your brain in an attempt to lessen your OCD symptoms.

If you have OCD and a cleaning or ordering compulsion, your symptoms can be treated. There’s a good outlook for people who seek treatment for their OCD.

The best outcomes happen when people are diagnosed early and start a robust treatment program right away.

Sometimes OCD goes into remission on its own, especially if it initially appears during childhood. Other times people need long-term treatment to keep symptoms in check.

Being a perfectionist about cleaning doesn’t necessarily mean you have OCD. Individuals with OCD experience persistent intrusive thoughts and a compulsion to carry out certain ritualistic behaviors.

OCD produces serious anxiety. Compulsive cleaning is often related to fears of contamination, and compulsive arranging can be caused by a need for symmetry and balance.

This disorder can be treated with therapy, medications, and procedures that stimulate parts of your brain known to be affected by the disorder. If you are diagnosed early and you participate in a treatment program consistently, it’s possible you’ll be able have a good quality of life.

Understanding OCD Cleaning Disorder - Signs

Obsessive-Compulsive Disorder is a mental health disorder categorized by the presence of recurring obsessive thoughts and subsequent compulsive behaviors done to get rid of them.

Under OCD, there is a cluster of symptoms based on which a group of subtypes has been identified.

These include:

Contamination and cleaning: Some people fear becoming contaminated by germs or other substances — including abstract contaminants like evil or bad luck. An obsession with contamination can often lead to a cleaning compulsion.
Symmetry and order: Some people become preoccupied with arranging objects in a particular order, often because of magical thinking.
Harm and checking: An excessive fear of being responsible for the damage can lead to compulsive checking behaviors, such as making sure you've turned off the stove or iron.
Unacceptable thoughts and mental rituals: These recurring unwanted thoughts involve sex, violence, or religious images. Trying to suppress the ideas can lead to even more anxiety.

These symptom dimensions link directly to cleaning tasks: contamination and cleaning and symmetry and order.

What is OCD Cleaning?

The cleaning type of OCD ( sometimes misnamed Obsessive Cleaning Disorder) thus borrows from the clusters mentioned above of symptoms; it goes beyond a simple need to maintain a tidy, sterile environment. People who suffer from compulsive cleaning may have a sense of contamination by dirt, germs, environmental contaminants, or chemical toxins. It is often characterized by two significant behaviors, which are

Self Cleaning: Involves a person engaging compulsively in hand washing. The urge typically arises from a fear of germs (the most common obsession seen in OCD). Still, it also can be embedded in fears of making others sick or being polluted or immoral. People with contamination fears will generally engage in extreme washing to remove dirt and germs or feel clean. Handwashing may be done in a ritualized manner. It is not unusual for people with this type of OCD to have red hands that may even bleed. Compulsive hand washers may also engage in excessive hand sanitizers between trips to the sink.
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Overt cleaning: People with contamination OCD may spend a lot of time cleaning family items or other lifeless objects. Someone with this type of OCD may wash their shoes, credit cards, phone, or other things that may have come into contact with them. These items may be deemed dirty or infected. As with handwashing, house cleaning is often a way to reduce germaphobia or impurity feelings. Although cleaning can help end these obsessive thoughts, the comfort does not last, and the desire to clean is often even more powerful the next time.

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What are the signs and symptoms of Obsessive cleaning?

The DSM-5(the manual used for diagnosis) highlights that compulsive acts can take time. The need to perform rituals specifically and compulsive actions can cause severe anxiety. OCD is much more than a desire to work or live in a clean environment or a fondness for neatness. Sometimes, it involves a debilitating and painful need to clean and reclean specific areas or items.

Some cleaning OCD symptoms can be enlisted as follows

Feeling disgusted or scared of particular objects or substances, including dirt, trash, or chemicals.
Having a strong urge to wash the hands or shower frequently
Using a specific process or ritual for cleansing themselves or their surroundings
Changing clothes multiple times a day
Damaging their skin or body through excessive cleaning

How to get rid of OCD Cleaning disorder?

Compulsive cleaning symptoms under OCD can be treated in the following ways:

Cognitive-behavioral therapy CBT is an effective treatment where patients meet with a therapist who can help them decrease their anxiety by recognizing thought practices that misinterpret their view of reality and generate stress. The therapist can help people learn how to restructure these thoughts in productive ways.
Exposure and response prevention The patient is asked to explain their obsessive thoughts and compulsive behaviors. The therapist then helps them slowly rehearse encountering stressful situations both in their imagination and in real life without using the existing compulsions. This form of therapy introduces the trigger to the client and focuses on cognitive restructuring.
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Medication: Psychiatric drugs, called SSRIs selective serotonin reuptake inhibitors, help many people control their obsessions and compulsions.

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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 aggravate the 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.

Pure obsessive-compulsive disorder/OCD. Pure OCD treatment

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What is pure OCD
Pure obsessive-compulsive disorder - symptoms
Pure Obsessive-Compulsive Disorder Treatment

Cognitive behavioral therapy
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Some people may suffer from "Pure Obsessive/Obsessive OCD" (sometimes also referred to as "Pure OCD"), they say they have obsessions (obsessions) but without being forced into compulsions (compulsions) . These obsessions often manifest as intrusive, unwanted thoughts and images as they perform actions that they believe may be harmful, cruel, immoral, sexually perverse, or blasphemous. For people diagnosed with Obsessive-Compulsive Disorder (OCD) in its purest form, these obsessions are so frightening and tormenting because they conflict with their values and beliefs.

OCD / Pure Obsessive Compulsive Disorder - Symptoms

Symptoms in people diagnosed with Pure Obsessive Compulsive Disorder can vary widely from person to person. Some examples of obsessions seen in pure OCD are:

Recurrent thoughts of harm or images of physical assault on one's spouse, parents, children, self, friends, or others (also called "Harming OCD"). ")
Emerging anxiety that you might run over a pedestrian while driving (also called hit and run OCD)
Excessive fear that you might inadvertently harm others (for example: setting fire to a house, unintentionally poisoning another person, inadvertently exposing toxic chemicals in an accessible place)
Persistent fear of child molestation (sometimes called pedophile OCD or POCD)
An obsessive fear that a person might be homosexual when in fact he or she is not (sometimes called "gay OCD" or "sexual orientation OCD" or "homosexual OCD" or "GOCD", English "gay ocd" or "sexual orientation OCD" or "homosexual OCD" or "HOCD")
Recurrent obsessive thoughts that the person doesn't really love their partner or is with the "wrong" partner (also called "relationship OCD" or "ROCD")
Intrusive thoughts that a person will say or write something inappropriate to someone, for example, a person will speak obscenely to his employer or write a hateful letter to his friend
Persistent intrusive thoughts or images that the person considers blasphemous or blasphemous, such as desire to worship Satan or have sex with Christ
Recurring fear that a person does not live (think) in accordance with their religion, morality, or ethical values (sometimes called "decency/morality OCD", English "crupulosity OCD")
Recurrent obsessive thoughts about the appearance of physiological problems with breathing, swallowing, blinking, thoughts that objects in the eyes may begin to “blur”, ringing in the ears, digestive problems, the appearance of physical sensations in certain parts of the body, etc. (sometimes called sensorimotor OCD, sensorimotor OCD, or psychosomatic OCD)

However, it should be noted that the term "pure OCD" is "in a certain way" a misnomer. Although at first glance it may seem that people suffering from "pure OCD" do not exhibit obsessive/compulsive behaviors, a careful assessment almost always reveals the presence of a variety of compulsive behaviors, behaviors to avoid something, behaviors that a person wants to complete any process, or "mental coercion." These compulsive behaviors/compulsions may not be as easily observed as other more obvious signs/symptoms in people diagnosed with OCD, such as compulsive handwashing and constant checking to see if the person has shut the door or not. But they are compulsive/compulsive actions in response to uncomfortable obsessions. Some common examples of compulsions (obsessive behavior) that are observed in people diagnosed with pure obsessive-compulsive disorder:

Avoidance of situations in which a person fears, is afraid of unwanted obsessions
Repeatedly seeking reassurance that the person does not and/or will not do what they consider "wrong" or "bad"
Compulsive checking of one's own body in order to obtain strong evidence that the person is not sexually attracted to another person whom he/she considers inappropriate, inappropriate (especially observed in cases of "pedophilia OCD", "sexual orientation OCD", and "relationship OCD ")
Quietly or silently, prays or repeats certain phrases in an attempt to counteract or neutralize, suppress thoughts that he considers immoral or blasphemous
Performs a behavior trying to make sure no bad things happen (example: counting, snapping fingers, knocking on wood)
Repeatedly assures other people that he or she had no thoughts/ideas that he or she would consider unacceptable
Constantly thinking about obsessions, thereby trying to prove to himself that he or she has not done and / or will not do anything that he or she may perceive as “inappropriate” or “wrong”

Obsessive Compulsive Disorder/OCD Pure Treatment

Obsessive Compulsive Disorder/OCD Pure Treatment Using Cognitive Behavioral Psychotherapy

For many years it was thought that treating OCD alone was almost impossible , since only obsessive thoughts, ideas were present, but there was no any compulsive behavior. However, a certain type of cognitive behavioral therapy (CBT) called Exposure and Response Prevention (EPR) has been shown to be effective when treating people who have pure OCD. Using EPR, patients are trained to face their own fears about certain thoughts, and are trained to actively challenge their compulsive (compulsive/repetitive) behaviors and the avoidance behaviors they used to deal with those thoughts. Another method that has been developed by Cognitive Behavioral Therapy that has proven to be extremely effective is Cognitive Restructuring. As a result of using this method, clients diagnosed with pure Obsessive Compulsive Disorder are taught to challenge the validity of their unwanted thoughts that cause them to suffer greatly.

In addition, a variant of EPR has been developed that has demonstrated its high efficacy in the treatment of OCD in its pure form. This method, sometimes called the "imagination" method, involves the use of short stories that are based on the patient's obsessions. These stories, for a person who has pure OCD, are recorded on audio and used as an EPR tool, thereby enabling the client to experience the impact of situations that he could not experience using traditional EPR methods (for example: obsessive thoughts about killing one of the spouses or corrupting the child). By combining this method with standard EPR methods for the aforementioned obsessions, as well as other cognitive-behavioral techniques, this type of "imagination" is able to significantly reduce the frequency and magnitude of these obsessive thoughts, as well as reduce the individual's sensitivity to thoughts and images that experiencing a person with a diagnosis of obsessive-compulsive disorder in its purest form.

One of the most effective developments in cognitive behavioral therapy for treating people diagnosed with pure OCD is Mindfulness Based Cognitive Behavioral Therapy. The main goal of mindfulness-based CBT is to learn to stop the subjective perception of psychological experiences that bring discomfort to a person. From the point of view of mindfulness-based cognitive behavioral therapy, much of the psychological stress we experience is nothing more than the result of our attempts to control and eliminate discomfort from unwanted intrusive thoughts, feelings, sensations. To put it another way, the discomfort we experience is not the problem—the problem is our attempts to control and eliminate that discomfort. For a person who suffers from pure OCD, the ultimate goal of mindfulness-based CBT is to develop the ability to more freely experience their unwanted thoughts, feelings, sensations without responding to them with avoidant behavior, seeking reassurance from other people, and/or mental (mental) rituals. . To learn more about how people diagnosed with pure Obsessive Compulsive Disorder are treated with mindfulness-based cognitive behavioral therapy, click here.

Obsessive Compulsive Disorder / OCD in its pure form - treatment using the Hypno-suggestive psychotherapy method (hypnosis and suggestion)

In addition, the treatment of OCD in its purest form is carried out using hypno-suggestive psychotherapy. Hypno-suggestive psychotherapy is a highly effective method of treatment that includes hypnosis and suggestion. Hypnosis, or the process of hypnotization, is the immersion of a person in a temporary state of consciousness, which is characterized by a narrowing of the volume of consciousness and a sharp focus on the suggestion received. Thanks to this, hypnosis (hypnosuggestive psychotherapy) is able to introduce new, more adaptive attitudes, both at the level of consciousness and at the unconscious level. We also train a person diagnosed with pure Obsessive-Compulsive Disorder in self-hypnosis skills, which allow him to consolidate and strengthen the results achieved during the work. Hypnosis, in the end, replacing unwanted behaviors, reducing discomfort from unwanted obsessions, allows you to more calmly and easily stay in situations where unwanted thoughts, feelings, sensations previously arose. Ultimately, through suggestion, hypnosis allows a person to completely get rid of his obsessive thoughts. To learn more about how people with pure OCD are treated using hypnosis, click here.

Obsessive Compulsive Disorder / pure OCD: individual treatment / psychotherapy

Kyiv OCD Center provides individual treatment (psychotherapy) for adults and adolescents who suffer from pure OCD. The main methods of treatment are: cognitive-behavioral psychotherapy, hypno-suggestive psychotherapy (hypnosis and suggestion). If you want to learn more about how individual treatment is carried out for people with a diagnosis of Obsessive-Compulsive Disorder in its purest form, you can call us by phone or write in any way convenient for you.

Pure Obsessive Compulsive Disorder/OCD: Group Treatment/Psychotherapy

In addition to individual treatment for people diagnosed with Pure Obsessive Compulsive Disorder, Kyiv OCD Center conducts weekly treatment groups for pure OCD and related disorders . Studies show that group treatment of people with OCD in its purest form, using cognitive-behavioral and hypnosuggestive psychotherapy, is highly effective.

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