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Does ocd cause mood swings


Bipolar and OCD: Is There a Link?

What are bipolar disorder and OCD?

Bipolar disorder is a condition that causes major changes in activity, energy, and mood.

Obsessive-compulsive disorder (OCD) results in a person having unwanted ideas, thoughts, or sensations to recur in the brain and body.

The two conditions share many symptoms. Some experts even believe they can occur together.

About 2.6 percent of American adults experience bipolar disorder symptoms and 1 percent experience OCD every year. More than 20 percent of people with bipolar disorder also show signs of OCD.

Bipolar disorder shares some similarities with OCD. Both people with bipolar disorder and OCD are likely to experience:

  • changes in mood
  • elevated mood
  • anxiety
  • social phobia

But several key differences exist. These are present with OCD, not bipolar disorder:

  • recurring obsessions and compulsions
  • uncontrollable ruminating thoughts

Bipolar-OCD comorbidity, or occurrence of both conditions in a person, is a fairly recently studied phenomenon. A 1995 study first found that more than half of those with bipolar disorder also experienced other mental disorders, including OCD.

Some people with bipolar disorder experience OCD symptoms without having OCD. This is known as having OCD tendencies. They may only experience these symptoms when they have a very low or very high mood.

But a person may have both conditions and experience their symptoms at all times. Symptoms of bipolar disorder with OCD comorbidity include:

  • depressive episodes — feeling very sad, or low
  • dramatic and sometimes fast shifts in mood
  • manic episodes — feeling very happy, or high
  • recurring obsessions and compulsions
  • social problems, such as social phobias
  • uncontrollable ruminating thoughts

Other symptoms may include:

  • higher rates of obsessive ideas about sex and religion than people with just OCD
  • lower rates of ritual checking than people with just OCD
  • higher rates of substance abuse than people with just bipolar disorder or OCD
  • more episodes of depression, increased rates of suicide, and more frequent admission to hospitals than people with just bipolar disorder or OCD
  • more chronic depressive and manic episodes and residual mood symptoms than people with just bipolar disorder

Because the conditions can occur together and share some symptoms, sometimes people are misdiagnosed with the opposite condition.

It can be helpful for those diagnosed with bipolar disorder who display symptoms of OCD to seek mental health counseling.

To check if symptoms are caused by OCD, a doctor will likely perform a physical exam, lab tests, and a psychological evaluation. It can sometimes be challenging to diagnose OCD because the disorder’s symptoms can be very similar to those associated with other mental health disorders that involve anxiety — like bipolar disorder.

Those who have OCD but show other signs of bipolar disorder may also want to seek mental health counseling. The anxious behaviors associated with OCD may be signs of manic or hypomanic bipolar episodes.

As with diagnosing OCD, a doctor is likely to conduct a physical exam, lab tests, and a psychological evaluation to help determine a diagnosis of bipolar disorder.

Treatment for each condition varies. So it’s important to have a proper diagnosis.

Treating one condition

Bipolar disorder

Bipolar disorder is a lifelong condition. Treatment must focus on the long term and continue even when a person feels fine. A psychiatrist handles treatment of people with bipolar disorder. They may prescribe a combination of medication and therapy.

The goal of bipolar disorder treatment is to even out mood and decrease symptoms fast. Once achieved, a person should focus on maintenance treatment to manage their disorder and prevent a relapse.

Common medications for bipolar disorder include:

  • Anticonvulsants: Some anti-seizure medications are used to control the changes in mood associated with bipolar disorder. Examples include:
    • valproate sodium injection (Depacon)
    • divalproex sodium (Depakote)
    • carbamazepine (Tegretol XR)
    • topiramate (Topamax)
    • gabapentin (Gabarone)
    • lamotrigine (Lamictal)
  • Antidepressants: These drugs treat depression associated with bipolar disorder. They aren’t always most effective because people with bipolar disorder also experience mania. Examples include:
    • serotonin
    • norepinephrine
    • dopamine
  • Antipsychotics: These drugs are used to treat a variety of mental disorders, including bipolar disorder. Examples include:
    • prochlorperazine (Compazine)
    • haloperidol (Haldol)
    • loxapine
    • thioridazine
    • molindone (Moban)
    • thiothixine
    • fluphenazine
    • trifluoperazine
    • chlorpromazine
    • perphenazine
  • Benzodiazepines: This medication is used to treat insomnia and anxiety, which people with bipolar disorder may experience. But these medications are highly addictive and should only be used on a short-term basis. Examples include:
    • aprazolam (Xanax)
    • chlordiazepoxide (Librium)
    • diazepam (Valium)
    • lorazepam (Ativan)
  • Lithium: This drug works as a mood stabilizer and is one of the most widely used and effective treatments for bipolar disorder.

Common bipolar disorder therapies include:

  • cognitive behavior therapy
  • psychotherapy
  • family therapy
  • group therapy
  • sleep
  • hospitalization
  • electroconvulsive therapy (ECT)
  • massage therapy

OCD

OCD, like bipolar disorder, is a long-term condition requiring long-term treatment. Also like bipolar disorder, treatment of OCD typically involves using a mix of both medication and therapy.

Typically, OCD is treated with antidepressants such as:

  • clomipramine (Anafranil)
  • fluozetine (Prozac)
  • fluvoxamine
  • paroxetine (Paxil, Pexeva)
  • sertraline (Zoloft)

But doctors may also use other types of antidepressants and antipsychotic medications.

When it comes to therapy, cognitive behavior therapy is most often used to treat OCD. Specifically, exposure and response prevention (ERP) is used. This involves exposing a person to a feared object or obsession, and then helping that person learn healthy ways to cope with their anxiety. The goal of ERP is for the person to manage their compulsions.

Treating both conditions

Experts say that the management of bipolar disorder and comorbid OCD should be focused first on stabilizing a person’s mood. This involves use of multiple medications, such as lithium with anticonvulsants or atypical antipsychotics with apripiprazole (Abilify).

But when the two conditions occur together, it’s also important for doctors to diagnose the type of bipolar disorder a person is experiencing.

For example, when treating type 2 bipolar disorder with comorbid OCD, after full treatment of mood symptoms with mood stabilizers, a doctor may want to cautiously add another treatment. Specifically, they may prescribe antidepressants effective for both depressive and OCD symptoms that have a low risk of inducing a full manic episode. These medications may include selective serotonin reuptake inhibitors (SSRIs): fluoxetine, fluvoxamine, paroxetine, and sertraline.

But doctors must take caution when mixing various medications to treat both conditions when they occur together. The wrong mix could cause more frequent, more intense, or unusual symptoms.

Bipolar disorder and OCD are different conditions with similar symptoms that can sometimes occur together. It’s important to determine which condition you have, or if you have both conditions, in order to receive appropriate treatment. Seek help from your doctor or mental healthcare provider if you suspect you have one or both conditions.

OCD Mood Swings (Info + Treatment)

Until the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. Many still consider anxiety to be the defining feature of the disorder, by which obsessions cause anxiety and compulsions alleviate those feelings associated with anxiety.

 

 

What is OCD? And how can it affect moods?

The defining feature of OCD is discomfort with uncertainty. Obsessions, or recurrent unwanted thoughts, images, or impulses, often trigger doubt or uncertainty, which is very uncomfortable and distressing to someone with OCD. Ritualistic compulsions, or behaviors that are intended to neutralize, prevent, or eradicate obsessions serve to get rid of doubt, which alleviates distress.

What happens to you when you are in distress and you cannot do anything to relieve it? Do you get angry and lash out at others? Do you get sad or hopeless and isolate? Maybe you feel so overwhelmed and break down and cry. Now imagine that this happens multiple times a day, every day. You would undoubtedly feel emotionally labile and helpless. That is the experience of someone with OCD.

Looking for more OCD resources:

  • OCD Sub types
  • Existential OCD
  • OCD Attack Symptoms
  • OCD and Anger

If any of the above sounds familiar, either because you have experienced it yourself or you have observed it in others, know that you are not alone. Drastic fluctuations in mood can often occur in individuals with OCD. This can be for various reasons. One reason is that the unwanted thoughts, images, or impulses can trigger intense emotions.

For example, having the thought that God does not exist might result in intense guilt. The image of sexual intercourse with a family member might trigger intense disgust and shame. It is common to develop feelings of inadequacy or low self-worth in individuals who experience these thoughts frequently enough. This subsequently contributes to depressed mood.

 

 

What are OCD Mood Swings and common symptoms to watch out for

OCD can impact mood when individuals are overwhelmed by their obsessions and/or compulsions. For example, someone may feel so overwhelmed by the frequency and intensity of their intrusive thoughts that they cry for long periods of time. Others may feel so hopeless about their ability to cope with their intrusive thoughts or resist compulsions that they stay in bed and avoid interaction with others. I have personally seen individuals experience intense anger and blame others when they are struggling with intrusive thoughts or strong urges to engage in compulsions. This can include family, friends, significant others, and treatment providers.

Mood swings may also result if an individual is deterred from engaging in compulsive behaviors.

One of the most common compulsions observed in people with OCD is to seek reassurance, either from someone else, from oneself, or from a source (i.e. the Internet). Intense feelings of anger are common when someone with OCD cannot get that reassurance.

If you had a nagging doubt that you did something offensive at a party and you asked your friend if they thought you did anything offensive, would you get upset with them if they would not tell you? This is a common example of when someone with OCD will experience intense anger.

 

 

 

How to manage OCD Mood Swings

One helpful strategy for managing intense emotions when one is struggling with OCD is to externalize the OCD. This is a strategy similar to cognitive de-fusion in Acceptance and Commitment Therapy (ACT). You may have a thought about harming your spouse, but cannot differentiate the discomfort associated with the thought from the fear of actually committing such an act. A common response to this obsession is to seek reassurance from your spouse, such as asking them if they think you would ever harm them or asking them if they think you are a good person.

Externalizing the OCD would involve you saying to yourself, “My OCD is telling me that I want to harm my spouse,” or “My OCD is telling me that I am a bad person because I thought about hurting my spouse.” If your spouse refuses to give you reassurance then externalizing the OCD would involve you saying to yourself, “My spouse is trying to help me and not help my OCD.” If you are the spouse in the situation, it helps to verbalize that you are not going to help the OCD and therefore will not give reassurance.

One must use caution with the practice of externalizing the OCD so that it does not become compulsive. It is critical that you do not tell yourself that the thought, image, or impulse is “just my OCD”. This is a compulsion and is attempting to neutralize the thought. The goal is to accept the thoughts and learn to view them as nonthreatening. That is ultimately going to help you overcome feelings of distress associated with your thoughts.

 

 

Next Steps: Seek help

It is important to note that OCD can coexist with other mental health conditions. Mood swings can be a symptom of a co-occurring mood disorder. If you struggle with OCD and experience frequent mood swings you may want to meet with a qualified mental health professional for an assessment to ensure you are getting the best treatment.

 

 

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Additional Resources on OCD Mood Swings

  • What is Reverse Sad?
  • What is OCD?
  • Existential OCD
  • 21 Self Care Ideas to try today

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. Obsessional 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.

Depression, OCD, anxiety - digestive symptoms

Depression, anxiety and OCD are associated with digestive disorders. It can be very difficult to figure out what is the cause and what is the effect. On the basis of these conditions, eating disorders develop, the body depletes its physical resources even more. Combination of depression, OCD, anxiety and bipolar disorder with eating disorders requires dual therapy. Listed here are the manifestations of common psychiatric disorders of the digestive system.

Psychiatric disorders are associated with eating disorders. Determining which is the cause and which is the effect can be difficult, but it has been proven that people with eating disorders are more prone to depression, anxiety, and OCD than others. In case of a combination of disorders, dual therapy is required, only in this case it is possible to guarantee the direction of complete recovery.

These are the four most common types of mental disorders, with a description of their impact on eating behavior.

Anxiety

The obsessive thoughts and feelings of fear that are characteristic of the condition make people restless, leading to physical symptoms. Often, people with anxiety experience palpitations, trouble sleeping, and trouble concentrating. Strong anxiety can come as a result of a specific event, it can also be unrelated to objective reality.

Anxiety exacerbates behavioral and thought disorders caused by eating disorders. With severe anxiety attacks, the patient ignores dietary guidelines, so anxiety treatment begins with normalizing the diet and learning skills to overcome negative thoughts.

Depression

Depression causes depression and feelings of emptiness, which negatively affects daily life. The disorder causes conflicting symptoms, often anxiety is combined with a decrease in physical energy, which makes the condition even more stressful. Other manifestations include headaches and indigestion.

When people with eating disorders are depressed, it is difficult for them to find the motivation to normalize their diet. Lack of motivation is the most difficult thing in the treatment of depression and related disorders.

Bipolar disorder

Typically, bipolar disorder causes permanent mood swings towards mania or depression. During periods of exacerbation, people are unable to use common sense, including in matters of nutrition.

Mood swings make the treatment of eating disorders more difficult and lengthy.

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