Ocd schizophrenia fear

Fear of Schizophrenia | NOCD

What is Schizophrenia OCD?

If you’re experiencing unwanted thoughts about losing your mind, becoming psychotic, or developing schizophrenia, it may be a sign of schizophrenia OCD. You might find yourself constantly questioning the state of your mind, which can cause you to be overly focused on feeling different than usual. It might make you start noticing coincidences and giving random events significance, or wondering about spiritual forces that cause you fear and distress.

These thoughts might result in increased anxiety, which then might lead to other physical sensations, such as dizziness, and or perhaps your preoccupation with the thoughts makes it harder for you to concentrate, leading you to question if those symptoms too could possibly be related to experiencing psychosis, and your anxiety grows. This cycle can lead you to doubt the most important things in your life: you may question your ability to support yourself, hold down a job, or engage in healthy relationships.

In response to these thoughts, doubts, and increasing anxiety, you may search for anything that might provide you with solid ground, firm answers, or certainty about what you’re experiencing. You research what you’re experiencing, read about similar experiences from others, and ask people in your life to make sure you’re acting normally and that your experiences match up with reality. You might even avoid places, people, or activities out of fear that they’ll trigger your thoughts again.

You may fear that there is no way out of this cycle, but there is hope. People suffering from fear of schizophrenia or psychosis themes in OCD can regain confidence and purpose in their lives by doing exposure and response prevention (ERP) therapy with an OCD specialist. You can learn to break the cycle of obsessions, doubts, anxiety, and compulsive behavior.

Learn more about Health Concern/Contamination OCD

Schizophrenia OCD – Common Obsessions

Losing your mind or becoming psychotic
Not being able to live the life you want
Not being able to take care of yourself
Not being able to support yourself financially
Not feeling able to identify real experiences
Not being able to trust memories
Living in a state of fear
Engaging in behaviors that you might not normally do
Not being able to function socially
Not being able to have a relationship

Common Triggers

People who have intrusive thoughts about developing schizophrenia might start to feel highly self-conscious, perhaps feeling as if others are watching them or laughing at them, especially in crowded settings. They also might feel triggered when feeling certain physical sensations, such as lightheadedness, fatigue, confusion, or difficulties with focus and memory.

These triggers and obsessions can form a vicious cycle, as many symptoms of anxiety are also triggers for people with fears of developing schizophrenia or psychosis. In OCD, when an obsession is triggered, it causes further anxiety, therefore reinforcing the cycle of symptoms.

External triggers might include being around others who have mental illness, watching movies or TV shows involving mental illness, or using psychoactive substances.

Other triggers for Schizophrenia OCD may include:

Feeling overstimulated, such as by loud noises, crowded places
Not remembering details of events or what was said in conversations
Feeling lightheaded or dizzy
Difficulty falling asleep
Feeling as if others are watching you, or possibly laughing at you
Feeling out of control
Coincidences
Deja vu

How can I tell if it’s OCD fear of schizophrenia, and not anxiety, cautiousness, stress, or actual psychosis?

This type of concern can be tricky to address, since seeking certainty about what you’re experiencing can quickly become a compulsive safety-seeking behavior. It’s best to ask a trained professional who has experience working with OCD.

A medical professional with experience treating OCD will look for a few different things in order to determine if what you’re struggling with is OCD. Are you experiencing repeated and unwanted thoughts, worries, feelings, or images about losing your mental health or developing schizophrenia or psychosis? Do these thoughts cause anxiety or distress? Do you engage in mental or physical compulsions in an attempt to minimize anxiety, find certainty, or avoid a feared outcome?

If these 3 circumstances are met, you may be suffering from schizophrenia OCD. The cycle of repetitive obsessions with compulsive behaviors in response is what sets OCD apart from other conditions.

Common Compulsions

You may be aware that your worries or thoughts aren’t real or rational; however, this understanding isn’t enough to make the thoughts and doubts stop or make the anxiety decrease. You may begin to wonder if your doubts themselves are a sign of psychosis or schizophrenia. Your continued struggle against your thoughts and worries can cause you to worry about your mental state even more .

You may become more and more preoccupied with physical symptoms, such as feeling overly sensitive in loud settings, or feeling more self conscious in social settings. Your rational mind can feel like it is losing its credibility, so you seek reassurance, feeling compelled to keep looking for answers.

Reassurance-seeking and continued research to find certainty are common compulsions in response to fears about schizophrenia or psychosis.

Other compulsions performed mentally or physically by people with fear of schizophrenia may include:

Reviewing social interactions, reviewing any possible symptoms you have been experiencing, and reviewing others’ reactions to your behaviors and conversations
Researching symptoms of schizophrenia
Seeking reassurance from medical professionals repeatedly, or from friends/family about how they perceive you
Avoiding situations that might seem over stimulating or stressful
Checking to see if you are thinking “correctly” about something.
Attempting to cope with anxiety and fear by using substances

How to treat fear of schizophrenia

Schizophrenia OCD can be debilitating, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with an OCD specialist, you can learn to manage OCD and live free from constant fear.

You will start by identifying your thoughts and triggers and ranking them by the level of anxiety they cause. You’ll also identify any safety-seeking or compulsive behaviors you are using in an attempt to reduce your distress or resolve your fears. The compulsions might involve reviewing current and past behaviors, seeking reassurance from others and/or self, researching about various psychotic disorders, seeking multiple medical assessments and opinions, or avoiding situations and media that might trigger the thoughts and feelings.

As you build an awareness of these factors, you will then build your treatment plan and work your way up your ladder of fears, starting with triggers that cause lower levels of distress to the higher levels. You will practice purposely triggering yourself to evoke various levels of distress, and learn to lean into the anxiety without trying to alleviate it by engaging in compulsions.

Instead, you will learn to sit with uncertainty, possibly telling yourself non-engagement messages like “maybe I am, or maybe I’m not.” This process will allow you to habituate to the distress and uncertainty you feel, which will make it easier in the future to manage the distress whenever it comes in the future. You will retrain your brain that you are able to tolerate this uncertainty, which then results in a decrease in the distress you feel when the thoughts come up. In time, your thoughts and worries may feel like little more than background noise.

Fear of Schizophrenia - Anxiety Care UK

This problem can be viewed as an illness phobia and many of the difficulties and recovery techniques described in that website article will apply here. However, from those coming to Anxiety Care with the problem, there is usually a very strong obsessional thinking element to this particular fear and the booklet ‘obsessional thinking’ might also be a useful read in conjunction with this article.

What is schizophrenia?

What it is NOT is multiple personality disorder, which is a completely separate and rare problem. Many people believe this is the ‘typical’ schizophrenic: someone who is host to numerous totally different personalities that ‘take over’ the body at different times: some of them invariably dangerous. Schizophrenia, in fact, has a number of different symptoms that interfere with the sufferer’s ability to think clearly, make rational decisions, relate to other people and cope with emotions. In the latter case a schizophrenic may display inappropriate emotions in some situations.

The ‘thought’ aspect can include difficulty in concentrating that makes work or study very hard or even impossible. Here thoughts may seem to wander from one subject to another where the original thought is quickly lost and the process may feel as if these thoughts are becoming indistinct or hazy. Someone with this problem may find it difficult to make him- or herself understood in conversation and may use inappropriate groups of words or nonsense words.

The more extreme thought problems and the ones most lay people are familiar with; are what is commonly referred to as ‘hearing voices’. In this situation a sufferer may feel that someone else’s thoughts are in their mind or that they are hearing some outsider speak to them when there is nobody present, probably urging them to do things, even dangerous things that they may feel powerless to resist. This can seem so real that the sufferer finds it difficult to believe that other people cannot hear these voices and does not understand that it is the brain mistaking personal thoughts for real experiences. People with severe depression may also hear voices that talk directly to them, however the voices heard by a schizophrenic may also seem to talk to each other.

When it feels as if some powerful presence is controlling one’s body and mind it will often seem necessary to find an explanation and people suffering in this way may believe that they are the subject of radio or TV ‘waves’, lasers or even aliens. Some people with thought problems may also believe that the TV or radio is discussing their personal and private lives or giving information that is specific to them alone and may find it difficult or impossible to believe that other people exposed to these programmes have not picked up the same information. When these delusions focus on this person feeling harassed or persecuted by some outside force or a particular person or group of people, these are known as paranoid delusions. Research suggests that up to 75% of schizophrenics will hear voices at some time during their illness.

Other symptoms that may seem to take away the quality of life rather than add another dimension to it as described above, can be a general reduction in energy, emotion and interest in life. A person with these negative symptoms may avoid other people, stay in bed and not bother with washing themselves or keeping their clothes clean. Such broad based symptoms can obviously be part of other problems such as depression and many parents may feel that their teenage children often fill these criteria.

Causes and onset

The cause of schizophrenia is not known but it is believed that it is most likely to be due to abnormalities of brain chemistry and/or brain structure. However, a physical test such as a brain scan would not be able to prove a person was or was not, schizophrenic; such a test could only rule out other physical reasons for certain behaviour. There are probably genetic elements involved in developing schizophrenia, and stress can be a factor but as a ‘last straw effect’ not a cause in itself. There is also research that suggests that illegal drugs such as marijuana, ecstasy and LSD can aggravate a present tendency into the full disorder. Amphetamines tend to generate schizophrenia-like symptoms, which cease when the person stops taking the drug.

About 1% of the population will suffer from this illness at some time in their lives and those with a parent who has the problem may be ten times as likely to contract schizophrenia: but this is still a 90% chance of not contracting it. Age of onset is rarely before age fifteen and women tend to contract it later than men: in the late twenties or thirties. The disorder appears equally in men and women.

Anxiety and obsession

Many people contacting Anxiety Care have used marijuana in the recent past and have experienced mental symptoms such as panic, confusion or paranoia that, even if minor and very temporary, have stayed with them in the form of a growing anxiety that they have, in some way, generated schizophrenia within themselves. If they, or in fact anyone have a tendency towards obsessional thinking, these fears might focus on intense monitoring of all thoughts and emotions that could conceivably ‘prove’ that they have this illness. Once this is done, the job becomes a life’s work unless help is obtained. That is because our thoughts tend to be random and very reactive: we encounter a situation and our minds throw up a range of thoughts and memories that relate to our past experience of this situation, some of them odd and barely relevant. If there is a good deal of emotion involved, the thoughts will be more intense and possibly broader in scope and even less relevant. If our minds are set to fear certain emotions, the thoughts that touch on these are likely to seem very powerful and relevant, simply through the anxiety they cause.

In this way, perfectly ‘normally-weird’ thoughts are easily grasped as ‘proof’ that this person is becoming schizophrenic. Our thoughts can be as random as the endless pages thrown up by an online search engine when we ask it about something: probably more so as our thoughts will leap on from one area to another as described in the obsessional thinking article. For example, thinking about one’s car might go to trips out, happy family days, the children, what they are doing now…etc. It could equally go to busy roads, being late, stress and unhappiness; or crashes; or high insurance. The list is almost endless. When a person’s mind is set to worry and suspicion, the thought process will tend to go that way almost automatically. That is, with the car; the end thought is more likely to involve fear of accidents or stress than happy days by the sea.

Violence

Another area of fear is that of violence. Many obsessional people mistake normal anger, even a temporary urge to strike someone, as a sign that they are becoming homicidal maniacs. They ignore the fact that most of us will experience this level of emotion at some time. A quick ‘straw poll’ among charity users and volunteers showed that many, when asked to think about it, had felt like hitting someone in the previous week. They had simply acknowledged the urge and let it go. However, someone keyed to be frightened by his or her violent or aggressive feelings would probably become very distressed by such thoughts. As the brain throws up similar past situations when we think about something, a person experiencing such an urge would then remember many other times he/she had felt that way and could easily be persuaded that he/she is dangerous. This can be particularly worrying if the urge is against a loved one. Many people with obsessional thinking problems seem to find it difficult to acknowledge that they can be angry with, and have aggressive thoughts against, people they love. This is very common when an infant has driven its mother to distraction and she suddenly feels like smacking it hard. Most mothers feel a little guilty at this point and then put the thought aside. The mother afraid of her violence does not. This can work equally when the person generating these feelings is a spouse, parent or older child.

Testing for schizophrenia

Many people with a fear of schizophrenia go for psychiatric testing, and although seeking reassurance is not a good way to deal with such a problem as it simply generates a reliance on this form of help and rarely lasts, this can be an option. When this is done, the person involved must try to accept the verdict. However, the mind tends to start looking for exceptions to any absolute ‘yes’ or ‘no’, particularly when there is heavy emotion involved. So it is not at all unusual for a person fearing psychotic illness to begin to doubt a diagnosis very quickly. This is usually on the grounds that the specialist: misheard, was trying to make the person feel better, was incompetent, missed something, that the symptoms got worse after the test, that new symptoms unknown to the tester are involved, etc., etc. The latter beliefs will then send the sufferer plunging into his or her mind in search of that item of ‘proof’ that was missed.

Tortured logic

Many people fearing psychotic illness involve extremely tortured logic to maintain the disorder. One person used his knowledge that he wasn’t schizophrenic to prove that he was. That is, having been diagnosed as free of psychosis, he viewed his overpowering belief that he was schizophrenic, as delusional: which can be a schizophrenic symptom. Then, as a delusional person, this proved to him that he was schizophrenic. In this case, the fact that up to 10% of normal people are more delusion than some severe psychotics and that his belief was obsessional rather than delusional, had no effect.

Obsession/delusion

This, ‘delusional or obsessional’? problem often occurs with OCD and with some people suffering with severe illness phobias (see HC in the ‘Obsessional Thinking’ article). And there probably isn’t a single answer. Whether a belief is simply very strong but open to negotiation, or whether it is totally believed regardless of proof to the contrary may well depend on how deeply involved in the problem the sufferer is at any specific time. That it, the beliefs may be on a continuum of certainty from ‘probably’ to ‘absolute’, depending on the mix of fear, depression or outside influences involved from day to day. This is, naturally viewed by some sufferers as proof that their schizophrenia waxes and wanes, rather than accepting the more rational belief that they have a severe anxiety disorder. And, of course, when pointed out, this choice of irrational over rational will prove to some people that they are psychotic as in the case above.

Family help

A person obsessed with the belief that they are, or will become, psychotic will not be persuaded differently by tests, at least long term. There will always be a reason to doubt the tests findings eventually: always. The answer is to stop seeking reassurance and, perhaps to take medication: one or other of the Serotonin Re-uptake Inhibitors seem to be current medication of choice. Sometimes the fears are so great and take up so much of the person’s time that only chemical help will reduce them enough for the sufferer to believe that he/she has a chance of overcoming them by personal effort.

If the family have been drawn into the reassurance seeking, they must work out a programme of refusal with the sufferer. This needs to be negotiated when the person involved is in a receptive mood. The family rules may, at first, allow one reassurance-seeking question a day, or questions aimed at only one family member, or at one specific time, or some mix of this. It has been seen, within the charity, that when the sufferer knows that he/she can ask a question at a certain time, the driving need for instant relief tends to abate and, often, the question itself does not need to be asked when the time comes round as the anxiety that generated the need has dropped. Refusal to give reassurance needs to be done calmly, never in anger. Specific wording should be used, perhaps: ‘we agreed that I would not reassure you.’
Or, if a time or a person is involved: ‘we agreed that you would only ask xxxxx’; or ‘we agreed that you could only seek reassurance from 8pm to 8.15pm.’

Nobody can force a person to drop these beliefs, it has to be learnt by the person suffering them, and given up by choice. Logic applied by well-meaning outsiders does not work, nor do appeals to ‘grow up’ or ‘pull yourself together’. That the fears are less disabling some times than others does not mean that the sufferer is putting it on: that is the way anxiety disorders work. Nobody lives in this hellish, terror-filled world of the mind by choice. But sometimes getting out can seem impossible.

Obsessive-compulsive disorder

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

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

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

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

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

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

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

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

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

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

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

CLINICAL PICTURE

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

Main clinical manifestations of OCD:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The course of obsessive-compulsive disorder.

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

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

DIFFERENTIAL DIAGNOSIS

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

Genetic factors

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

FORECAST

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

TREATMENT: BASIC METHODS AND APPROACHES

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

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

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

Drug therapy

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

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

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

Psychotherapy

Behavioral psychotherapy

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

Social rehabilitation

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

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

Obsessive Compulsive Disorder Treatment

Great Thought is an obsessive compulsive disorder treatment program. We will relieve you of obsessive thoughts, movements and rituals. Let's get back to life!

Symptoms of obsessive-compulsive disorder

Frightening images and drives
Compulsive acts (rituals)
Intrusive check of one's own actions
Fear of trouble, pollution or infection
Inexplicable desire to count something
Excessive organization and pedantry
Perfectionism in relationships, work and even leisure
"Stuck", "looping" on one's thoughts

You feel that over time your mood becomes worse: apathy, depression, obsessions increase, and rituals begin to fill all your free time or harm your physical health.

You may have had more than one meeting with psychologists, psychotherapists and psychiatrists. You are not given the "scary" psychiatric diagnoses of Schizophrenia or Bipolar Disorder, but are prescribed medication and psychotherapy nonetheless. However, such treatment cannot be called effective - the symptoms persist and only aggressive pharmacotherapy temporarily reduces anxiety.

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder is a syndrome characterized by the presence of obsessive thoughts (obsessions) to which a person reacts with certain actions (compulsions). The causes of the disorder are rarely superficial. The syndrome is also accompanied by the development of obsessive memories and various pathological phobias. May be chronic, episodic or progressive.

Obsession - obsessive thought, persistent desire for something, uncontrollable and accompanied by anxiety and intense anxiety. In an attempt to cope with such thoughts, a person resorts to committing compulsions.

Compulsion - an irresistible need to perform certain actions (rituals), which can be assessed by the person himself as irrational or meaningless, and the internal need to perform them is forced and is the result of obsessive ideas.

Common examples of OCD manifestations

An exaggerated sense of danger. Fear of the materiality of thoughts:
- "now I will lose control and hurt my loved ones"
- "something terrible is about to happen, I can feel it"
- "I shouldn't think like that, all this will come true because of me"
Pathological fear of pollution. Thirst for Purity
Excessive perfectionism, exaggerated responsibility - "everything must be done perfectly", "everything depends on me, mistakes are unacceptable"

How does this painful algorithm work?

Most people have unwanted or intrusive thoughts quite often, but all sufferers of the disorder greatly exaggerate their importance. Fear of one's own thoughts leads to attempts to neutralize the negative feelings that arise from obsessions, for example by avoiding thought-provoking situations or by engaging in "rituals" of excessive self-cleansing or prayer.

As we noted earlier, repetitive avoidance behavior can "get stuck", "loop", that is, have a tendency to repeat. The cause of obsessive-compulsive disorder is the interpretation of intrusive thoughts as catastrophic and true.

If you periodically experience over the years:

Constant or fluctuating anxiety
The need to perform certain ritualized actions
A persistent decline in the quality of life due to the need to avoid certain thoughts and actions, places and events

And you are also persecuted:

Significant problems in studies and career
Failure to establish a serious relationship
Constant criticism and pressure from relatives
Many senseless activities
Excessive involvement in computer games and the Internet, alcohol
Loneliness and isolation

We strongly recommend that you do not delay seeking help and that you complete a remedial program. Consultations and psychotherapeutic sessions according to the program are held several times a week, until the relief of severe symptoms, then the frequency of meetings with specialists is reduced to 2–3 per month. Count on the fact that in the end we will deal with your problem together.

Treatment of obsessive-compulsive disorder in Neuro-Psi

Every day the specialists of the NEURO-PSI clinic analyze the world practice in the field of psychiatry and psychotherapy. The goal is the impartial selection and implementation of those methods of treatment and psychological assistance, the effectiveness of which has been convincingly proven in independent studies.

We are guided by the principles of evidence-based medicine and use as a basic method of treatment a psychotherapeutic paradigm, the effectiveness of which has been widely recognized by the professional community.

1. What is the essence of the obsessive-compulsive disorder treatment program

Since obsessive thoughts, rituals and conditions are only symptoms of mental dysfunction, the root cause must be treated in order to achieve a stable result. A comprehensive work is carried out with the client, taking into account the main factors that create well-being.

The main emphasis is on teaching the client how to properly respond to his thoughts, emotions, inner feelings and interpretation of external events.

All types of psychotherapeutic and drug treatments serve the same goal: to achieve the best result in the shortest possible time. At the same time, by coordinating the efforts of specialists in various fields, the most complete coverage of all types of mental illnesses, disorders and disorders is possible.

2. What treatments are used

Priority:
- Cognitive-behavioral psychotherapy (Сognitive-Behavioral Therapy).
- Schema Therapy.
- Reality Therapy.
- Choice Theory.
- Rational pharmacotherapy.
Psychopharmacotherapy (if indicated)
Biofeedback Therapy
Rational psychocorrection of stress
- Jacobson progressive muscle relaxation.
- Traditional and modern gymnastic systems, relaxation techniques.
- Breathing techniques .
- Stress exposure.
- Teaching self-control.
Lifestyle modification
- Working with bad habits.
- Correction of the diet.
- Professional and social adaptation.

3. How is the treatment under the program

Each treatment program at the NEURO-PSI clinic consists of four stages:

diagnostics,
work with disease symptoms,
work with the causes of the disease,
consolidation of the achieved results.

Work efficiency is increased by dividing the treatment process into a predetermined number of sessions, at convenient times and without hospitalization. This means that each program is adapted to the problem that the client has addressed.

The program method of treatment is predictable, time-limited, productive, and, most importantly, understandable for the client.

Of course, the treatment takes place in a comfortable mode without interruption from work, study or family. Specialists of various profiles will work with you (team method). This is necessary to minimize the risk of diagnostic errors that could lead to the adoption of a suboptimal treatment plan.

Improvements in well-being and mood (healing) occur in stages: after the decrease in emotional problems, bodily symptoms decrease. Working with the causes (etiology) of obsessive-compulsive disorder helps to avoid relapses in the future.

4. What are the results and prognosis?

Upon completion of the program, you get rid of obsessive thoughts and rituals, fear of pollution, unmotivated fears, panic attacks and multiple vegetative symptoms (sudden jumps in blood pressure, heart palpitations, dizziness, nausea).

According to statistics, the effectiveness of the methods used approaches 100% if all recommendations of specialists are followed.

Skills you acquire during the program:

self-control and self-regulation
constructive analysis of the state of the organism
understanding one's own mental and emotional sphere
ability to control one's attention
ability to act consciously in stressful situations

Significantly improves emotional and physical condition, gains self-confidence, in the future.

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