Ocd vs psychosis

The Connection Between OCD & Psychosis

Not everyone with obsessive-compulsive disorder experiences symptoms of psychosis, but some people might.

Obsessive-compulsive disorder (OCD) is a relatively common mental health condition. Both adults and children can be diagnosed with OCD.

While highly treatable, OCD is often misunderstood and misdiagnosed. The media still portrays people living with OCD as hyper-focused on cleanliness and organization.

But these are only a couple of examples of the many symptoms that can present with OCD. In addition to obsessions and compulsions, some people with OCD may experience symptoms of psychosis. Everyone’s symptoms and experiences with OCD are as unique as they are.

Obsessive-compulsive disorder is characterized by recurrent and disturbing thoughts (obsessions) and repetitive, ritualized behaviors (compulsions).

Obsessions can also take the form of intrusive images or unwanted impulses. Compulsions tend to interfere with a person’s daily life, including activities and interactions.

This is a rather general picture of what OCD looks like, but there’s not just one type of thought or behavior you might experience with OCD.

Symptoms of OCD vary from person to person, and obsessions and compulsions can change over time.

If you have OCD, the types of obsessions you have could relate to include:

harm
losing control
perfectionism
religion
sexual thoughts

Some common compulsions may relate to:

checking
cleaning and washing
repeating (like rewriting or repetitive body movements)
mental repetitions or reviews

Not everyone with OCD will develop psychosis, but for some people, it’s possible to experience symptoms of psychosis.

Psychosis is when you lose some contact with reality. When you experience symptoms of psychosis, you may have difficulty understanding what’s real and what is not.

Experiencing psychosis with OCD is more common when OCD symptoms or anxiety levels are particularly high.

DSM-5 diagnosis

Even before the connection between OCD and psychosis was fully realized, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) outlined that “obsessional thoughts, impulses, or images are a product of the person’s mind” in OCD.

In other words, awareness that obsessions and compulsions are products of your mind is considered a characteristic of OCD.

Previously, it was believed that people with OCD should not be experiencing symptoms of psychosis.

According to the DSM-5, OCD has specifiers that show if a person has:

good or fair insight: recognizes that beliefs are definitely or likely not true
poor insight: feels that beliefs are probably true
absent insight or delusional beliefs: thinks that all beliefs are true

Someone who’s considered to have OCD with poor or absent insight might not readily acknowledge their thoughts and behaviors as problematic or unreasonable. This can be considered psychosis.

OCD with poor or absent insight is when symptoms of psychosis might appear.

How prevalent is OCD?

OCD is a fairly common condition that affects adults and children of all races, genders, ethnicities, and backgrounds. About 1 in 100 U.S. adults have it.

According to the International OCD Foundation, OCD symptoms first appear between ages 8 and 12 or between late teens and early adulthood.

Typically, OCD is diagnosed by age 19. OCD can still be diagnosed later in adulthood, but it’s less common.

How is OCD diagnosed?

Behaviors and thoughts associated with OCD exist in most people to some extent. But showing harmless or mild symptoms of OCD is not enough for a diagnosis.

To be diagnosed with OCD, your symptoms must:

get in the way of your daily functioning
cause a great deal of distress
consume excessive amounts of energy or time

To measure whether your symptoms meet the requirements for an OCD diagnosis, you’ll likely need to be interviewed by a trained mental health professional.

The list of potential OCD symptoms is fairly long. No two people will have the same symptoms at the same time.

The main two OCD symptoms are obsessions and compulsions. Some examples include:

Obsessive fear of contamination: compulsive handwashing, avoiding physical contact, doing laundry excessively
Fear of death or harm: compulsively checking that doors are locked, checking that appliances are turned off, unreasonable avoidance of certain activities
Fear of discarding something: saving useless items
Fear of violating religious rules: compulsively praying, repeatedly confessing perceived sins
Fear of asymmetry: a need to arrange items so they’re perfectly aligned, mentally plotting the arrangement of objects on a grid or streets on a map

What psychosis feels like

When you experience symptoms of psychosis, your brain processes information in a way that causes a permanent or temporary disconnect from reality.

Psychosis isn’t necessarily its own disorder but can be a symptom of a mental health condition or from medical events, such as injuries and some illnesses.

Usually, the onset of psychosis requires immediate medical attention.

The signs and symptoms of psychosis may include:

difficulty concentrating
depressed mood
sleeping too much or not enough
anxiety
paranoia
withdrawal from family and friends
delusions
hallucinations
disorganized speech, such as switching topics erratically
suicidal thoughts or actions

Some signs of psychosis may overlap with other conditions (like depressed mood, anxiety, or sleep difficulties), but if you believe you’re having symptoms of psychosis, consider seeking help right away.

While OCD is considered a mental health condition, psychosis is not. Psychosis describes a mental state in many other conditions, including OCD.

While someone with OCD can experience psychosis, this does not mean that OCD is a psychotic disorder. This distinction is important to make, especially when seeking treatment.

Misdiagnosis of OCD with psychosis

Occasionally, poor insight with OCD may be mistakenly attributed to a psychotic disorder and misdiagnosed.

In a 2012 case study, one woman had a 1-year history of symptoms including social withdrawal, muttering to herself, and feeling extremely suspicious. She firmly held onto delusions about her acquaintances, despite her husband telling her otherwise.

Since her grasp of reality seemed distorted, doctors ruled that her behaviors showed signs of psychosis.

But after she was hospitalized, it became clear that her symptoms of psychosis accompanied OCD symptoms, including repetition of thoughts (obsessions) and behaviors (compulsions).

Recognizing her patterns in obsessive thoughts and compulsive behaviors eventually led to a correct diagnosis.

There are many treatment options for managing symptoms of OCD, including therapy and medications.

People with OCD may have to work with a therapist and try multiple strategies to develop the right treatment plan.

According to the International OCD Foundation, 7 out of 10 people with OCD will benefit from cognitive behavioral therapy known as exposure response prevention (ERP).

Many people can also benefit from medication in addition to therapy.

Support groups can also help people with OCD feel more connected to others living with the same condition.

Many mental health centers and hospitals offer outpatient day programs that may help support people with OCD. With day programs, you can attend treatment during the day for up to 5 days a week.

Aside from medication and therapy, you can do several other things to feel better.

If you have OCD, you can practice specific self-care techniques at your own pace and in the comfort of your own home to help you manage stress and relieve symptoms associated with your condition:

Mindfulness. Because intrusive thoughts are common in OCD, practicing mindfulness can help you recognize thought patterns and work to rethink them.
Journaling. Writing may help you note unwanted or intrusive thoughts, as well as discover rituals and compulsions used to combat these thoughts.
Self-talk. Positive self-talk like affirmations may help change an obsessive inner monologue so you’re kinder and more compassionate to yourself.
Sleep. A consistent sleep routine and peaceful sleep environment may help reduce symptoms of psychosis (and benefit overall health).
Exercise. Some research suggests that exercise can help soothe symptoms of psychosis in people with OCD.

If you’re living with OCD, your symptoms can be wide-ranging and even change over time. You may also develop symptoms of psychosis.

There are numerous strategies for coping with OCD (with and without psychosis), including:

therapy
medication
self-care

With the support of a therapist or other healthcare professionals, you can explore treatment options to find what works best for you.

For more resources and information on OCD and psychosis, you can visit the International OCD Foundation.

OCD And Psychosis

Janet Singer, an advocate for Obsessive Compulsive Disorder (OCD) awareness By Janet Singer

Janet Singer's son Dan suffered from obsessive-compulsive disorder (OCD) so severe he could not even eat. What followed was a journey from seven therapists to ...Read More

When my son Dan’s obsessive-compulsive disorder became severe, he was in college, fifteen hundred miles away from home. My husband and I arranged for him to see a psychiatrist near his school, who telephoned us (with our son’s permission) after he met with Dan. The doctor certainly didn’t sugarcoat anything. “Your son is suffering from severe OCD, and he is borderline psychotic.”

I knew very little about OCD at that time, but I knew what psychotic meant: out of touch with reality. I was terrified. Psychosis made me think of schizophrenia, though that illness was never mentioned. In fact, after I united with Dan and we met with the psychiatrist together, there was no more reference to psychosis.

So what was going on? What my son was experiencing was OCD with poor insight. In many instances, OCD sufferers are aware that their obsessions and compulsions are irrational or illogical. They know, for example, that tapping the wall a certain number of times will not prevent bad things from happening. And they know their compulsive tapping is interfering with their lives. But they can’t control their compulsions, and so they tap away. Those who have OCD with poor insight do not clearly believe their thoughts and behaviors are unreasonable, and might see their obsessions and compulsions as normal behavior; a way to stay safe. It is interesting to note that the recently published DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) specifies that OCD may be seen with: good or fair insight, poor insight, or absent insight/delusional beliefs. In all previous editions of the DSM, the criteria for the diagnosis of obsessive-compulsive disorder included the sufferer’s realization that their obsessions and compulsions are irrational or illogical. Now, absent insight/delusional beliefs can be part of an OCD diagnosis. In addition, the statement, “At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable,” has been removed.

Another important aspect of the disorder to be aware of is the fact that OCD sufferers’ levels of insight can fluctuate, depending on the circumstances. When Dan was initially diagnosed with OCD, he did indeed have good insight. He knew his obsessions and compulsions made no sense. But by the time he met with the psychiatrist mentioned earlier his OCD had gotten so severe that he had poor, or possibly even absent, insight. This is when the doctor used the term “borderline psychosis.” In some cases, OCD sufferers’ levels of insight can change quickly. For example, while calmly discussing a particular obsession and compulsion, those with OCD might acknowledge their thoughts and behaviors are unreasonable. But an hour later, when they are panic-stricken and in the middle of what they perceive as imminent danger, they might totally believe what they had previously described as nonsensical. This is the nature of obsessive-compulsive disorder.

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It is crucial to differentiate between OCD and a psychotic disorder, because drugs that are prescribed for psychosis (antipsychotics) have been known to induce and/or exacerbate symptoms of OCD. In addition, research has shown that these antipsychotics often do not help those with severe OCD. In Dan’s case, the antipsychotics he was prescribed did indeed exacerbate his OCD, in addition to causing a host of serious side-effects, both physical and mental.

OCD sufferers and their care-givers need to be aware that things are not always what they seem. A misdiagnosis of psychosis in those with OCD is just one example. A comorbid diagnosis of depression and/or ADHD are others. Because the DSM-5 categorizes certain behaviors as belonging to specific illnesses, we really need to be careful not to jump to conclusions in reference to diagnoses and subsequent treatments. In the case of obsessive-compulsive disorder, maybe the best way to proceed is by treating the OCD first, and then reassessing the situation. Once OCD has been reined in, we might be surprised to find that symptoms typically associated with other disorders have fallen by the wayside as well.

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Obsessive-compulsive disorder

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

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

Compulsions (lat. compello - I force). 1. Obsessive drives, a kind of obsessive phenomena (obsessions). Characterized by irresistible attraction that arises contrary to the mind, will, feelings. Often they are unacceptable to the patient, contrary to his moral and ethical properties. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the patient as wrong and painfully experienced by them, especially since their very appearance, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsions is also used in a broader sense to refer to any obsessions in the motor sphere, including obsessive rituals. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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”. nine0003

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).

nine0002 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.

nine0003

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. nine0003

Obsessive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a sense of shame, remorse. 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. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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). nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

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). nine0003

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. nine0003

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. nine0003

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. nine0003

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. nine0003

OCD: what is obsessive-compulsive mental disorder, diagnosis, treatment

In our time, obsessive-compulsive mental disorder is faced by those who knew this disease only by hearsay. Surprisingly, psychologists note that many OCD patients can find advantages in their illness. Still, it is better to diagnose the disease and try to cope with it. The statistics are disappointing - up to 3% of the world's population is faced with a violation.

What is OCD (obsessive compulsive disorder)? nine0145

OCD, or obsessive-compulsive disorder, is a mental disorder characterized by obsessive thoughts (obsessions) and actions (compulsions). Striking examples include the desire for perfect cleanliness, the fear of catching various diseases, a manic attachment to certain rituals (for example, pressing the doorbell three times, washing hands after each handshake, etc.).

Often, the manifestation of obsessive-compulsive disorder is accompanied by bodily harm to oneself or other people. It is important to diagnose the disease in time so that it does not develop into a pathology. nine0003

Obsessive-compulsive disorder is also called obsessive-compulsive disorder. The disease can be chronic, episodic or progressive. Equally, the disease is present in both men and women. Sometimes the patient himself understands that his thoughts in their manifestation are absurd, and the behavior that follows them is very ineffective. But resisting them is useless. Suppressing these actions only increases the anxiety state.

If we consider the disease from the side of physiology, then it leads to functional disorders in the following parts of the brain: nine0003

basal ganglia;
frontal part;
caudate nucleus;
amygdala.

The severity of obsessive-compulsive personality disorder in patients can vary and most often depends on the presence of stressful situations in a person's life. Violation can change life for the worse, reduce communication with society. A distinctive feature of obsession can be considered the absence of rationalism, and compulsions - that they cannot be abandoned. nine0003

Patients, realizing their situation, are afraid to go crazy, start worrying about their relatives, about their own and their safety. In practice, such neuroses do not lead to serious consequences or mental disorders, and aggressive thoughts do not lead to subsequent actions.

This is what distinguishes a person with OCD from mentally deranged or hallucinating patients. A patient with OCD has the following symptoms:

high intelligence;
adequate thinking; nine0156
conscientiousness and anxiety;
high sense of responsibility;
pedantry;
desire to be the best.

Symptoms of obsessive-compulsive disorder

The most obvious symptoms include the obsessive and compulsive disorders already mentioned, that is, obsessive thoughts and a manic desire to perform any action. Thoughts can manifest as images, delusional ideas, inexplicable drives. Obsessive-compulsive disorder and its symptoms are observed in the form of the inability to make decisions regarding everyday situations. nine0003

Of the main signs of OCD, the following can be distinguished: obsessive-compulsive disorder:

intrusive thoughts;
anxiety and various fears;
the same rituals that a person performs daily.

Among the mental symptoms in patients, the following are observed:

fear of catching an infection;
causeless anxiety;
maniacal desire for order and cleanliness; nine0156
excessive superstition.

With OCD, the patient appropriates all incoming thoughts, in contrast to the disease of a split personality, when a person hears "foreign" voices.

These actions themselves do not bring pleasure to a person, but they can reduce the level of anxiety and stress. This does not last long and after a while the obsession returns, a phobia sets in and everything starts in a circle. Outwardly, compulsions can resemble ordinary work, for example, a person lays out things, constantly cleans the house, although the house can be perfectly clean anyway. nine0003

Sometimes the manifestation of obsessive-compulsive disorder manifests itself physically. A person does not sleep well, he has headaches, heartaches, blinking becomes more frequent, nervous tics and convulsions occur, pressure rises, appetite is disturbed, and sexual desire decreases.

The manifestations of obsessive-compulsive disorder are constant and manic in nature, they cause inconvenience to a person.

Causes of obsessive-compulsive disorder nine0145

Scientists are still conducting various studies to establish the exact causes of the violation. But there are no exact data in this area. Despite this, it is customary to single out several areas that can cause obsessive-compulsive disorder syndrome, the reasons are:

Psychological. OCD occurs when a person develops aggression towards an object. It also includes stressful situations that provoke a violation. The state appears as an exit of emotions, as a marker of anxiety. nine0156
Biological. The disorder is the result of a disease of the brain or nervous system. It can be provoked by various kinds of injuries, hormonal disorders or anatomical features.
Genetic. The disease can be inherited.
Sociological. They arise as a response of the body to external factors.
Exogenous. They manifest themselves in the form of traumatic situations that can happen at work or in personal life.

Disease pathogenesis

Despite various theories of the occurrence of OCD, the pathogenesis of obsessive-compulsive disorder has a well-defined nature of occurrence, although not fully understood. These structures of the body interact with each other through serotonin. The lack of this hormone is due to the heightened effect of neurons on the cerebral cortex. This provokes a blockage of the nerve impulse, which does not reach the next neuron.

Classification and stage of development of ROC nine0145

Obsessive-compulsive disorder has different degrees of severity and manifests itself in the following stages:

"Mental chewing gum" or rumination. When a person sets himself unsolvable questions and tasks.
Arrhythmia. Obsession, which is manifested by the constant re-reading of various objects.
Intrusive reproduction. It manifests itself in the painful formation of a person to remember everything that is not related to a given period of time, event or conversation. nine0156
Onomatomania. An obsessive desire to remember all the words, titles and names.

There are several variants of manifestation. For example, they can be expressed in simple symbolic actions. The patient can put a certain prohibition on performing actions, for example, counting steps for failure or success. They can also be expressed in physical actions aimed at self-harm: pulling out body hair and eating it. As a rule, an accurate diagnosis requires complete immersion in the disease in order to understand whether it is different from other mental disorders. nine0003

The manifestation of obsessive-compulsive disorder is equally observed in both men and women. It is much less common in children, although it is believed that the first signs may appear before the age of 11 years.

Obsessive-compulsive disorder is most common in adolescents. Studies have shown that the disorder affects mainly adolescents aged 11-17 years. Up to 85% of all patients are adolescents.

Each person, as a rule, goes through three stages that are inherent in OCD: nine0003

Misunderstanding. At this stage, intrusive thoughts are mild. A person feels a violation of the habitual consciousness, anxiety, cannot understand the nature of the occurrence of manic impulses.
Understanding. Accompanied by a visit to a specialist. The patient understands that disturbances are present, but cannot yet realize the changes. Often at this stage there is hope that the state will change and life will return to its previous course.
Adoption. The patient comes to terms with the mental disorder, agrees to treatment. He ceases to regard obsession and compulsion as a temporary condition. At this stage, it is important to fully interact with the attending physician, to obtain comprehensive information about the disease. nine0156

The obsessive-compulsive disorder scale was introduced to determine the stage of the disorder. It's called the Yale-Brown scale. It was developed at Yale University under the direction of Wayne Goodman. This manual is accepted throughout the world as a traditional method for identifying the stage of OCD.

Complications of obsessive-compulsive disorder

In obsessive-compulsive disorder, the consequences can be irreversible and cover completely different areas of life: nine0003

Suicidal behavior. In a severe stage, the patient may commit suicide or try to cause physical harm to another person.
From constant contact with soap and detergents that a person uses so actively, dermatitis can develop.
Possible problems in the social sphere. Inability to communicate with society. A person falls out of society - he does not have a hobby, he is afraid to appear in public places, he cannot concentrate on work. nine0156
There are conflicts with relatives and friends. Some people with OCD are unable to start a family and have difficulty raising children.

When to see a doctor?

At the slightest suspicion of the listed symptoms, you should immediately contact a specialist. Often a person with OCD is not able to independently realize and accept that his behavior and way of thinking has changed.

If you have problems with society and loved ones, then you should listen to their advice and make an appointment with a doctor. nine0003

Diagnostics

The violation is included in the International Classification of Diseases (ICD-10). Diagnosis of obsessive-compulsive disorder includes a mandatory visit to a specialist with subsequent diagnosis.

When making a diagnosis, the doctor relies on the following criteria:

The patient has intrusive thoughts. The frequency of their appearance in this case exceeds the permissible norm for two weeks.
Obsessive thoughts and actions qualitatively worsen the life of the patient. nine0156
The implementation of obsessions and compulsions causes discomfort in the patient.
Actions and thoughts occur regularly and frighten the patient with their frequency.
There is no specificity in thoughts and actions, their nature is associated with anxiety, generates stress in a person, internal tension.

The diagnosis is made if the patient has obsessive thoughts or ideas. They adopt an image that prompts them to impulsively perform some kind of action. nine0003

There is a mixed form of the disorder where the patient is equally haunted by obsessive thoughts and there is a manic execution of compulsions.

Treatment

Comprehensive treatment of obsessive-compulsive disorder includes an individual visit to a psychotherapist - a specialist identifies the causes of the disease, helps to recognize the signs of an obsessive-compulsive disorder, and accepts that the patient has OCD. The next step is the CBT method (Cognitive Behavioral Therapy). The psychotherapist teaches the patient to monitor the appearance of OCD, find ways to change negative thoughts, displace them and change them into optimistic actions. Medications in this case are prescribed with the consent of the patient. nine0003

Antidepressants and anxiolytics (drugs that relieve anxiety) are prescribed as medicines. Treatment with sedatives is also possible, which helps relieve depressive thoughts, remove depressed mood.

Therapy for obsessive-compulsive disorder may include biofeedback therapy. Sensors are installed on the patient, with the help of which breathing, muscle work and heart rate are controlled. This technique helps to control the condition and further cope with emerging obsessive thoughts and negative emotions. nine0003

You can get treatment from private practitioners, but it is better to choose clinics that specialize in the treatment of mental disorders. Such institutions employ doctors with many years of experience who have been practicing and treating obsessive-compulsive disorder for many years.

+7 (495) 121-48-31

Prevention and recommendations for illness

OCD is typical for people who have any other mental disorders. Also, with a stable calm state of patients diagnosed with OCD, its recurrence is possible. Since the specific cause of the violation has not been established, then prevention is advisory in nature. nine0003

For obsessive-compulsive disorder, recommendations in terms of prevention can be primary and secondary:

Primary. A person learns about a genetic predisposition, corrects his behavior with the help of a specialist, uses various methods to prevent the occurrence of a violation. Primary prevention also includes educational methods.
Secondary. Used to prevent recurrence of OCD. In this case, you will also need the help of a specialist to correct behavior, calm and sufficient sleep, abstinence from alcoholic beverages and drugs. You can also follow a special diet that is aimed at producing serotonin. nine0156

If any signs appear, it is better to consult a doctor, and not try to come to terms with unfamiliar conditions. It is useful to get comprehensive information about OCD from people who have suffered this disorder.

References:

Erich Fromm, "The human soul, its capacity for good and evil"
Karen Horney, Neurosis and Personal Growth: The Struggle for Self-Realization
Goldsmith G.
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