Ocd with time

OCD and Time Management - Obsessive Compulsive Disorder (OCD) & Anxiety Disorder Attacks, Symptoms & Treatment

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

Time management is a hot topic these days. Whether related to the workplace, school, homemaking, child-rearing, or our personal lives, there just never seems to be enough time to do all the things we need, or want, to do. We are so overloaded that there are self-help books, as well as experts and entire companies dedicated to this subject. When did it all get so complicated?

And if you have obsessive-compulsive disorder, there’s a good chance you’ll have even more challenges to deal with.

To me, one of the most frustrating aspects of my son Dan’s severe OCD was how much time he appeared to spend doing absolutely nothing. He had schoolwork and other responsibilities to attend to, yet he’d just sit in a “safe” chair for hours and hours on end. I now know that he spent this time focusing on his obsessions and compulsions, which were in his mind and not obvious to me. As Dan’s OCD improved, the chair sitting stopped, but he still often took longer than others to complete his school assignments. This seemed to be attributed to his difficulty balancing details within the big picture as well as over-thinking.

While Dan’s problem of apparently wasting time is common for those with OCD, the opposite end of the spectrum can also be an issue. Some OCD sufferers might feel the constant need to be busy and productive, as well as having every event and task of the day carefully reviewed and planned. For Dan, spur-of-the-moment plans were not even a possibility when his OCD was in control.

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Something else OCD sufferers might deal with in regard to time management is lack of punctuality. This might be because they feel the need to finish whatever task they are working on before they can move on to something else (even if most people wouldn’t consider it important), or perhaps due to trouble with transitions. Of course, time spent attending to obsessions and compulsions can always account for any struggles with time management.

From what I’ve written, it is easy to conclude that those with OCD do not manage their time well, and might even be perceived as lazy. I believe the opposite is true. OCD sufferers work harder than ever just to get through the day, and they are also excellent time managers. Look at everything they have to manage! For example, even though my son Dan sat in his “safe” chair for hours on end, somehow he was still able to meet all his responsibilities. Many of those with OCD not only fulfill their own obligations, they meet the “obligations” of their disorder as well. Talk about multi-tasking! Add to this the fact that many OCD sufferers are also perfectionists and it is not surprising that their burdens might eventually become too much to handle.

In my opinion, those with OCD don’t need lessons in time management. What they need is to fight their OCD, and the frontline treatment for the disorder is Exposure and Response Prevention Therapy. Obsessions and compulsions are time-consuming, as is constant worry. Getting back the time that OCD steals is nothing short of a gift and can open up a world of possibilities to not only OCD sufferers, but to the people who want to spend time with them.

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Strategies for OCD and Time Management

OCD can impact your time management in several ways, such as making you spend extra time on overthinking, perfectionism, and trying to focus.

Many people assume you must be meticulous if you have obsessive-compulsive disorder (OCD). This stereotype means you’re expected to be great at managing your time and completing tasks — but this isn’t always the case.

On the contrary, OCD can make time management difficult.

Depending on the nature of your OCD, you might find it hard to be punctual or to finish your tasks in a timely manner due to obsessions and compulsions getting in the way. This can hurt your home situation, work, and relationships with others.

That said, there are effective treatments for OCD, and it’s possible to learn efficient time management techniques.

There are many ways in which OCD can affect time management.

For starters, obsessions and compulsions can take up a lot of time. Simple tasks can take longer than necessary. If you have a checking compulsion, for example, you might feel compelled to check all your windows and doors exactly ten times before leaving for work. This can impact your schedule and punctuality.

OCD can also be mentally draining. Because obsessions are unwanted and intrusive thoughts, they can show up at inopportune moments — say, when you’re approaching a deadline — and refuse to go away. This can make it hard to focus on tasks, which makes it more difficult to meet deadlines.

Procrastination can also result from OCD. Many people avoid their OCD triggers — in fact, avoidance can be a compulsion. You might avoid a task or put it off as long as possible. For example, you might have to drive to a certain area for a work task, but because you’re afraid of driving on a certain road, you put it off until the last minute.

Below, we look at 5 tips for managing your time better when dealing with OCD.

First things first: if you’re not currently seeing a therapist, you might consider doing so. Talk therapy is one of the most effective ways to manage OCD symptoms, and managing your symptoms is the key to managing your time.

The most common treatment for OCD is a type of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP) therapy. ERP helps you learn to manage obsessions without engaging in your compulsions. Eventually, your obsessions lose their power.

Other forms of therapy for OCD include:

acceptance and commitment therapy (ACT)
Eye-Movement Desensitization and Response (EMDR) therapy
imaginal exposure (IE)
psychodynamic therapy

Some people might benefit from using prescription medication alongside talk therapy. You can speak with a doctor and therapist if you’d like to try medication for OCD.

For more information on OCD treatment, you can check out this article.

Perfectionism is not the same thing as OCD, but many people with OCD are also perfectionists, according to 2020 research.

Perfectionism can lead to procrastination. Perfectionists are afraid of being unable to complete tasks perfectly. This fear can compel you to put tasks off for as long as possible.

Similarly, perfectionists might self-sabotage so they have an excuse for not completing something perfectly. To avoid feeling shame about handling a meeting incorrectly, for example, you might fill your morning schedule so that you can show up late and blame something else for the meeting going badly.

You can tackle perfectionism by:

talking about it in therapy
identifying when and how your perfectionism comes up
identifying and challenging harmful self-talk
recognizing cognitive distortions, or flaws in thinking, that may be contributing to perfectionism

Consider looking for resources for perfectionists, such as The Perfectionism Project podcast or workbooks like “The Perfectionism Workbook: Proven Strategies to End Procrastination, Accept Yourself, and Achieve Your Goals“.

Research, including a 2018 study, shows that stress can worsen the symptoms of OCD. Stress can also make it difficult to focus on tasks, which can make it difficult to finish activities timeously.

Try to find healthy ways to cope with stress. You could try the following:

exercise
meditation
journaling
deep breathing exercises
relaxation techniques
spending time in nature

Taking care of your basic needs — like sleeping enough and eating a balanced diet — can help you feel well enough to cope with day-to-day stressors.

Different time management techniques work for different people. If your current method isn’t working for you, consider trying another.

Popular time management techniques and philosophies include:

time blocking and time boxing to make smarter use of your time
“eating the frog,” meaning do your most difficult task first to get it out of the way
the Eisenhower matrix to help you prioritize tasks
the rapid planning method (RPM) to help you plan your progress
bullet journaling — a method that combines mindfulness with productivity
deep work that helps you get into a flow

If you try multiple time management techniques and find the same challenges keep coming up, take note. For example, if you constantly overfill your schedule, time management will always be tricky until you address it directly. Figuring out why you overfill your schedule can help you avoid it in the future.

When planning ahead, you can’t always predict the little tasks that will affect your schedule. Instead of squeezing too many tasks into your day, try adding some wiggle room in between tasks.

Adding in buffer time can look like:

waking up ten minutes earlier
giving yourself a five-minute breather between tasks
allocating a little more time to challenging activities
asking for an extra day to complete a work task

This is not about allocating time for you to focus on your obsessions and carry out your compulsions. Rather, it’s about accepting that you’re human and that life can get in the way of punctuality. Buffer time also helps reduce stress as you’ll feel less pressed for time.

If you’re finding it hard to manage your time with OCD, you’re not alone: OCD can make time management difficult for many.

Learning to manage your OCD symptoms can help you improve your time management skills. Consider speaking with a therapist to directly tackle your OCD.

Looking for a therapist, but not sure where to start? Psych Central’s How to Find Mental Health Support resource can help.

Obsessive-Compulsive Disorder (OCD) - key facts in English

Obsession

See our disclaimer that applies to all translations available on this site.

What is obsessive-compulsive disorder?

At times, we can all get hung up on some things, but if:

Terrible thoughts obsessively come into your head, even if you try to get rid of them,

You have to count things over and over again or touch them , or repeating some actions, for example, washing hands,

You may have obsessive compulsive disorder (OCD).

Who gets OCD?

About 1 in 50 people will experience OCD at some point in their lives. Equally, it can be men and women. In the UK, their number is about 1 million people. OCD usually begins in adolescence or early adulthood. Symptoms of OCD may get worse or worse over time, but often people don't seek help for many years.

What are the signs and symptoms of obsessive-compulsive disorder?

Recurring thoughts that make you feel anxious - "obsessions" or "obsessions". It can be unpleasant words or phrases, mental pictures or doubts.
The things you do over and over again that help you feel less anxious are 'compulsions'. You can try to correct or "neutralize" thoughts by counting over and over again, saying a special word, or performing certain rituals.

What are the causes of OCD?

Many factors can play a role in the occurrence of OCD. One or more of the following could explain why you or someone you know has OCD.

In some cases, OCD is inherited, so sometimes the disorder can run in the family.
Stressful life events cause OCD in about a third of cases.
Life changes in which you have to take on more responsibility, such as puberty, the birth of a child, or a new job.
If you have OCD and it lasts for some time, you may develop an imbalance of serotonin (also known as 5HT), a brain neurotransmitter.
You are a neat, pedantic, methodical person - but you take it too far.
If you have extremely high standards of morality and responsibility, you may feel especially bad about having unpleasant thoughts. To the point where you start to be wary and keep a close eye on them, which makes their appearance even more likely.

How to help yourself

If you regularly force yourself to think the thoughts that are bothering you, you will be able to control them better. You can write them down - on a recorder or on paper, and then listen to or reread. You should do this regularly, for about half an hour every day. At the same time, try to resist compulsive behavior.
Do not use alcohol to control your anxiety.
If your intrusive thoughts are about your faith or religion, discuss them with your religious leader to help you understand if it's an OCD problem.
Try using a self-help book.

Professional help Various types of psychotherapy

Exposure and response prevention

Helps stop the mutual reinforcing of compulsive behavior and anxiety.

We know that if you stay in a stressful situation long enough, you will gradually get used to it and the anxiety will go away. In this way, you gradually face the situation that you fear (exposure), but stop yourself from doing your usual compulsive rituals of checking or clearing (avoiding a response) and wait for your anxiety to go away.

Cognitive therapy

Instead of getting rid of your thoughts, cognitive therapy helps you change how you react to them. It specifically targets unrealistic self-critical thoughts. Useful if you have intrusive thoughts but are not performing any rituals or activities to reduce your anxiety. Can be used with Exposure and Response Prevention.

Antidepressant treatment

Even if you are not depressed, SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants can help. They may be used alone or with cognitive behavioral therapy for moderate to severe OCD. If the medicine doesn't help at all after three months of taking it, you can change it to another SSRI antidepressant or a medicine called Clomipramine (Anafranil).

How effective is the treatment?

Exposure and prevention of response

About three out of four people who completed this therapy did well, but one in four will return symptoms and require additional treatment. Approximately one in four people refuse to try this type of CBT or do not complete it because they find it too hard for them.

Medications

About six out of 10 people feel better with medication and their symptoms lessen by about half. Medications do help prevent the return of OCD for as long as they are taken, even years later. Unfortunately, about half of those who stop taking the drug return symptoms within a few months afterward. This is less likely when drug treatment is combined with cognitive behavioral therapy.

Which approach is best for me?

Mild OCD

Exposure and response prevention can be done without professional help. This method is effective and has no side effects, but you will feel more anxious for a while. You must be motivated and ready for hard work. Cognitive therapy and drug treatment are equally effective.

Moderate or severe OCD

Initially, you can choose either CBT (up to 10 hours in contact with a therapist) or medication (within 12 weeks). If you do not get better, you should try both treatments together.
If you have severe OCD, it is best to use medication and CBT together from the start.
Taking medication alone will help you if you don't feel able to face the anxiety that Exposure and response prevention will cause, but the chances of OCD coming back are higher - about one in two compared to one in four with psychotherapy treatment. The medicine must be taken for about a year and is obviously not ideal during pregnancy or breastfeeding.

The original page produced by the RCPsych Public Education Editorial Board. Series Editor: Dr Philip Timms.

Information about treatments can change rapidly and the College updates its mental health information pages regularly.

Translated by: Maria Kadmenskaya

Translation date: August 2011

(c) February 2013. Royal College of Psychiatrists. This booklet may be downloaded, printed, copied and distributed free of charge provided that no profit is made from its use and that the Royal College of Psychiatrists is credited and credited as the author. Permission to reproduce this booklet in any other form must be obtained from the Director of Publications. The College does not allow this booklet to be transferred or reprinted to any other site, but does allow a direct link.

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Obsessive Compulsive Disorder

A significant 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 as early as 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 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 arguments for and against even the simplest everyday actions are endlessly reconsidered. 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 obsession 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 - persistently 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 a 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 feeling of shame, remorse. They dominate the mind of the patient, despite the efforts and efforts not to think about them.

Obsessive inclinations - 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 actions - actions performed against the wishes of patients, despite the 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 affective-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 persistence 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 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.

Treatment of OCD begins with an explanation to the patient of the symptoms 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.

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