What causes ocd to develop

Obsessive-Compulsive Disorder (OCD) | Johns Hopkins Medicine

What is obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a common anxiety disorder. It causes unreasonable thoughts, fears, or worries. A person with OCD tries to manage these thoughts through rituals.

Frequent disturbing thoughts or images are called obsessions. They are irrational and can cause great anxiety. Reasoning doesn’t help control the thoughts. Rituals or compulsions are actions that help stop or ease the obsessive thoughts.

What causes OCD?

Experts aren’t sure of the exact cause of OCD. Genetics, brain abnormalities, and the environment are thought to play a role. It often starts in the teens or early adulthood. But, it can also start in childhood. OCD affects men and women equally. It appears to run in families.

Other anxiety problems, depression, eating disorders, or substance abuse may happen with OCD.

What are the symptoms of OCD?

Obsessions are unfounded thoughts, fears, or worries. They happen often and cause great anxiety. Reasoning does not help control the obsessions. Common obsessions are:

A strong fixation with dirt or germs
Repeated doubts (for example, about having turned off the stove)
A need to have things in a very specific order
Thoughts about violence or hurting someone
Spending long periods of time touching things or counting
Fixation with order or symmetry
Persistent thoughts of awful sexual acts
Troubled by thoughts that are against personal religious beliefs

While you may know that the thoughts are unreasonable and not due to real-life problems, it’s not enough to make the unwanted thoughts go away.

Compulsions are repetitive, ritualized acts. They are meant to reduce anxiety caused by the obsession(s). Examples are:

Repeated hand-washing (often 100+ times a day)
Checking and rechecking to make sure that a door is locked or that the oven is turned off for example
Following rigid rules of order, such as, putting on clothes in the same order each day, or alphabetizing the spices, and getting upset if the order becomes disrupted

Compulsive acts can become excessive, disruptive, and time-consuming. They may interfere with daily life and relationships.

People may avoid situations in which they might have to face their obsessions. Some try alcohol or drugs to calm themselves.

How is OCD diagnosed?

OCD is diagnosed during a physical and psychiatric exam when obsessions and compulsions:

Take up at least one hour each day
Are distressing
Interfere with daily life

Always see your healthcare provider for a diagnosis.

How is OCD treated?

Your healthcare provider will figure out the best treatment based on:

How old you are
Your overall health and medical history
How sick you are
How well you can handle specific medicines, procedures, or therapies
How long the condition is expected to last
Your opinion or preference

Treatment may include:

Anti-anxiety or antidepressant medicines are often used.
Cognitive behavioral therapy can also help.

Key points about OCD

OCD is a common condition. It causes persistent disturbing thoughts and compulsive rituals that attempt to ease anxiety.
The rituals become consuming and interrupt daily life.
Stressful events may trigger the OCD episodes or make them worse.
You may or may not have insight into the irrational thoughts or behaviors.
Medicines and therapy can help reduce the time spent in the thought patterns or compulsive behaviors. Treatment is most successful when both are used.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.

What causes OCD | OCD-UK

Controversy Time!

In spite of a range of theories and considerable research, scientists so far have not been able to identify a definitive cause for why a person develops Obsessive-Compulsive Disorder (OCD).

However, there are plenty of theories surrounding the potential causes of OCD, involving one of or a combination of either; neurobiological, genetic, learned behaviours, pregnancy, environmental factors or specific events that trigger the disorder in a specific individual at a particular point in time.

We will summarise some of the suggested theories on this page, but before we begin it’s important we make it clear that this is just theory.

There have been many explanations of why people develop OCD. Some have argued that it is inherited, whilst others have said that life events can cause it. Others have suggested that it’s caused by a chemical imbalance in the brain. Different people, different researchers find different explanations more helpful than others. But here’s the point, we simply don’t know!

So let’s summarise some of those explanations.

Biological Factors
Some mental health researchers have encouraged us to think of research on brain scans and similar as indicating that OCD is linked to a genetic or biological cause. This research is often described in terms of chemical imbalances in the brain, faulty brain circuitry or genetic defects.
However, despite the recognition that certain parts of the brain are different in OCD sufferers, when compared with non-sufferers, it is still not known how these differences relate to the precise mechanisms of OCD.
Brain imaging studies have consistently demonstrated differing blood flow patterns among people with OCD compared with controls, and the cortical and basal ganglia regions are most strongly implicated. However, subsequent meta-analysis studies found that differences between people with OCD and healthy controls were found consistently only in the orbital gyrus and the head of the caudate nucleus.
So yes, whilst it’s true to say that sometimes people with OCD are found to have different brain activity, it could be argued this would be expected.
A brain scan is sensitive to different patterns of activity in the brain and can, for example, detect the difference in terms of the way the brain reacts between expert musicians listening to music and people with no special knowledge of music.
These areas of the brain become relevant and ‘switched on’ in particular environments where the person is worrying. It is therefore not surprising that there are brain activation differences between people with OCD and those without; this does not mean that OCD is a biological disease.
PANDAS
A 1998 finding implicated the basal ganglia as a key brain region in OCD with the discovery that in a sub-group of children with OCD the disorder may have been triggered by infections.
Streptococcal infections trigger an immune response, which in some individuals generates antibodies that cross-react with the basal ganglia. The explanation was that some children begin to exhibit OCD symptoms after a severe strep throat infection. It is thought that the body’s natural response to infection, the production of certain antibodies, when directed to parts of the brain might be linked in some way to Paediatric Autoimmune Neuropsychiatric Disorders associated with Streptococcal Infection (PANDAS).
This mechanism may explain the subgroup of children in whom OCD develops after a streptococcal infection, and worsens with recurrent infections. However, a later 2004 study found no link between subsequent infections and exacerbation of symptoms.
What we do know is that if OCD results from a strep throat infection the symptoms will start quickly, probably within one or two weeks.
So it could be that PANDAS whilst not a cause for OCD, triggers symptoms in children who are already predisposed to the disorder, perhaps through genetics or other causal explanations.
Genetic Factors
Overall, genetic studies indicate some tendency towards anxiety that runs in families, although this is probably only slight.
Some research points to the likelihood that OCD sufferers will have a family member with OCD or with one of the other disorders in the OCD ‘spectrum’. In 2001, a meta-analytic review reported that a person with OCD is 4 times more likely to have another family member with OCD than a person who does not have the disorder.
This and other studies have raised the possibility of familial prevalence of OCD and led to a search to identify specific genetic factors that may be involved. S However, despite a proliferation of studies, and dozens of potential gene candidates suggested, researchers have so far failed to identify a consistent candidate gene responsible for OCD.
It also needs to be remembered that many sufferers do not identify OCD anywhere else in their family, or even other anxiety problems. This theory could be further questioned based on speaking to identical twins where one will have OCD and the other has no anxiety problem at all.
What this suggests is that genetics may not be the only cause of OCD (if at all), and that family prevalence of OCD could be learned behaviours in some cases. So although we cannot rule genetics out, it’s clear that it’s not the whole story and learned or environment factors may play a more significant part.
In summary, there is no obvious benefit to offering biological explanations for the cause of OCD, especially if such suggestions lead those who suffer to dismiss existing psychological treatment methods.
Chemical Imbalance
It’s common to see and hear mental health professionals describing the cause of OCD in terms of a ‘biochemical imbalance’. These approaches have focused on one particular neurotransmitter, serotonin.

Serotonin is the chemical in the brain that sends messages between brain cells and it is thought to be involved in regulating everything from anxiety, to memory, to sleep.
Through the accidental discovery in the late sixties of the effectiveness of the serotonin active tricyclic antidepressant clomipramine, which did not substantially impact on serotonin, led to the serotonin hypothesis.
Initially, it was suggested that there was a gross deficit in serotonin; when this was not actually identified, increasingly subtle abnormalities were suggested, with the evidence overall remaining implausible at best.
In more recent years some researchers have argued that the most robust evidence for the serotonin hypothesis is the specificity of serotonin reuptake inhibitors (SRI) and selective serotonin reuptake inhibitor (SSRI) medication.
However, given that this effect was the observation that generated the hypothesis, it cannot reasonably be considered as evidence for it.
It’s worth noting that relapse is frequently associated with the withdrawal of SSRI medications in OCD, more so than in other conditions, especially where no behavioural therapy is in place, which is yet to be fully understood. This could mean that serotonin is an important neurotransmitter involved in the maintenance of OCD, if not a specific cause.
Overall, there is a place for SSRIs in the treatment of OCD, especially where co-morbidity is present, provided that medication remains part of informed patient choice, and combined with psychological therapy like CBT.
Psychological Theories
Other research has revealed that there may be a number of other factors that could play a role in the onset of OCD, including behavioural, cognitive, and environmental factors.
For example, according to the Learning Theory, OCD symptoms are a result of a person developing learned negative thoughts and behaviour patterns, towards previously neutral situations which can result from life experiences.
Research has revealed a great deal about the psychological factors that maintain OCD, which in turn has led to effective psychological treatment in the form of Cognitive Behavioural Therapy (CBT).
Behavioural Theory – Learned Theory
During the 50s and 60s researchers reported the successful behaviour treatment of two cases of chronic obsessional neurosis (a forerunner for the Obsessive-Compulsive Disorder name), followed by a series of successful case reports.
This discovery and research heralded the application of psychological models to obsessions and the development of effective behavioural treatments.
This research later proposed that ritualistic behaviours were a form of learned avoidance.
Behaviour therapy for phobias had proved successful in the treatment of phobic avoidance through desensitisation, but attempts to generalise these methods to compulsions had been unsuccessful.
Researchers argued that it was necessary to tackle avoidance behaviours directly by ensuring that compulsions did not take place within or between treatment sessions. This thinking anticipated cognitive approaches in that they emphasised the role of the expectations of harm in obsessions and the importance of invalidating these expectations during treatment, but this was subsequently regarded as peripheral to the major task of preventing compulsions.
Around the same time in the early seventies other researchers developed treatment methods in which exposure to feared situations was the central feature. These differing approaches were subsequently incorporated into a highly effective programme of behavioural treatment incorporating the principles of what we now refer to as exposure and response prevention (ERP).
Support for the use of this method came from a series of experiments in which it was demonstrated that, when a ritual is provoked, discomfort and the urge to ritualise spontaneously subside when no rituals (compulsions) take place.
These researchers elegantly specified the behavioural theory of OCD, that behavioural treatment of OCD is based on the hypothesis that obsessional thoughts have through conditioning, become associated with anxiety that has failed to extinguish.
Sufferers have developed avoidance behaviours (such as obsessional checking and washing), which prevent the extinction of anxiety. This leads directly to the behavioural treatment known as ERP, in which the person is: (a) exposed to stimuli that provoke the obsessional response, and (b) helped to prevent avoidance and escape (compulsive) responses.
An important contribution to the development of ERP was the observation that the occurrence of obsessions leads to an increase in anxiety, and that the compulsions lead to its subsequent attenuation. When the compulsions were delayed or prevented, people with OCD experienced a spontaneous decay in anxiety and the urges to perform compulsions. Continued practice led to the extinction of anxiety. The ‘spontaneous decay experiments’ that demonstrated this were crucial both for therapists and patients to be confident that, if they confronted their fears, anxiety and discomfort would diminish and ultimately disappear.
These early behavioural theories and experiments set the stage for later cognitive-behavioural theory and treatment.
Cognitive theory
Many cognitive theorists believe that individuals with OCD have faulty beliefs, and that it is their misinterpretation of intrusive thoughts that leads to OCD.
According to the cognitive model of OCD, everyone experiences intrusive thoughts from time-to-time. However, people with OCD often have an inflated sense of responsibility and misinterpret these thoughts as being very important and significant which could lead to catastrophic consequences.
The repeated misinterpretation of intrusive thoughts leads to the development of the obsessions and because the thoughts are so distressing, the individual engages in compulsive behaviour to try to resist, block, or neutralise the obsessive thoughts.
The cognitive-behavioural theory developed following a focus on the meaning attributed to internal (or external) events. The cognitive-behavioural theory builds on behavioural theory as it begins with an identical proposition that obsessional thinking has its origins in normal intrusive cognitions. However, in the cognitive theory the difference between normal intrusive cognitions and obsessional intrusive cognitions lies not in the occurrence or even the (un)controllability of the intrusions themselves, but rather in the interpretation made by people with OCD about the occurrence and/or content of the intrusions.
If the appraisal is focused on harm or danger, then the emotional reaction is likely to be anxiety. Such evaluations of intrusive cognitions and consequent mood changes may become part of a mood-appraisal negative spiral but would not be expected to result in compulsive behaviour. Cognitive-behavioural models therefore propose that normal obsessions become problematic when either their occurrence or content are interpreted as being personally meaningful and threatening, and it is this interpretation which mediates the distress caused.
Thus, according to the cognitive hypothesis, researchers have hypothesised that OCD would occur if intrusive cognitions were interpreted as an indication that the person may be, may have been, or may come to be, responsible for harm or its prevention.
Central to how threatening this appraisal is the idea of not only how likely the outcome is, but how ‘awful’ this is to the individual. Furthermore, this is set against the individual’s sense of how they might cope in these circumstances.
According to cognitive models, the interpretation of an intrusive thought results in a number of voluntary and involuntary reactions which each in their turn can have an impact on the strength of belief in the original interpretation. Negative appraisals can therefore act as both causal and maintenance agents in OCD.
Some researchers believe that this theory questions the biological theory because people may be born with a biological predisposition to OCD but never develop the full disorder, while others are born with the same predisposition but, when subject to sufficient learning experiences, develop OCD.
Psychoanalytic Theory
Commonly accepted in the past, but nowadays increasingly disregarded, the psychoanalytic theory suggests that OCD develops because of a person’s fixation arising from unconscious conflicts or discomfort they experienced during infancy or childhood, or the way a person interacted with his or her parents during childhood. This theory is now quite rightly disregarded due to the failure of psychoanalytic therapy to treat OCD.
Stress
Stress and parenting styles are environmental factors that have been blamed for causing OCD, but no evidence is yet to show that. Stress does not actually cause OCD, but major stresses or traumatic life events may precipitate the onset of OCD. However, these are not thought to cause OCD, but rather trigger it in someone already predisposed to the disorder.
If left untreated, everyday anxiety and stress in a person’s life will worsen symptoms in OCD. Problems at school or work, university exam pressures and normal everyday problems that relationships can bring are all contributory factors to increasing the frequency and severity of a person’s OCD.
Depression
Depression is also sometimes thought to cause OCD, although without question depression will make OCD symptoms worse, the majority of experts believe that depression is often a consequence of OCD rather than a cause.
SUMMARY
As you can see there is a range of factors have been identified as contributing to the cause of OCD, and there is still a great deal of theoretical contention surrounding the definitive cause.
However, despite most of the above theories offering compelling and highly informative insights, it’s a possibility that a combination of the theories may eventually be identified as the actual cause of OCD and that it is likely that for any given person a number of factors are involved.
Whilst the cause is currently still being debated, sometimes vigorously by the scientists, what is not in contention is the fact that Obsessive-Compulsive Disorder is indeed a chronic (at times), but equally very treatable medical condition.
It’s also important that we don’t become fixated on what causes our OCD at the expense of fighting and tackling it. Even if we think we have identified a cause, it won’t necessarily help us overcome OCD , so our focus must remain on tackling the problem we have right now, today, in the here and now.

What to read next:
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of Obsessive-Compulsive Disorder or any other medical condition. OCD-UK have taken all reasonable care in compiling this information, but always recommend consulting a doctor or other suitably qualified health professional for diagnosis and treatment of Obsessive-Compulsive Disorder or any other medical condition.

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

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

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

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

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

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

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

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

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

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

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

CLINICAL PICTURE

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

Main clinical manifestations of OCD:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The course of obsessive-compulsive disorder.

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

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

DIFFERENTIAL DIAGNOSIS

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

Genetic factors

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

FORECAST

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

TREATMENT: BASIC METHODS AND APPROACHES

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

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

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

Drug therapy

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

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

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

Psychotherapy

Behavioral psychotherapy

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

Social rehabilitation

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

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

OKR. Causes, symptoms and treatment of obsessive-compulsive disorder

What is OCD, causes and symptoms of obsessive-compulsive disorder. Differential diagnosis and criteria for diagnosis, basic principles of OCD treatment. Prognosis of the course and treatment of this disease. All these topics became the subject of a conversation with the Chief Physician of the Health Harmony Medical Center, a leading psychiatrist, psychiatrist-narcologist and psychotherapist Vladislav Sipovich.

What is OCD and how common is it?

Obsessive-compulsive disorder (OCD) is a mental illness that combines a group of obsessive-compulsive disorder syndromes (symptom complexes) associated with obsessive thoughts and actions, which got their name from the Latin words obsessio (blockade, siege) and compulsio (coercion). To put it simply, obsessions are obsessive illogical thoughts, and compulsions are irrational actions imposed by them, which together is interpreted as an obsessive state. In fact, OCD is an obsessive-compulsive disorder (OCD), as evidenced by the ICD (International Classification of Diseases) classification of almost all types of obsessive-compulsive disorders into the category of obsessive-compulsive disorder.

Compulsions are obsessive irresistible urges, uncontrollable by a person, developing against his will and mind, causing negative emotions and often incompatible with his moral and ethical principles. Patients are aware of all the incorrectness and irrationality of their actions, but they cannot resist them. The uncontrollability of compulsions by consciousness leads to the appearance of a feeling of fear, anxiety and the development of depression. In an extended context, compulsions are a wide variety of obsessive physical actions, often acquiring a ritual character.

The obsessive-compulsive disorder syndrome is characterized by multiple repetition of psychopathological phenomena in the patient's mind, accompanied by a feeling of involuntariness, coercion, awareness of their irrationality and, at the same time, unsuccessful attempts to resist them. All these phenomena have a negative impact on the general emotional background, often cause depressive moods and reduce performance. At the same time, the patient has a critical attitude towards obsessive-compulsive states. As for questions about the impact of OCD on intelligence, the answers in this case are ambiguous. Some authors believe that the obsessive state does not reduce the intellectual potential of the patient, others note cognitive impairments regarding spatial and verbal memory, speech fluency, and information processing speed.
NS is also differentiated depending on its localization in the mental-emotional (phobia) and / or motor sphere (compulsions). Independently, these types of NS practically do not occur; in the human mind, they are usually present in combination with each other, and in different proportions. If obsessive thoughts are difficult for others to notice, then compulsive actions are obvious and it is impossible to hide them from the close environment.

In addition, NS can be divided into the following conditions:
• Caused by certain and obvious psychogenic causes.
• Having no apparent cause, the so-called cryptogenic NS.
OCD can occur as an independent mental disorder, or in combination with sluggish schizophrenia, depression, epilepsy, after traumatic brain injury, and in some somatic diseases.

According to statistics, OCD affects 1 to 3% of the population, with the average age of hospitalized patients being 31.6 years, although the disease usually begins in adolescence and young age (10-25 years). This indicates that a significant period of time elapses between the onset of the disease and a visit to a specialist, on average about 7.5 years. At the same time, most of the patients who first applied to the doctor are no longer able to study or work, and only a quarter of them can fully perform these functions.

Who is most likely to develop OCD?

More than others, persons with a psychasthenic character are prone to the occurrence of obsessive states - suspicious, superstitious, emotionally labile, prone to dramatization of events. In addition, contributing factors to OCD may include:
• Psychic trauma and associated memories and experiences.
• Stimuli coinciding with those that have provoked feelings of fear in the past.
• Conflict situations that caused significant stress.

As for the hidden causes of OCD, they may be due to the peculiarities of the psyche of a particular person.

The neurochemical cause of OCD is a change in the metabolism of neurotransmitters, in particular the synthesis and transmission of serotonin and dopamine. The identification of this etiological factor led to a revolution in the pharmacological treatment of OCD through the development of selective serotonin reuptake inhibitor drugs (SSRIs).

There is evidence of a genetic predisposition to OCD - in 5-7% of patients, one or both parents also suffered from this disorder. Although the figure is small, it is still higher than that of the general population.

In addition, there are studies that support the theory of the onset and worsening of OCD symptoms in streptococcal infection when it affects the nervous tissue.

What are the symptoms of OCD and what is characteristic of its clinical picture?

According to ICD-10, the basic signs of OCD are regularly repeated obsessive thoughts (obsessions) and compulsive actions in the form of peculiar rituals.

The clinical course is dominated by thoughts and memories associated with fear and anxiety. They are painful for the patient, alien to his thinking, arise involuntarily, as if "from within". The patient can fight them only by performing stereotypical ritual actions that relieve nervous tension and eliminate anxiety. After performing the ritual, the patient receives calm and relief for a while. But it does not last long - until the next occurrence of obsessive thoughts. By the way, for the diagnosis of OCD, the duration and frequency of occurrence of obsessive states are important. If the performance of ritual actions in total takes more than 1 hour a day for 1-2 weeks or more, then we can talk about the presence of an obsessive-compulsive disorder in a person.

As I said, the initial stage of development of OCD usually falls on adolescence and adolescence (10-25 years). Moreover, it is during this period that the most pronounced clinical picture of the disease is observed, the main manifestations of which are the following symptoms:

1. The presence of obsessions - fleeting painful thoughts, ideas and images that forcibly intrude into a person’s thinking, which he tries to resist. This confrontation between the occurrence of obsessions and attempts to fight them can cause a deep internal conflict in the human psyche. The form of obsessions can be very diverse - individual words, phrases, poems, song verses, images, scenes, etc. Moreover, they can be quite shocking, lustful, obscene and disgusting.

2. The emergence of obsessional stimuli - urges to commit certain actions, including dangerous, shameful and even sadistic ones. For example, running across the road in front of a moving vehicle, undressing in a public place, shouting obscenities, or even hitting a child.

3. Performing obsessional rituals, of which there are two options:
• Mental in the form of a mental repetition of a count or certain words. In this case, the account is often combined with words. For example, say the words “nothing will happen” or “everything will be fine” 6 times, and repeat this procedure three times. Yes, and finish with a verse of some unknown why of the chosen song or poetic lines. The ritual is quite complex and demanding, because at the slightest failure it must be repeated, otherwise, according to the patient, it will lose its effectiveness.
• Physical actions that are sometimes striking in their absurdity. For example, if washing hands too often can be explained by the fear of infection, then looking in the mirror a certain number of times before leaving the house has no logical reason. Over time, rituals can become more complex and become a problem in everyday life and at work.

4. Internal obsessive discussions about arguments for and against certain actions. Intrusive doubts can be about even the simplest situations, such as turning off household appliances, closing locks, fear of hitting someone while driving, remorse for not observing religious requirements, or using obscene language.

5. Perfectionism - the desire for order and symmetry, when everything should be perfectly ordered and located in its place.

6. Compulsions - regular repetition of acts of a protective and preventive nature in relation to even the most unlikely situations potentially dangerous for the patient himself and his family. Often patients in this case avoid the circumstances and places with which their fears are connected. For example, kitchens with knives or workshops with piercing and cutting tools. It is hard to imagine the torment of a housewife who is afraid to be in her own kitchen or a professional seamstress who is afraid of scissors and needles.

7. Superstition, exaggerated attention to everything that can be associated with good or bad luck.

8. Obsessive fears (phobias) up to panic attacks.

All these psychopathological phenomena are accompanied by a feeling of anxiety of varying strength, which all obsessive and compulsive rituals are aimed at weakening.

The so-called Yale-Brown scale is used to assess the severity and dynamics of the clinical picture of OCD. It consists of 10 points that the patient must answer during a conversation with a doctor. Responses are scored on a five-point scale from 0 to 4 and cover a one-week period. The sum of the obtained indicators allows us to differentiate the severity of OCD symptoms, for example, a sum of up to 7 points indicates a subclinical course, and 32-40 points indicate an extremely severe course of OCD. Comparison of weekly indicators allows you to evaluate the effectiveness of treatment and the course of the disease in dynamics. It should be noted that adapted versions of the Yale-Brown scale have been developed for the patient's self-assessment of his mental state.

What are the types of obsessions and how do they manifest themselves?

Differentiation of obsessions (obsessions) is of practical importance for diagnosis and choice of treatment. Learn more about Gestalt Therapy. In modern psychiatry, the following types of obsessions are distinguished:
• Obsessive doubts - constant uncertainty in committing or not committing certain actions. For example, whether the door is locked or not, whether the iron or gas is turned off, the form may be filled out incorrectly or the details on business documents are mixed up, the order of the authorities was executed correctly or not, etc. It is characteristic that repeated checks do not lead to getting rid of doubts, but only generate more and more uncertainty in oneself and one's actions.
• Intrusive memories of sad, unpleasant or shameful events associated with feelings of shame and remorse. They literally dominate the patient and interfere with an adequate response to current events.
• Obsessive urges to commit dangerous, cruel, and sometimes sadistic acts. This is the most destructive type of obsessions, which cause fear and horror in the patient from the failure of attempts to get rid of them. An example would be the desire to throw yourself or push a loved one under the wheels of a moving vehicle, physically abuse your wife or kill your own child. The experienced fear of the implementation of such acts can be attributed to the most painful phobias.
• Obsessions make up a fairly diverse group of obsessions and relate either to a figurative vision of the results of one's own or someone else's violent behavior, or the perception of implausible, sometimes absurd situations as having happened in reality. For example, the patient may be convinced that his loved one was buried alive, represents all the suffering of the buried alive and suffers from this. As the disease progresses, a person ceases to distinguish between reality and fiction, finally becomes convinced of the correctness of his ideas, which translates obsession into the category of overvalued delusional ideas.
• Obsessive antipathy towards certain people - relatives, respected persons, clergy and even saints. This irrational antipathy is connected with cynical, blasphemous thoughts in relation to them, sometimes even inducing violent actions.
• Obsessive phobias expressed as inexplicable fear of heights, crowds, open or closed spaces, sudden death, incurable disease, etc. Very rarely, phobias multiply like mushrooms after rain and take on the character of panphobia, when a person is afraid of everything. In addition, such a paradoxical effect as the emergence of an obsessive fear of the development of fears (phobophobia) is possible.

Obsessions are also differentiated into such types as:
• Obsessions of neutral content, which include obsessive counting, memories of terms, insignificant situations, obsessive reflections on neutral topics, etc.
• Contrasting, otherwise aggressive obsessions that manifest as fear of harming oneself or loved ones, blasphemous thoughts and/or sadistic notions. Such obsessions are completely alien to the consciousness of the patient, are not motivated and are accompanied by strong affective manifestations.
• Obsessions of pollution and/or infection (mysophobia). This group includes a variety of obsessive fears of pollution by dust, earth, excrement, toxic substances, pathogens. The latter has gained particular relevance today in the era of the coronavirus pandemic. In addition, people are afraid of small objects entering the body, such as broken glass or needles. Preventive measures on the part of the patient often do not usually attract others, especially when frequent washing and wearing masks become justified and necessary in an epidemic. But, when they acquire hypertrophied and irrational forms, it is already impossible to explain them by excessive cleanliness or disgust. When a patient in normal conditions of existence, without a real threat of infection, continues to observe the maximum security regime, does not leave the room and does not even let his loved ones near him, this already threatens with complete desocialization and is not justified by the force of habit. Here the help of a specialist is already needed.

The above list of the most common obsessions includes isolated monophobia in the form of movement disorders, most often from childhood. These may be such habitual phenomena as:
• smoothing of hair that seems to fall, which actually lie perfectly in the hairstyle;
• getting rid of an imaginary speck in the eye by blinking;
• habitual tics;
• Head movements simulating the dropping of an invisible headgear;
• biting and licking lips;
• spitting, etc.

All of these monodisorders are quite successfully corrected and treated, and rarely progress.

What is the differential diagnosis of OCD aimed at?

Differential diagnosis distinguishes OCD from a number of other mental disorders that are also characterized by obsessions and ritualistic activities. OCD in the case of obsessive thoughts of perverse content, as well as eccentric, complicated and expanding rituals, must be differentiated from sluggish schizophrenia. The presence of prolonged obsessive-compulsive disorder must be distinguished from paroxysmal schizophrenia. The possibility of schizophrenia may be indicated by sharply increasing anxiety, the inclusion of new objects in the sphere of obsessive associations, when objects, situations or accidentally spoken words that were previously indifferent to the patient remind him of phobias and take on a menacing significance.
Sometimes it is necessary to differentiate OCD with habitual tics from Gilles de la Tourette's syndrome with generalization of tics, when the latter are localized in the face, neck, limbs and are expressed by grimacing, sticking out the tongue, sharp and strong gestures.

In addition, it is necessary to differentiate between OCD and depressive disorder. This is due to the fact that they often accompany each other. In the acute phase, a disorder is usually diagnosed, the symptoms of which prevail. When the process is chronic, a diagnosis is made of that disorder, the symptoms of which persist when the symptoms of another disappear.

The ICD-10 notes that the differential diagnosis between obsessive-compulsive disorder and depressive disorder (F32, F33) can be difficult because the two types of symptoms often occur together. In an acute episode, preference is given to the disorder whose symptoms occur first. When both are present but neither dominates, it is recommended to assume that the depression was primary. In chronic disorders, it is recommended to give preference to one of the disorders whose symptoms persist most often in the absence of symptoms of the other.

What are the characteristics of OCD?

A feature of the course of OCD is the chronicity of the pathological process. The transition to single episodes and complete recovery are extremely rare, but a relative positive is that with properly organized treatment, as well as with mild forms of OCD, it is possible to achieve long-term stabilization of the process and alleviate symptoms, which allows the patient to re-adapt to life in society.

Severe and complicated forms of OCD in the form of various phobias can be persistent, difficult to treat and often recur.

How to treat obsessive-compulsive disorder?

Obsessive-compulsive disorder, the treatment of which depends on the nature of the course, clinical picture, symptoms and mental characteristics of the patient, has uniform principles in the organization of therapy. First of all, this is a complex treatment that combines the following main areas:
• Drug therapy, which is selected strictly individually, taking into account the characteristics of OCD symptoms, gender, age, and the presence of concomitant diseases. In the pharmacotherapy of OCD, tranquilizers, antidepressants of the SSRI class, MAO inhibitors, beta-blockers for the relief of autonomic symptoms, as well as antipsychotics are used. Therefore, self-medication is categorically excluded, because only a psychiatric specialist can evaluate all the risks and effectiveness of using certain drugs, develop a competent treatment regimen and prescribe the correct dosage. What is the difference between a psychotherapist and a psychiatrist.
• Psychotherapy, the main purpose of which is to inspire the patient to believe in the success of treatment, overcome his fears about prescribed psychotropic drugs, and convince him of the need to strictly follow the treatment regimen developed by the doctor. All this can be achieved only on the basis of a trusting relationship between the doctor and the patient and with the active support of the patient from his relatives. If the patient has ritual actions, such a method of psychotherapy as creating conditions for aggravating the situation with simultaneous blocking of the reaction to what is happening is quite effective. As a result, rituals are less pronounced, and with their “depreciation”, obsessive thoughts also go away. In the treatment of panphobia, behavioral psychotherapy gives a good effect, but it should be borne in mind that it is ineffective in the treatment of obsessive "non-ritual" thoughts that are not accompanied by rituals.

At the first stages of treatment for OCD, the patient should be explained the nature of his disturbing symptoms, assure him that he is not going crazy (patients with OCD are often convinced of this) and establish psycho-emotional contact with him. At the same time, it is important to enlist the support of the patient's relatives, who should not indulge his obsessions, but at the same time be sympathetic to his condition and try to soften the psychological situation.

It should be noted that psychotherapy, for all its importance, cannot replace drug treatment. Explanatory and educational psychotherapy alone can be counterproductive, as in some cases it leads to an increase in the intensity of negative reflections on the topics discussed. Only complex treatment is most effective, and long-term use of pharmacological drugs is necessary to prevent relapses.

As for prognosis, 2/3 of OCD patients improve after treatment for a year, closer to the end of this period. If the improvement occurs after the expiration of 1 year, then during the course of the disease there is an alternation of periods of remissions and exacerbations.
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