What is it like to have ocd
What Is It Like To Have OCD? Why Do OCD Thoughts Feel So Real?
- Obsessive-compulsive disorder, or OCD, is a prevalent mental health condition that can be chronic.
- OCD is fairly common, affecting 1 in 40 individuals.
- OCD is characterized by unwanted intrusive thoughts, images or urges (obsessions) that cause distress and drive people to engage in compulsions.
- Intrusive thoughts represent one major grouping of OCD symptoms. They are recurring and unwanted thoughts that feel impossible to stop and are often scary or disturbing to the person experiencing them.
- To learn more about intrusive thoughts (aka “OCD thoughts”), visit the NOCD blog.
Every day, from the time I wake up to the time I finally go to bed, I’m overwhelmed by disturbing thoughts that I don’t want to have. They’re usually about things that matter a lot to me, and I’ve started doing specific things (sometimes over and over) just to make sure the thoughts won’t come true. I’ve also been avoiding situations that might bring the thoughts back. Why do I feel like this all the time?
If you’re asking yourself this, you’re not alone. In movies and on TV, OCD is usually portrayed as perfectionism or germaphobia. People also tend to think of it as an odd or frustrating personality quirk. But OCD is actually a debilitating and usually chronic psychiatric disorder. It’s also fairly common, affecting 1 in 40 individuals.
What is it like to have OCD?
Let’s say you’re a 12-year-old kid and you’ve just gotten home from a tiring day at school. You just want to fly through your homework and go spend time with your friends, but your mom reminds you that you still have to clean your room. You’re not going to convince her, so you’ll do it as quickly as possible. You start to tidy things up, but then a thought pops into your head: “My sister is going to die unless I do this right.”
Instead of focusing on school, work, family, friends, health or recreation, people with OCD end up spending their time and energy on compulsions. Most of them know this behavior is illogical, but this doesn’t convince their brain that it can take a break.
The thought terrifies you. Your head starts to spin: “Oh no, this means I really have to get this right, or she’s going to die and it’ll be my fault.” This is why I always tell mom I can’t clean my room, but she doesn’t get it. Your stomach feels sick, you’re getting dizzy, and you feel like you just have to tell someone about the thought. But it’s a crazy thought, and you know it, so you don’t tell anyone. You put everything back on the floor and try again. You fold your green shirt, and then the blue one, and finally the red. You think, “If I don’t get this right in the next two tries, she’s going to die.” So you start over again, completely panicked.
This isn’t an extreme case meant to shock you. It’s adapted from a real patient’s story, and it’s typical of the condition. In this case, the first intrusive thought is, “My sister is going to die unless I do this right. ” The obsessions come next: “Oh god, this means I really do have to get this right.” The bodily distress coincides with the obsessions, and the two build on one another to become seemingly unbearable. Then, to protect the sister and get rid of distress, the compulsion: folding things in a specific way. Although the logic of our world doesn’t suggest any connection between folding clothes and a sister’s wellbeing, the logic of this person’s mind tells them it does.
Instead of focusing on school, work, family, friends, health or recreation, people with OCD end up spending their time and energy on compulsions. Most of them know this behavior is illogical, but this doesn’t convince their brain that it can take a break and stop seeking certainty all the time. That’s why explaining to someone with OCD that their actions are irrational probably isn’t doing them any good. They already know this; in fact, their frustration at the impossibility of controlling their thoughts and compulsions despite knowing that they are irrational is itself a source of suffering.
OCD can wreak havoc on every part of someone’s life. It doesn’t help that the people around them misunderstand their symptoms, calling them control freaks, neat freaks, obsessive, “sort of OCD” or whatever else. As it turns out, people with OCD don’t really want control (in the form of neatness, or cleanliness, or whatever else). They feel like they need control because their mind is constantly telling them things aren’t all right, and because lacking control leads to overwhelming distress.
In some cases, OCD symptoms can become so severe that people consider suicide. If you ever consider suicide, please call your local emergency number or go directly to a hospital. In the United States, you can also call the Suicide Hotline at 1-800-273-8255.What are OCD thoughts? How to know if your intrusive thoughts — or unwanted thoughts — are from OCDHere are examples of intrusive thoughts, images, urges, sensations and memories. Photo via Valentin Salja/Unsplash
You hear an awful lot about “intrusive thoughts” as one of the key components of obsessive-compulsive disorder (it’s the “obsessive” part). But did you know that intrusive thoughts can show up in many ways beyond just words in your mind? They can take the form of unwanted images, sensations, ideas, memories and urges.
These can take many forms. Some people are preoccupied with excessive thoughts about germs or contamination, some with rigid morality, some with a need for symmetry, balance, or numerical patterns. One common form of OCD involves intrusive thoughts of terrible things happening.
- Learn more: Intrusive Thoughts and How to Treat Them
Imagine yourself in a situation that really matters to you. Maybe you’re in an interview for your dream job, or meeting your infant nephew for the first time. Now imagine the very worst, most disturbing, outcomes your mind can come up with. You get a phone call during the interview and find out you’ve got terminal cancer, you go crazy while meeting your nephew and stab him to death. For most of us, these thoughts seem “messed up” or funny, because they’re so out of place. But for someone with OCD, these disturbing thoughts might feel like real possibilities — even if that person knows their thoughts are probably irrational. The more they fight their own thoughts or try to protect against them, the more they tend to get “stuck.”
As you might guess, these thoughts make people feel deeply uncertain about some of the most important aspects of their lives. Unable to feel like their thoughts are just thoughts, people with OCD develop a strong distress response — their mind and body go on high alert. Tolerating this distress is extremely difficult, so people feel the need to do something about the thoughts. Sometimes it’s about trying to make sure the thoughts don’t come true, and other times it’s about escaping the pain of having the thoughts at all.
Examples of intrusive thoughts, images, urges, sensations and memories
OCD and unwanted thoughts
When it comes to intrusive thoughts, this example is the most common: simple statements that come to mind in basic sentences or even just highly charged words. Example: “I’m contaminated after touching that public bathroom door with my bare hand!”
OCD and unwanted images
If you are a more visual thinker, your intrusive thoughts may appear as extremely vivid static images or mini-movies playing on the screen of your mind. Example: A flash of a scene of your loved ones bloodied on the floor as you murder them with a knife.
OCD and unwanted sensations
Perhaps you have noticed a sensation somewhere in your body that gave you pause, something that felt out of context or caused you to worry about what it meant that you felt it. Example: A sudden irregularity in your heartbeat while you are sitting on the couch watching TV.
OCD and unwanted ideas
These intrusive thoughts tend to show up as those pesky “What if?” questions that our brains just love to dream up and pitch to us at any given moment. Example: What if I pushed the guy in front of me into the oncoming train?
OCD and unwanted memories
Real events can be part of OCD, in addition to imaginary scenarios the disorder dreams up for you. This is a particularly sneaky trick that OCD tries to play, because if it can root itself in something that actually happened. The real-life basis of an idea makes it seem like a more real problem for you to pay attention to (Hint: It’s not). Example: Recalling over and over the time you made a social blunder in elementary school.
OCD and unwanted urges or impulses
Sometimes intrusive thoughts aren’t verbal or visual but more physical. You may feel an urge to do something or act out in some way that is inconsistent with who you are as a person and the values you hold. Example: You’re standing on your roof deck and suddenly have the urge to jump.
Your intrusive thoughts may show up in just one form or in a mishmash of forms. Either way, there’s relief: Exposure and response prevention (ERP), a type of cognitive behavioral therapy (CBT), is considered the gold standard of treatment when it comes to OCD. Read on for more information about ERP therapy.
How to treat and overcome OCD intrusive thoughtsIntrusive thoughts make OCD feel inescapable. They’re in your mind and body, but you feel like you can’t control them. Photo via Tachina Lee/Unsplash
Intrusive thoughts are a commonly known symptom of obsessive-compulsive disorder, or OCD. These unwanted thoughts pop up in your mind, whether or not they’re rational or in line with your values and beliefs.
Everyone has this kind of thought once in a while. They picture having sex with a coworker, even though they’re married. They look at an annoying fellow commuter and think, “I could push him in front of the bus and no one would notice.” For people without OCD, those moments pass as quickly as they come, but OCD forces you to fixate on those intrusive thoughts. The thoughts feel inescapable. They’re in your mind and body, but you feel like you can’t control them. You know they’re not rational, but you feel compelled to let them direct your behavior. They demand that you do something to make them go away — often a compulsive behavior.
The gold standard for OCD treatment, and for dealing with intrusive thoughts, is exposure and response prevention therapy, or ERP. This powerful behavioral approach teaches you how to tolerate intrusive thoughts without turning to compulsions.
In ERP therapy, you work with a trained therapist who works with you to design exposure exercises specifically geared to your needs and goals. Each exercise puts you into a situation that usually generates anxiety-provoking intrusive thoughts. Instead of doing a compulsive action, you sit with the anxieties and worries and choose a different, more adaptive response.
As you work through your ERP exercises, you learn that you can handle intrusive thoughts and the anxieties that go along with them. In time, most people find that their anxiety decreases and their intrusive thoughts become much less problematic. Sometimes, those intrusive thoughts even fade into the background.
At NOCD, you’ll find a skilled team of therapists who can help you overcome your intrusive thoughts with ERP therapy. Schedule your free 15-minute consultation today and start taking intrusive thoughts out of the driver’s seat.
What it feels like to live with OCD« Blog
by Alice Franklin
This story is part of our blog series called “Stories from the OCD Community.” Stories from the community are submitted and edited by Toni Palombi. If you are interested in sharing your story you can view submission details at www.iocdf.org/ocd-stories.
For as long as I can remember, I have had obsessive compulsive disorder (OCD). Going to bed as a little girl was a time-consuming ordeal. I would be tucked in by my mum and dad, and upon them leaving me to head off into the land of nod, I would get up again, close the door just so, turn the CD player on and off 17 times and check under my bed 17 times. I would meticulously line up my toys so each of them had an equal amount of space, and then eventually go to sleep, much later than my parents ever realised.
OCD wasn’t just there in the night, of course. It followed me around in the day, too. Every time I would walk into a room, I would check the corner for spiders, check under the table for spiders, check under the seats for spiders. It wasn’t that I was a crippling arachnophobe, it was more that spiders were wrong, weren’t meant to be there, had to be removed.
OCD wasn’t just there when I was a child, either. It followed me into adulthood, taking a more pernicious form; I found myself losing control of my thoughts entirely, my mind being completely absorbed by my obsessions, even if the compulsions had calmed down a little.
For me, OCD feels like you’re not in control of your brain. Intrusive thoughts – vivid, visual images of the most horrendous things – plague me on a daily basis. I pick up a knife to chop an onion and see myself stabbing someone. I pick up a cup of tea and see myself throwing it on someone. I stand on the Tube platform and see myself pushing someone onto the tracks.
The questions I ask myself whilst thinking these thoughts do not help matters at all: What kind of person could conjure up such ideas? What if I did act upon these images? What if these things are what I subconsciously want to do? The questions only lead me around in circles, and fuel the intrusive thoughts until they return with a dizzying ferocity.
Ruminations over past events play in my mind so loudly it’s almost as though they’re audible. A constant soundtrack to my days, it’s as though I’m listening to the same song on repeat for years, only the song is a hellish event from my past and it accompanies me from the second I open my eyes to the second I finally manage to close them at night.
The questions I ask myself during my ruminations are not helpful: What if I said something differently? What if I did something differently? What if it had never happened at all? The questions only lead me around in circles, and fuel more ruminations.
Right now, my OCD is just about under control. Yes, thoughts still intrude. Yes, I still ruminate. But the intrusions and ruminations are muted somehow. I am on 150mg of sertraline and have educated myself on unhelpful thought patterns.
For now, I am just grateful for the quieter spell, but nevertheless irritated when people laugh off OCD as a personality quirk, when it’s dismissed as something everyone “is a little bit of,” when it’s aligned with being meticulous, organised, a perfectionist – qualities anyone could put down on a CV, rather than what it is: a horrible condition that requires treatment, support and empathy.
These misconceptions about OCD need to change. It’s about time OCD was taken seriously, because what it is, is no fun at all.
Alice Franklin is a writer who has Tourette syndrome and OCD. She writes at a leisurely pace, runs at a leisurely pace, and hammocks at leisurely pace. Previously, her work has appeared in two Spanish short story anthologies, Liars’ League, and the Financial Times. She blogs about OCD, autism and Tourette’s here and you can follow her on Twitter here.
A prominent role among mental illnesses is played by syndromes (complexes of symptoms), united in the group of obsessive-compulsive disorder (OCD), which received its name from the Latin terms obsessio and compulsio.
Obsession (lat. obsessio - taxation, siege, blockade).
Compulsions (lat. compello - I force). 1. Obsessive drives, a kind of obsessive phenomena (obsessions). Characterized by irresistible attraction that arises contrary to the mind, will, feelings. Often they are unacceptable to the patient, contrary to his moral and ethical properties. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the patient as wrong and painfully experienced by them, especially since their very appearance, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsions is also used in a broader sense to refer to any obsessions in the motor sphere, including obsessive rituals. nine0003
In domestic psychiatry, obsessive states were understood as psychopathological phenomena, characterized by the fact that phenomena of a certain content repeatedly appear in the mind of the patient, accompanied by a painful feeling of coercion [Zinoviev PM, 193I]. For N.s. characteristic involuntary, even against the will, the emergence of obsessions with clear consciousness. Although the obsessions are alien, extraneous in relation to the patient's psyche, the patient is not able to get rid of them. They are closely related to the emotional sphere, accompanied by depressive reactions, anxiety. Being symptomatic, according to S.L. Sukhanov , "parasitic", they do not affect the course of intellectual activity in general, remain alien to thinking, do not lead to a decrease in its level, although they worsen the efficiency and productivity of the patient's mental activity. Throughout the course of the disease, a critical attitude is maintained towards obsessions. N.s. conditionally divided into obsessions in the intellectual-affective (phobia) and motor (compulsions) spheres, but most often several of their types are combined in the structure of the disease of obsessions. The isolation of obsessions that are abstract, affectively indifferent, indifferent in their content, for example, arrhythmomania, is rarely justified; An analysis of the psychogenesis of a neurosis often makes it possible to see a pronounced affective (depressive) background at the basis of the obsessive account. Along with elementary obsessions, the connection of which with psychogeny is obvious, there are “cryptogenic” ones, when the cause of painful experiences is hidden [Svyadoshch L.M., 1959]. N.s. are observed mainly in individuals with a psychasthenic character. This is where apprehensions are especially characteristic. In addition, N.S. occur within the framework of neurosis-like states with sluggish schizophrenia, endogenous depressions, epilepsy, the consequences of a traumatic brain injury, somatic diseases, mainly hypochondria-phobic or nosophobic syndrome. Some researchers distinguish the so-called. "Neurosis of obsessive states", which is characterized by the predominance of obsessive states in the clinical picture - memories that reproduce a psychogenic traumatic situation, thoughts, fears, actions. In genesis play a role: mental trauma; conditioned reflex stimuli that have become pathogenic due to their coincidence with others that previously caused a feeling of fear; situations that have become psychogenic due to the confrontation of opposing tendencies [Svyadoshch A.M., 1982]. It should be noted that these same authors emphasize that N.s.c. occurs with various character traits, but most often in psychasthenic personalities.
Currently, almost all obsessive-compulsive disorders are united in the International Classification of Diseases under the concept of "obsessive-compulsive disorder".
OKR concepts have undergone a fundamental reassessment over the past 15 years. During this time, the clinical and epidemiological significance of OCD has been completely revised. If it was previously thought that this is a rare condition observed in a small number of people, now it is known that OCD is common and causes a high percentage of morbidity, which requires the urgent attention of psychiatrists around the world. Parallel to this, our understanding of the etiology of OCD has broadened: the vaguely formulated psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm that explores the neurotransmitter disorders that underlie OCD. And most importantly, pharmacological interventions specifically targeting serotonergic neurotransmission have revolutionized the prospects for recovery for millions of OCD patients worldwide. nine0003
The discovery that intense serotonin reuptake inhibition (SSRI) was the key to effective treatment for OCD was the first step in a revolution and spurred clinical research that showed the efficacy of such selective inhibitors.
As described in ICD-10, the main features of OCD are repetitive intrusive (obsessive) thoughts and compulsive actions (rituals).
In a broad sense, the core of OCD is the syndrome of obsession, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, memories that arise in addition to the desire of patients, but with awareness of their pain and a critical attitude towards them. Despite the understanding of the unnaturalness, illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessional impulses or ideas are recognized as alien to the personality, but as if coming from within. Obsessions can be the performance of rituals designed to alleviate anxiety, such as washing hands to combat "pollution" and to prevent "infection". Attempts to drive away unwelcome thoughts or urges can lead to severe internal struggle, accompanied by intense anxiety. nine0003
Obsessions in the ICD-10 are included in the group of neurotic disorders.
The prevalence of OCD in the population is quite high. According to some data, it is determined by an indicator of 1. 5% (meaning "fresh" cases of diseases) or 2-3%, if episodes of exacerbations observed throughout life are taken into account. Those suffering from obsessive-compulsive disorder make up 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally. nine0003
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 , analyzing the features of the dynamics of OCD in the form of "insanity of doubt with delusions of touch, points to a gradually becoming more complicated clinical picture - obsessive doubts are replaced by ridiculous fears of" touch "to surrounding objects, motor rituals join, the fulfillment of which is subject to the whole life sick. However, only at the turn of the XIX-XX centuries. researchers were able to more or less clearly describe the clinical picture and give syndromic characteristics of obsessive-compulsive disorders. The onset of the disease usually occurs in adolescence and adolescence. The maximum of clinically defined manifestations of obsessive-compulsive disorder is observed in the age range of 10-25 years. nine0003
Main clinical manifestations of OCD:
Obsessional thoughts - painful, arising against the will, but recognized by the patient as their own, ideas, beliefs, images, which in a stereotyped form forcibly invade the patient's consciousness and which he tries to resist in some way. It is this combination of an inner sense of compulsive urge and efforts to resist it that characterizes obsessional symptoms, but of the two, the degree of effort exerted is the more variable. Obsessional thoughts may take the form of single words, phrases, or lines of poetry; they are usually unpleasant to the patient and may be obscene, blasphemous, or even shocking. nine0003
Obsessional imagery is vivid scenes, often violent or disgusting, including, for example, sexual perversion.
Obsessional impulses are urges to do things that are usually destructive, dangerous or shameful; for example, jumping into the road in front of a moving car, injuring a child, or shouting obscene words while in society.
Obsessional rituals include both mental activities (eg, counting repeatedly in a particular way, or repeating certain words) and repetitive but meaningless acts (eg, washing hands twenty or more times a day). Some of them have an understandable connection with the obsessive thoughts that preceded them, for example, repeated washing of hands - with thoughts of infection. Other rituals (for example, regularly laying out clothes in some complex system before putting them on) do not have such a connection. Some patients feel an irresistible urge to repeat such actions a certain number of times; if that fails, they are forced to start all over again. Patients are invariably aware that their rituals are illogical and usually try to hide them. Some fear that such symptoms are a sign of the onset of insanity. Both obsessive thoughts and rituals inevitably lead to problems in daily activities. nine0003
Obsessive rumination (“mental chewing gum”) is an internal debate in which the arguments for and against even the simplest everyday actions are endlessly revised. Some obsessive doubts relate to actions that may have been incorrectly performed or not completed, such as turning off the gas stove faucet or locking the door; others concern actions that could harm other people (for example, the possibility of driving past a cyclist in a car, knocking him down). Sometimes doubts are associated with a possible violation of religious prescriptions and rituals - “remorse of conscience”. nine0003
Compulsive actions - repetitive stereotypical actions, sometimes acquiring the character of protective rituals. The latter are aimed at preventing any objectively unlikely events that are dangerous for the patient or his relatives.
In addition to the above, in a number of obsessive-compulsive disorders, a number of well-defined symptom complexes stand out, and among them are obsessive doubts, contrasting obsessions, obsessive fears - phobias (from the Greek. phobos).nine0002 Obsessive thoughts and compulsive rituals may intensify in certain situations; for example, obsessive thoughts about harming other people often become more persistent in the kitchen or some other place where knives are kept. Since patients often avoid such situations, there may be a superficial resemblance to the characteristic avoidance pattern found in phobic anxiety disorder. Anxiety is an important component of obsessive-compulsive disorders. Some rituals reduce anxiety, while after others it increases. Obsessions often develop as part of depression. In some patients, this appears to be a psychologically understandable reaction to obsessive-compulsive symptoms, but in other patients, recurrent episodes of depressive mood occur independently. nine0003
Obsessions (obsessions) are divided into figurative or sensual, accompanied by the development of affect (often painful) and obsessions of affectively neutral content.
Sensual obsessions include obsessive doubts, memories, ideas, drives, actions, fears, an obsessive feeling of antipathy, an obsessive fear of habitual actions.
Obsessive doubts - intrusively arising contrary to logic and reason, uncertainty about the correctness of committed and committed actions. The content of doubts is different: obsessive everyday fears (whether the door is locked, whether windows or water taps are closed tightly enough, whether gas and electricity are turned off), doubts related to official activities (whether this or that document is written correctly, whether the addresses on business papers are mixed up , whether inaccurate figures are indicated, whether orders are correctly formulated or executed), etc. Despite repeated verification of the committed action, doubts, as a rule, do not disappear, causing psychological discomfort in the person suffering from this kind of obsession. nine0003
Obsessive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a sense of shame, 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. nine0003
Manifestations of obsessive ideas can be different. In some cases, this is a vivid "vision" of the results of obsessive drives, when patients imagine the result of a cruel act committed. In other cases, obsessive ideas, often referred to as mastering, appear in the form of implausible, sometimes absurd situations that patients take for real. An example of obsessive ideas is the patient's conviction that the buried relative was alive, and the patient painfully imagines and experiences the suffering of the deceased in the grave. At the height of obsessive ideas, the consciousness of their absurdity, implausibility disappears and, on the contrary, confidence in their reality appears. As a result, obsessions acquire the character of overvalued formations (dominant ideas that do not correspond to their true meaning), and sometimes delusions. nine0003
An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) - unjustified, driven away by the patient from himself antipathy towards a certain, often close person, cynical, unworthy thoughts and ideas in relation to respected people, in religious persons - in relation to saints or ministers churches.
Obsessive acts are acts done against the wishes of the sick, despite efforts made to restrain them. Some of the obsessive actions burden the patients until they are realized, others are not noticed by the patients themselves. Obsessive actions are painful for patients, especially in those cases when they become the object of attention of others. nine0003
Obsessive fears, or phobias, include an obsessive and senseless fear of heights, large streets, open or confined spaces, large crowds of people, the fear of sudden death, the fear of falling ill with one or another incurable disease. Some patients may develop a wide variety of phobias, sometimes acquiring the character of fear of everything (panphobia). And finally, an obsessive fear of the emergence of fears (phobophobia) is possible.
Hypochondriacal phobias (nosophobia) - an obsessive fear of some serious illness. Most often, cardio-, stroke-, syphilo- and AIDS phobias are observed, as well as the fear of the development of malignant tumors. At the peak of anxiety, patients sometimes lose their critical attitude to their condition - they turn to doctors of the appropriate profile, require examination and treatment. The implementation of hypochondriacal phobias occurs both in connection with psycho- and somatogenic (general non-mental illnesses) provocations, and spontaneously. As a rule, hypochondriacal neurosis develops as a result, accompanied by frequent visits to doctors and unreasonable medication. nine0003
Specific (isolated) phobias - obsessive fears limited to a strictly defined situation - fear of heights, nausea, thunderstorms, pets, treatment at the dentist, etc. Since contact with situations that cause fear is accompanied by intense anxiety, the patients tend to avoid them.
Obsessive fears are often accompanied by the development of rituals - actions that have the meaning of "magic" spells that are performed, despite the critical attitude of the patient to obsession, in order to protect against one or another imaginary misfortune: before starting any important business, the patient must perform some that specific action to eliminate the possibility of failure. Rituals can, for example, be expressed in snapping fingers, playing a melody to the patient or repeating certain phrases, etc. In these cases, even relatives are not aware of the existence of such disorders. Rituals, combined with obsessions, are a fairly stable system that usually exists for many years and even decades. nine0003
Obsessions of affectively neutral content - obsessive sophistication, obsessive counting, recalling neutral events, terms, formulations, etc. Despite their neutral content, they burden the patient, interfere with his intellectual activity.
Contrasting obsessions ("aggressive obsessions") - blasphemous, blasphemous thoughts, fear of harming oneself and others. Psychopathological formations of this group refer mainly to figurative obsessions with pronounced affective saturation and ideas that take possession of the consciousness of patients. They are distinguished by a sense of alienation, the absolute lack of motivation of the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions and complain of an irresistible desire to add endings to the replicas they have just heard, giving an unpleasant or threatening meaning to what has been said, to repeat after those around them, but with a touch of irony or malice, phrases of religious content, to shout out cynical words that contradict their own attitudes and generally accepted morality. , they may experience fear of losing control of themselves and possibly committing dangerous or ridiculous actions, injuring themselves or their loved ones. In the latter cases, obsessions are often combined with object phobias (fear of sharp objects - knives, forks, axes, etc.). The contrasting group also partially includes obsessions of sexual content (obsessions of the type of forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals). nine0003
Obsessions of pollution (mysophobia). This group of obsessions includes both the fear of pollution (earth, dust, urine, feces and other impurities), as well as the fear of penetration into the body of harmful and toxic substances (cement, fertilizers, toxic waste), small objects (glass fragments, needles, specific types of dust), microorganisms. In some cases, the fear of contamination can be limited, remain at the preclinical level for many years, manifesting itself only in some features of personal hygiene (frequent change of linen, repeated washing of hands) or in housekeeping (thorough handling of food, daily washing of floors). , "taboo" on pets). This kind of monophobia does not significantly affect the quality of life and is evaluated by others as habits (exaggerated cleanliness, excessive disgust). Clinically manifested variants of mysophobia belong to the group of severe obsessions. In these cases, gradually becoming more complex protective rituals come to the fore: avoiding sources of pollution and touching "unclean" objects, processing things that could get dirty, a certain sequence in the use of detergents and towels, which allows you to maintain "sterility" in the bathroom. Stay outside the apartment is also furnished with a series of protective measures: going out into the street in special clothing that covers the body as much as possible, special processing of wearable items upon returning home. In the later stages of the disease, patients, avoiding pollution, not only do not go out, but do not even leave their own room. In order to avoid contacts and contacts that are dangerous in terms of contamination, patients do not allow even their closest relatives to come near them. Mysophobia is also related to the fear of contracting a disease, which does not belong to the categories of hypochondriacal phobias, since it is not determined by fears that a person suffering from OCD has a particular disease. In the foreground is the fear of a threat from the outside: the fear of pathogenic bacteria entering the body. Hence the development of appropriate protective actions. nine0003
A special place in the series of obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, unlike organically conditioned involuntary movements, are much more complex motor acts that have lost their original meaning. Tics sometimes give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures. Patients suffering from tics can shake their heads (as if checking whether the hat fits well), make hand movements (as if discarding interfering hair), blink their eyes (as if getting rid of a mote). Along with obsessive tics, pathological habitual actions (lip biting, gnashing of teeth, spitting, etc.) are often observed, which differ from obsessive actions proper in the absence of a subjectively painful sense of persistence and experience them as alien, painful. Neurotic states characterized only by obsessive tics usually have a favorable prognosis. Appearing most often in preschool and primary school age, tics usually subside by the end of puberty. However, such disorders can also be more persistent, persist for many years and only partially change in manifestations. nine0003
The course of obsessive-compulsive disorder.
Unfortunately, chronization must be indicated as the most characteristic trend in the OCD dynamics. Cases of episodic manifestations of the disease and complete recovery are relatively rare. However, in many patients, especially with the development and preservation of one type of manifestation (agoraphobia, obsessive counting, ritual handwashing, etc. ), a long-term stabilization of the condition is possible. In these cases, there is a gradual (usually in the second half of life) mitigation of psychopathological symptoms and social readaptation. For example, patients who experienced fear of traveling on certain types of transport, or public speaking, cease to feel flawed and work along with healthy people. In mild forms of OCD, the disease usually proceeds favorably (on an outpatient basis). The reverse development of symptoms occurs after 1 year - 5 years from the moment of manifestation. nine0003
More severe and complex OCDs such as phobias of infection, pollution, sharp objects, contrasting performances, multiple rituals, on the other hand, may become persistent, resistant to treatment, or show a tendency to recur with disorders that persist despite active therapy. Further negative dynamics of these conditions indicates a gradual complication of the clinical picture of the disease as a whole.
It is important to distinguish OCD from other disorders that involve compulsions and rituals. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when the obsessive thoughts are unusual in content (eg, mixed sexual and blasphemous themes) or the rituals are exceptionally eccentric. The development of a sluggish schizophrenic process cannot be ruled out with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity (inconsistency of thinking and actions), and the uniformity of emotional manifestations. Prolonged obsessional states of a complex structure must be distinguished from the manifestations of paroxysmal schizophrenia. Unlike neurotic obsessive states, they are usually accompanied by a sharply increasing anxiety, a significant expansion and systematization of the circle of obsessive associations, which acquire the character of obsessions of "special significance": previously indifferent objects, events, random remarks of others remind patients of the content of phobias, offensive thoughts and thereby acquire in their view a special, menacing significance. In such cases, it is necessary to consult a psychiatrist in order to exclude schizophrenia. It can also be difficult to differentiate between OCD and conditions with a predominance of generalized disorders, known as Gilles de la Tourette's syndrome. Tics in such cases are localized in the face, neck, upper and lower extremities and are accompanied by grimaces, opening the mouth, sticking out the tongue, and intense gesticulation. In these cases, this syndrome can be excluded by the coarseness of movement disorders characteristic of it and more complex in structure and more severe mental disorders. nine0003
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.
Approximately two-thirds of OCD patients improve within a year, more often by the end of this period. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of improvement in health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic personality with severe symptoms of the disease, or if there are continuous stressful events in the patient's life. Severe cases can be extremely persistent; for example, a study of hospitalized patients with OCD found that three-quarters of them remained symptom-free 13 to 20 years later. nine0003
TREATMENT: BASIC METHODS AND APPROACHES
Despite the fact that OCD is a complex group of symptom complexes, the principles of treatment for them are the same. The most reliable and effective method of treating OCD is considered to be drug therapy, during which a strictly individual approach to each patient should be manifested, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of other diseases. In this regard, we must warn patients and their relatives against self-treatment. If any disorders similar to mental ones appear, it is necessary, first of all, to contact the specialists of the psycho-neurological dispensary at the place of residence or other psychiatric medical institutions to establish the correct diagnosis and prescribe competent adequate treatment. At the same time, it should be remembered that at present a visit to a psychiatrist does not threaten with any negative consequences - the infamous "accounting" was canceled more than 10 years ago and replaced by the concepts of consultative and medical care and dispensary observation. nine0003
When treating, it must be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement). The apparent suffering of the patient often seems to call for vigorous effective treatment, but the natural course of the condition must be kept in mind in order to avoid the typical error of over-intensive therapy. It is also important to consider that OCD is often accompanied by depression, the effective treatment of which often leads to an alleviation of obsessional symptoms. nine0003
The treatment of OCD begins with an explanation of the symptoms to the patient and, if necessary, with reassurance that they are the initial manifestation of insanity (a common concern for patients with obsessions). Those suffering from certain obsessions often involve other family members in their rituals, so relatives need to treat the patient firmly, but sympathetically, mitigating the symptoms as much as possible, and not aggravating it by excessive indulgence in the sick fantasies of patients. nine0003
The following therapeutic approaches exist for the currently identified types of OCD. Of the pharmacological drugs for OCD, serotonergic antidepressants, anxiolytics (mainly benzodiazepine), beta-blockers (to stop autonomic manifestations), MAO inhibitors (reversible) and triazole benzodiazepines (alprazolam) are most often used. Anxiolytic drugs provide some short-term relief of symptoms, but should not be given for more than a few weeks at a time. If anxiolytic treatment is required for more than one to two months, small doses of tricyclic antidepressants or small antipsychotics sometimes help. The main link in the treatment regimen for OCD, overlapping with negative symptoms or ritualized obsessions, are atypical antipsychotics - risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants or other antidepressants - moclobemide, tianeptine, or with high-potency benzodiazepine derivatives ( alprazolam, clonazepam, bromazepam). nine0003
Any comorbid depressive disorder is treated with antidepressants at an adequate dose. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms, but the results of a controlled clinical trial showed that the effect of this drug is insignificant and occurs only in patients with distinct depressive symptoms.
In cases where obsessive-phobic symptoms are observed within the framework of schizophrenia, intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect. In some cases, it is advisable to connect traditional antipsychotics (small doses of haloperidol, trifluoperazine, fluanxol) and parenteral administration of benzodiazepine derivatives. nine0003
One of the main tasks of the specialist in the treatment of OCD is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the "harm" caused by psychotropic drugs, to convey his conviction in the effectiveness of treatment, subject to the systematic observance of the prescribed prescriptions. The patient's faith in the possibility of healing must be supported in every possible way by the relatives of the OCD sufferer. If the patient has rituals, it must be remembered that improvement usually occurs when using a combination of the method of preventing a reaction with placing the patient in conditions that aggravate these rituals. Significant but not complete improvement can be expected in about two-thirds of patients with moderately heavy rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts also recede. In panphobia, predominantly behavioral techniques are used to reduce sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases where ritualized phobias predominate, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for obsessive thoughts that are not accompanied by rituals. Thought-stopping has been used by some experts for many years, but its specific effect has not been convincingly proven. nine0003
We have already noted that obsessive-compulsive disorder has a fluctuating (fluctuating) course and over time the patient's condition may improve regardless of which particular methods of treatment were used. Until recovery, patients can benefit from supportive conversations that provide continued hope for recovery. Psychotherapy in the complex of treatment and rehabilitation measures for patients with OCD is aimed at both correcting avoidant behavior and reducing sensitivity to phobic situations (behavioral therapy), as well as family psychotherapy to correct behavioral disorders and improve family relationships. If marital problems exacerbate symptoms, joint interviews with the spouse are indicated. Patients with panphobia (at the stage of the active course of the disease), due to the intensity and pathological persistence of symptoms, need both medical and social and labor rehabilitation. In this regard, it is important to determine adequate terms of treatment - long-term (at least 2 months) therapy in a hospital with subsequent continuation of the course on an outpatient basis, as well as taking measures to restore social ties, professional skills, family relationships. Social rehabilitation is a set of programs for teaching OCD patients how to behave rationally both at home and in a hospital setting. Rehabilitation is aimed at teaching social skills to properly interact with other people, vocational training, as well as skills necessary in everyday life. Psychotherapy helps patients, especially those who experience a sense of their own inferiority, treat themselves better and correctly, master ways to solve everyday problems, and gain confidence in their strength. nine0003
All of these methods, when used judiciously, can increase the effectiveness of drug therapy, but are not capable of completely replacing drugs. It should be noted that explanatory psychotherapy does not always help, and some patients with OCD even worsen because such procedures encourage them to think painfully and unproductively about the subjects discussed in the course of treatment. Unfortunately, science still does not know how to cure mental illness once and for all. OCD often has a tendency to recur, which requires long-term prophylactic medication. nine0003
Obsessive Compulsive Disorder Treatment
Great Thought is an obsessive compulsive disorder treatment program. We will relieve you of obsessive thoughts, movements and rituals. Let's get back to life!
Symptoms of obsessive-compulsive disorder
- Frightening images and drives
- Compulsive acts (rituals)
- Intrusive check of one's own actions
- Fear of trouble, pollution or infection
- Inexplicable desire to count something
- Excessive organization and pedantry
- Perfectionism in relationships, work and even leisure
- "Stuck", "looping" on one's thoughts
You feel that over time your mood becomes worse: apathy, depression, obsessions increase, and rituals begin to fill all your free time or harm your physical health.
You may have had more than one meeting with psychologists, psychotherapists and psychiatrists. You are not given the "scary" psychiatric diagnoses of Schizophrenia or Bipolar Disorder, but are prescribed medication and psychotherapy nonetheless. However, such treatment cannot be called effective - the symptoms persist and only aggressive pharmacotherapy temporarily reduces anxiety. nine0003
What is obsessive-compulsive disorder?
Obsessive-compulsive disorder is a syndrome characterized by the presence of obsessive thoughts (obsessions) to which a person reacts with certain actions (compulsions). The causes of the disorder are rarely superficial. The syndrome is also accompanied by the development of obsessive memories and various pathological phobias. May be chronic, episodic or progressive.
Obsession - obsessive thought, persistent desire for something, uncontrollable and accompanied by anxiety and intense anxiety. In an attempt to cope with such thoughts, a person resorts to committing compulsions. nine0003
Compulsion - an irresistible need to perform certain actions (rituals), which can be assessed by the person himself as irrational or meaningless, and the internal need to perform them is forced and is the result of obsessive ideas.
Common examples of OCD manifestations
- An exaggerated sense of danger. Fear of the materiality of thoughts:
- "now I will lose control and hurt my loved ones"
- "something terrible is about to happen, I can feel it"
- "I shouldn't think like that, all this will come true because of me"
- Pathological fear of pollution. Thirst for Purity
- Excessive perfectionism, exaggerated responsibility - "everything must be done perfectly", "everything depends on me, mistakes are unacceptable"
How does this painful algorithm work?
Most people have unwanted or intrusive thoughts quite often, but all sufferers of the disorder greatly exaggerate their importance. Fear of one's own thoughts leads to attempts to neutralize the negative feelings that arise from obsessions, for example by avoiding thought-provoking situations or by engaging in "rituals" of excessive self-cleansing or prayer. nine0003
As we noted earlier, repetitive avoidance behavior can "get stuck", "loop", that is, have a tendency to repeat. The cause of obsessive-compulsive disorder is the interpretation of intrusive thoughts as catastrophic and true.
If you periodically experience over the years:
- Constant or fluctuating anxiety
- The need to perform certain ritualized actions nine0147 A persistent decline in the quality of life due to the need to avoid certain thoughts and actions, places and events
And you are also persecuted:
- Significant problems in studies and career
- Failure to establish a serious relationship
- Constant criticism and pressure from relatives
- Many senseless activities
- Excessive involvement in computer games and the Internet, alcohol
- Loneliness and isolation
We strongly recommend that you do not delay seeking help and that you complete a remedial program. Consultations and psychotherapeutic sessions according to the program are held several times a week, until the relief of severe symptoms, then the frequency of meetings with specialists is reduced to 2–3 per month. Count on the fact that in the end we will deal with your problem together.
Treatment of obsessive-compulsive disorder in Neuro-Psi
Every day the specialists of the NEURO-PSI clinic analyze the world practice in the field of psychiatry and psychotherapy. The goal is the impartial selection and implementation of those methods of treatment and psychological assistance, the effectiveness of which has been convincingly proven in independent studies.
We are guided by the principles of evidence-based medicine and use as a basic method of treatment a psychotherapeutic paradigm, the effectiveness of which has been widely recognized by the professional community. nine0003
1. What is the essence of the obsessive-compulsive disorder treatment program
Since obsessive thoughts, rituals and conditions are only symptoms of mental dysfunction, the root cause must be treated in order to achieve a stable result. A comprehensive work is carried out with the client, taking into account the main factors that create well-being.
The main emphasis is on teaching the client how to properly respond to his thoughts, emotions, inner feelings and interpretation of external events. nine0003
All types of psychotherapeutic and drug treatments serve the same goal: to achieve the best result in the shortest possible time. At the same time, by coordinating the efforts of specialists in various fields, the most complete coverage of all types of mental illnesses, disorders and disorders is possible.
2. What treatments are used
- Cognitive-behavioral psychotherapy (Сognitive-Behavioral Therapy). nine0147 Schema Therapy.
- Reality Therapy.
- Choice Theory.
- Rational pharmacotherapy.
- Jacobson progressive muscle relaxation. nine0147 Traditional and modern gymnastic systems, relaxation techniques.
- Working with bad habits.
- Correction of the diet.
- Professional and social adaptation.
3. How is the treatment under the program
Each treatment program at the NEURO-PSI clinic consists of four stages:
- work with disease symptoms,
- work with the causes of the disease,
- consolidation of the achieved results.
Work efficiency is increased by dividing the treatment process into a predetermined number of sessions, at convenient times and without hospitalization. This means that each program is adapted to the problem that the client has addressed. nine0003
The program method of treatment is predictable, time-limited, productive, and, most importantly, understandable for the client.
Of course, the treatment takes place in a comfortable mode without interruption from work, study or family. Specialists of various profiles will work with you (team method). This is necessary to minimize the risk of diagnostic errors that could lead to the adoption of a suboptimal treatment plan.
Improvements in well-being and mood (healing) occur in stages: after the decrease in emotional problems, bodily symptoms decrease. Working with the causes (etiology) of obsessive-compulsive disorder helps to avoid relapses in the future. nine0003
4. What are the results and prognosis?
Upon completion of the program, you get rid of obsessive thoughts and rituals, fear of pollution, unmotivated fears, panic attacks and multiple vegetative symptoms (sudden jumps in blood pressure, heart palpitations, dizziness, nausea).
According to statistics, the effectiveness of the methods used approaches 100% if all recommendations of specialists are followed.