Anxiety is common to all people to one degree or another, and many of us sometimes perform rituals of varying degrees of irrationality designed to insure us against trouble - banging our fist on the table or putting on a lucky T-shirt. an important event. But sometimes this mechanism gets out of control, causing serious mental disorder. “Theories and Practices” explains what tormented Howard Hughes, how an obsession differs from schizophrenic delusion, and what magical thinking has to do with it.

Endless Ritual

Jack Nicholson's character famous film“It Couldn’t Be Better” was distinguished not only by his complex character, but also by a whole set of oddities: he constantly washed his hands (with new soap each time), ate only with his own cutlery, avoided the touch of others and tried not to step on cracks in the asphalt. All these “eccentricities” are typical signs of obsessive-compulsive disorder, a mental illness in which a person is obsessed with obsessive thoughts that force him to regularly repeat the same actions. OCD is a real boon for a screenwriter: this disease is more common in people with high intelligence, it gives the character originality, noticeably interferes with his communication with others, but at the same time is not associated with a threat to society, unlike many other mental disorders. But in reality, the life of a person with obsessive-compulsive disorder cannot be called easy: behind innocent and even funny, at first glance, actions hide constant tension and fear.

It’s as if a record is stuck in such a person’s head: the same unpleasant thoughts regularly come to mind, having little rational basis. For example, he imagines that there are dangerous microbes everywhere, he is constantly afraid of hurting someone, losing something, or leaving the gas on when leaving home. He may be driven crazy by a leaking faucet or an asymmetrical arrangement of objects on the table.

The flip side of this obsession, that is, obsession, is compulsion, the regular repetition of the same rituals that should prevent the impending danger. A person begins to believe that the day will go well only if he reads a nursery rhyme three times before leaving the house, that he will protect himself from terrible diseases if he washes his hands several times in a row and uses his own cutlery. After the patient performs the ritual, he experiences relief for a while. 75% of patients suffer from both obsessions and compulsions at the same time, but there are cases when people experience only obsessions without performing rituals.

At the same time, obsessive thoughts differ from schizophrenic delusions in that the patient himself perceives them as absurd and illogical. He is not at all happy about washing his hands every half hour and zipping his fly five times in the morning - but he simply cannot get rid of the obsession any other way. The level of anxiety is too high, and rituals allow the patient to achieve temporary relief. But at the same time, the love of rituals, lists, or putting things on shelves in itself, if it does not bring discomfort to a person, is not considered a disorder. From this point of view, aesthetes who diligently arrange carrot peelings lengthwise in Things Organized Neatly are absolutely healthy.

The biggest problems for OCD patients are obsessions of an aggressive or sexual nature. Some people become afraid that they will do something bad to other people, even to the point of sexual violence and murders. Obsessive thoughts can take the form of individual words, phrases or even lines of poetry - a good illustration is the episode from the movie “The Shining”, where main character, going crazy, starts typing the same phrase “all work and“no play makes Jack a dull boy.” A person with OCD experiences enormous stress - he is simultaneously horrified by his thoughts and tormented by a feeling of guilt for them, tries to resist them, and at the same time tries to ensure that the rituals he performs go unnoticed by others. In all other respects, his consciousness functions completely normally.

It is believed that obsessions and compulsions are closely related to “magical thinking” that arose at the dawn of humanity - the belief in the ability to take control of the world with the help of the right attitude and rituals. Magical thinking draws a direct parallel between a mental desire and a real consequence: if you draw a buffalo on the wall of a cave, setting yourself up for a successful hunt, you will certainly be lucky. Apparently, this way of perceiving the world originates in the deep mechanisms of human thinking: neither scientific and technological progress, nor logical arguments, nor sad personal experience, which proves the uselessness of magical passes, does not relieve us of the need to look for relationships between random things. Some scientists believe that it is embedded in our neuropsychology - the automatic search for patterns that simplify the picture of the world helped our ancestors survive, and the most ancient parts of the brain still work according to this principle, especially in a stressful situation. Therefore, when elevated level With anxiety, many people begin to fear their own thoughts, fearing that they may become reality, and at the same time believe that a set of some irrational actions will help prevent an undesirable event.

Story

In ancient times, this disorder was often associated with mystical causes: in the Middle Ages, people obsessed with obsessive ideas were immediately sent to exorcists, and in the 17th century, the concept was reversed - it was believed that such conditions arise due to excessive religious zeal.

In 1877, one of the founders of scientific psychiatry, Wilhelm Griesinger and his student Karl-Friedrich-Otto Westphal, found that the basis of “obsessive-compulsive disorder” is a disorder of thinking, but it does not affect other aspects of behavior. They used the German term Zwangsvorstellung, which, having been variously translated in Britain and the US (as obsession and compulsion respectively), became the modern name for the disease. And in 1905, the French psychiatrist and neurologist Pierre Marie Felix Janet isolated this neurosis from neurasthenia as a separate disease and called it psychasthenia.

Opinions varied about the cause of the disorder - for example, Freud believed that obsessive-compulsive behavior referred to unconscious conflicts that manifested themselves in the form of symptoms, while his German colleague Emil Kraepelin classified it as “constitutional mental illnesses” caused by physical causes.

Famous people also suffered from obsessive disorder - for example, inventor Nikola Tesla counted steps while walking and the volume of food portions - if he failed to do this, the lunch was considered spoiled. And entrepreneur and American aviation pioneer Howard Hughes was terrified of dust and ordered employees before visiting him to “wash themselves four times, each time using a large number of foam from a new bar of soap."

Defense mechanism

The exact causes of OCD are not clear even now, but all hypotheses can be divided into three categories: physiological, psychological and genetic. Proponents of the first concept associate the disease either with the functional and anatomical features of the brain, or with metabolic disorders (biologically active substances that transmit electrical impulses between neurons, or from neurons to muscle tissue) - primarily serotonin and dopamine, as well as norepinephrine and GABA. Some researchers have noted that many obsessive-compulsive disorder patients had birth trauma at birth, which also supports physiological causes of OCD.

Supporters psychological theories believe that the disease is associated with personal characteristics, character, psychological trauma and incorrect reaction to negative impact environment. Sigmund Freud theorized that obsessive-compulsive symptoms are caused by defense mechanisms psyche: isolation, liquidation and reactive formation. Isolation protects a person from anxiety-causing affects and impulses, displacing them into the subconscious; elimination is aimed at combating the emerging repressed impulses - in fact, the compulsive act is based on it. And finally, reactive formation is the manifestation of patterns of behavior and consciously experienced attitudes that are opposite to emerging impulses.

There is also scientific evidence that genetic mutations contribute to OCD. They were found in unrelated families whose members suffered from OCD - in the serotonin transporter gene, hSERT. Studies of identical twins also support the existence hereditary factor. In addition, people with OCD are more likely to have close relatives with the same disorder than healthy people.

Maksim, 21 years old, suffers from OCD since childhood

It started for me at about 7-8 years old. The neurologist was the first to report the possibility of OCD; even then there was a suspicion of obsessive neurosis. I was constantly silent, replaying in my head various theories, like “mental chewing gum.” When I saw something that caused me anxiety, obsessive thoughts about it began, although the reasons seemed to be quite insignificant and, perhaps, would never have affected me.

At one time I had an obsessive thought that my mother might die. I replayed the same moment in my head, and it captured me so much that I could not sleep at night. And when I’m riding in a minibus or in a car, I constantly think that we’re going to get into an accident, that someone is going to crash into us, or that we’re going to fly off a bridge. A couple of times the thought arose that the balcony under me would fall apart, or that someone would throw me out of there, or that I myself would slip and fall in the winter.

We never really talked to the doctor, I just took different medications. Now I move from one obsession to another and follow some rituals. I am constantly touching something, no matter where I am. I walk from corner to corner throughout the room, straightening the curtains and wallpaper. Maybe I'm different from other people with this disorder, everyone has their own rituals. But it seems to me that those people who accept themselves as they are are luckier. They are much better off than those who want to get rid of it and are very worried about it.

Obsessive-compulsive disorder is a syndrome whose causes are rarely obvious. It is characterized by the presence of obsessive thoughts (obsessions), to which a person responds with certain actions (compulsions).

Obsession (lat. obsessio - “siege”) is a thought or desire that constantly pops up in the mind. This thought is difficult to control or get rid of, and it causes a lot of stress.

Common obsessions in OCD are:

• fear of contamination (from dirt, viruses, germs, body fluids, excrement or chemicals);
• concerns about possible dangers(external, for example, fear of being robbed and internal, for example, fear of losing control and harming someone close to you);
• excessive concern about precision, order, or symmetry;
• sexual thoughts or images.

Almost everyone has experienced these intrusive thoughts. However, for a person with OCD, the level of anxiety from such thoughts is off the charts. And in order to avoid too much anxiety, a person is often forced to resort to some “protective” actions - compulsions (Latin compello - “to force”).

Compulsions in OCD are somewhat reminiscent of rituals. These are actions that a person repeats over and over again in response to an obsession in order to reduce the risk of harm. The compulsion can be physical (like repeatedly checking to see if a door is locked) or mental (like saying a certain phrase in your head). For example, this could be uttering a special phrase to “protect relatives from death” (this is called “neutralization”).

Common in OCD syndrome are compulsions in the form of endless checks (for example, gas taps), mental rituals (special words or prayers repeated in in the prescribed manner), check.

The most common is fear of germs combined with compulsive washing and cleaning. Because of the fear of getting infected, people go to great lengths: they do not touch door handles, toilet seats, and avoid shaking hands. Typically, with OCD syndrome, a person stops washing his hands not when they are clean, but when he finally feels “relief” or “right.”

Avoidance behavior is a central part of OCD and includes:

1. desire to avoid situations evoking feelings anxiety;
2. the need to perform compulsive actions.

Obsessive-compulsive disorder can cause many problems and is usually accompanied by shame, guilt and depression. The disease creates chaos in human relationships and affects performance. According to WHO, OCD is one of the ten diseases leading to disability. People with OCD syndrome do not seek professional help because they are embarrassed, afraid or do not know that their illness can be treated, incl. non-medicinal.

What Causes OCD

Despite many studies on OCD, it is still impossible to say for sure what it is. main reason violations. Both physiological factors (impaired chemical balance in nerve cells) and psychological factors may be responsible for this condition. Let's look at them in detail.

Genetics

Research has shown that OCD can be passed down through generations to close relatives, in the form of a greater tendency to develop painful obsessive states.

A study of adult twins showed that the disorder is moderately hereditary, but no single gene has been identified as causing the condition. However special attention deserve genes that could play a role in the development of OCD: hSERT and SLC1A1.

The task of the hSERT gene is to collect “waste” serotonin in nerve fibers. Recall that the neurotransmitter serotonin is necessary for the transmission of impulses in neurons. There are studies that support unusual hSERT mutations in some obsessive-compulsive disorder patients. As a result of these mutations, the gene begins to work too quickly, collecting all the serotonin before the next nerve “hears” the signal.

SLC1A1 is another gene that may be involved in obsessive-compulsive disorder. This gene is similar to hSERT, but its responsibilities include transporting another neurotransmitter - glutamate.

Autoimmune reaction

Some cases of rapid onset of OCD in children can be a consequence of Group A streptococcal infection, which causes inflammation and dysfunction basal ganglia. These cases are grouped into clinical conditions called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection).

Another study suggested that the episodic occurrence of OCD is not due to streptococcal infection, but rather to prophylactic antibiotics that are prescribed to treat infections. OCD conditions may also be associated with immunological reactions to other pathogens.

Neurological problems

Brain imaging techniques have allowed researchers to study the activity of specific areas of the brain. Some parts of the brain have been shown to have unusual activity in OCD sufferers. OCD symptoms involved are:

• orbitofrontal cortex;
• anterior cingulate gyrus;
• striatum;
• thalamus;
• caudate nucleus;
• basal ganglia.

The circuit involving the above areas regulates primitive behavioral aspects such as aggression, sexuality and bodily secretions. Activation of the circuit triggers appropriate behavior, such as washing hands thoroughly after touching something unpleasant. Normally, after the necessary act, the desire decreases, that is, the person stops washing his hands and moves on to another activity.

However, in patients diagnosed with OCD, the brain has some difficulty turning off and ignoring the urges from the circuit, which creates communication problems in these areas of the brain. Obsessions and compulsions continue, leading to repetition of certain behaviors.

The nature of this problem is not yet clear, but it is most likely associated with a violation of brain biochemistry, which we talked about earlier (reduced activity of serotonin and glutamate).

Causes of OCD from the point of view of behavioral psychology

According to one of the fundamental laws of behavioral psychology, repetition of a particular behavioral act makes it easier to reproduce it in the future.

All people with OCD do is try to avoid things that can trigger fear, “fight” thoughts, or perform “rituals” to reduce anxiety. Such actions temporarily reduce fear, but paradoxically, according to the law stated above, they increase the likelihood of obsessive behavior occurring in the future.

It turns out that avoidance is the cause of obsessive-compulsive disorder. Avoiding the object of fear instead of enduring it can lead to dire consequences.

People who are in a stressful state are most susceptible to developing pathology: they begin new job, end relationships, suffer from overwork. For example, a person who has always calmly used public restrooms suddenly, in a state of stress, begins to “wind up” himself, saying that the toilet seat is dirty and there is a danger of contracting an illness... Further, by association, fear can spread to other similar objects: public sinks, showers, etc.

If a person avoids public toilets or begins to perform complex cleansing rituals (cleaning seats, door handles, followed by a thorough hand washing procedure) instead of coping with fear, this may result in the development of a real phobia.

Cognitive Causes of OCD

The behavioral theory described above explains the occurrence of pathology with “wrong” behavior, while the cognitive theory explains the occurrence of OCD with the inability to correctly interpret one’s thoughts.

Most people experience unwanted or intrusive thoughts several times a day, but all sufferers greatly exaggerate the importance of these thoughts.

For example, against a background of fatigue, a woman who is raising a child may periodically have thoughts about harming her baby. The majority, of course, brushes aside such obsessions and ignores them. People suffering from OCD exaggerate the importance of thoughts and react to them as a threat: “What if I’m really capable of this?!”

The woman begins to think that she could become a threat to the child, and this causes her anxiety and other negative emotions such as disgust, guilt and shame.

Fear of one's own thoughts may lead to attempts to neutralize the negative feelings arising from obsessions, for example, by avoiding situations that trigger the corresponding thoughts, or by participating in "rituals" of excessive self-purification or prayer.

As we noted earlier, repeated avoidance behavior can become “stuck” and tend to repeat itself. It turns out that the cause of obsessive-compulsive disorder is the interpretation of intrusive thoughts as catastrophic and true.

Researchers theorize that OCD sufferers place exaggerated importance on thoughts due to false beliefs learned in childhood. Among them:

• exaggerated responsibility: the belief that a person bears overall responsibility for the safety of others or harm caused to them;
• belief in the materiality of thoughts: the belief that negative thoughts can “come true” or influence other people and should be controlled;
• exaggerated sense of danger: tendency to overestimate the likelihood of danger;
• exaggerated perfectionism: the belief that everything must be perfect and mistakes are unacceptable.

Environment, distress

Stress and psychological trauma can trigger the process of OCD in people who have a tendency to develop this condition. Studies of adult twins have shown that obsessive-compulsive neurosis in 53-73% of cases arose due to adverse environmental influences.

Statistics confirm the fact that most people with OCD symptoms experienced a stressful or traumatic life event just before the onset of the disease. Such events may also cause existing symptoms of the disorder to worsen. Here is a list of the most traumatic environmental factors:

• abuse and violence;
• change of housing;
• disease;
• death of a family member or friend;
• changes or problems at school or work;
• relationship problems.

What contributes to the progression of OCD?

For effective treatment of obsessive-compulsive disorder, knowledge of the causes of the pathology is not so important. It is much more important to understand the mechanisms that support OCD. This is the key to overcoming the problem.

Avoidance and compulsive rituals

Obsessive-compulsive disorder is maintained by a vicious cycle of compulsion, anxiety, and response to the anxiety.

Whenever a person avoids a situation or action, the behavior becomes “hardwired” into a corresponding neural circuit in the brain. The next time in a similar situation, he will act in the same way, which means he will again miss the chance to reduce the intensity of his neurosis.

Compulsions are also reinforced. A person feels less anxious after checking that the lights are off. Therefore, it will act the same way in the future.

Avoidance and impulsive actions “work” at first: the patient thinks that he has prevented harm, and this stops the feeling of anxiety. But in the long term they will create even more anxiety and fear because they feed the obsession.

Exaggerating your capabilities and “magical” thinking

A person with OCD over-exaggerates their capabilities and ability to influence the world. He believes in his power to cause or prevent bad events with the power of thought. “Magical” thinking involves the belief that the performance of certain special actions, rituals, will prevent something unwanted (similar to superstition).

This allows a person to feel the illusion of comfort, as if he has more influence over events and control over what is happening. As a rule, the patient, wanting to feel calmer, performs rituals more and more often, which leads to the progression of neurosis.

Excessive concentration on thoughts

This refers to the degree of importance a person places on intrusive thoughts or images. It is important to understand here that obsessive thoughts and doubts - often absurd and opposite to what a person wants or does - appear in everyone! In the 1970s, researchers conducted experiments in which they asked people with and without OCD to list their intrusive thoughts. There was no difference between the thoughts recorded by both groups of subjects - with and without the disease.

The actual content of intrusive thoughts comes from a person's values: the things that are most important to him. Thoughts represent a person's deepest fears. So, for example, any mother always worries about the health of her child, because he is the most important thing for her. great value in life, and she will be in despair if something bad happens to him. This is why obsessive thoughts about harming the baby are so common among mothers.

The difference is that people with obsessive-compulsive disorder experience distressing thoughts more often than others. But this happens due to too much significance that patients attribute to these thoughts. It's no secret: what more attention The more you devote to your obsessive thoughts, the worse they seem. Healthy people They can simply ignore obsessions and not concentrate their attention on them.

Overestimation of danger and intolerance of uncertainty

Another important aspect is overestimating the danger of the situation and underestimating your ability to cope with it. Many OCD sufferers believe that they need to know for sure that bad things won't happen. For them, OCD is a kind of absolute insurance policy. They think that if they try harder and do more rituals and better insurance, they will get more certainty. In reality, trying harder only leads to more doubt and a greater sense of uncertainty.

Perfectionism

Some types of OCD involve the belief that there is always a perfect solution that everything should be done perfectly, and that the slightest mistake will have serious consequences. This is common in people with OCD who seek order, and is especially common in those with anorexia nervosa.

Looping

As they say, fear has big eyes. There are typical ways to “wind up” yourself and increase anxiety with your own hands:

• “Everything is terrible!” ‒ means the tendency to describe something as “terrible”, “nightmarish” or “the end of the world”. It only makes the event seem more frightening.
• "Catastrophe!" - means expecting a catastrophe as the only possible outcome. The idea that something catastrophic will happen if it is not prevented.
• Low tolerance for disappointment - when any excitement is perceived as “unbearable” or “intolerable.”

In OCD, a person first involuntarily plunges himself into a state of extreme anxiety due to his obsessions, then tries to escape from them by suppressing them or performing compulsive actions. As we already know, it is precisely this behavior that increases the frequency of obsessions.

Treatment of OCD

Research shows that psychotherapy significantly helps 75% of patients with obsessive-compulsive disorder. There are two main ways to treat neurosis: medications and psychotherapy. They can also be used together.

However, non-drug treatment is preferable because OCD is highly treatable without medication. Psychotherapy does not have side effects on the body and has a more sustainable effect. Medication may be recommended as treatment if the neurosis is severe, or as a short-term measure to relieve symptoms while you begin psychotherapy.

Cognitive behavioral psychotherapy (CBT), short-term strategic psychotherapy, and also are used to treat obsessive-compulsive disorder.

Exposure—the controlled confrontation with fear—is also used in the treatment of OCD.

The first effective psychological method The technique of confrontation with parallel suppression of the anxiety reaction has been recognized in the fight against OCD. Its essence lies in a carefully dosed confrontation with fears and obsessive thoughts, but without the usual reaction of avoidance. As a result, the patient gradually gets used to them, and fears begin to fade away.

However, not everyone feels able to undergo such treatment, so the technique has been refined through CBT, which focuses on changing the meaning of intrusive thoughts and urges (the cognitive part), as well as changing the response to the urge (the behavioral part).

Obsessive-compulsive disorder: causes

Obsessive-compulsive disorder is a pathological condition that has a clear onset and is reversible with proper treatment. This syndrome is considered under the heading of borderline mental disorders.

Obsessive-compulsive disorder (OCD) is distinguished from pathology at the neurotic level by its greater severity, frequency of occurrence, and intensity of obsessions.

To date, information about the prevalence of the disease cannot be called reliable and accurate. The inconsistency of the data can be explained by the fact that so many people suffering from obsessions do not contact mental health services. Therefore, in clinical practice, in terms of frequency, obsessive-compulsive disorder ranks after anxiety-phobic disorders and conversion disorders. However, anonymous sociological surveys show that over 3% of respondents suffer from obsessions and compulsions to varying degrees of severity. First episode of obsessive-compulsive disorder most often occurs between 25 and 35 years of age . Neurosis is recorded in people with different levels of education, financial situation and social status. In most cases, the occurrence of obsessions is determined in unmarried women and single men. OCD often affects people with a high IQ whose professional responsibilities involve active mental activity. Residents of large industrial cities are more susceptible to the disease.

In most patients with OCD, symptoms are chronic: compulsions occur regularly or are constantly present. Manifestations of obsessive-compulsive disorder may be sluggish and perceived by the patient as tolerable. Or, as the disease develops, the symptoms become aggravated at a rapid speed, not giving the person the opportunity to live a normal life. Depending on the severity and rate of development of symptoms, obsessive-compulsive disorder either partially impedes the patient’s full activity or completely prevents interaction in society.

In severe cases of OCD, the patient becomes a hostage to the obsessions that overcome him. In some cases, the patient completely loses the ability to control the thinking process and cannot control his behavior. For obsessive-compulsive disorder Characterized by two leading symptoms - obsessive thoughts and compulsive actions.

• Obsessions and compulsions arise spontaneously, are obsessive and irresistible in nature, and cannot be independently eliminated either by willpower or conscious personal work. The individual evaluates the obsessions that overcome him as alien, illogical, inexplicable, irrational, absurd phenomena.
• Obsessions are usually called intrusive, persistent, oppressive, weary, frightening or threatening thoughts that come to mind involuntarily, in addition to the desire of the subject.

With obsessive-compulsive disorder, the patient may experience both obsessions and compulsions at the same time. There may also be exclusively obsessive thoughts without subsequent ritual actions. Or the person may suffer from the oppressive feeling of having to carry out compulsive actions and perform them repeatedly.

In the vast majority of cases, obsessive-compulsive disorder has a clear, pronounced start. Only in isolated cases is a gradual slow increase in symptoms possible. The manifestation of pathology almost always coincides with the period when a person is in a severe stressful state. The onset of OCD is possible as a result of sudden exposure to extreme stressful situations. Or the first episode of the disorder is a consequence of prolonged chronic stress. It should be pointed out that the trigger for obsessive-compulsive disorder is not only stress in its understanding as a traumatic situation. The onset of the disease often coincides with stress caused by physical ill health and severe somatic illness.

Obsessive-compulsive disorder: pathogenesis

Most often, a person pays attention to the existence of obsessions and compulsions after he has experienced a serious life drama. It also becomes noticeable to others that after the tragedy the person began to behave differently and seemed to be in his own world of reflection. Despite the fact that the symptoms of obsessive-compulsive disorder become pronounced precisely after extreme circumstances in the life of the subject, acts only as a trigger for the visible manifestation of pathology. A psychotraumatic situation is not directly cause of OCD

, it only provokes a rapid aggravation of the disease.

Reason 1. Genetic theory

Predisposition to pathological reactions is inherent at the gene level. It has been established that most patients with obsessive-compulsive disorder have defects in the gene responsible for transporting the neurotransmitter serotonin. More than half of the examined individuals had mutations in the seventeenth chromosome in the SLC6A4 gene, the serotonin transporter.

Scientists also suggest that excessive anxiety is also transmitted from descendants to ancestors. Many cases have been recorded in which grandparents, parents and children had similar or performed similar ritual actions.

Reason 2. Features of higher nervous activity

The development of obsessive-compulsive disorder is also influenced by the individual properties of the nervous system, which are determined by innate qualities and acquired experiences throughout life. Most patients with OCD have a weak nervous system. The nerve cells of such people are not able to fully function under prolonged stress. In many patients, an imbalance in the processes of excitation and inhibition is determined. Another feature identified in such individuals is the inertia of nervous processes. That is why sanguine people are rarely found among patients with obsessive-compulsive disorder.

Reason 3. Constitutional and typological aspects of personality

The risk group includes anankaste individuals. They are characterized by an increased tendency to doubt. These pedantic individuals are absorbed in studying details. These are suspicious and impressionable people. They strive to do everything the best way and suffer from perfectionism. They scrupulously think about the events of their lives every day and endlessly analyze their actions.

Such subjects are unable to make an unambiguous decision even when all the conditions for the correct choice exist. Anancasts are not able to displace obsessive doubts, which provokes the emergence of a strong feeling about the future. They cannot resist the illogical desire to double-check the work done. To avoid failure or mistakes, Anankasts begin to use saving rituals.

Reason 4. The influence of neurotransmitters

Doctors suggest that a disruption in serotonin metabolism plays a role in the development of obsessive-compulsive disorder. In the central nervous system, this neurotransmitter optimizes the interaction of individual neurons. Disturbances in serotonin metabolism do not allow for high-quality exchange of information between nerve cells.

Reason 5. PANDAS syndrome

Nowadays, there is a lot of confirmation of the assumption made about the connection between obsessive-compulsive disorder and infection of the patient’s body with group A beta-hemolytic streptococcus. These cases are designated by the English term

PANDAS. The essence of this autoimmune syndrome is that when there is a streptococcal infection in the body, the immune system is activated and, trying to destroy microbes, mistakenly attacks nerve tissue.

Obsessive-compulsive disorder: clinical picture

The leading symptoms of obsessive-compulsive disorder are obsessive thoughts and compulsive actions. The criteria for making a diagnosis of OCD are the severity and intensity of symptoms. Obsessions and compulsions occur regularly or are constantly present in a person. Symptoms of the disorder make it impossible for the subject to fully function and interact in society.

Despite the diversity and variety of obsessive thoughts and ritual actions, all symptoms of obsessive-compulsive disorder can be divided into several classes.

Group 1. Ineradicable doubts

In this situation, a person is overcome by obsessive doubts about whether some action has been completed or not. He is haunted by the need to conduct a re-check, which, from his point of view, can prevent catastrophic consequences. Even repeated checks do not give the subject confidence that the matter has been carried out and completed.

The patient's pathological doubts may relate to traditional everyday activities, which, as a rule, are performed automatically. Such a person will check several times: is the gas valve closed, is the water tap closed, is the lock closed? Entrance door. He returns to the scene of action several times and touches these objects with his hands. However, as soon as he leaves his home, doubts overcome him with greater force.

Painful doubts can also affect professional responsibilities. The patient is confused whether he has completed the required task or not. He is not sure that he compiled the document and sent it by e-mail. He questions whether all the details are included in the weekly report. He re-reads, looks through, double-checks again and again. However, after leaving workplace, obsessive doubts arise again.

It is worth pointing out that obsessive thoughts and compulsive actions resemble vicious circle, which a person cannot break through the efforts of will. The patient understands that his doubts are unfounded. He knows that he has never made similar mistakes in his life. However, he cannot “talk” his mind into not making repeated checks.

Only a sudden “insight” can break the vicious circle. This is a situation where a person’s mind becomes clearer, the symptoms of obsessive-compulsive disorder subside for a while, and the person experiences relief from obsessions. However, a person cannot bring the moment of “insight” closer by force of will.

Group 2. Immoral obsessions

This group of obsessions is represented by obsessive ideas of indecent, immoral, illegal, blasphemous content. A person begins to be overcome by an indomitable need to commit an indecent act. In this case, the person has a conflict between her existing moral standards and an indomitable desire for antisocial action.

The subject may be overcome by a desire to insult and humiliate someone, to be rude and rude to someone. A respectable individual may be haunted by some absurd undertaking that represents a debauched immoral act. He may begin to blaspheme God and speak unflatteringly about the church. He may be overwhelmed by the idea of ​​engaging in sexual debauchery. He may feel a desire to commit a hooligan act.

However, a patient with obsessive-compulsive disorder fully understands that such an obsessive need is unnatural, indecent, and illegal. He tries to drive away such thoughts from himself, but the more effort he makes, the more intense his obsessions become.

Group 3. Overwhelming worries about pollution

Symptoms of obsessive-compulsive disorder also cover the topic. The patient may be pathologically afraid of contracting some difficult-to-diagnose and incurable disease. In such a situation, he takes protective actions to prevent contact with germs. He takes strange precautions, fearing viruses.

Obsessions are also manifested by an abnormal fear of contamination. People with obsessive-compulsive disorder may fear that they will be covered in dirt. They are terrified of house dust, so they clean for days on end. Such subjects are very careful about what they eat and drink, because they are convinced that they can be poisoned by poor-quality food.

In obsessive-compulsive disorder, common themes of obsession are the patient's thoughts about polluting his own home. Such subjects are not satisfied with standard apartment cleaning methods. They vacuum carpets several times, wash the floor using disinfectants, and wipe furniture surfaces using cleaning products. For some patients, cleaning their home takes up the entire waking period; they take a break only while sleeping at night.

Group 4. Obsessive actions

Compulsions are actions, behaviors and behavior in general that a person with obsessive-compulsive disorder uses to overcome obsessive thoughts. Compulsive acts are committed by the subject as a ritual designed to protect against some potential disasters. Compulsions are performed regularly and frequently, and a person cannot refuse or suspend their implementation.

There are a great many types of compulsions, since they reflect the subject’s obsessive thinking in a particular area. The most common forms of protective and preventive actions are:

• activities carried out due to existing superstitions and prejudices, for example: fear of the evil eye and a preventive method - regular washing with “holy” water;
• stereotypical, mechanically performed movements, for example: pulling out one's own hair from the head;
• execution of any process devoid of common sense and necessity, for example: brushing your hair for five hours;
• excessive personal hygiene, for example: taking a shower ten times a day;
• uncontrollable need to recalculate all surrounding objects, for example: counting the number of dumplings in a serving;
• an uncontrollable desire to place all objects symmetrically to each other, the desire to arrange things in a strictly established sequence, for example: arranging units of shoes in parallel;
• craving for collecting, collecting, hoarding, when the hobby goes from the category of hobby to pathology, for example: keeping at home all the newspapers purchased over the past ten years.

Obsessive-compulsive disorder: treatment methods

The treatment regimen for obsessive-compulsive disorder is selected for each patient individually, depending on the severity of symptoms and the severity of existing obsessions. In most cases, it is possible to help a person by providing treatment on an outpatient basis. However, some patients with severe OCD require hospitalization in an inpatient facility because there is a risk that intrusive thoughts will require them to perform actions that could cause real harm to the person and those around them.

The classic method of treating obsessive-compulsive disorder involves the sequential implementation of activities that can be divided into four groups:

• pharmacological therapy;
• psychotherapeutic influence;
• use of hypnosis techniques;
• implementation of preventive measures.

Drug treatment

The use of medications has the following goals: to strengthen nervous system patient, minimize feelings and anxieties, help take control of one’s own thinking and behavior, eliminate existing depression and despair. Treatment for OCD begins with two weeks of benzodiazepines. In parallel with tranquilizers, the patient is recommended to take antidepressants from the SSRI class for six months. To get rid of the symptoms of the disorder, it is advisable to prescribe atypical antipsychotics to the patient. In some cases, the use of mood stabilizers may be required.

Psychotherapeutic treatment

Modern psychotherapy has in its arsenal a variety of proven and effective techniques for getting rid of obsessive-compulsive disorder. More often OCD treatment carried out using the cognitive-behavioural method. This technique involves helping the client identify destructive components of thinking and subsequently acquiring a functional way of thinking. During psychotherapeutic sessions, the patient gains skills to control his thoughts, which makes it possible to manage his own behavior.

Another psychotherapeutic treatment option that has shown good results in the treatment of obsessive-compulsive disorder is exposure and response prevention techniques. Placing a patient in artificially created frightening conditions, accompanied by a clear and understandable step by step instructions, how to prevent compulsions, gradually softens and eliminates the symptoms of obsessive-compulsive disorder.

Hypnosis treatment

Many people suffering from obsessive-compulsive disorder report that when they give in to their obsessive ideas and perform compulsive actions, they feel as if they are in a state of trance. That is, they concentrate within themselves, so the fruits of their imagination become more real than the objectively existing reality. That is why it is advisable to influence obsessions precisely in a state of trance, immersion into which occurs during a hypnosis session.

During a hypnosis session, the associative connection between overwhelming obsessions and the need to use a stereotypical model of behavior occurs. Hypnosis techniques help the patient become convinced of the inappropriateness, absurdity and alienness of the obsessive thoughts that arise. As a result of hypnosis, the need to perform certain rituals disappears. He gains free thinking and takes control of his own behavior.

Preventive actions

To prevent relapses of obsessive-compulsive disorder, it is recommended:

• take a contrast shower in the morning;
• V evening time arrange baths with the addition of relaxing natural oils or soothing herbal compositions;
• ensuring a good night's sleep;
• daily walks before bed;
• stay in the fresh air for at least two hours a day;
• active exercise stress, outdoor sports;
• drawing up a healthy menu, excluding foods with stimulating properties from the diet;
• refusal of alcoholic beverages;
• avoiding smoking;
• creating a favorable atmosphere at home, eliminating stressful situations;
• normalization of work schedule;
• performing breathing exercises.

Despite the persistent course of obsessive-compulsive disorder, the disease is treatable provided the patient fully follows all medical recommendations.

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Obsessive-compulsive disorder (OCD) is one of the common syndromes of psychological illness. A severe disorder is characterized by the presence of disturbing thoughts (obsessions) in a person, which provoke the appearance of constantly repeating certain ritual actions (compulsions).

Obsessive thoughts conflict with the patient’s subconscious, causing him depression and anxiety. And manipulative rituals designed to relieve anxiety do not bring the expected effect. Is it possible to help a patient, why does this condition develop, turning a person’s life into a painful nightmare?

Obsessive-compulsive disorder causes suspiciousness and phobias in people

Every person has encountered this type of syndrome in their life. People call this an “obsession.” Such ideas-states are divided into three general groups:

1. Emotional. Or pathological fears that develop into a phobia.
2. Intelligent. Some thoughts, fantastic ideas. This includes intrusive disturbing memories.
3. Motor. This type of OCD manifests itself in the unconscious repetition of certain movements (wiping the nose, earlobes, frequent washing of the body, hands).

Doctors classify this disorder as a neurosis. The name of the disease “obsessive-compulsive disorder” is of English origin. Translated it sounds like “obsession with an idea under duress.” The translation very accurately defines the essence of the disease.

OCD negatively affects a person's standard of living. In many countries, a person with such a diagnosis is even considered disabled.

People encountered obsessive-compulsive disorder back in the dark Middle Ages (at that time this condition was called obsession), and in the 4th century it was classified as melancholy. OCD was periodically recorded as paranoia, schizophrenia, manic psychosis, and psychopathy. Modern doctors classify pathology as neurotic conditions.

Obsessive-compulsive disorder is amazing and unpredictable. It is quite common (statistically, it affects up to 3% of people). Representatives of all ages are susceptible to it, regardless of gender and level of social status. Studying the features of this disorder for a long time, scientists made interesting conclusions:

• It has been noted that people suffering from OCD have suspiciousness and increased anxiety;
• obsessive states and attempts to get rid of them with the help of ritual actions can occur periodically or torment the patient for whole days;
• the disease has a bad effect on a person’s ability to work and perceive new information (according to observations, only 25-30% of patients with OCD can work productively);
• patients suffer and personal life: half of people diagnosed with obsessive-compulsive disorder do not create families, and in the case of illness, every second couple breaks up;
• OCD is more likely to attack people who do not have higher education, but representatives of the world of intellectuals and people with high level intelligence, such pathology is extremely rare.

How to recognize the syndrome

How to understand that a person suffers from OCD and is not subject to ordinary fears or is not depressed and protracted? To understand that a person is sick and needs help, pay attention to the typical symptoms of obsessive-compulsive disorder:

Intrusive thoughts. Anxious thoughts that constantly follow the patient often concern fear of illness, germs, death, possible injuries, and loss of money. From such thoughts, an OCD patient becomes panicked, unable to cope with them.

Constant anxiety. Being caught up in obsessive thoughts, people with obsessive-compulsive disorder experience an internal struggle with their own condition. Subconscious “eternal” anxieties give rise to a chronic feeling that something terrible is about to happen. It is difficult to remove such patients from a state of anxiety.

Repetition of movements. One of the most striking manifestations of the syndrome is the constant repetition of certain movements (compulsions). Obsessive actions come in a wide variety. The patient can:

• count all the steps of the ladder;
• scratching and twitching certain parts of the body;
• constantly wash your hands for fear of contracting the disease;
• synchronously arrange/lay out objects and things in the closet;
• come back many times to once again check whether household appliances, lights are turned off, and whether the front door is closed.

Often, impulsive-compulsive disorder requires patients to create their own system of checks, some kind of individual ritual of leaving the house, going to bed, and eating. Such a system can sometimes be very complex and confusing. If something in it is violated, a person begins to carry it out again over and over again.

The entire ritual is carried out deliberately slowly, as if the patient is delaying time in fear that his system will not help, and internal fears will remain.

Attacks of the disease are more likely to occur when a person finds himself in the middle of a large crowd. He immediately wakes up with disgust, fear of illness and nervousness from the feeling of danger. Therefore, such people deliberately avoid communication and walking in crowded places.

Causes of pathology

The first causes of obsessive-compulsive disorder usually appear between the ages of 10 and 30. By the age of 35-40, the syndrome is already fully formed and the patient has a pronounced clinical picture of the disease.

But why does obsessive neurosis not come to all people? What must happen for the syndrome to develop? According to experts, the most common culprit of OCD is an individual characteristic of a person’s mental make-up.

Doctors divided provoking factors (a kind of trigger) into two levels.

Biological provocateurs

The main biological factor causing obsessive-compulsive disorder is stress. Stressful situation never goes away without a trace, especially for people predisposed to OCD.

In susceptible individuals, obsessive-compulsive disorder can even cause overwork at work and frequent conflicts with relatives and colleagues. Other common biological causes include:

• heredity;
• traumatic brain injuries;
• alcohol and drug addiction;
• disturbance of brain activity;
• diseases and disorders of the central nervous system;
• difficult birth, trauma (for the child);
• complications after severe infections affecting the brain (after meningitis, encephalitis);
• metabolic disorder, accompanied by a drop in the levels of the hormones dopamine and serotonin.

Social and psychological reasons

• family serious tragedies;
• severe psychological trauma from childhood;
• parental long-term overprotection of the child;
• long work accompanied by nervous overload;
• strict puritanical, religious education, based on prohibitions and taboos.

An important role is played by psychological condition the parents themselves. When a child constantly observes their manifestations of fear, phobias, and complexes, he himself becomes like them. The problems of loved ones seem to be “drawn in” by the baby.

When to see a doctor

Many people suffering from OCD often do not even understand or perceive the existing problem. And even if they notice strange behavior, they do not appreciate the seriousness of the situation.

According to psychologists, a person suffering from OCD must undergo a full diagnosis and begin treatment. Especially when obsessive states begin to interfere with the lives of both the individual and those around him.

It is imperative to normalize the condition, because OCD has a strong and negative impact on the well-being and condition of the patient, causing:

• depression;
• alcoholism;
• isolation;
• thoughts of suicide;
• rapid fatigue;
• mood swings;
• decline in quality of life;
• growing conflict;
• gastrointestinal disorder;
• constant irritability;
• difficulty making decisions;
• loss of concentration;
• abuse of sleeping pills.

Diagnosis of the disorder

To confirm or refute the mental disorder OCD, a person should consult a psychiatrist. After a psychodiagnostic conversation, the physician will differentiate the presence of pathology from similar mental disorders.

The psychiatrist takes into account the presence and duration of compulsions and obsessions:

1. Obsessive states (obsessions) acquire a medical basis when they are stable, regularly repeated and importunate. Such thoughts are accompanied by feelings of anxiety and fear.
2. Compulsions (obsessive actions) arouse the interest of a psychiatrist if, at the end of them, a person experiences a feeling of weakness and fatigue.

Attacks of obsessive-compulsive disorder should last for an hour, accompanied by difficulty communicating with others. To accurately identify the syndrome, doctors use a special Yale-Brown scale.

Treatment of obsessive-compulsive disorder

Doctors are unanimously inclined to believe that it is impossible to cope with obsessive-compulsive disorder on your own. Any attempts to take control of your own consciousness and defeat OCD lead to a worsening of the condition. And the pathology is “driven” into the crust of the subconscious, destroying the patient’s psyche even more.

Mild form of the disease

Treatment of OCD in the initial and mild stages requires constant outpatient monitoring. During the course of psychotherapy, the doctor identifies the reasons that provoked obsessive-compulsive neurosis.

The main goal of treatment consists of establishing trust relationships the sick person and his close circle (relatives, friends).

Treatment of OCD, including combinations of psychological correction methods, may vary depending on the effectiveness of the sessions.

Treatment of complicated OCD

If the syndrome occurs in more complex stages, it is accompanied by obsessive phobia the patient is faced with the possibility of contracting diseases, fears of certain objects, treatment is complicated. Specific medications (in addition to psychological correction sessions) enter the fight for health.

Medicines are selected strictly individually, taking into account the state of health and concomitant diseases of the person. The following groups of medications are used in treatment:

• anxiolytics (tranquilizers that relieve anxiety, stress, panic);
• MAO inhibitors (psychoenergizing and antidepressant medications);
• atypical antipsychotics (antipsychotics, new class drugs that relieve symptoms of depression);
• serotonergic antidepressants (psychotropic drugs used in the treatment of severe depression);
• antidepressants of the SSRI category (modern third-generation antidepressants that block the production of the hormone serotonin);
• beta blockers (medicines whose action is aimed at normalizing cardiac activity, problems with which are observed during attacks of acute respiratory syndrome).

Prognosis of the disorder

OCD is a chronic disease. This syndrome is not characterized by complete recovery, and the success of therapy depends on the timely and early start of treatment:

1. At mild form Recession syndrome (relief of manifestations) is observed 6-12 months after the start of therapy. Patients may remain with some symptoms of the disorder. They are expressed in a mild form and do not interfere with everyday life.
2. In more severe cases, improvement becomes noticeable 1-5 years after the start of treatment. In 70% of cases, obsessive-compulsive disorder is clinically curable (the main symptoms of the pathology are relieved).

OCD in severe, advanced stages is difficult to treat and is prone to relapse. Aggravation of the syndrome occurs after discontinuation of medications, against the background of new stress and chronic fatigue. Cases of complete recovery of OCD are very rare, but they are diagnosed.

With adequate treatment, the patient is guaranteed stabilization of unpleasant symptoms and relief of severe manifestations of the syndrome. The main thing is not to be afraid to talk about the problem and start therapy as early as possible. Then the treatment of neurosis will have a much greater chance of complete success.

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