OCD mental disorder treatment. Obsessive compulsive disorder. What Causes Obsessive-Compulsive Disorder to Exacerbate?

Psychologist, psychotherapist.

obsessive-compulsive disorder(OCD) is a mental disorder characterized by intrusive, unpleasant thoughts that occur against the will of the patient (obsessions) and actions, the purpose of which is to reduce the level of anxiety.

To determine the severity of obsessive and compulsive symptoms, the following is used: OCD test - Yale-Brown scale. - Ed.

The ICD-10 describes obsessive-compulsive disorder (F42) as follows:

"The essential feature of the condition is the presence of repetitive obsessive thoughts or compulsive actions. Intrusive thoughts are ideas, images or impulses that come to the patient's head again and again in a stereotyped form. They are almost always upsetting, and the patient often unsuccessfully tries to resist them. However, however, the patient considers these thoughts to be his own, even if they are involuntary and disgusting.

Obsessions, or rituals, are stereotypical behaviors that the patient repeats over and over again. They are not a way to have fun or an attribute of useful tasks. These actions are a way to prevent the occurrence of an unpleasant event, which, as the patient fears, may otherwise occur, harming him or them to another person. Usually such behavior is recognized by the patient as meaningless or ineffective and repeated attempts are made to resist it. Anxiety is almost always present. If compulsive actions are suppressed, anxiety becomes more pronounced.

Personal experience of Katerina Osipova. Katya is 24 years old, 13 of them she lives with a diagnosis of OCD: "Me and my friend OCD" (ed. note)

Symptoms of obsessive-compulsive personality disorder

• The personality is preoccupied with the details, the list, the order to such an extent that life goals are lost sight of.
• Shows perfectionism that interferes with the task of completion (unable to complete the project because his own standards are not met in this project).
• Excessively devoted to work, productivity, productivity to the exclusion of leisure and friendship, despite the fact that such an amount of work is not justified by economic necessity (money is not the main interest).
• The personality is superconscious, scrupulous and inflexible in matters of morality, ethics, values ​​that do not include cultural and religious identification (intolerant).
• The personality is incapable of getting rid of spoiled or useless objects, even if they have no sentimental value.
• Resists delegating or working with other people until they present a fit for her or his way of doing things (everything must be done as she sees fit, on her terms).
• He is afraid to spend money on himself and other people, because. money should be kept for a rainy day to deal with future disasters.
• Demonstrates rigidity and stubbornness.

If more than 4 characteristics are present (usually from 4 to 8), then with a high probability we can talk about obsessive-compulsive personality disorder.

OCD develops around the age of 4-5 years, when parents place the main emphasis in education on the fact that if the child does something, then he must do it correctly. The emphasis is on achieving excellence. Such a child was supposed to be an example for other children and receive praise and approval from adults. Thus, from childhood, such a person is under the yoke of parental instructions about what she should do and what she should not do. She is overwhelmed with duty and responsibility, the need to follow the rules that were once laid down by the parent. We can notice children around us who think and act like adults. As if they are in a hurry to grow up and take on adult responsibility. Their childhood ends too soon. From childhood, they try to do more or do better than other people have already done. And this way of acting and thinking remains with them into adulthood. Such children did not learn to play, they were always busy with business. Becoming adults, they do not know how to relax, rest, take care of their needs and desires. It often happens that one of the parents (or both) themselves had OCD, did not know how to relax and rest, devoting themselves to work or household chores. The child learns such behavior from them, tries to imitate his parents, considering this a kind of norm, "because it was customary in our family."

Obsessive-compulsive individuals are very sensitive to criticism. Because if they are criticized, it means that they failed to do faster, better, more, and therefore they cannot treat themselves well, feel good. They are perfectionists. They are very tense in order to have time to do everything that they have planned, and they experience anxiety as soon as they realize that they have stopped doing some important business. They are especially anxious and guilty if they have any negative thoughts and reactions invading their work routine, and, of course, sexual thoughts, feelings and needs. They then use little rituals, such as counting to get away from invading thoughts, or doing their tasks in a certain order so that they gain control and ease their anxiety. Individuals with OCD expect equally high standards and excellence from other people, and can easily become critical when other people don't live up to their high standards. These expectations and frequent criticism can cause great difficulties in personal relationships. Some relationship partners perceive OCD personalities as boring because they focus on work and have great difficulty in relaxing, relaxing, enjoying themselves.

Causes of Obsessive-Compulsive Personality Disorder

• Personality traits (hypersensitivity, anxiety, a tendency to think more than feel);
• Education with an emphasis on a sense of duty, responsibility;
• genetic predisposition;
• neurological problems;
• Stress and trauma can also trigger the OCD process in people who are prone to developing the condition.

Examples of obsessive-compulsive disorder

The most common concerns are cleanliness (such as fear of dirt, germs, and infections), safety (such as worrying about leaving the iron on in the house, which could start a fire), inappropriate sexual or religious thoughts (such as wanting to have sex with "forbidden" partner - someone else's spouse, etc.). Striving for symmetry, precision, accuracy.

Frequent hand washing or the desire to constantly rub and wash something in the house; rituals to test and protect oneself from imaginary danger, which may include whole chains of actions (for example, to enter and exit the room correctly, touch something with the hand, take three sips of water, etc.) are also fairly common examples obsessive-compulsive disorder.

Symptoms of obsessive-compulsive disorder

With the onset of symptoms of obsessive-compulsive disorder, life will never be the same again. Once broken, the brain seems to lose its adequacy and makes you do abnormal things. Thoughts and actions seem to lose consistency with reality. Why does this happen?

Often, along with obsessive-compulsive personality disorder, a person has hypochondria, anxiety, panic and other neurotic disorders. What are the causes of obsessive-compulsive disorder and how to get rid of it yourself, read in this article.

Obsessive Compulsive Personality Disorder: What is it?

Obsessive-compulsive personality disorder, or obsessive-compulsive disorder, is a neurotic disorder that includes the presence of obsessions and compulsions. If there are no compulsions, they speak of obsessive-phobic disorder.

Constant uncontrolled thoughts and rituals take away a normal life. A person does not get enough sleep, he does not have enough time for everyday activities. Can't study or work. He is busy endlessly cleaning, washing his hands, organizing objects, checking his security, keeping accounts. It becomes difficult to be around him. The patient himself understands this and also suffers from forced social isolation.

Signs of obsessive-compulsive disorder

Obsessions: recurring unwanted thoughts, ideas, or images that cause intense anxiety and cannot be resolved.

Compulsions: forced repetitive actions designed to reduce internal tension, from which it is impossible to get rid of.

Obsessive-compulsive personality disorder is characterized by a chronic process. Symptoms may subside and recur with stress, overwork, or lack of sleep. One obsessive action is joined by another, fears grow and multiply. The question arises: "Why me?". It's scary not to control your brain. Why do I have symptoms of obsessive-compulsive disorder? Yuri Burlan's "System-Vector Psychology" will help you figure it out.

Causes of Obsessive-Compulsive Disorder

The psyche of an individual is made up of vectors. A vector is a part of the psyche with its own desires. Opportunities are given to achieve them. Realization of desires gives a person a feeling of happiness, non-realization - suffering. But in a state of non-realization, the vector will strive to "get its own" in any way. It will manifest itself in an unhealthy way.

Each vector has its own desires, its own characteristics and characteristics, not similar to others. There are eight vectors in total. modern man maybe 3-5 vectors. Symptoms of obsessive-compulsive disorder occur in a person in different combinations of skin, anal, visual or sound vectors during overstress, prolonged non-realization of properties, or in the case of psychotrauma of the vector in childhood. The symptomatology also depends on the vector in which the cause is. Consider the most common examples of obsessive-compulsive disorder.

Obsessive Compulsive Disorder: Examples

• Skin vector - the desire for property and social superiority.

A person with endowed with the ability to self-discipline, self-control and self-restraint. Its properties are: logical thinking, quick counting, saving time, resources and space, creating reserves for a rainy day, ambitious and competitive, careerism. People with a skin vector find themselves in trade, business, organization and management, lawmaking, engineering, design. Wherever the use of advanced vector qualities is required. Not achieving property acquisitions, career growth and status, he experiences stress. Also a strong stress for him is a financial collapse, dismissal, robbery, loss of valuables. Congenital fear - infection of the skin with microbes. When the properties of the vector are not applied in the social sphere, the following symptoms of obsessive-compulsive disorder may begin to manifest themselves:

Misophobia - fear of infection and washing hands.

Arithmomania is an obsessive account.

Obsessive adherence to the daily routine, diet and drink.

Obsessive fear of failure or loss of things, robbery.

Intrusive security check - closing doors, checking keys, whether the iron is turned off, etc.

• The anal vector is the desire to learn, to pass on experience and knowledge to the younger generation.

The properties are opposite to those of the skin. If the skin is fast and agile, then the anal is slow and assiduous. When both vectors are combined, contradictions may arise. A person with an anal vector is tenacious to details, doubtful, thorough, rigid, gets things done and is prone to perfectionism. Purification, the desire for purity, is a key aspect in the anal vector. His value is the family and children, they are excellent husbands and wives, fathers and mothers. People with an anal vector become professionals in their field, the best artisans, teachers, historians. Congenital fear - disgrace, make a mistake. Overstress is cheating spouse, loss of respect, shame, quick changes (change of job, place of residence, etc.). In this case, the following symptoms of obsessive-compulsive disorder may occur:

Obsessive perfectionism.

Obsessive observance of order - ordering, sorting objects.

Intrusive cleaning and cleansing.

An obsessive fear of harming loved ones or oneself.

The presence of both anal and cutaneous vectors gives combined symptoms of obsessive-compulsive disorder.

• The visual vector is the desire to experience vivid emotions.

People with are very emotional, impressionable, suspicious, suggestible and self-suggestible, have a developed imagination, appreciate beauty, enjoy brightness and color. All people are afraid of death, but in a visual person, the fear of death is an innate emotion, the first and very strong one. Such people can develop phobias of all kinds and stripes, anxiety states, panic attacks. Anxious background in the visual vector enhances stress in the skin and anal vectors and is a factor of reduced stress resistance in general. For example, thoughts about death arise due to infection of the hands, and the ritual of washing hands temporarily reduces anxiety in the visual vector. In the structure of obsessive-compulsive personality disorder, phobophobia (fear of fear) may appear.

• The sound vector is the desire to know the root cause, the meaning of life and oneself.

A person with an abstract intellect - he is a thinker, philosopher, ideologist. Closed introvert looking inward. The sound vector is dominant. Due to the peculiarities of the perception of the sound vector, the symptoms of obsessive-compulsive disorder often take on the character of paralogical judgments and conclusions, overvalued and delusional ideas.

Other symptoms of an unrealized sound vector may also be accompanied: depression, a sense of the meaninglessness of life, insomnia or excessive sleepiness,. Sound people are particularly concerned about the symptoms of obsessive-compulsive disorder, due to an innate fear of going insane.

Treatment of obsessive-compulsive disorder

OCD medication and psychotherapy do not return a person to a normal life, but only help to reduce symptoms. There may be periods of improvement during the course of the disease. They are associated with the emergence of the realization of vectors and a decrease in the level of stress. The disorder is returning along the beaten path, acquiring new symptoms like a snowball. After all, the structure of personality, the type of response has not changed.

Anyone suffering from obsessive-compulsive disorder understands that this is not normal, but there is nothing they can do. As if programmed, he is drawn to perform these actions, think these thoughts and be afraid. The unconscious cannot be controlled by will power; on the contrary, it controls a person. The person with the disorder feels it more strongly than others. The struggle takes years of life, and a complete cure does not occur. And a person talks about the disease calmly, resigned to the fact that it is absolutely impossible to influence him.

The diagnosis of obsessive-compulsive disorder combines different symptoms. Systemic vector psychology explains how such heterogeneous symptoms fit into one diagnosis. With the help of the knowledge of vectors, it turns out to put everything on the shelves, clearly knowing where which symptom came from. Only in this way does it become possible to talk about the problem not speculatively, but understanding its causes.

Why does training cure obsessive-compulsive disorder? It's not just that a person understands his vector set. Each vector is the very essence of the psyche, hidden in the unconscious. The disclosure of this part of the mental gives a deep understanding of the causes of the disease in a particular case. The conscious is already controllable, and for this you do not have to make volitional efforts. After all, looking into the darkness, we do not know what is there, right? Having illuminated this place with a flashlight, we already see what's what. You can arm yourself with a flashlight with the help of training, and then you will never have to wander in the semi-darkness again.

Symptoms of obsessive-compulsive disorder arise as a result of stress, non-realization of the properties and psychotraumas of vectors. What program failed - you need to figure it out. Who am I, in what state is my psyche, what happens in my vectors that I behave like this? Disclosure of the essence of vectors at the training "Systemic Vector Psychology of Yuri Burlan" allows you to deeply understand the cause of obsessive-compulsive disorder in each individual case. Having become conscious, a part of the unconscious becomes part of consciousness and loses its power over a person - this is how psychoanalysis works. The person begins to behave normally in a natural way, on his own. Stress resistance increases, anxiety and fears go away. This is a chance to get rid of obsessive-compulsive disorder on your own, without pills and doctors.

For free lectures "System-Vector Psychology of Yuri Burlan". You will learn more about the features of the cutaneous and anal vectors.

Living with obsessive-compulsive disorder (OCD) is not easy. With this disease, intrusive thoughts arise, causing severe anxiety. To get rid of anxiety, a person suffering from OCD is often forced to certain rituals.

In the classification of mental illness, OCD is classified as an anxiety disorder, and anxiety is familiar to almost everyone. But this does not mean that any healthy person understands what an OCD sufferer has to experience. Headaches are also familiar to everyone, but this does not mean that we all know what migraine sufferers feel.

Symptoms of OCD can interfere with a person's ability to work, live, and relate to others.

“The brain is designed in such a way that it always warns us of the dangers that threaten survival. But in OCD patients, this brain system does not work properly. As a result, they are often overwhelmed by a tsunami of unpleasant experiences and are unable to focus on anything else,” explains psychologist Stephen Philipson, clinical director of the Center for Cognitive Behavioral Therapy in New York.

OCD is not associated with any one specific fear. Some obsessions are well known - for example, patients may constantly wash their hands or check to see if the stove is turned on. But OCD can also manifest as hoarding, hypochondria, or the fear of harming someone. A fairly common type of OCD, in which patients are tormented by a paralyzing fear about their sexual orientation.

As with any other mental illness, only a professional doctor can make a diagnosis. But there are still a few symptoms that experts say could indicate the presence of OCD.

1. They bargain with themselves.

OCD sufferers often believe that if they check the stove again or search the Internet for symptoms of the illness they claim to be suffering from, they will finally be able to calm down. But OCD is often deceptive.

“Biochemical associations arise in the brain with the object of fear. The repetition of obsessive rituals further convinces the brain that the danger is indeed real, and thus completes the vicious circle.

2. They feel an obsessive need to perform certain rituals.

Would you agree to stop doing the usual rituals (for example, not checking 20 times a day if Entrance door) if you were paid $10 or $100 or some other significant amount for you? If your anxiety is so easily bribed, then most likely you are just more afraid of robbers than usual, but you do not have OCD.

For a person suffering from this disorder, the performance of rituals seems to be a matter of life and death, and survival can hardly be valued in money.

3. It is very difficult to convince them that their fears are unfounded.

OCD sufferers are familiar with the verbal construction “Yes, but...” (“Yes, the last three tests showed that I do not have this or that disease, but how do I know that the samples were not mixed up in the laboratory?”). Since it is rarely possible to be absolutely sure of something, no amount of belief helps the patient overcome these thoughts, and he continues to be tormented by anxiety.

4. They usually remember when the symptoms started.

“Not everyone with OCD can tell exactly when the disorder first appeared, but most do remember,” Philipson says. At first, there is just an unreasonable anxiety, which then takes shape in a more specific fear - for example, that you, while preparing dinner, will suddenly stab someone with a knife. For most people, these experiences pass without consequences. But OCD sufferers seem to be falling into an abyss.

If the patient is afraid of pollution, the first exercise for him will be to touch the doorknob and not wash his hands afterwards.

“At such moments, panic makes an alliance with a certain idea. And it’s not easy to end it, like any unhappy marriage, ”Philipson says.

5. They are consumed by anxiety.

Almost all the fears that torment OCD sufferers have some basis. Fires do happen, and hands are really full of bacteria. It's all about the intensity of the fear.

If you are able to live a normal life despite the constant uncertainty associated with these risk factors, you most likely do not have OCD (or a very mild case). Problems begin when anxiety completely consumes you, preventing you from functioning normally.

Fortunately, OCD can be adjusted. Medications play an important role in therapy, including some types of antidepressants, but psychotherapy, especially cognitive behavioral therapy (CBT), is equally effective.

Within CBT, there is an effective treatment for OCD called reaction-avoidance exposure. In the course of treatment, the patient, under the supervision of a therapist, is specifically placed in situations that cause increasing fear, while he must not succumb to the desire to perform the usual ritual.

For example, if the patient is afraid of pollution and constantly washes his hands, the first exercise for him will be to touch the doorknob and not wash his hands after that. In the following exercises, the perceived danger is increased - for example, you will need to touch the handrail on the bus, then the faucet in the public toilet, and so on. As a result, fear gradually begins to subside.

In Russia, the diagnosis of obsessive-compulsive disorder (OCD) and other disorders from its group has always caused a lot of controversy and controversy, and often people suffering from this disorder undeservedly received a stigmatizing diagnosis "" and did not have access to modern methods treatment.

Previously, obsessive-compulsive disorder was classified as a group, but now it is increasingly isolated as a separate group of diseases that have similar neurobiological, phenomenological, psychopathological features, as well as comparable approaches to therapy. In the latest revision of the DSM-5 American Classification of Mental Disorders, a group of obsessive-compulsive disorders has taken its place next to anxiety and stress-related disorders. It includes categories such as OCD (obsessive-compulsive disorder), body dysmorphic disorder ( body dysmorphic disorder), trichotillomania (compulsive hair pulling), and compulsive excoriations ( excoriation disorder).

Obsessions, anxiety, compulsions

Obsessive-compulsive disorder has several symptoms.

obsessions are obsessive thoughts, desires, doubts or images that cause anxiety. For example, an obsessive fear of contracting a dangerous infection or unacceptable thoughts of a sexual, religious nature, the fear of looking ridiculous or being dangerous to other people. The more a person tries not to think about it, to get distracted and stop worrying, the more often he returns to these thoughts and images again and again, they flood the consciousness more and more and cause pronounced anxiety.

A person suffering from obsessions is trying to cope with this condition, to do something to prevent an imaginary danger to himself or others, as well as to reduce his own anxiety, discomfort, and feel relief. These actions are called compulsions, and sometimes they become excessive and even pretentious. For example, people who have an obsessive fear of pollution may wipe all surfaces of the apartment with alcohol, wash their hands many times a day, or go out only with gloves. Those who are wary of their own taboo thoughts, such as those about sex or religion, actively avoid having sex or visiting religious places.

But if a collision with a frightening stimulus is nevertheless inevitable, then compulsions (otherwise called rituals) help to neutralize the danger. Rituals can be incomprehensible actions for people around: for example, a person needs to turn around himself several times, knock on wood, do something at certain hours and days of the week. The belief that, by observing certain rituals, we can influence reality, is called magical thinking in psychology. In everyday life, we regularly encounter it in the form of superstitions.

Sometimes obsessive actions (compulsions) are not associated with negative emotions. Such manifestations include, for example, obsessive counting, singing, or a desire not to step on the joints of tiles on the sidewalk.

In any obsessive-compulsive disorder, there is a triad: obsessive thoughts - obsessions, the anxiety they cause, and actions aimed at reducing anxiety - compulsions. The relief that results from these actions is usually temporary. In the long term, compulsions do not help, but only support the problem and maladjust the person.

With OCD, a person spends a lot of time on obsessive thoughts and compulsive actions. Everyday life, relationships with loved ones begin to suffer. It is not possible to find time for important things, as the symptoms of the disorder take more and more time - up to several hours a day, and in some cases even all day. Symptoms of obsessive-compulsive disorder significantly reduce the ability to work: in patients aged 15 to 44 years, the World Health Organization lists OCD as one of the twenty most frequently disabling diseases.

Different forms of OCD

There are various types of obsessive-compulsive disorder. Some people have more pronounced obsessions, others have compulsions. For example, trichotillomania - the compulsive pulling of hair from the head - is manifested only by compulsions, and the obsessive part is either absent or not realized.

Intrusive thoughts and compulsive actions are individual, but there are typical anxiety themes that are most common among people with OCD. For example, many forms of OCD are associated with a sense of heightened responsibility for oneself or others. A typical fear is the fear of contamination or infection. Touching dirty surfaces, objects that have been on the street, touching the floor, with shoes, a person fears that he may get dirty or contract a dangerous disease, and his compulsive actions are aimed at trying to clean his hands, body, clothes after a collision with the outside world.

There is also the concept of "mental dirt", when a person feels dirty and compulsively seeks to be cleansed when morally unacceptable and unpleasant thoughts appear to him. Often taboo, "blasphemous" thoughts are associated with this type of OCD. A deeply religious person may think of an obscene scene of a religious nature, and a person of high moral behavior may have an obsessive thought that he is committing obscene acts in a public place. In such cases, mental rituals may appear: for example, immediately after a “bad” thought, think about something good.

Ideas related to order, symmetry, and the perfect execution of actions or rituals are frequent. A person has an obsessive thought that it is necessary to lay out clothes in a closet in a strict order, sort them by color or other characteristics, ideally park a car, leave things in strictly designated places for them, and if this is not done, something bad can happen. .

Another typical manifestation is an obsessive fear of harming others. Obsessive-compulsive disorder often occurs in young mothers in the early postpartum period in the form of fear of harming their child: “What if I drop the baby, take a knife or throw it out the window?” A mother may compulsively hide all sharp objects, distrust herself, and ask only her husband to rock, bathe, and swaddle the baby.

Intrusive thoughts are not always a disorder

Can intrusive thoughts occur normally? Canadian scientists conducted a multicenter study in 14 countries [ 1]DA Clark, 2014. Healthy people were asked if they had ever had obsessive thoughts or thoughts, the content of which seemed to them strange, unacceptable. The results of this study showed that normally 80% of people have such thoughts periodically, more often during stressful periods.

Why doesn't a single obsessive thought that occurs to most people become a disorder? Most of us don't rate obsessions as something frightening or abnormal: a strange thought came, twirled, and left. In obsessive-compulsive disorder, an obsessive thought is followed by anxiety or even fear, and then there is an obsessive desire to get rid of it - a compulsion, then another thought, and again a compulsion. The vicious circle is repeated many times and leads to maladjustment. That is, people who suffer from OCD are wary of intrusive thoughts, in contrast to people without OCD who treat strange ideas as "brain spam" that just comes to mind periodically.

It often happens that in the course of life one obsessive experience replaces another. For example, at 20 years old, a person was worried about the fear of infection, and at 25 years old, ideas of harm are disturbing. OCD symptoms increase with an increase in the overall level of stress, and weaken with a decrease. At the same time, there are observations that show that during times of severe shocks, such as wars or disasters, OCD symptoms could temporarily stop. Extreme stress can serve as an antidote, but only temporarily.

Statistics

There is no specific group of people who are more likely to have OCD. Obsessive-compulsive disorder can affect both adults and adolescents and children. The most common age of diagnosis is about 19–20 years, but there are cases of diagnosis after 35 years. Approximately 1.2% of US adults are thought to have OCD, with women diagnosed with it more than men: 1.8% versus 0.5%. More than half of patients hide the symptoms of obsessive-compulsive disorder. Between the onset of obsessive-compulsive disorder and the visit to the doctor, on average, 12-14 years pass.

Genetics and biology of OCD

There are studies that confirm that there is a genetic predisposition to developing OCD. This is a polygenic disease: we cannot identify a single gene that is responsible for the disorder. So far, we can say for sure: if a parent has OCD, the likelihood that a child or teenager will have OCD is higher than in the average population. How much higher is unknown. We are talking about increased risks, and not the absolute inheritance of a genetic predisposition.

Biological determinants show that people with OCD have more anxious brains. Their limbic system is more reactive. The frontal cortex, which is responsible for the cognitive regulation of emotions, responds more slowly to emotional outbursts. This is not about structural features, but about the features of the functioning of the brain of people with OCD. At the same time, numerous studies of the structure of the brain of OCD patients and possible neuropsychological abnormalities did not reveal any pathologies in the anatomical structure of the brain. There is also evidence that the risk of OCD is higher in people who have experienced physical or sexual abuse or mental trauma in childhood. A number of cases have shown that people who had a streptococcal infection in childhood are at risk of developing OCD or OCD-like symptoms. Science cannot yet reliably explain this phenomenon.

Combination with other diseases

Obsessive-compulsive disorder is a separate disorder, it is not a symptom of another disease. This is very important, especially for the Russian context. A number of psychiatrists of the Soviet psychiatric school believed that obsessive-compulsive disorder does not exist, and its manifestations are symptoms of schizophrenia. In this regard, a large number of people suffering from obsessive-compulsive disorder have undeservedly received a severe, stigmatizing diagnosis. Now all over the world OCD is distinguished as a separate disease, it has its own diagnostic criteria, symptoms and strategies for effective treatment. It is very important that people receive the correct diagnosis and timely effective treatment.

People with OCD may have comorbid (coexisting) disorders. For example, against the background of obsessive-compulsive disorder, panic disorder may develop or individual panic attacks may occur. Or a person with OCD may develop depression after a long illness. A person can be so immersed in his experiences that he stops going out into the street, communicating with people around him. He understands that this is not normal, but he cannot do anything. Such a mode of life inevitably leads to the formation of secondary depression.

Medication and psychotherapy

There are several approaches to treating OCD. The most famous - drug treatment. It is carried out according to a clear protocol generally accepted in the world: they start with the drugs of the first choice, and if the drug does not work at maximum doses, they prescribe a second drug and evaluate its effectiveness for a certain time, and so on until the result is achieved.

The main group of drugs for the treatment of OCD are selective serotonin reuptake inhibitors. These drugs are usually used in higher dosages than for the treatment of depression. The effectiveness of treatment is assessed after 8–12 weeks, which is significantly later than the standard for anxiety or depressive disorders (6 weeks). If serotonin reuptake inhibitors do not work, another drug is used, the tricyclic antidepressant clomipramine, which has been shown to be very effective in treating OCD in many studies. Atypical antipsychotics may also be used in combination with antidepressants. With well-chosen therapy, symptoms can become significantly less intense or stop altogether.

In addition, psychotherapeutic treatment is widely used for OCD. Cognitive-behavioral therapy has proven its effectiveness here. The process of psychotherapy involves discussing the idea that people often suffer from anxiety when they perceive situations as more dangerous than they really are. Effective cognitive work helps a person to formulate an alternative, less threatening interpretation of what is happening, which coincides with his life experience and the ideas of other people. Later on, cognitive-behavioral therapists use exposure and reaction avoidance techniques to test these new interpretations. For example, a person with a fear of infection, who is afraid to touch surfaces in public places, together with the therapist, voluntarily holds his hand on such a surface for 10 seconds. At this moment, he has a strong anxiety, an acute desire to realize a compulsion - to remove his hand and go to wipe it with alcohol. Together with the therapist, the patient plans that he will not react in this way, hold for 10 seconds and will not go to wash his hand. When such actions are repeated many times, the anxiety for the tenth time is much less than the first, and if this is done enough times, the anxiety can be generally reduced. Many modern studies show that psychotherapy is more effective method treatment than pharmacotherapy, with fewer relapses.

In very severe or long-term disorders, drug treatment or psychotherapy alone does not give the desired result. Then a combination of drug and psychotherapeutic treatment will be effective.

ROC research

To date, a lot of research has been done on obsessive-compulsive disorder. We roughly understand the biological background and features of the psychological functioning of people with OCD. We know how to treat this disorder, but this knowledge is not enough. Still, there are cases in which we fail to help the patient with known methods, and we do not really understand why this happens. Now there are developments of new technological methods of providing assistance in resistant cases. This is done using the deep brain stimulation method. deep brain stimulation). An electrode is implemented into the brain, which stimulates the brain in a certain area and reduces the symptoms of OCD. Because it is an invasive treatment and its long-term effects are still poorly understood, deep brain stimulation remains in the area of ​​scientific research and is not used in practice.

Through psychological research, we know that in different cultures, obsessive-compulsive disorders can manifest themselves in specific ways, for example, if there are bad omens in the culture, compulsions can develop in response to these omens (“the black cat crossed the road”). We know that family context can influence the course of OCD. Indulgence in obsessions and compulsions of a sick family member, unfortunately, does not contribute to recovery, but to the consolidation of the disorder. The influence of social, cultural, family factors on the course of this disorder is now very interesting for science.

Research is underway in which experts are trying to explore the relationship between OCD and autism spectrum disorders. It was noted that certain correlations exist, but causal relationships have not yet been established. We still know very little about the genetics and biology of this disorder. Knowing more about OCD, we can be more effective in treating this disease, which is difficult for patients and their families.

I seem to have OCD. When is it time to see a psychotherapist?

If you notice any of the following symptoms, you should contact a psychotherapist. If the specialist confirms the diagnosis, you will get help.

Strange, unpleasant, disturbing thoughts often come to mind. You don't want to think about it, but thoughts keep coming beyond your will.

Anxious thoughts take up more than one hour a day, cumulatively.

Thoughts begin to seriously interfere, causing great anxiety or anxiety.

Due to obsessive thoughts, you have to skip important things, cancel plans. A lot of time is spent dealing with disturbing ideas, usual life starts to fade into the background.

Many patients with obsessive-compulsive disorder are very embarrassed about their thoughts, they think that they are stupid, strange or dangerous. They feel embarrassed and try to talk less about them, because often even relatives can laugh and say: “Listen, well, some kind of stupidity” and not take their experiences seriously.

Why is it important to see a specialist as soon as possible? The sooner treatment is started, the more likely it will be easier to help the patient. With an early start of treatment, a person can be helped exclusively by psychotherapy, without the use of psychopharmacological agents.

It is also important to know when not to contact a psychotherapist. If you have a ridiculous thought in your head, an annoying song stuck in your head, or you have been thinking about something for several days and cannot get the thought out of your head, there is no need to panic. Remember the research: 80% of people at some time in their lives may experience intrusive thoughts. This is fine. So-called brain spam comes into our heads and is not a sign of a disorder. You should worry when you see that these thoughts take up too much of your time and because of them your life begins to change negatively.

OCD and falling in love

It is believed that falling in love resembles the symptoms of OCD. Indeed, falling in love is a mental fixation on one object. In terms of the power with which falling in love captures our thoughts, there really is a similarity. But at the same time, unlike OCD, falling in love is pleasant, as a rule, you don’t want to get rid of it. Being in love often helps a person, makes him more efficient and productive, unlike OCD, which can seriously impair the quality of life. These are different phenomena, and falling in love is a normal, healthy state of a person, and not at all an obsessive-compulsive disorder.

We thank Daria Maryasova, psychiatrist, psychotherapist, candidate of medical sciences, for her help in the scientific editing of the article.

obsessive-compulsive disorder(from lat. obsessio- "siege", "envelopment", lat. obsessio- “obsession with an idea” and lat. compello- "I force", lat. compulsion- "coercion") ( OKR, neurosis of obsessive states) - mental disorder . May be chronic, progressive or episodic.

In OCD, the sufferer involuntarily experiences intrusive, disturbing, or frightening thoughts (called obsessions). He constantly and unsuccessfully tries to get rid of the anxiety caused by thoughts with the help of equally obsessive and tedious actions (compulsions). Sometimes separate obsessional(mainly obsessive thoughts - F42.0) and separately compulsive(mainly obsessive actions - F42.1) disorders.

Obsessive-compulsive disorder is characterized by the development of obsessive thoughts, memories, movements and actions, as well as a variety of pathological fears (phobias).

To identify obsessive-compulsive disorder, the so-called Yale-Brown scale is used.

Epidemiology

CNCG study

OCD and intelligence

intellect

OCD, 5.5% - alcoholism, 3% - psychosis and affective disorders

Story

bipolar affective disorder

Antiquity and the Middle Ages

Intrusive27 phenomena have been known for a long time. From the IV century BC. e. obsessions were part of the structure of melancholia. So, her complex according to Hippocrates included:

"Fears and despondency that exist for a long time."

In the Middle Ages, such people were considered possessed.

new time

The first clinical description of the disorder belongs to Felix Platery (1614). In 1621, Robert Burton in his book Anatomy of Melancholy described the obsessive fear of death. Similar obsessive doubts, fears were described in 1660 by Jeremy Taylor and John Moore, Bishop of Ele. In 17th-century England, obsessive-compulsive states were also classified as "religious melancholy", but, on the contrary, they were believed to occur due to excessive devotion to God.

19th century

In the 19th century, the term “neurosis” was widely used for the first time, to which obsessions were ranked. Obsessions began to be differentiated from delusions, and compulsions from impulsive actions. Influential psychiatrists debated whether OCD should be classified as a disorder of the emotions, will, or intellect.

folie de doute

obsessive state Zwangsvorstellung obsession, and in the USA - English. compulsion

20th century

neurasthenia Pierre Maria Felix Jane identified this neurosis as psychasthenia in his work fr. psychasthenia phobic anxiety disorders Sigmund Freud paranoia psychoses like schizophrenia neuroses .

• fear of infection or pollution;
• fear of harming yourself or others;

Treatment

• b) There must be at least one thought or action that the patient unsuccessfully resists, even if there are other thoughts and/or actions that the patient no longer resists.
• c) The thought30 of performing a compulsive action should not in itself be pleasurable (simply reducing tension or anxiety is not considered pleasurable in this sense).
• d) Thoughts, images or impulses must be unpleasantly repetitive.

It should be noted that the performance of compulsive actions is not in all cases necessarily correlated with specific obsessive fears or thoughts, but may be aimed at getting rid of a spontaneously arising feeling of internal discomfort and / or anxiety.

It includes:

• obsessive-compulsive neurosis
• obsessional neurosis
• anancaste neurosis

In order to establish a diagnosis, it is necessary to first exclude anancaste personality disorder (F60.5).

Differential diagnosis according to ICD-10

The ICD-10 notes that the differential diagnosis between obsessive-compulsive disorder and depressive disorder (F 32 ., F 33 .) can be difficult because the two types of symptoms often occur together. In an acute episode, preference is given to the disorder whose symptoms occur first. When both are present but neither dominates, it is recommended to assume that the depression was primary. In chronic disorders, it is recommended to give preference to one of the disorders whose symptoms persist most often in the absence of symptoms of the other.

Random panic attacks (F41.0) or mild phobic (F40.) symptoms are not considered to preclude a diagnosis of OCD. However, obsessional symptoms that develop in the presence of schizophrenia (F 20 .), Gilles de la Tourette syndrome (F 95.2 .), or an organic mental disorder, are regarded as part of these conditions.

It is noted that although obsessions and compulsions usually coexist, it is advisable to establish one of these types of symptoms as dominant, since it may depend on how patients react to different types therapy.

Etiology and pathogenesis

Symptoms and behavior of patients. Clinical picture

Patients with OCD are suspicious people, prone to rare maximally decisive actions, which is immediately noticeable against the background of their dominant calmness. The main signs are painful stereotyped, obsessive (obsessive) thoughts, images or drives, perceived as meaningless, which in a stereotyped form again and again come to the mind of the patient and cause an unsuccessful attempt at resistance. Their typical themes include:

• fear of infection or pollution;
• fear of harming oneself or others;
• sexually explicit or violent thoughts and images;
• religious or moral ideas;
• fear of losing or not having some things that you may need;
• order and symmetry: the idea that everything should be lined up “correctly”;
• superstition, excessive attention to something that is seen as good luck or bad luck.

Compulsive actions or rituals are stereotyped actions repeated over and over again, the meaning of which is to prevent any objectively unlikely events. Obsessions and compulsions are more often experienced as alien, absurd and irrational. The patient suffers from them and resists them.

The following symptoms are indicators of obsessive-compulsive disorder:

• intrusive, repetitive thoughts;
• anxiety following these thoughts;
• certain and, in order to eliminate anxiety, often repeated identical actions.

A classic example of this disease is the fear of pollution, in which the patient has every contact with dirty, in his opinion, objects causes discomfort and, as a result, obsessive thoughts. To get rid of these thoughts, he begins to wash his hands. But even if at some point it seems to him that he has washed his hands enough, any contact with a “dirty” object forces him to start his ritual again. These rituals allow the patient to achieve temporary relief. Despite the fact that the patient is aware of the senselessness of these actions, he is not able to fight them.

obsessions

People with OCD experience intrusive thoughts (obsessions), which are usually unpleasant. Any minor events are capable of provoking obsessions - such as an extraneous cough, contact with an object that is perceived by the patient as non-sterile and non-individual (handrails, door handles etc.), as well as personal concerns not related to cleanliness. Obsessions can be frightening or obscene, often alien to the patient's personality. Exacerbations can occur in crowded places, for example, in public transport.

Compulsions

To combat obsessions, patients use protective actions (compulsions). Actions are rituals designed to prevent or minimize fears. Actions such as constantly washing hands and washing, spitting saliva, repeatedly avoiding potential danger (endless checking of electrical appliances, closing the door, closing the zipper in the fly), repeating words, counting. For example, in order to make sure that the door is closed, the patient needs to pull the handle a certain number of times (while counting the times). After performing the ritual, the patient experiences temporary relief, moving into an "ideal" post-ritual state. However, after some time, everything repeats again.

Etiology

At the moment, the specific etiological factor is unknown. There are several valid hypotheses. There are 3 main groups of etiological factors:

1. Biological:
   1. Diseases and functional and anatomical features of the brain; features of the functioning of the autonomic nervous system.
   2. Violations in the metabolism of neurotransmitters -5 in the first place, serotonin and dopamine, as well as norepinephrine and GABA.
   3. Genetic - increased genetic concordance.
   4. Infectious factor (PANDAS-syndrome theory).
2. Psychological:
   1. psychoanalytic theory.
   2. The theory of IP Pavlov and his followers.
   3. Constitutional-typological - various accentuations of personality or character.
   4. Exogenous-psychotraumatic - family, sexual or industrial.
3. Sociological (micro- and macro-social) and cognitive theories (strict religious education, environmental modeling, inadequate response to specific situations).

Psychological theories

Psychoanalytic theory

In 1827, Jean-Étienne Dominique Esquirol described one of the forms of obsessive-compulsive disorder - "disease of doubt" (fr. folie de doute). He vacillated between classifying it as a disorder of the intellect and the will.

I. M. Balinsky in 1858 noted that all obsessions have a common feature - alienation to consciousness, and proposed the term " obsessive state". The representative of the French psychiatric school, Benedict Augustin Morel, in 1860 considered the cause of obsessive states to be a violation of emotions through a disease of the autonomic nervous system, while the representatives of the German, W. Griesinger and his student Karl-Friedrich-Otto Westphal, in 1877 indicated that they emerge when unaffected in other respects the intellect and cannot be expelled from consciousness by it, and they are based on a thought disorder similar to paranoia. It is the term of the latter German. Zwangsvorstellung, translated into English in the UK as English. obsession, and in the USA - English. compulsion gave the modern name to the disease.

20th century

In the last quarter of the 19th century, neurasthenia included a huge list of different diseases, including OCD, which was still not considered a separate disease. In 1905, Pierre Maria Felix Janet singled out this neurosis from neurasthenia as a separate disease and called it psychasthenia in his work fr. Les Obsessions and la Psychasthenie(Obsessions and Psychasthenia). In the same year, S. A. Sukhanov systematized the data about him. The term "psychasthenia" became widely used in Russian and French science, while in German and English the term "obsessive-compulsive disorder" was used. In the United States, it began to be called obsessive-compulsive neurosis. The difference here is not only in terminology. In Russian psychiatry, obsessive-compulsive disorder is understood not only as obsessive-compulsive disorder, but also as phobic anxiety disorders (F40.), which have different designations both in ICD-10 and in DSM-IV-TR. P. Janet and other authors considered OCD as a disease caused by congenital features of the nervous system. In the early 1910s, Sigmund Freud referred obsessive-compulsive behavior to unconscious conflicts that manifest as symptoms. E. Kraepelin placed him not to psychogenies, but to "constitutional mental illness" along with manic-depressive psychosis and paranoia. Many scientists attributed it to psychopathy, and K. Kolle and some others - to endogenous psychoses such as schizophrenia, but at the moment it is attributed specifically to neuroses.

Treatment and therapy

Modern therapy of obsessive-compulsive disorders must necessarily provide for a complex effect: a combination of psychotherapy with pharmacotherapy.

Psychotherapy

The use of cognitive-behavioral psychotherapy gives its results. The idea of ​​treating OCD with cognitive behavioral therapy is promoted by the American psychiatrist Jeffrey Schwartz. The technique he developed allows the patient to resist OCD by changing or simplifying the procedure of "rituals", reducing it to a minimum. The basis of the technique is the patient's awareness of the disease and step-by-step resistance to its symptoms.

According to Jeffrey Schwartz's four-step method, it is necessary to explain to the patient which of his fears are justified and which are caused by OCD. It is necessary to draw a line between them and explain to the patient how a healthy person would behave in this or that situation (it is better if a person representing authority for the patient serves as an example). As an additional technique, the “thought stop” method can be used.

According to some authors, the most effective form of behavioral therapy for OCD is exposure and prevention. Exposure consists of placing the patient in a situation that provokes the discomfort associated with obsessions. At the same time, the patient is given instructions on how to resist the performance of compulsive rituals - the prevention of a reaction. According to many researchers, most patients achieve sustained clinical improvement after this form of therapy. Randomized controlled trials have shown that this form of therapy is superior whole line other types of interventions, including placebo drugs, relaxation, and anxiety management skills training.

Unlike drug therapy, after the withdrawal of which the symptoms of obsessive-compulsive disorder often worsen, the effect achieved by behavioral psychotherapy persists for several months and even years. Compulsions usually respond better to psychotherapy than obsessions. The overall effectiveness of behavioral psychotherapy is approximately comparable to drug therapy and is 50-60%, but many patients refuse to participate in it because of fear of increased anxiety.

Group, rational, psychoeducational (teaching the patient to be distracted by other stimuli that alleviate anxiety), aversive (use of painful stimuli when obsessions appear), family and some other methods of psychotherapy are also used.

In the presence of severe anxiety in the first days of pharmacotherapy, it is advisable to prescribe benzodiazepine tranquilizers (clonazepam, alprazolam, gidazepam, diazepam, phenazepam). At chronic forms OCD, not amenable to treatment with antidepressants of the serotonin reuptake inhibitor group (about 40% of patients), is increasingly used atypical antipsychotics (risperidone, quetiapine).

According to numerous studies, the use of benzodiazepines and neuroleptics has a mainly symptomatic (anxiolytic) effect, but does not affect nuclear obsessive symptoms. Moreover, the extrapyramidal side effects of classic (typical) neuroleptics can lead to an increase in compulsions.

There is also evidence that some of the atypical antipsychotics (with antiserotonergic effects - clozapine, olanzapine, risperidone) can cause and exacerbate obsessive-compulsive symptoms. There is a direct relationship between the severity of such symptoms and doses/duration of use of these drugs.

To enhance the effect of antidepressants, you can also use mood stabilizers (lithium preparations, valproic acid, topiramate), L-tryptophan, clonazepam, buspirone, trazodone, gonadotropin-releasing hormone, riluzole, memantine, cyproterone, N-acetylcysteine.

biological therapy

It is used only in severe OCD, refractory to other types of treatment. In the USSR, in such cases, atropinocomatous therapy was used.

In the West, electroconvulsive therapy is used in these cases. However, in the CIS countries, the indications for it are much narrower, and it is not used for this neurosis.

Physiotherapy

According to data for 1905, for the treatment of obsessive-compulsive disorder in pre-revolutionary Russia, they used:

1. Warm baths (35 ° C) lasting 15-20 minutes with a cool compress on the head in a well-ventilated room 2-3 times a week with a gradual decrease in water temperature in the form of rubdowns and douches.
2. Rubbing and dousing with water from 31 ° C to 23-25 ​​° C.
3. Bathing in river or sea water.

Prevention

1. Primary psychoprophylaxis:
   1. Prevention of psychotraumatic influences at work and at home.
   2. Prevention of iatrogenic and didactogeny (proper upbringing of a child, for example, not instilling in him opinions about his inferiority or superiority, not generating a deep fear and guilt when committing "dirty" acts, healthy relationships between parents).
   3. Prevention of family conflicts.
2. Secondary psychoprophylaxis (relapse prevention):
   1. Changing the attitude of patients to psycho-traumatic situations through conversations (treatment by persuasion), self-hypnosis and suggestion; timely treatment when they are detected. Conducting regular check-ups.
   2. Contributing to an increase in brightness in the room - remove blackout curtains, use bright lighting, make the most of daylight hours, phototherapy. Light promotes the production of serotonin.
   3. Restorative and vitamin therapy, sufficient sleep.
   4. Diet therapy (complete nutrition, refusal of coffee and alcoholic beverages, include in the menu foods with a high content of tryptophan (amino acids from which serotonin is formed): dates, bananas, plums, figs, tomatoes, milk, soy, dark chocolate).
   5. Timely and adequate treatment of other diseases: endocrine, cardiovascular, especially cerebral atherosclerosis, malignant neoplasms, iron and vitamin B12 deficiency anemia.
   6. Be sure to avoid the occurrence of drunkenness, and even more so alcoholism, drug addiction and substance abuse. The use of alcoholic beverages irregularly in small quantities acts as a sedative, so it cannot provoke a relapse. The effect of "soft drugs" such as marijuana on OCD recurrence has not been studied, so they are also best avoided.
3. All of the above applies to individual psychoprophylaxis. But it is necessary to carry out social psychoprophylaxis at the level of institutions and the state as a whole - the improvement of work and living conditions, service in the armed forces.

Forecast

Chronization is most characteristic of OCD. Episodic manifestation of the disease and complete recovery is relatively rare (acute cases may not recur). In many patients, especially with the development and preservation of one type of manifestation (arithmomania, ritual handwashing), a long-term stable condition is possible. In such cases, there is a gradual mitigation of psychopathological symptoms and social readaptation.

In mild forms, the disease usually occurs on an outpatient basis. The reverse development of manifestations occurs after 1-5 years from the moment of detection. Mild symptoms may remain that do not significantly interfere with functioning, except during periods of increased stress or situations in which a comorbid Axis I disorder develops (see DSM-IV-TR), such as depression.

More severe and complex OCD, with contrasting beliefs, multiple rituals, phobias complication of infection, pollution, sharp objects, and apparently related obsessions or cravings, on the contrary, may become resistant to treatment or show a tendency to relapse (50 -60% in the first 3 years) with persistent disorders despite active therapy. Further deterioration of these conditions indicates a gradual aggravation of the disease as a whole. Obsessions in this case may be prone to expansion. A common reason for their amplification is either the resumption of a traumatic situation, or a weakening of the body, overwork and prolonged lack of sleep.

Attempts are being made to establish which patients require long-term therapy. Approximately two-thirds of OCD patients improve within 6 months to 1 year, more often by the end of this period. In 60-80%, the condition does not just improve, but almost recovery occurs. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of remission lasting from several months to several years. The prognosis is worse if we are talking about an anancaste person with severe symptoms of the disease, or if there is continuous stress 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. Therefore, successful medical treatment must be continued for 1-2 years before discontinuation is considered and discontinuation of pharmacotherapy should be carefully considered, most patients are advised to continue with some form of treatment. There is evidence that CBT may have a longer lasting effect than some SSRIs after discontinuation. It has also been proven that people whose improvement is based only on drug therapy tend to experience relapses after discontinuation of the drug.

Without treatment, the symptoms of OCD can progress to the point where they affect the patient's life, impair their ability to work and maintain important relationships. Many people with OCD have suicidal thoughts and about 1% commit suicide. Specific symptoms OCD rarely progresses to the development of physical disorders. However, symptoms such as compulsive handwashing can lead to dry and even damaged skin, and repeated trichotillomania can lead to crusting on the patient's head.

However, in general, OCD, in comparison with endogenous mental illnesses, like all neuroses, has a favorable course. Although the treatment of the same neurosis in different people can vary greatly depending on the social, cultural and intellectual level of the patient, his gender and age. Thus, the most successful results in patients aged 30-40 years, women and married.

In children and adolescents, OCD, on the contrary, is more stable than other emotional disorders and neuroses, and without treatment, after 2-5 years, a very small number of them fully recover.

Between 30% and 50% of children with obsessive-compulsive disorder continue to exhibit symptoms 2 to 14 years after diagnosis. Although the majority, along with those who underwent drug treatment (for example, SSRIs), have a slight remission, however, less than 10% achieve it completely. The reasons for the adverse effects of this disease are: poor initial response to therapy, history of tic disorders and psychopathy of one of the parents. Thus, obsessive-compulsive disorder is a serious and chronic disease for a significant number of children.

In some cases, a condition bordering on neurosis and an anancastic personality disorder is possible, which is favored by: personality accentuation according to the psychasthenic type, personality infantilism, somatic illness, prolonged psychotrauma, age over 30 years or prolonged OCD, developing in 2 stages:

1. Depressive neurosis (ICD-9:300.4 / ICD-10:F0, F33.0, F34.1, F43.21).
2. Obsessive borderline state (according to O. V. Kerbikov) with a predominance of obsessions, phobias and asthenia.

Characteristics of cognitive (cognitive) function

A 2009 study that used a set of neuropsychological tasks to evaluate 9 cognitive areas by a specific executive function center concluded that there were few neuropsychological differences between people with OCD and healthy participants when confounding factors were controlled for.

Labor expertise

Neuroses are usually not accompanied by temporary disability. In case of protracted neurotic conditions, the medical control commission (VKK) decides on changing working conditions and transferring to easier work. In severe cases, the VKK sends the patient to the Medical Labor Expert Commission (VTEK), which can determine the III group of disability and make recommendations regarding the type of work and working conditions (light duty, shortened working hours, work in a small team).

Legislation abroad

While research has shown that OCD sufferers are generally remarkably predisposed to ensure the safety of themselves and others, some legislations have a general mental illness law that may inadvertently adversely affect the civil rights and freedoms of OCD sufferers.

Statistical data

At the moment, information on the study of the epidemiology of OCD is very contradictory. This is due to different methodological approaches to its calculation, which have developed historically in connection with different diagnostic criteria, as well as insufficient research of the disorder, dissimulation and overdiagnosis.

Quite often, the prevalence of OCD is indicated in the range of 1-3%. According to other clarified data, its prevalence is approximately 1-3:100 in adults and 1:200-500 in children and adolescents, although clinically recognized cases are less common (0.05-1%), since many people may not have this disorder. diagnosed due to stigmatization.

The beginning of the disease. First medical consultation. duration. Severity of OCD

Obsessive-compulsive disorder most often begins between the ages of 10 and 30. In this case, the first visit to a psychiatrist usually occurs only between 25 and 35 years. It can take up to 7.5 years between the onset of the disease and the first consultation. Average age hospitalization - 31.6 years.

The OCD propagation period increases in proportion to the observation period. For a period of 12 months, it is equal to 84:100000, for 18 months - 109:100000, 134:100000 and 160:100000 for 24 and 36 months, respectively. This rise exceeds that expected for a chronic disease with essential care in a stable population. During the 38 months available for the study, in 43% of patients, the diagnosis made during the study was not included in the official outpatient medical record. 19% did not visit a psychiatrist at all. However, 43% of patients visited a psychiatrist at least once during 1998-2000. The average frequency of visits to a psychiatrist for 967 patients is 6 times in 3 years. Based on these data, it can be concluded that patients with obsessive-compulsive disorder are under-managed.

At first medical examination, only one in 13 new cases in children and adolescents and one in 23 adults had a Yale-Brown degree of OCD in the English study. CNCG study was hard. If 31% of cases with questionable criteria are not taken into account, the number of such cases increases to 1:9 in persons under 18 years of age and 1:15 after. The proportion of mild, moderate and severe severity was the same among both newly diagnosed cases of OCD and among cases previously identified. It was 2:1:3=mild:medium:severe.

OCD and social conditions, including family life. Gender studies

OCD occurs in people of all socioeconomic levels. Studies on the distribution of patients by class are contradictory. According to one of them, 1.5% of patients belong to the upper social class, 23.81% to the upper middle class and 53.97% to the middle class. According to another, among patients from Santiago, the lower class showed a greater tendency to the disease. These studies are essential for public health, as patients from the lower class may not always receive the necessary care. The prevalence of OCD is also related to the level of education. The incidence of the disease is lower in those who graduated from a higher educational institution (1.9%) than in those who do not have a higher education (3.4%). However, among those who graduated from a higher educational institution, the frequency is higher among those who graduated with an advanced degree (respectively 3.1% : 2.4%). Most patients who come for a consultation cannot study or work, and if they can, they do it at a very low level. Only 26% of patients can work fully.

Up to 48% of OCD patients are single. If the degree of the disease is severe before the wedding, the chance for a marriage union decreases, and if it is concluded, in half the cases problems arise in the family.

There are some gender differences in the epidemiology of OCD. At the age of 65 years, the disease was more often diagnosed in men (except for the period of 25-34 years), and after - in women. The maximum difference with a predominance of sick men was observed in the period of 11-17 years. After 65, the incidence of obsessive-compulsive disorder dropped in both groups. 68% of those hospitalized are women.

OCD and intelligence

Patients with OCD are most often people with a high level of intelligence. According to various sources, among OCD patients, the frequency of high IQ is from 12% to 28.53%. At the same time, high rates of verbal IQ.

OCD and psychogenetics. Comorbidity

The twin method shows high concordance among monozygotic twins. According to studies, 18% of parents of patients with obsessive-compulsive disorder have mental disorders: 7.5% - OCD, 5.5% - alcoholism, 3% - anancaste personality disorder, psychosis and affective disorders - 2%. Among non-mental illnesses, relatives of patients with this disease often suffer from tuberculous meningitis, migraine, epilepsy, atherosclerosis, and myxedema. It is not known whether these diseases are associated with the occurrence of OCD in relatives of such patients. However, there are no absolutely accurate studies of the genetics of non-mental diseases among patients with obsessive-compulsive disorder. 31 patients out of 40 were the first or only child. However, no correlation was found between malformations and future development of OCD. The fertility rate in patients with this disease is 0-3 for both sexes. The number of premature babies in such patients is small.

25% of patients with OCD had no comorbid conditions. 37% had another mental disorder, 38% had two or more. The most commonly diagnosed conditions were major depressive disorder (MDD), anxiety disorder (including anxiety disorder), panic disorder, and acute stress reaction. 6% were diagnosed with bipolar affective disorder. The only difference in the sex ratio was that 5% of the women were diagnosed with an eating disorder. Among children and adolescents, 25% of patients with obsessive-compulsive disorder did not have other mental disorders, 23% had 1, and 52% had 2 or more. The most common were MDD and ADHD. At the same time, as among healthy individuals under 18 years of age, ADHD was more common in boys (in a particular case, 2 times). 1 in 6 was diagnosed with oppositional defiant disorder and anxiety disorder (F93.8). 1 out of 9 girls had an eating disorder. Boys often had Tourette's syndrome.

OCD in cinema and animation

• In Martin Scorsese's The Aviator, the lead character (Leonardo DiCaprio's Howard Hughes) suffered from OCD.
• As Good As It Gets, the main character (Melvin Adell, played by Jack Nicholson) suffered from OCD. He constantly washed his hands, and in boiling water and each time with new soap, wore gloves, ate only with his cutlery, was afraid to step on a crack in the asphalt, avoided being touched by strangers, had his own ritual of turning on the light and closing the lock.
• In Clinic, Dr. Kevin Casey, played by Michael J. Fox, suffers from OCD with many rituals.
• In Orson Scott Card's novel Xenocide, artificially bred "god-talkers" suffer from OCD, and their compulsive gestures are considered a rite of purification.
• Dirty Love is a realistic portrayal of the symptoms of OCD and Tourette's Syndrome, which cause the main character Mark, played by Michael Sheen, to lose his home, wife, and job.
• In Girls, the protagonist Hanna Horvath suffers from OCD, which is expressed in a constant count of up to eight.
• The title character of Monk suffers from OCD.
• In the movie The Inner Road, one of the main characters suffers from OCD.
• In The Big Bang Theory, protagonist Sheldon Lee Cooper (played by Jim Parsons) torments his friends about the rules and conditions of being around him because of OCD.
• In Glee, school psychologist Emma Pillsbury is obsessed with cleanliness because of her OCD.
• In the TV series Scorpio, one of the characters, Sylvester Dodd, suffers from OCD.

Data

• In 2000, a team of chemists (Donatella Marazziti, Alessandra Rossi and Giovanni Battista Cassano of the University of Pisa and Hagop Suren Akiskal of the University of California at San Diego) received the Ig Nobel Prize in Chemistry for their discovery that, on a biochemical level, romantic love is indistinguishable from severe obsessive-compulsive disorder.

Literature

• Freud Z. Beyond the Pleasure Principle (1920)
• Lacan J. L'Homme aux rats. Seminar 1952-1953
• Melman C. La nevrose obsessionelle. Seminar 1988-1989. Paris: A.L.I., 1999.
• V. L. GAVENKO, V. S. BITENSKY, V. A. ABRAMOV Psychiatry and narcology (mentor). - Kiev: Health, 2009. - P. 512. - ISBN 978-966-463-022-8. (ukr.)
• A. M. Svyadoshch. Obsessive-compulsive disorder (obsessive-compulsive and phobic neurosis). // Neuroses (a guide for doctors). - 4th, revised and supplemented. - St. Petersburg: Peter (publishing house), 1997. - S. 69-95. - 448 p. - ("Practical medicine"). - 7000 copies. - ISBN 5-88782-156-6.