What is Obsessive Compulsive Disorder?
Obsessive compulsive disorder – obsessive thoughts and / or actions. (in the French and national literature – psychasthenia, in the German – anancasma, in the Anglo-Saxon – obsessive-compulsive disorder). The main feature is repetitive obsessive thoughts or compulsive actions. Obsessive thoughts are ideas, images, or cravings that stereotyped again and again to the patient’s mind. They are almost always painful (because they have aggressive or obscene content, or simply because they are perceived as meaningless), and the patient often tries unsuccessfully to resist them. Nevertheless, they are perceived as their own thoughts, even if they arise involuntarily and are unbearable. Compulsive acts or rituals are repetitive stereotyped acts. They do not deliver internal pleasure and do not lead to the implementation of internally useful tasks. Their meaning is to prevent any objectively unlikely events that cause harm to the patient or by the patient. Usually, although not necessarily, such behavior is perceived by patients as senseless or fruitless, and he repeats attempts to resist him; in very long conditions, resistance may be minimal. Often there are vegetative symptoms of anxiety, but also characterized by internal stress or mental stress without obvious autonomic arousal. There is a close relationship between obsessive symptoms, especially obsessive thoughts, and depression. In patients with obsessive-compulsive disorder, depressive symptoms are often observed, and in patients with recurrent depressive disorder, obsessive thoughts may develop during depressive episodes. In both situations, the increase or decrease in the severity of depressive symptoms is usually accompanied by parallel changes in the severity of obsessional symptoms.
Obsessive compulsive disorders are divided into:
- Mostly obsessive thoughts or thoughts (mental chewing). They can take the form of ideas, mental images or impulses to actions. They are very different in content, but almost always unpleasant for the subject. Sometimes ideas are simply useless, including endless quasi-philosophical reasoning on unimportant alternatives. These non-resolving considerations on alternatives are an important part of many other obsessional reflections and are often combined with the impossibility of making trivial but necessary decisions in everyday life. The relationship between obsessive thinking and depression is especially close.
- Predominantly compulsive actions (obsessive rituals). Obsessive actions relating to continuous monitoring of the prevention of a potentially dangerous situation or order and accuracy. The basis of external behavior is fear, usually danger to the patient or the danger caused by the patient, and ritual action is fruitless or symbolic attempt to prevent danger. Compulsive ritual actions can take many hours a day every day and are combined with indecision and slowness. They are equally found in both sexes, but hand washing rituals are more characteristic for women, and slowness without repetition is for men. Compulsive ritual actions are less closely related to depression than obsessive thoughts, and more easily amenable to behavioral therapy.
- Mixed obsessive thoughts and actions. Elements of obsessive thinking and compulsive behavior are combined equally. This subcategory should not be applied if one of the disorders clearly dominates, as thoughts and actions can respond to different types of therapy.
Obsessive-compulsive disorder can equally be in men and women, and anankast traits often act as the basis of the personality.
Causes of Obsessive Compulsive Disorder
Biological factors play a role, in particular trauma in childbirth. A number of patients had EEG changes. The risk of obsessive-compulsive disorder in the immediate family is 3-7% compared with 0.5% in other types of anxiety disorders. More importance is attached to psychogenic factors, as well as disruption of normal growth and development.
Psychoanalysis examines rituals and related compulsions and obsessions, with fixation in the anal-sadistic phase or regression to this phase. A stereotypical return to a previous thought or action can be a method of tranquilization with a high level of anxiety or hiding aggression directed at someone from the immediate environment.
Pathogenesis during Obsessive Compulsive Disorder
The onset is usually in childhood or adolescence. The course is variable and in the absence of pronounced depressive symptoms, most likely its chronic type.
Symptoms of Obsessive Compulsive Disorder
Complaints of repetitive stereotypical, obsessive (obsessive) thoughts, images or cravings, perceived as meaningless, which in a stereotypical form again and again come to mind of the patient and cause an unsuccessful attempt to resist. Compulsive acts or rituals are repeated and repeated stereotypical acts, the meaning of which is to prevent any objectively unlikely events. Obsessions and compulsions are experienced as alien, absurd and irrational. The patient suffers from them and resists them. The most common obsessive fear of pollution (mizofobiya), which is accompanied by many hours of washing; obsessive doubts, accompanied by compulsive checks (whether the door is closed, the gas is turned off), and obsessive tardiness, in which the obsessions and compulsions are combined and the patient is very slow in performing his daily activities.
Predominantly obsessive thoughts or thoughts (mental chewing gum) (F42.0).
Subjectively unpleasant, useless ideas, fears, images, philosophical arguments on unimportant alternatives that do not lead to decisions. Z. Freud described the “rat man” syndrome as a fear of sharp objects and especially of a patient’s razor, which supplanted an aggressive view of a close fantasy of Chinese torture with a rat that was launched into the anus to the subject of torture.
Predominantly compulsive actions (obsessive rituals) (F42.1).
Obsessive actions relating to continuous monitoring of the prevention of a potentially dangerous situation or order and accuracy. Basically – fear (for example, the fear of pollution, leading to obsessive washing of hands). Compulsive ritual actions can take many hours a day every day and are combined with indecision and slowness. Often, both thinking and behavior are equally combined, in which case mixed obsessional thoughts and actions are diagnosed (F44.2).
Diagnosis of Obsessive Compulsive Disorder
For an accurate diagnosis, obsessional symptoms or compulsive actions, or both, should take place the largest number of days in a period of at least 2 weeks in a row and be a source of distress and disruption of activity. Obsessive symptoms should have the following characteristics:
- they should be regarded as the patient’s own thoughts or impulses;
- there must be at least one thought or action that the patient resists unsuccessfully, even if there are others that the patient no longer resists;
- the idea of performing an action should not be pleasant per se (a simple reduction of tension or anxiety is not considered pleasant in this sense);
- thoughts, images or impulses must be unpleasantly repetitive.
Although obsessional thoughts and compulsive actions usually coexist, it is advisable to establish one of these types of symptoms as dominant in some patients, since they can respond to different types of therapy.
It should be noted: Compulsive actions are not necessarily in all cases related to specific obsessive fears or thoughts, but may be aimed at getting rid of the spontaneously arising feeling of internal discomfort and / or anxiety.
Differential Diagnosis: A differential diagnosis between obsessive-compulsive disorder and depressive disorder can be difficult because these 2 types of symptoms often occur together. In the acute episode, preference should be given to the disorder, the symptoms of which arose first; when both are represented, but neither dominates, it is usually best to consider depression as primary. In chronic disorders, preference should be given to those of them, whose symptoms persist most often in the absence of the symptoms of the other.
Accidental panic attacks or mild phobic symptoms are not an obstacle to diagnosis. However, obsessive symptoms that develop in the presence of schizophrenia, Gilles de la Tourette syndrome, or organic mental disorder should be regarded as part of these conditions.
Treatment of Obsessive Compulsive Disorder
Antidepressants, especially tricyclic, in particular, melipramine, tetracyclic (mianserin, maprotilin (lyudiomil), anticonvulsants, in particular carbamazepine, paradoxical intention in the field of behavioral therapy, psychoanalysis, with heavy obsessions – electro-convulsive therapy.