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

With OCD, the patient involuntarily experiences intrusive, disturbing or frightening thoughts (so-called obsessions). He constantly and unsuccessfully tries to get rid of anxiety caused by thoughts through equally obsessive and tiresome actions (compulsions). Sometimes it stands out separately obsessive(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

intelligence

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

Story

bipolar affective disorder

Antiquity and the Middle Ages

Obsessive27 phenomena have been known for a long time. From the 4th century BC. e. obsessions were part of the structure of melancholia. So, her complex according to Hippocrates included:

“Fears and despondency that have existed 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 Plater (1614). In 1621, Robert Barton described in his book “The Anatomy of Melancholy” obsessive fear of death. Similar obsessive doubts and fears were described in 1660 by Jeremy Taylor and John Moore, Bishop of El. In England in the 17th century, obsessive states were also classified as “religious melancholy,” but, on the contrary, they were believed to occur due to excessive dedication to God.

19th century

In the 19th century, the term “neurosis” became widespread for the first time, and obsessions were included in this category. Obsessions began to be differentiated from delusions, and compulsions from impulsive actions. Influential psychiatrists have debated whether OCD should be classified as a disorder of the emotions, will, or intellect.

folie de doute

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

XX century

neurasthenia Pierre Marie Felix Janet identified this neurosis as psychasthenia in his work fr. psychasthenia phobic anxiety disorders Sigmund Freud paranoia psychoses such as schizophrenia neuroses.

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

Treatment

• b) There must be at least one thought or action that the patient is unsuccessfully resisting, even if there are other thoughts and/or actions that the patient is no longer resisting.
• c) The thought30 of performing an obsessive action should not in itself be pleasant (merely reducing tension or anxiety is not considered pleasant in this sense).
• d) The 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
• obsessive neurosis
• anancaste neurosis

To make a diagnosis, it is necessary to first exclude anancastic personality disorder (F60.5).

Differential diagnosis according to ICD-10

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

Occasional panic attacks (F41.0) or mild phobic (F40.) symptoms are not considered a barrier to a diagnosis of OCD. However, obsessive 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 the dominant one, since this may determine how patients respond to different types of 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 calm. The main signs are painful stereotypical, intrusive (obsessive) thoughts, images or desires, perceived as meaningless, which in a stereotypical form come to the patient’s mind again and again and cause an unsuccessful attempt at resistance. Their typical topics include:

• fear of infection or contamination;
• fear of harming yourself 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 considered as good or bad luck.

Compulsive actions or rituals are stereotypical behaviors 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:

• obsessive, recurring 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 experiences every contact with what he considers dirty objects causing discomfort and, as a result, obsessive thoughts. To get rid of these thoughts, he starts washing his hands. But even if at some point it seems to him that he has washed his hands sufficiently, 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 realizes the meaninglessness of these actions, he is not able to fight them.

Obsessions

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

Compulsions

To combat obsessions, patients use protective actions (compulsions). Activities are rituals designed to prevent or minimize fears. Actions such as constantly washing hands and face, spitting saliva, repeatedly avoiding potential danger (endlessly checking electrical appliances, closing the door, closing the zipper on 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 itself again.

Etiology

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

1. Biological:
   1. Diseases and functional-anatomical features of the brain; features of the functioning of the vegetative nervous system.
   2. Disturbances in the exchange of neurotransmitters - primarily 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 I.P. Pavlov and his followers.
   3. Constitutional-typological - various accentuations of personality or character.
   4. Exogenously-psychotraumatic - family, sexual or industrial.
3. Sociological (micro- and macrosocial) and cognitive theories (strict religious education, modeling of the environment, inadequate response to specific situations).

Psychological theories

Psychoanalytic theory

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

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

XX 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 Marie Felix Janet isolated this neurosis from neurasthenia as a separate disease and called it psychasthenia in his work fr. Les Obsessions et la Psychasthenie(Obsessions and Psychasthenia). In the same year, data about him were systematized by S. A. Sukhanov. The term “psychasthenia” became widely used in Russian and French science, while in German and English the term “obsessive-compulsive neurosis” was used. In the USA it became known as obsessive-compulsive neurosis. The difference here is not only in terminology. In domestic psychiatry, obsessive-compulsive disorder is understood not only as obsessive-compulsive disorder, but also as phobic anxiety disorders (F40.), which have different designations in both ICD-10 and DSM-IV-TR. P. Janet and other authors considered OCD as a disease caused by congenital features nervous system. In the early 1910s, Sigmund Freud attributed obsessive-compulsive behavior to unconscious conflicts that manifest as symptoms. E. Kraepelin placed it not among psychogeniuses, but among “constitutional mental illnesses” 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 classified specifically as neuroses.

Treatment and therapy

Modern therapy for obsessive-compulsive disorder must necessarily include a complex effect: a combination of psychotherapy and pharmacotherapy.

Psychotherapy

The use of cognitive behavioral psychotherapy is producing results. The idea of ​​treating OCD with cognitive behavioral therapy is promoted by 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 a given situation (it is better if the example is a person who represents an authority for the patient). As an additional technique, the “thought stopping” method can be used.

According to some authors, the most effective form of behavioral therapy for OCD is the exposure and warning method. Exposure involves 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 performing compulsive rituals - preventing a reaction. According to many researchers, most patients achieve lasting clinical improvement after this form of therapy. Randomized controlled trials have shown that this form of therapy is superior to a range of other 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 due to fear of increased anxiety.

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

If there is severe anxiety in the first days of pharmacotherapy, it is advisable to prescribe benzodiazepine tranquilizers (clonazepam, alprazolam, gidazepam, diazepam, phenazepam). In chronic forms of OCD that cannot be treated with antidepressants of the serotonin reuptake inhibitor group (about 40% of patients), atypical antipsychotics (risperidone, quetiapine) are increasingly used.

According to numerous studies, the use of benzodiazepines and antipsychotics has a mainly symptomatic (anxiolytic) effect, but does not affect nuclear obsessional symptoms. Moreover, extrapyramidal side effects classical (typical) antipsychotics can lead to increased obsessions.

There is also evidence that some of the atypical antipsychotics (those with antiserotonergic effects - clozapine, olanzapine, risperidone) can cause and worsen obsessive-compulsive symptoms. There is a direct relationship between the severity of such symptoms and the 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 for severe OCD that is refractory to other types of treatment. In the USSR, atropinocomatosis therapy was used in such cases.

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

Physiotherapy

According to data for 1905, the following were used to treat obsessive-compulsive disorder in pre-revolutionary Russia:

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. Swimming in river or sea water.

Prevention

1. Primary psychoprophylaxis:
   1. Prevention of traumatic influences at work and at home.
   2. Prevention of iatrogeny and didactogeny ( proper upbringing a child, for example, do not instill in him an opinion about his inferiority or superiority, do not create a feeling of deep fear and guilt when committing “dirty” acts, healthy relationships between parents).
   3. Preventing family conflicts.
2. Secondary psychoprophylaxis (relapse prevention):
   1. Changing the attitude of patients to traumatic situations through conversations (persuasive treatment), self-hypnosis and suggestion; timely treatment when detected. Conducting regular medical examinations.
   2. Helping to increase brightness in a room is to remove thick curtains, use bright lighting, make the most of daylight hours, and light therapy. Light promotes the production of serotonin.
   3. General restorative and vitamin therapy, adequate sleep.
   4. Diet therapy (nutrition, avoidance of coffee) alcoholic drinks, include in the menu foods with a high content of tryptophan (the amino acid 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. It is imperative to avoid the occurrence of drunkenness and especially alcoholism, drug addiction and substance abuse. Drinking alcoholic beverages irregularly in small quantities has a sedative effect and therefore cannot provoke a relapse. The effect of using “soft drugs” such as marijuana on the relapse of OCD has not been studied, so they are also best avoided.
3. All of the above related to individual psychoprophylaxis. But it is necessary at the level of institutions and the state as a whole to carry out social psychoprophylaxis - improving the health of work and living conditions, service in the armed forces.

Forecast

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

In mild forms, the disease usually occurs on an outpatient basis. Reverse development of manifestations occurs within 1-5 years from the moment of discovery. There may be mild symptoms that do not significantly impair functioning except during periods of increased stress or situations in which a comorbid Axis I disorder (see DSM-IV-TR), such as depression, develops.

More severe and complex OCD with contrasting ideas, numerous rituals, complications with phobias of infection, pollution, sharp objects, and, obviously, obsessive ideas or compulsions associated with these phobias, on the contrary, may become resistant to treatment or show a tendency to relapse (50 -60% in the first 3 years) with disorders that persist despite active therapy. Further deterioration of these conditions indicates a gradual aggravation of the disease as a whole. Obsessions in this case may tend to expand. Common reason their intensification is either the resumption of a traumatic situation, or a weakening of the body, overwork and prolonged lack of sleep.

Efforts are being made to determine which patients require long-term therapy. In approximately two thirds of cases, improvement with OCD treatment occurs within 6 months to 1 year, most often by the end of this period. In 60-80% the condition not only improves, but practically recovers. If the disease continues for more than a year, fluctuations are observed during its course - periods of exacerbations alternate with periods of remission, lasting from several months to several years. The prognosis is worse if we are talking about an anancastic personality 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 had unchanged symptoms 13-20 years later. Therefore, successful drug treatment should be continued for 1–2 years before discontinuation is considered and discontinuation of pharmacotherapy should be carefully considered, with most patients being advised to continue some form of treatment. There is evidence that cognitive behavioral therapy may have a longer lasting effect than some SSRIs after discontinuation. It has also been proven that people whose condition improves based on drug therapy alone tend to experience relapses after stopping the drug.

No treatment OCD symptoms may progress to such an extent that they affect the patient's life, impairing his ability to work and maintain important relationships. Many people with OCD have suicidal thoughts, and about 1% commit suicide. Specific symptoms of OCD rarely progress to the development of physical impairment. However, symptoms such as compulsive hand washing can lead to dry and even damaged skin, and recurring trichotillomania can lead to crusting on the patient's scalp.

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 are in patients aged 30-40 years, women and married people.

In children and adolescents, OCD, on the contrary, is more persistent than other emotional disorders and neuroses, and without treatment after 2-5 years, very few 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 undergoing drug treatment (for example, SSRIs), experience a slight remission, less than 10% achieve it completely. The reasons for the adverse consequences of this disease are: a weak primary response to therapy, a history of tic disorders, and psychopathy of one of the parents. Thus, obsessive-compulsive disorder is a serious and chronic condition for a significant number of children.

In some cases, a condition bordering between neurosis and anancastic personality disorder is possible, which is favored by: personality accentuation according to the psychasthenic type, personality infantilism, somatic illness, long-term psychotrauma, age over 30 years or long-term 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 battery of neuropsychological tasks to assess 9 cognitive domains specifically centered on executive function concluded that there were few neuropsychological differences between people with OCD and healthy participants when confounding factors were controlled.

Labor expertise

Neuroses are usually not accompanied by temporary disability. In case of prolonged neurotic conditions, the medical control commission (MCC) decides on changing working conditions and transferring to a more light work. In severe cases, the VKK refers the patient to a medical-labor expert commission (VTEK), which can determine disability group III and give recommendations regarding the type of work and working conditions (light duty, shortened working hours, work in a small team).

Legislation abroad

Although research suggests that OCD sufferers are generally remarkably predisposed to keeping themselves and others safe, some legislation has blanket mental illness laws that may inadvertently have an adverse impact on the civil rights and liberties of OCD sufferers.

Statistical data

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

Quite often the prevalence of OCD is stated to be between 1-3%. According to other updated 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 may not have this disorder diagnosed due to stigma.

Beginning of the disease. First medical consultation. Duration. Severity of OCD

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

The period of spread of OCD 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 what would be expected for a chronic disease with the necessary medical care in a stable population. During the 38 months available for the study, 43% of patients did not have a study diagnosis recorded 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 per 967 patients is 6 times over 3 years. Based on these data, it can be concluded that patients with obsessive-compulsive disorder are not sufficiently supervised.

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

OCD and social conditions, including family life. Gender studies

OCD occurs in all socioeconomic levels. Studies on the distribution of patients into classes 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 significant for health care, since patients from the lower class cannot always get the help they need. The prevalence of OCD is also associated with educational level. The incidence of the disease is lower in those who have completed higher education (1.9%) than in those who have not. higher education(3.4%). However, among those who graduated from higher education, the frequency is higher among those who graduated with an advanced degree (respectively 3.1%: 2.4%). Most patients who come for consultation cannot study or work, and if they can, they do so at a very low level. Only 26% of patients can work fully.

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

There are certain 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 25-34 years), and after that - in women. The maximum difference with a predominance of sick men was observed in the period 11-17 years. After 65, the incidence of obsessive-compulsive disorder fell 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 data, among patients with OCD, the frequency of high IQ is from 12% to 28.53%. At the same time, high levels of verbal IQ.

OCD and psychogenetics. Comorbidity

The twin method shows high concordance among monozygotic twins. According to research, 18% of parents of patients with obsessive-compulsive disorder have mental disorders: 7.5% - OCD, 5.5% - alcoholism, 3% - anancastic 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 unknown 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 illnesses among patients with obsessive-compulsive disorder. 31 out of 40 patients were the first or only child. However, no correlation was found between the developmental defects and the 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% suffered from one other mental disorder, 38% from 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 gender ratio was that 5% of women were diagnosed with an eating disorder. Among children and adolescents, 25% of patients with obsessive-compulsive disorder had no 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 this particular case - 2 times). 1 in 6 was diagnosed with oppositional defiant disorder and excessive anxiety disorder (F93.8). 1 in 9 girls had an eating disorder. Boys often had Tourette's syndrome.

OCD in cinema and animation

• In Martin Scorsese's film The Aviator, the main character (Howard Hughes played by Leonardo DiCaprio) suffered from OCD.
• In the movie As Good As It Gets, the main character (Melvin Adell played by Jack Nicholson) suffered from a whole complex of OCD. He constantly washed his hands, in boiling water and with new soap each time, wore gloves, ate only with his own cutlery, was afraid of stepping on a crack in the asphalt, avoided the touch of strangers, had his own ritual of turning on the light and closing the lock.
• In the TV series Scrubs, Dr. Kevin Casey, played by Michael J. Fox, suffers from OCD with a lot of rituals.
• In Orson Scott Card's novel Xenocide, an artificially bred subspecies of people who speak to the gods suffer from OCD, and their compulsive gestures are considered a rite of purification.
• The film "Dirty Love" quite realistically depicts the symptoms of OCD and Tourette's syndrome, due to which the main character Mark, played by Michael Sheen, loses his home, wife and job.
• In the series "Girls" main character Hannah Horvath suffers from OCD, which involves constantly counting to eight.
• The title character of Monk suffers from OCD.
• In the movie "Inner Road" one of the main characters suffers from OCD.
• In The Big Bang Theory, main character Sheldon Lee Cooper (played by Jim Parsons) bullies his friends about the rules and conditions of being around him due to his OCD.
• In the series "Glee" school psychologist Emma Pillsbury is obsessed with cleanliness due to OCD.
• In the TV series Scorpio, one of the characters, Sylvester Dodd, suffers from OCD.

Data

• In 2000, a group of chemists (Donatella Marazziti, Alessandra Rossi and Giovanni Battista Cassano from the University of Pisa and Hagop Suren Akiskal from the University of California at San Diego) received the Ig Nobel Prize in chemistry for the discovery that at the level of biochemistry romantic love cannot be distinguished from severe obsessive-compulsive disorder.

Literature

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

Obsessive-compulsive disorder is mental illness person, otherwise called obsessive-compulsive neurosis. For example, a pathological urge to wash your hands two hundred times in one day due to thoughts of countless bacteria, or counting pages book to read in an effort to know exactly how much time to spend on one sheet, or returning home multiple times before work in doubt whether the iron or gas is turned off.

That is, a person suffering from obsessive-compulsive disorder suffers from obsessive thoughts that dictate the need for tedious, repetitive movements, which leads to stress and depression. This condition undoubtedly reduces the quality of life and requires treatment.

Description of the disease

The official medical term “obsessive-compulsive disorder” is based on two Latin roots: “obsession,” which means “being overwhelmed or besieged by an obsessed idea,” and “compulsion,” which means “compulsory action.”

Sometimes local disorders occur:

• a purely obsessive disorder, experienced only emotionally and not physically;
• separately compulsive disorder, when restless actions are not caused by clear fears.

Obsessive-compulsive disorder occurs in about three out of a hundred cases in adults and about two out of five hundred in children. Mental pathology can manifest itself in different ways:

• occur sporadically;
• progress from year to year;
• be chronic.

The first signs are usually observed no earlier than 10 years and rarely require immediate treatment. Initial obsessive-compulsive neurosis appears in the form of various phobias and strange obsessive states, the irrationality of which a person is able to understand independently.

By the age of 30, the patient may have already developed a pronounced clinical picture, with a refusal to perceive his fears adequately. In advanced cases, a person usually has to be hospitalized and treated for more effective methods than regular psychotherapeutic sessions.

Causes

Today, the exact etiological factors for the occurrence of obsessive-compulsive syndrome are unknown. There are only a few theories and assumptions.

Among the biological causes, the following factors are considered possible:

• pathologies of the autonomic nervous system;
• peculiarity of the transmission of electronic impulses in the brain;
• disturbance of the metabolism of serotonin or other substances necessary for normal functioning neurons;
• suffered traumatic brain injuries;
• infectious diseases with complications;
• genetic inheritance.

In addition to biological factors, obsessive-compulsive disorder can have a lot of psychological or social causes:

• psychotraumatic family relationships;
• strictly religious upbringing;
• work in stressful working conditions;
• experienced fear due to a real threat to life.

Panic fear may have roots in personal experience or be imposed by society. For example, watching crime news provokes anxiety about being attacked by robbers on the street or fear of car theft.

The person tries to overcome the obsessions that arise by repeating “control” actions: looking over his shoulder every ten steps, pulling the car door handle several times, etc. But such compulsions do not provide relief for long. If you don’t start fighting them in the form of psychotherapeutic treatment, obsessive-compulsive syndrome threatens to completely overwhelm a person’s psyche and turn into paranoia.

Symptoms in adults

Symptoms of obsessive-compulsive disorder in adults develop approximately the same clinical picture:

1. First of all, neurosis manifests itself in obsessive painful thoughts:

• about sexual perversions;
• about death, physical harm or violence;
• blasphemous or sacrilegious ideas;
• fears of diseases, viral infections;
• anxiety about the loss of material values, etc.

Such painful thoughts terrify a person with obsessive-compulsive disorder. He understands their groundlessness, but cannot cope with the irrational fear or superstition that all this will one day come true.

2. The syndrome in adults also has external symptoms, expressed in repetitive movements or actions:

• recalculation of the number of steps on the stairs;
• Very frequent washing hands;
• rechecking turned off taps and closed doors several times in a row;
• putting the table in symmetrical order every half hour;
• arranging books on a shelf in a certain order, etc.

All these actions are a kind of ritual to “get rid of” obsessive-compulsive disorder.

3. Obsessive-compulsive disorder tends to worsen in crowded places. In a crowd, the patient may experience periodic panic attacks:

• fear of infection due to the slightest sneeze from someone else;
• fear of coming into contact with the “dirty” clothes of other passers-by;
• nervousness due to “strange” smells, sounds, sights;
• fear of losing personal belongings or becoming a victim of pickpockets.

Due to such obsessive-compulsive disorders, a person with obsessive-compulsive neurosis tries to avoid crowded places.

4. Since obsessive-compulsive disorder affects, to a greater extent, people who are suspicious and have the habit of controlling everything in their lives, the syndrome is often accompanied by a very strong decrease in self-esteem. This happens because a person understands the irrationality of the changes happening to him and is powerless in the face of his own fears.

Symptoms in children

Obsessive-compulsive disorder occurs less frequently in children than in adults. But it has a similar obsessive state:

• the fear of getting lost in the crowd forces children who are already quite old to hold their parents’ hands and constantly check whether the hoop is tightly clasped together;
• the fear of ending up in an orphanage (if adults have at least once threatened such “punishment”) makes the child want to very often ask his mother if he is loved;
• panic at school over a lost notebook leads to a frantic counting of all school subjects while folding a briefcase, and at night waking up in a cold sweat and rushing back to this activity;
• obsessive complexes, which are intensified by the “persecution” of classmates because of dirty cuffs, can torment so much that the child completely refuses to go to school.

Obsessive-compulsive disorder in children is accompanied by sullenness, unsociability, frequent nightmares and poor appetite. Contacting a child psychologist will help you get rid of the syndrome faster and prevent its development.

What to do

Obsessive-compulsive personality disorder can occur occasionally in any person, even a completely mentally healthy person. It is very important to recognize the beginning symptoms at the very first stages and begin treatment with a psychologist, or at least try to help yourself by analyzing your own behavior and developing a certain defense against the syndrome:

Step 1. Learn what obsessive-compulsive disorder is.

Read the causes, symptoms and treatments several times. Write down on a piece of paper the signs that you observe. Next to each disorder, leave a space for detailed description and making a plan describing how to get rid of it.

Step 2. Ask for an outside assessment.

If you suspect obsessive-compulsive disorder, it is best, of course, to consult a specialist doctor who will help you start effective treatment. If the first visit is very difficult, you can ask loved ones or a friend to confirm the symptoms of the disorder that have already been written down or add some others that the person himself does not notice.

Step 3. Look your fears in the eye.

A person with obsessive-compulsive disorder is usually able to understand that all fears are just a figment of his imagination. If every time a new desire arises to wash your hands or check a locked door, you remind yourself of this fact and interrupt the next “ritual” with a simple effort of will, it will be easier and easier to get rid of obsessive neurosis.

Step 4. Praise yourself.

You need to celebrate the steps towards success, even the smallest ones, and praise yourself for the work you have done. When a person suffering from the syndrome at least once feels that he is stronger than his obsessive states, that he is able to control them, the treatment of neurosis will go faster.

If a person finds it difficult to find sufficient strength within himself to get rid of obsessive-compulsive neurosis, he should consult a psychologist.

Psychotherapy methods

Treatment in the form of psychotherapeutic sessions for obsessive-compulsive syndrome is considered the most effective. Today, specialist psychologists have in their medical arsenal several effective techniques to get rid of such obsessive-compulsive neurosis:

1. Cognitive behavioral therapy for the disorder. Founded by psychiatrist Jeffrey Schwartz, the idea is to resist the syndrome by keeping compulsions to a minimum and then to their disappearance. A step-by-step method of absolute awareness of one’s disorder and its causes leads the patient to decisive steps that help get rid of neurosis for good.

2. “Thought stopping” technique. Behavioral therapy theorist Joseph Wolpe formalized the idea of ​​using an “outside perspective.” A person suffering from neurosis is asked to remember one of the vivid situations when his obsessive states manifest themselves. At this moment, the patient is loudly told “Stop!” and the situation is analyzed using a number of questions:

• Is there a high chance that this could happen?
• How much does a thought interfere with living an ordinary life?
• How strong is the internal discomfort?
• Will life be simpler and happier without this obsession and neurosis?

Questions may vary. There may be many more. Their main task in the treatment of obsessive-compulsive neurosis is to “photograph” the situation, to examine it, as if in slow motion, to see it from all angles.

After this exercise, it becomes easier for a person to face fears and control them. The next time, when obsessive-compulsive neurosis begins to haunt him outside the walls of the psychologist’s office, the internal cry “Stop!” will be triggered, and the situation will take on completely different contours.

The given methods of psychotherapy are far from the only ones. The choice remains with the psychologist, after questioning the patient and determining the degree of obsessive-compulsive syndrome using the Yale-Brown scale, which was specially designed to identify the depth of neurosis.

Treatment with medications

Some complex cases of obsessive-compulsive disorder cannot be treated without medication. Especially when metabolic disorders necessary for the functioning of neurons were discovered. The main drugs for the treatment of neurosis are SRIs (serotonin reuptake inhibitors):

• fluvoxamine or escitalopram;
• tricyclic antidepressants;
• paroxetine, etc.

Modern scientific research in the field of neurology has discovered therapeutic potential in agents that release the neurotransmitter glutamate and help, if not get rid of neurosis, then significantly mitigate it:

• memantine or riluzole;
• lamotrigine or gabapentin;
• N-acetylcysteine, etc.

But conventional antidepressants are prescribed as a means of symptomatic action, for example, to eliminate neurosis, stress arising from constant obsessive states or mental disorders.

Psychologist, psychotherapist.

Obsessive-compulsive disorder(OCD) is a mental disorder characterized by intrusive, unpleasant thoughts that arise against the patient's will (obsessions) and actions whose goal is to reduce the level of anxiety.

To determine the severity of obsessive and compulsive symptoms, the following is used: (editor's note)

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

"An essential feature of the condition is the presence of repetitive or forced actions. Obsessive thoughts are ideas, images or impulses that come to the patient's head again and again in a stereotypical form. They are almost always distressing, and the patient often tries unsuccessfully to resist them. However, the patient considers these thoughts to be his own, even if they are involuntary and disgusting.
, or rituals, are stereotypical mannerisms that the patient repeats over and over again. They are not a way to gain pleasure or an attribute of performing useful tasks. These actions are a way to prevent the possibility of an unpleasant event occurring that the patient fears might otherwise occur, causing harm to him or her to another person. Typically, 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 has been living with a diagnosis of OCD: (editor's note)

Symptoms of obsessive-compulsive personality disorder

• The personality is concerned with details, lists, order to the extent that life goals are lost from sight.
• Exhibits perfectionism that interferes with the task of completion (unable to complete a project because his own standards are not met in this project).
• Overly devotes himself to work, productivity, productivity to the exclusion of rest and friendship, despite the fact that such an amount of work is not justified by economic necessity (the main interest is not money).
• The personality is hyper-conscious, scrupulous and inflexible in matters of morality, ethics, values ​​that do not include cultural and religious identification (intolerant).
• The personality is unable to get rid of damaged or useless items, even if they have no sentimental value.
• Resists delegating or working with other people until they are consistent with 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 saved for a rainy day to cope with future disasters.
• Shows 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 overloaded with duty and responsibility, the need to follow the rules that were once laid down by her parent. We may notice children around us who think and behave like adults. It's like they're in a hurry to grow up and take on adult responsibilities. Their childhood ends too early. From childhood, they try to do more or do better than what 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. When they become adults, they do not know how to relax, rest, or take care of their needs and desires. It often happens that one of the parents (or both) themselves had OCD and did not know how to relax and rest, devoting themselves to work or household chores. The child learns this behavior from them and tries to imitate his parents, considering this a kind of norm, “because it was customary in our family.”

Obsessive-compulsive individuals react very painfully to criticism. Because if they are criticized, it means they failed to do faster, better, more, and therefore they cannot treat themselves well, feel good. They are perfectionists. They are very stressed to get everything done that they set out to do, and they experience anxiety as soon as they realize that they have stopped doing something important. They are especially worried and feel guilty if they have any negative thoughts and reactions interfering with their work routine, and, of course, sexual thoughts, feelings and needs. They then use small rituals, such as counting, to escape intruding thoughts, or doing their tasks in a certain order so that they gain control and relieve their anxiety. Individuals with OCD expect the same high standards and perfection from other people, and can easily become critical when other people do not live up to their expectations. high standards. These expectations and frequent criticism can cause great difficulties in personal relationships. Some relationship partners perceive OCD individuals as boring because they focus on work and have great difficulty in relaxing, resting, and enjoying themselves.

Causes of obsessive-compulsive personality disorder

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

Examples of obsessive-compulsive disorder

The most common concerns are about cleanliness (for example, fear of dirt, germs, and infections), safety (for example, worrying about leaving the iron on in the house and causing a fire), and inappropriate sexual or religious thoughts (for example, thoughts about wanting sex with a “forbidden” partner – someone else’s spouse, etc.). The desire 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 can include entire chains of actions (for example, correctly exiting and entering a room, touching something with your hand, taking three sips of water, etc.) are also fairly common examples obsessive-compulsive disorder.

Every person is visited by unpleasant or frightening thoughts, but while most can easily brush them aside, for some this is impossible.

Such people think about why such a thought occurred to them, returning to it again and again. They can only get rid of it by performing certain actions.

In psychiatry this is called obsessive-compulsive disorder (OCD) or, in foreign literature obsessive compulsive.

Obsessions are frightening thoughts, images or impulses that do not leave a person. Compulsions are certain actions that help temporarily eliminate obsessive thoughts and reduce anxiety. The condition can progress, causing the person to have more and more compulsions, and be chronic or episodic.

Frequent intrusive thoughts

The most common obsessions and corresponding compulsions:

1. Fear of contracting a disease or fear of germs. In order to prevent this, a person tries to wash his hands or take a shower as often as possible, wash his clothes, and thoroughly wash all surfaces with which he comes into contact. This can take many hours every day.
2. Fear of harming yourself or your loved ones. The patient tries not to be alone or with the person he believes could cause harm. Hides potentially dangerous things, such as knives, ropes, heavy objects.
3. Fear that the right thing won't be available. A person repeatedly checks his pockets and bags to see if he forgot to put documents, essential items or medicines.
4. Order and symmetry. It must be in a room where everything is in its place and subject to certain rules. They are very careful to ensure that even small objects are placed in a certain order, for example, arranged in height or symmetrically. And if someone touches or places a folder on the table incorrectly, the person experiences emotional stress.
5. Superstitions. A person may fear that he will have bad luck if he does not perform a certain ritual. Thus, an OCD patient, leaving the house, had to put on “lucky” shoes, look in the mirror twice and stick out his tongue at himself, and pull the door handle seventeen times. If something unpleasant happened to him, he increased the number of actions.
6. Thoughts that are prohibited by religion or morality. In order to drive away images or inappropriate thoughts, a person can read a prayer or take donations to the church, giving the last.
7. Thoughts of a sexual nature with elements of cruelty. A person tries to avoid intimacy out of fear of committing an unacceptable act towards a partner.

Clinical manifestations of OCD

Compulsive-obsessive disorder has characteristic symptoms:

• thoughts should be perceived as your own, and not as a voice from above or another person;
• the patient resists these thoughts and tries unsuccessfully to switch to others.
• the thought that what is presented can happen frightens a person, makes him feel shame and guilt, causes tension and loss of activity;
• the obsession is often repeated.

OCD in its purest form

OCD may be dominated by compulsions or obsessions, but so-called OCD in its pure form also occurs.

Sufferers admit that they have obsessive thoughts that conflict with their beliefs and values, but consider that they do not have compulsive behavior, i.e., no ritual actions. In order to get rid of thoughts that cause fear and shame, they can spend hours explaining to themselves why they should not pay attention to it.

When working through the problem, it turns out that they perform certain actions to get rid of tension. These actions are not obvious to others. This could be reciting a prayer or spell, counting, clicking joints, stepping from foot to foot, shaking your head.

Causes of the disorder

Impulsive compulsive disorder is thought to be caused by a combination of biological, social, and psychological factors.

Modern medicine is able to visualize the anatomy and physiology of the human brain. Research has shown that there are a number of significant differences in brain function in people with OCD.

There are differences in the connections of various parts, for example, the anterior part of the frontal lobe, the thalamus and striatum, and the anterior cingulate cortex.

Anomalies were also found in the transmission of nerve impulses between neuron synapses. Scientists have identified a mutation in the genes of serotonin and glutamate transporters. As a result of the anomaly, the neurotransmitter is processed even before it transmits an impulse to another neuron.

A quarter of people with the disorder have relatives with the same condition, suggesting genetics.

Group A streptococcal infection can cause OCD because it causes malfunction and inflammation of the basal ganglia.

Psychologists say that people who have developed obsessive-compulsive personality disorder have some thinking characteristics:

1. Confident that they can control everything, even your own thoughts. If a thought appeared, it means that it was in the subconscious and the brain had been thinking about it for a long time, and, accordingly, it is part of the personality.
2. Hyperresponsibility. A person is responsible not only for actions, but also for thoughts.
3. Belief in the materiality of thought. If a person imagines something terrible, then it will happen. He believes that he is capable of causing trouble.
4. Perfectionism. A person has no right to make a mistake. He must be perfect.

Compulsive personality disorder most often occurs in a person who was brought up in a family where parents controlled all areas of the child’s life, making excessive demands and demanding ideal behavior from him.

In the presence of the two components listed above, the impetus for the manifestation of the disorder can be a stressful situation, overwork, overexertion or abuse of psychotropic substances. Stress can be caused by moving, changing jobs, threats to life and health, divorce, or the death of a loved one.

The actions of a person with obsessive-compulsive disorder are cyclical.

First, a certain thought arises that frightens and makes you feel shame and guilt about it. Then there is a concentration on this thought against the will. The result is mental tension and increasing anxiety.

The human psyche finds a way to calm down by performing stereotypical actions that he thinks will save him. Thus, short-term relief occurs. But the feeling of his abnormality due to the thought that has arisen does not leave him and he returns to it again. The cycle takes on a new turn.

What influences the development of neurosis

The more often the patient resorts to ritual actions, the more dependent he becomes on them. It's like a drug.

Disorders are reinforced by avoidance of situations or actions that cause obsessions. A person, trying not to face a potentially dangerous situation, still thinks about it and becomes convinced of his abnormality.

The situation can be aggravated by the behavior of loved ones who call the person suffering from the disorder crazy or forbid them to perform the ritual.

After all, if he is crazy, then he really can carry out the actions that he is so afraid of. And imposing a ban on compulsions leads to an increase in anxiety. But the opposite situation also happens, when relatives are involved in the performance of the ritual, thereby confirming its necessity.

Diagnosis and treatment

The symptoms of obsessive-compulsive disorder are similar to those of schizophrenia. Therefore, a differential diagnosis needs to be made. Especially if the obsessive thoughts are unusual and the compulsions are eccentric. The important thing is whether thoughts are perceived as your own or as imposed.

Depression is also often accompanied by OCD. If they are equally strong, then it is recommended that depression be considered primary.

The obsessive compulsive disorder test or Yale-Brown scale is used to determine the severity of the symptoms of the disorder. It consists of two parts of five questions: the first part allows you to understand how often obsessive thoughts appear and whether they can be attributed to OCD; the second part analyzes the impact of compulsions on everyday life.

If obsessive and compulsive disorder is not very pronounced, then a person can try to cope on his own. To do this, you need to learn to switch your attention to other actions. For example, start reading a book.

Postpone the ritual for 15 minutes, and gradually increase the delay time and reduce the number of ritual actions. This way you will understand that you can calm down without performing stereotypical actions.

If the severity is moderate or higher, you need to seek help from any of the specialists: psychotherapist, psychologist, psychiatrist.

If the disorder is severe, the psychiatrist will make a diagnosis and prescribe medication. Medications are prescribed to alleviate the condition - serotonin reuptake antidepressants or selective serotonin reuptake inhibitors. Atypical ones are also used to control symptoms. They will help you calm down and reduce anxiety.

However, drug treatment for compulsive obsessive disorder does not have a permanent effect. After the end of the reception drugs OCD is back. The most effective way is psychotherapy. With its help, almost 75% of those who seek help recover.

A psychotherapist may offer: cognitive behavioral psychotherapy, exposure, hypnosis.

Exposure with response prevention techniques are effective for OCD. It lies in the fact that a person, faced with his experiences in a controlled situation, learns to cope with them without the usual reaction of avoidance.

So, to treat a person with a fear of germs, they may suggest touching a subway handrail or an elevator button and not washing your hands for as long as possible. The tasks are gradually becoming more complicated and they are asked to reduce the number of actions and the duration of the ritual. uh

Over time, the patient gets used to it and stops being afraid. However, not everyone can handle this technique. More than half of patients refuse it due to strong feelings.

Cognitive therapy helps the patient see the irrationality of his fears, dismantle his way of thinking and realize that it is wrong. Teaches effective ways switching attention and adequately responding to obsessive thoughts without the use of ritual.

The patient can get help family therapy. Thanks to it, family members will be able to better understand the causes of the disorder and learn how to behave correctly if obsessions begin. After all, close people can both help cope with the problem and cause harm with their behavior.

Group psychotherapy will provide support and approval, and reduce feelings of inferiority. The success of a fellow sufferer is highly motivating. And the person understands that he can cope with the problem.

May trouble pass everyone by

Obsessive compulsive disorder can and should be stopped at the approaches to mental and neurological health, for this it is necessary:

• using techniques to combat stress;
• timely rest, avoid overwork;
• timely resolution of intrapersonal conflicts.

OCD is not a mental illness because it does not lead to personality changes; it is a neurotic disorder. It is reversible and with proper treatment disappears completely.

Are you still carrying hand sanitizer? Is your wardrobe organized in every sense in your closet? Such habits may simply be a reflection of personality or beliefs, but sometimes they cross an invisible line and become obsessive-compulsive disorder (OCD), which affects almost 1% of Americans.

How to distinguish a habit from a medical diagnosis that requires the help of a specialist? The task is not easy, says Professor Jeff Zymanski. But some symptoms indicate a problem openly.

Frequent hand washing

The compulsion to wash your hands or use hand sanitizer is common among OCD sufferers, so much so that they have even been categorized as “washers.” The main reason for obsessive hand washing is the fear of bacteria, and less often, the desire to protect others from one’s own “uncleanness.”

When to ask for help: If you can't forget about germs even after washing your hands, are afraid that you didn't wash them thoroughly enough, or that you might have contracted AIDS from a supermarket cart, there's a good chance you're one of the "washers." Another telltale sign is the ritualism of washing: you feel like you have to soap and rinse your hands five times, lathering each individual nail.

Obsession with cleaning

People with OCD and a passion for handwashing often go to another extreme: they become obsessed with cleaning the house. The reason for this obsessive state is also germophobia or the feeling of “uncleanness”. Although cleaning relieves germ anxiety, the effects don't last long and the urge to clean again becomes stronger than before.

When to ask for help: If you spend several hours every day cleaning your home, there's a good chance you have obsessive-compulsive disorder. If satisfaction from cleaning occurs within 1 hour, it will be more difficult to make a diagnosis.

Obsessive checking of actions

If you need to make sure 3-4, or even 20 times, that the stove is turned off, and Entrance door closed - this is another common (about 30%) manifestation of obsessive-compulsive disorder. Like other compulsive behaviors, repeated checking stems from fear for one's own safety or a deep-seated feeling of irresponsibility.

When to ask for help: It's perfectly reasonable to double check something important. But if obsessive checking interferes with your life (you start being late for work, for example) or takes on a ritual form that you cannot break, you may be a victim of OCD.

An inexplicable desire to count

Some people with obsessive-compulsive disorder attach great importance to counting and count everything that catches their eye: the number of steps, the number of red cars passed, etc. Often the reason for counting is superstition, fear of failure if some action is not performed a certain “magic” number of times.

When to ask for help:“It all depends on the context,” explains Rzymanski. - Does this behavior make sense for you? Counting steps from the door to the car, for example, can be done out of boredom. But if you can’t get rid of the numbers in your head and the constant counting, it’s time to turn to a specialist.”

Total organization

People with obsessive-compulsive disorder are capable of perfecting the art of organization. Things on the table should lie smoothly, clearly and symmetrically. Always.

When to ask for help: If you want your desk to be clean, neat and organized, it may be easier for you to work this way, and you are doing this out of a completely normal need for order. People with OCD may not need this, but still organize the surrounding reality, which otherwise begins to frighten them.

Fear of trouble

Everyone has anxious thoughts about a possible unpleasant incident or violence. And the harder we try not to think about them, the more persistently they appear in our heads, but for people with OCD, fear goes to the extreme, and the troubles that happen cause too strong a reaction.

When to ask for help: It is important to set the line between periodic unpleasant thoughts and fears and excessive worries. OCD may occur if you avoid, for example, walking in the park for fear of being mugged, or calling a loved one several times a day to inquire about their safety.

Obsessive thoughts of a sexual nature

Just like thoughts of violence, obsessive-compulsive disorder often involves intrusive thoughts about inappropriate behavior or taboo desires. Those suffering from OCD may, against their will, imagine themselves harassing co-workers or strangers, or begin to doubt their sexual orientation.

When to ask for help:“Most people will tell you: No, I don’t want to do this at all and it doesn’t reflect my inner beliefs at all,” comments Zymanski. “But a person with OCD will say differently: These thoughts are disgusting, they don’t come to anyone but me, and what will they think about me now?!” If a person’s behavior changes because of these thoughts: he begins to avoid acquaintances with gay people or people who appear in his fantasies - this is already an alarming sign.

Unhealthy relationship analysis

People with OCD are known for their obsessive tendency to analyze relationships with friends, colleagues, partners and family members. For example, they may worry for a particularly long time and analyze whether the incorrect phrase they said became the reason for the detachment of a colleague or a misunderstanding - a reason to part with a loved one. This state can extremely increase the sense of responsibility and the difficulty of perceiving unclear situations.

When to ask for help: Breaking up with a loved one may get stuck in your head, which is normal, but if these thoughts snowball over time, developing into a complete erosion of self-confidence and a negative attitude towards yourself, you should seek help.

Finding support

Those suffering from obsessive-compulsive disorder often try to relieve their pain with support from friends and family. If, for example, they are afraid of messing up at a party, then they ask their friends to “rehearse” a possible situation in advance, and more than once.

When to ask for help: Asking friends for help is a completely normal part of friendship, but if you find yourself regularly asking the same question - or friends telling you so - it could be a sign of OCD. Worse, receiving approval and support from loved ones can worsen the manifestation of this obsessive state. It's time to turn to professionals.

Dissatisfaction with your appearance

Body dysmorphophobia - the conviction that there is some kind of flaw in one's appearance, often accompanies OCD, and forces people to obsessively evaluate their body parts that seem ugly to them - the nose, skin, hair (by the way, unlike eating disorders, dysmorphophobia does not focus their attention on weight or diets).

When to ask for help: It's completely normal to not be excited about some part of your body. It’s another matter when you spend hours in front of the mirror, looking at and criticizing this place.