Have you noticed that you are overwhelmed by an intrusive thought? No matter what you do, you can’t get rid of it? This thought is unwanted and creates fear? You yourself understand that it is absurd and the anxiety is therefore irrational, but at the same time it seems real to you, even knowing that it has no logical, adequate justification? Maybe you get a feeling that you need to take action to reduce fear, so protection rituals appear on a daily basis for objectively unjustified motives? The above does not include normal daily habits and positive actions. For example, there are people who like to keep their house in perfect order. Everyone happens to come back to check that the front door is locked. Or we all sometimes imagine something worrying about our health or the health of people close to us.
The main thing is to understand the difference! If the intrusive thought takes up most of your time and attention, and you or someone close to you or an acquaintance suffers from it, then be sure to read the article below, because you may need the help of a specialist!
Obsessive compulsive disorder ( hereinafter referred to as OCD ) terminologically denotes:
- intrusive thoughts – obsessions.
- intrusive actions – compulsions.
In OCD, the thoughts are repetitive, unwanted, disturbing, absurd in themselves, but there is no control over them. Some people come up with peculiar, logically unreasonable – they understand it themselves, but cannot influence it – rituals to eliminate the intrusive problem. In this way, they relieve excessive, inexplicable, inappropriate anxiety, realizing that these actions do not change anything. Obsessions and compulsions have a significant impact on daily activities, work, recreation – socially limiting, lowering self-confidence, consuming more and more time.
The most frequent harassment is related to:
- cleaning/washing – fear of dirt, infections, secretions; obsessive washing of hands and/or the whole body, cleaning and disinfection of room objects;
- checking – for fear of causing an accident due to carelessness,
- hoarding – for fear of throwing away something valuable, also for difficulties in differentiating the worthless, therefore even packages, bags, etc. are hoarded;
- order – a pedantic order that must be constantly renewed, for example, symmetry, folding clothes according to one standard in the closet, arranging spices in alphabetical order, etc.;
- counting – on a bookshelf, counting tiles, etc.; according to human notions, not counting will lead to misfortune.
Intrusive thoughts are most often associated with:
- aggression – fear of hurting oneself or others;
- the sexual sphere – perverse fantasies, thoughts of incest, fear of homosexuality, violence, one can have sexual thoughts in the church,
- religion – for fear of angering or blaspheming God.
The leading complaint in this case is the fear of the transformation of thoughts into reality. However, so far there are no known cases in which these thoughts would be implemented.
Aggravating factors for harassment are conflicts, moments of crisis in life, radical changes in everyday life. For example, stress due to moving, changing jobs.
Where is the norm, where is the pathology?
Understandable, acceptable anxiety about objectively justified conditions is the norm, because everyone can have different disturbing thoughts. Also repetition of desired daily activities. Routine bed-making or when working conditions are related to specific activities, such as counting goods, is absolutely normal. The desire to live in a clean environment is also only understandable.
The only question is whether these thoughts do not become the central axis of your daily life, around which all other spheres of life revolve, as well as whether they are not joined by illogical, exaggerated actions to reduce fear. Then in this case there is reason to think. A form of behavior in which the whole life revolves around a symptom is a pathology.
How does harassment occur?
There are various internal stimuli in our subconscious, which we can metaphorically call “what I really want”. At the same time, there is our conscious Super Ego , which is essentially upbringing, morality, religion. This is the learned and deeply rooted model of what is RIGHT – “good girls don’t do that” , “a real man needs…” – despite our true desires – a person suppresses his aggression, guilt, fear, resentment , dislike and other negative emotions. There is a battle of motives between “what I really want” and “what is necessary, what is RIGHT” , thus imperceptibly the level of anxiety arises and increases in the person himself – neurosis is formed.
How does anxiety level lead to OCD?
Anxiety for the person himself is an unpleasant feeling of fear, because the worst thing is not understanding what exactly to be afraid of. It is a feeling within which “as if something bad could happen” , but it is difficult for KAS to justify it himself. So, in order to calm down, the psyche unconsciously develops a defense tactic for the person himself with the thought “now I will know what to be afraid of and suffer from anxiety, for example, I will be afraid of germs” . Consequently, there is a shallow feeling that control over the disturbing has appeared. E.g., in case of microbial fear, control by continuous hand washing. A person feels that everything has been structured, that is, now he knows what he is afraid of, as well as how to fight it, but he falls into a trap, because the problem is not solved and there is an illusory control, so that the psyche protects itself from anxiety. Then a person enters a state similar to drug addiction. That is, over time, simple actions to calm down no longer help, because they consume more and more time. This is well illustrated by the example of excessive hand washing. At first, a person washes his hands more and more often, then he starts to do it with antibacterial soap, then with a brush, then he does it all longer and longer, he starts washing with boiling water, later he washes his hands up to the elbow, up to the shoulder, after a while he touches everything only with napkins, then with sterile gloves and do not shake hands with others. The range of fantasy is unfathomable. In the described example, you can get to a situation where there is no more skin on your hands.
Why OCT?
OCD is etiologically based on complex biological, psychological and social factors. In studies, OCD is more common between parents and children. Similar results are also found in the case of twins, and in general, similar symptoms have been observed within families.
OCD can also be caused by disorders of the brain, such as epilepsy, head trauma, and other somatogenic factors. Likewise, disorders of the functioning of neurotransmitters – serotonin, noradrenaline, etc. – may be involved in the development of OCD. Overactive impulse transmission in nerve cells can be genetically determined due to the aforementioned somatic diseases, as well as exogenously caused due to psychotraumatic events.
Psychological and social triggers are experienced psychotraumas, especially in childhood, as well as upbringing. For example, if there were very puritanical and/or religious strict frameworks in the family, within which there was too much emphasis on moral aspects, without taking into account the wishes, feelings and emotions of the child, or if there was an emotional coldness cultivated in the family, within which it was not accepted to show love, anger, resentment , may develop OCD. Resistance to “unauthorized” impulses creates neurosis. Not all people with similar psychotraumas have the same disorders – genetic determinants play a major role.
Most often, OCD begins between the ages of 10 and 30.
Statistically, OCD manifests itself in 1 – 3% of the population. This means that approximately 58,500 people suffer from OCD in Latvia.
Why does the psyche help in this way?
In order not to encounter the neurotic situation that has been experienced for years. A person suffers from it, because he has not resolved it anyway, because it is very painful for him to look deep inside himself, into his inner conflict – unresolved conflict with mother, father, childhood trauma – which unconsciously draws attention to specific rituals. In them, all attention is focused on the process, not on oneself and one’s pain, because it is very unbearable for a person to think about the specific problem due to the emotionally sensitive internal structure. Therefore, the psyche “gives him something to switch to” – ” let your anxiety be here, not inside, because inside is unbearable” .
What personality traits are more common in people with OCD?
Very intellectual, who avoids conflicts and also wants a utopically harmonious, peaceful atmosphere in the relationships of those around them. Basically, they unconsciously do not allow their aggression and other negative emotions to manifest – the family has taught them not to show emotions. Therefore, from the outside, these people are extremely benevolent and condescending. Inside – sensitive, emotionally vulnerable, with low self-confidence and fear of criticism. We should also mention the rigidity of the personality, that is, the fear of change – everything should be according to a certain schedule, very predictable. For example, moving or changing jobs is abnormally stressful for them.
Diagnostics
Only a specialist competent in this matter can diagnose and prescribe treatment. Therefore, please contact a psychiatrist and psychotherapist if the criteria listed below are observed:
- have intrusive thoughts and/or actions observed practically continuously for at least two weeks;
- intrusive ideas and actions are characterized by the following common features: they are one’s own intrusive ideas (in differential diagnosis, for example, in the case of schizophrenia, they are “from the outside”, that is, they are imposed by another person); the intrusive thoughts are constantly recurring, and at least one intrusive thought or intrusive action is recognized as exaggerated and useless;
- there is an effort to resist the intrusive ideas – unsuccessful attempts to resist can be observed with at least one intrusive thought or action;
- reproduction of thought or behavioral obsessions is not pleasant;
- you subjectively suffer from intrusive thoughts or actions; objectively, the level of social adaptation decreases – it takes a lot of time to realize intrusive ideas.
The OCD assessment scale YALE-BROWN OBSESSIVE COMPULSIVE SCALE (Y-BOCS) has also been developed , in which 5 questions are devoted to intrusive thoughts or obsessions and 5 questions are devoted to intrusive actions or compulsions (please count the total number of points to determine the result):
1. Duration of obsessions per day:
not at all (0 points)
less than an hour (1 point)
1 – 3 hours (2 points)
3 – 8 hours (3 points)
more than 8 hours (4 points)
2. The level of disturbance in everyday life due to obsessions:
not disturbed (0 points)
slightly disturbed (1 point)
has a negative impact, but everyday life has not changed (2 points)
very disturbing (3 points)
completely impaired daily life (4 points)
3. Level of mental discomfort:
not at all (0 points)
weak (1 point)
strong, but overall I feel good (2 points)
strong and affects well-being (3 points)
I feel severe discomfort practically all day (4 points)
4. Resistance to obsessions:
practically always have the ability to resist (0 points)
mostly I can resist (1 point)
sometimes I can resist well (2 points)
most often I can’t resist (3 points)
unable to resist (4 points)
5. Control over obsessions:
full control (0 points)
mostly in control (1 point)
sometimes manages to control (2 points)
can control insignificantly (3 points)
not controllable (4 points)
6. Duration of compulsions per day:
not at all (0 points)
less than an hour (1 point)
1 – 3 hours (2 points)
3 – 8 hours (3 points)
more than 8 hours (4 points)
7. Level of disruption of daily life due to compulsions:
not disturbed (0 points)
slightly disturbed (1 point)
has a negative impact, but everyday life has not changed (2 points)
very disturbing (3 points)
completely impaired daily life (4 points)
8. Level of mental discomfort:
not at all (0 points)
weak (1 point)
strong, but overall I feel good (2 points)
strong and affects well-being (3 points)
I feel severe discomfort practically all day (4 points)
9. Resisting compulsions:
practically always have the ability to resist (0 points)
mostly I can resist (1 point)
sometimes I can resist well (2 points)
most often I can’t resist (3 points)
unable to resist (4 points)
10. Control over compulsions:
full control (0 points)
mostly in control (1 point)
sometimes manages to control (2 points)
can control insignificantly (3 points)
not controllable (4 points)
Summative assessment:
- 0-7 points – subclinical condition
- 8-15 – weakly pronounced OKT
- 16-23 – moderately severe OCD
- 24-31 – severe OCT
- 32-40 – extremely severe OCD
In any case, whatever the degree, if there is even one of these results, it is advisable to consult a specialist!
If the doctor thinks it is necessary, an electroencephalogram (EEG) can be performed, which sometimes shows nonspecific changes, as well as a positron-emission tomography, which can detect decreased metabolism in the brain.
OCD Panacea!
- Professional consultation – psychiatrist and psychotherapist visit.
- Medicines and psychotherapy are used in the treatment.
Medications increase serotonin levels in the brain with antidepressants. They were originally synthesized to treat depression, but their effectiveness in OCD therapy has been proven. They reduce anxiety, tension and restore psycho-emotional stability. It is important to know that the full effect of antidepressants in OCD only takes about 10 weeks. It takes time for the brain to adjust. Therefore, you should not stop taking the medication at your own discretion, even if you observe a positive result! Antidepressants must be taken for at least 6 months, often for several years. Some of the patients are cured, some have reduced symptoms, but the condition may worsen if the medication is used for a short time. ANTIDEPRESSANTS ARE NOT ADDICTIVE despite society’s stigma in this regard! Such a myth arose precisely because of arbitrary, incorrect withdrawal of medication. It should be remembered that it takes time to achieve a complete remission or a permanent reduction of symptoms.
Neuroleptics and tranquilizers are also used for the symptomatic treatment of anxiety and sleep disorders.
A combined approach is used in psychotherapy . In cognitive-behavioral therapy, the psychotherapist helps you to see the irrationality of your beliefs and to feel that fear passes even if you do not take any actions to seemingly protect yourself from illusory dangers. You can also artificially increase your anxiety by exercising with more vivid impulses, such as putting your hands in the mud or walking out of the house, accepting the fear that anything could happen. As a result of the “I’m ready for it” therapy, more insignificant thoughts and actions performed on a daily basis, such as the fear of germs and touching ordinary objects, stop worrying, and the symptoms decrease. Unfortunately, this method does not address the unconscious inner cause of fear, sorrow, and pain. Therefore, in monotherapy, by eliminating the existing problems, it can act as a trigger for other symptoms through which OCD will manifest itself. Therefore, in addition to cognitive-behavioral therapy, the problem is treated and solved in the depths by psychoanalysis, through which one learns not only to see absurd obsessions, but also helps to become aware of the causes that led to OCD, because “what you are aware of dominates you, but it just comes at the level of awareness, You begin to rule over it!”
Example. Man X, with the guise of a socially positive family man, has a parallel relationship with another woman he loves. In him, there is a battle of motives, an internal conflict, between the conscious, socially accepted, “right” image and the unconscious, true essence, which currently wants to love, wants to be free, happy. Neurosis is formed, because a person may not even admit to himself what he really wants. Psychotherapy helps you learn to understand your entire emotional spectrum – disgust, aggression, guilt, fear, etc. Often a person cannot even say that he loves, because he was born with emotional coldness in childhood, or he does not show anger, because in the family model he did not have the right to express aggressive feelings, which led to OCD through the prism of anxiety. It is practically impossible to get cured without psychotherapy, because the psyche’s defense mechanisms will most likely not allow you to identify the real reason yourself.
At home, it is also recommended to start a self-analysis diary before visiting a specialist, in which you should write down what you thought, what you communicated with, what and what emotions you felt throughout the day. In this way, even unconscious things are formed in the overall picture.
You have to work on resisting your thoughts or actions and accepting them. The more you resist a thought, the calmer your mind will be, thus reducing the vicious circle of “fear of fear”. Even the most terrible thoughts, for example, about killing a close person, no matter how paradoxical it may seem, one should try to take it as calmly as possible, and also think about the provoking factors of the last day – disputes, stress at work, unexpressed resentment, etc. – due to which the level of anxiety has increased and with it their OCD symptoms. You need to rest, talk to those closest to you, what is not satisfying, etc. It is only a “sick thought”, more precisely, a symptom, not a “bad you”. Calmly reflect on the situation without blaming and criticizing yourself.
In terms of prevention, one cannot help but write about the rapidly increasing level of neuroticism in society. The reasons for this are daily stress factors, such as career building requirements and labor market competition, which increases every year, as well as a sedentary lifestyle, ever-increasing comfort – cars, washing machines, dishwashers, computers, etc. Our psycho-physiology is not designed for such conditions. As a result, there is a mismatch between psychological overload and the diametrically opposite decrease in physical activity. We invite you to focus on a more natural way of life, even if it is a small step, as well as to reduce the use of urbanization and the comfort of technology for the benefit of your mental health.
!!! Another important advice – be here and now. Anxiety comes from fear and doubt about future plans. Keep that in mind!
Everyday recommendations for fellow human beings
Do not support rituals. At the same time, you need to understand that this is not a disorder caused by a lack of discipline or willpower for your loved one. Support him by remembering that OCD doesn’t have to be the main topic of conversation to avoid adding to the tension! Most often, people with OCD have low self-esteem and the inability to make decisions, so you should not criticize, but praise, without increasing fear and doubt. If you want to express something judgmental, emphasize it as a criticism of the actions, not of him – emphasize that it is not his fault that you want to express your thoughts about the particular action.
Many people with OCD become socially isolated because this is their safe environment with the order they create. Encourage him to step out of his comfort zone by taking care of his daily activities!
Motivate your loved one to show all emotions, from love to anger, so that what is not said does not lead to anxiety. Start with yourself. Tell the sick person how much he means to you and what in particular does not satisfy you in his behavior.
Also, don’t become co-dependent by taking on the role of savior, because then the OCD sufferer may shift the responsibility to you without struggling themselves, but don’t ignore it either. Bring up the issue empathetically, showing love and reassurance that you will be there.
Authors of the article: resident doctor – in psychiatry, Alice Maksimova-Agafonova doctor psychiatrist Pēteris Zālītis
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