Obsessive Compulsive Disorder (OCD) is the occurrence of a person who has recurring intrusive thoughts or actions that are difficult to resist. Trying to abstain from them is associated with increasing fear, anxiety, tension or suffering. What does obsessive compulsive disorder manifest itself, what are its causes and what is the treatment like?

Obsessive-compulsive disorder(OCD, or obssessive-compulsive disorder) is now the official name. The term "obsessive compulsive disorder" is used less and less and appears mainly in everyday language, as in the current ICD-10 classification the term neurotic disorders has been replaced with the term anxiety disorders.

Contents:

  1. Symptoms of Obsessive Compulsive Disorder
  2. Types of obsessions
  3. Kinds of compulsions
  4. Other symptoms of obsessive compulsive disorder
  5. Causes of Obsessive Compulsive Disorder
  6. Obsessive Compulsive Disorder - Treatment
  7. Cognitive model of obsessive-compulsive disorder
  8. Cognitive model of obsessive-compulsive disorder - working methods
  9. Behavioral model of obsessive-compulsive disorder
  10. Behavioral model of obsessive-compulsive disorder - working methods

Symptoms of Obsessive Compulsive Disorder

Obsessive-compulsive disorder may be predominantly obsessive or intrusive (rituals / compulsions).

The hallmark of OCD is that obsessions and / or compulsions are perceived by the patient as unwanted and often perceived as illogical.

Hence, a person experiencing OCD is ashamed of them.

Types of obsessions

Intrusive thoughts (otherwise known as obsessions) are intense, intense and are practically always experienced by a given person as unpleasant, embarrassing, absurd and unwanted. They are considered as your own thoughts.

Obsessions can be divided into the following categories:

  • intrusive uncertainty - most often it concerns the mundane things, e.g. recurring uncertainty whether the door has been closed, the light turned off, taps with water turned off, items placed properly and evenly, hands properly and effectively washed, etc.
  • thinks about blasphemouswhether obscene or vulgar in nature - often exacerbated in places or circumstances in which they are especially out of place (e.g. church, prayer, meeting with loved ones, etc.). They are intrusive, unwanted and often contrast with the patient's worldview
  • intrusive impulses - e.g. irresistible thoughts about screaming or exposing oneself in a public place, doing something compromising or being aggressive towards people towards whom we have no malicious intent and who are close to us ( e.g. push the mother, kick the baby, lean out of the window excessively, etc.). In OCD, these impulses are never carried out by the patient, but they are accompanied by an intense fear that they will soon be realized and try to prevent them
  • illuminations - continuous, long, useless, pseudo-philosophical and difficult to break "chewing" one topic, issue or thought with the inability to make a decision and come to constructive conclusions
  • obsessive fear of dirt, uncleanness, bacteria, self-pollution or others. It is characterized by the obsessive need to maintain a perfect, unreal order, symmetry, a specific arrangement of objects in the environment, etc.

Kinds of compulsions

Invasive activities (also known as compulsions), like obsessions, are unwanted, recurrent. They are experienced as meaningless and embarrassing.

Compulsions can take the following form:

  • intrusive checking of everything (doors, water taps, objects, etc.) as a response to intrusive uncertainty
  • recurrent cleaning, obsessive hand washing, stacking, etc. associated with uncertainty about whether these activities were performed correctly, in accordance with self-imposed procedures and whether they were effective
  • recurring correcting, arranging, arranging related to an obsessive pursuit of order, symmetry, a specific arrangement of objects
  • complex activities, resembling bizarre rituals that the patient must perform to prevent mounting tension or the threat of catastrophic, but highly improbable consequences (e.g. "I have to wear black socks or a white blouse, I have to slap my right knee five times, that nothing bad happens to my family, that nobody gets sick ")
  • compulsory stockpiling

Other symptoms of obsessive compulsive disorder

Obsessive disorder may sometimes be accompanied by other symptoms:

  • anxiety disorders, e.g. panic disorder or generalized anxiety disorder
  • depression - treatment-resistant or long-untreated obsessive-compulsive disorder may be fora person causing significant suffering, may seriously impair his or her functioning at home, work, school or university. In response to these serious disruptions in social / professional functioning, you may experience low mood, low self-esteem, develop feelings of helplessness and hopelessness, and even develop a full episode of depression
  • depersonalization and derealization - sometimes the anxiety and tension accompanying compulsions or an attempt to resist them are so great that they cause a periodic feeling of unreal. Then a person may have the impression that he or she does not have full contact with the world, that the people and objects around him are unreal, artificial, that they are like decorations (derealization). She may also have the impression that her own thoughts are separating from her, as if they didn't belong to her, that the sensations, emotions of an action or part of her body were not hers
  • tics - these are involuntary, recurring movements (e.g. eye blinking, shrugging, grimacing, etc.) or vocal phenomena (grunting, barking, hissing and others). Tics, like obsessions, feel like something that is very difficult or impossible to resist
  • Ajchmophobia - it is an intense fear of sharp objects combined with avoiding contact with them and hiding them
  • mysophobia - excessive fear of dirt combined with a strong need to avoid contact with it and remove it
  • baccylophobia - fear of germs analogous to mizophobia

Causes of Obsessive Compulsive Disorder

The causes of OCD are complex and include:

  • an early-stage and wide-ranging sense of responsibility for risk prevention (reinforced and reassured in childhood)
  • childhood experience in which sensitivity to liability issues arose as a result of constant protection against it;
  • rigid and radical understanding of duty
  • specific experience or experiences in which the act or omission actually made a clear impact on a serious personal or other misfortune
  • an experience where thoughts or actions (or their omissions) and the following misfortune are wrongly associated with the following misfortune
  • abnormalities in the anatomy and / or functioning of the central nervous system
  • perinatal load
  • genetic and environmental factors

Obsessive Compulsive Disorder - Treatment

People suffering from obsessive-compulsive disorder (OCD) experience deep discomfort caused by the course of symptoms and often feel ashamed of their neurosis.

Over the years, the symptoms endured in loneliness have become more and more intense and resistant to change, which is why it is so important to start appropriate psychotherapy.

In the case of obsessive-compulsive disorders, the most commonly used is cognitive-behavioral therapy (CBT), which aims to break the vicious circle and the mechanism of the build-up of anxiety symptoms.

Cognitive model of obsessive-compulsive disorder

It emphasizes the role of interpretation (giving meaning) that accompanies the experienced obsessions. In a person suffering from obsessive compulsive disorder the following may occur:

  • thought-action fusion ("magical thinking"), ie the belief that "bad" thoughts can provoke bad consequences, eg theft, car accident, illness, death; the belief that the mere possession of thoughts is already a manifestation of hidden desire and inevitably leads to bad consequences
  • exaggerated responsibility, i.e. exaggerating the belief that someone has the power to cause or prevent negative events / consequences
  • belief in the possibility of controlling thoughts, i.e. that control is desirable and necessary so that bad things do not happen
  • perfectionism, i.e. the belief that there is one right course of action and that you must not make mistakes, and that it is possible to achieve flawless and perfect behavior
  • overestimating the threat, i.e. the belief that bad things will happen easily, while underestimating the ability to deal with them
  • intolerance to uncertainty, i.e. the absolute conviction that you should be absolutely sure of something to avoid danger

An example of anxiety-supporting mechanisms is shown in Figure 1.

Cognitive model of obsessive-compulsive disorder - working methods

  1. Identifying the beliefs that support the OCD.
  2. Write down your beliefs.
  3. Constructing experiments aimed at refuting beliefs, i.e. developing ways to verify reality in real life.
  4. Constructing experiments to "confirm" beliefs.
  5. Performing the experiments.
  6. Check the results.
  7. Save applications.

According to Barbara Kosmala, a psychotherapist, when working with patients suffering from OCD, it is worth combining different help strategies.

Negative interpretations and assumptions may initially cause a heightened level of anxiety, so it's worth working on beliefs, not just external compulsions.

Initially, less anxiety will also cause lesscompulsory rituals.

Behavioral model of obsessive-compulsive disorder

A person suffering from obsessive-compulsive disorder, wanting to cope with unpleasant sensations, undertakes actions that bring them temporary relief, and which in the long run support and intensify their neurosis. In other words, the mechanism of coping with unpleasant symptoms is that giving in to rituals for a while reduces anxiety and causes relief (see Figure 2).

Then, however, it strengthens and deepens the baseline anxiety level, which inevitably leads to more frequent and more compulsive compulsions. The mechanism of a vicious, self-driving wheel appears.

These activities that bring relief are called neutralizations, such as avoiding certain situations or engaging in rituals and activities to reduce mental tension.

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Example: Mrs. Kasia came back from work and washed her hands. After a while, she felt an enormous urge to wash her hands again. She found it absurd, but refraining from washing again made her tense.

At one point, her anxiety grew so intense it was unbearable, so she decided to wash her hands one more time. She was relieved for a moment.

However, the tension increased again and it was hard to handle. Over the years, Kasia has washed her hands eight times, many times a day, neglecting other activities.

She had very dry, parchment skin, which was exposed to mechanical abrasions, which increased her fear and the need to wash her hands more and more often.

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Undertaking treatment allows you to break such a vicious circle, and also minimizes the risk of developing complications, such as, for example, depression. The discussed mechanisms supporting he alth anxiety are shown in Fig. 2.

Behavioral model of obsessive-compulsive disorder - working methods

The primary strategies for treating obsessive-compulsive disorder in behavioral therapy are exposure and response prevention. According to Barbara Kosmala, a psychotherapist, during a session the therapist should use three steps:

1. Justify this aid strategy as follows:

"One of your problems is that you believe that failure to perform a given activity, e.g. not checking something, may lead to bad events. It is understandable that you are trying to prevent this. / a P. a whole range of coping strategies (the so-called neutralization) to make the situation as safe as possible.

It is very important for P. to understand that he is thinkingintrusions are normal. Due to the above coping strategies, P. is not able to experience and discover that these thoughts are meaningless.

This is because P. prevents misfortune and is thus unable to know that this misfortune will not happen.

So as long as you use your coping strategies, your anxiety will remain (it will decrease for a short time and increase in the long run).

It is important for P. to discover that P. thoughts are not threatening and therefore to abandon neutralizing behavior. By allowing thoughts to come and not applying precautionary behaviors, you will discover that these thoughts are meaningless and that you will not feel such compulsion and fear. "

2. Determine with the patient an inventory of all compulsions and their neutralization.

3. Carry out with him exhibitions without neutralization, i.e. exposure and response prevention.

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Psychiatry