Every person at least once in his life experienced a "visit" of unpleasant thoughts that frightened him, bringing him to a terrible state. Fortunately, for the most part, a person can not concentrate his attention on them and, easily dismissing them, move on, enjoying life. But, unfortunately, there are people who cannot do this. They cannot let go of an unpleasant thought, but begin to delve into and look for a reason for the appearance of such thoughts and fears. Such people come up with specific actions for themselves, performing which they can calm down for a while. This phenomenon is called OCD.

And in today's article we'll talk about a personality disorder called OCD (Obsessive Compulsive Disorder).

Expanding the term, we get to the point

Obsessions are thoughts, images and even impulses that frighten the patient and do not let him go. Compulsions are already specific actions that a person takes in order to eliminate these thoughts and calm down.

In a patient, this condition can progress, and in this case, the person has to make more compulsions in order to calm down.

OCD itself can be chronic or episodic. More importantly, this condition causes real inconvenience to a person, affecting all areas of his life.

Top frequent obsessive thoughts

On account of this issue, a lot of studies have been carried out that have helped to identify which obsessive thoughts are most often found in people.

Of course, in fact, there are a lot of obsessions, different people suffering from this disorder have a variety of thoughts and fears. But above we have listed the most common today.

How does the disease manifest

The most characteristic of this disease are the following symptoms:

• When a patient has a thought, he is perceived not as the voice of another from the outside, but as his own.
• The patient himself understands that this is not normal and makes efforts to resist them: he struggles with these thoughts, tries to switch his attention to other things, but all to no avail.
• A person all the time experiences feelings of guilt and fear, due to the fact that his fantasies, thoughts can come true.
• Obsessions are ongoing and can be repeated very often.
• After all, this tension leads a person to a loss of strength, and subsequently the person becomes inactive and fearful, closes off from the outside world.

Unfortunately, not knowing or not fully understanding the complexity of this disorder, others do not understand that the person has a real problem. For many people who are unaware of obsessive-compulsive disorder, these symptoms can only cause laughter or confusion. However, OCD is a serious personality disorder that affects everyone in every area of ​​a person's life.

Pure OCD

In this disorder, there is a predominance of either compulsion or obsession. However, pure OCD may also occur. In this case, the person realizes that he has this disorder. Understands that there are obsessive thoughts that do not correspond to their values ​​and beliefs. But they are sure that they do not have compulsive manifestations, in other words, they do not do any rituals to free themselves from fearful thoughts.

In fact, this is not entirely true, because in this variant of OCD, a person may not knock on wood, may not pull pens and all that, but at the same time, he may for a long time, sometimes spend hours convincing yourself that you don't need to pay attention to these thoughts or fears.

And they themselves do certain actions. These actions may not be visible to others, but still, even in this type of obsessive-compulsive disorder, a person gets rid of emotional stress through certain actions: it can be a quiet prayer, counting to 10, shaking the head, stepping from one leg to another and the like.

All this can be unnoticed for others, and for the patients themselves, too. However, whatever the type of OCD, it is still accompanied by some kind of compulsions: it does not matter whether these actions are conscious or unconscious.

What causes OCD?

Like any other problem, illness or disorder. and OCD has causes. And to understand the full picture of the problems, you need to start by examining exactly the cause.

To date, researchers of this problem have come to the conclusion that a combination of three factors at once leads to obsessive-compulsive disorder: social, psychological and biological.

Thanks to the latest technology scientists can already study the anatomy and physiology of the human brain. And studies of the brains of OCD sufferers have shown that there are some significant differences in brain function in these people. Basically, there are differences in different regions such as the anterior frontal lobe, thalamus and striatum of the anterior cingulate cortex.

Studies have also shown that patients have certain abnormalities that are associated with nerve impulses between the synapses of neurons.

In addition, a gene mutation was identified that are responsible for the transfer of serotonin and glutamate. All these anomalies lead to the fact that in a person the processing of neurotransmitters occurs before he is able to transmit an impulse to the next neuron.

Most scientists, when talking about the causes of OCD, insist on genetics. Since more than 90% of patients with this disorder have sick relatives. Although this may be controversial, as in these cases, the child, living with a mom who has OCD, may simply take this disorder for granted and apply it in his life.

Streptococcal infection of Group A can also be cited as causes.

As for psychological reasons, then experts in this field assure that people who are predisposed to OCD have a peculiarity in thinking:

• Overcontrol - such people believe that they have the power to control everything, including their own thoughts.
• Over-responsibility - such people are confident that each person is responsible not only for their actions, but also for their thoughts.
• Materiality of thoughts - the whole psychology of such people is built on the belief that thought is material. They piously believe that if a person can imagine something, then it will be. It is for this reason that they believe that they are capable of calling upon themselves trouble.
• Perfectionists - OCD owners are the most violent representatives of perfectionism, they are confident that a person should not be wrong and should be perfect in everything.

This disorder is often found in those people who were brought up in strict families, where the parents controlled all the steps of the child, set high standards and goals. And the child wants in vain to meet these requirements.

And in this case: that is, if a person has the peculiarities of thinking (mentioned above) and over-control of parents in childhood, the appearance of obsessive-compulsive disorder is only a matter of time. And just one, the slightest push, a stressful situation (divorce, death of a loved one, move, job loss, etc.), fatigue, prolonged stress or use large quantities psychotropic substances can cause OCD.

The nature of the disorder

This disorder is for the most part cyclical, and the patient's actions themselves occur in cycles. In the beginning, a person has a thought that frightens him. Then, with the growth of this thought, shame, feelings of guilt, anxiety appear in him. After the person, not wanting it, more and more concentrates his attention on the thought that frightens him. And all this time, he has growing tension, anxiety and a sense of fear.

Naturally, in such conditions, the human psyche cannot remain in a helpless state for a long time, and in the end he finds how to calm down: by doing certain actions, rituals. After performing stereotyped actions, a person feels relief for a while.

But this is only for a short time, since a person realizes that something is wrong with him and these sensations make him return to strange and frightening thoughts again and again. And then the whole cycle begins to repeat itself.

Many people naively believe that these ritual actions of patients are harmless, but in fact, the patient eventually begins to become dependent on these actions. It's like drugs, the more you try, the harder it is to quit. In fact, ritual actions are increasingly rooting this disorder and lead to the person avoiding certain situations that cause obsession.

As a result, it turns out that a person avoids dangerous moments and begins to convince himself that he has no problems. And this leads to the fact that he does not take measures for treatment, which ultimately further exacerbates the situation.

Meanwhile, the problem is aggravated, since the patient hears reproaches from the patient's family, he is mistaken for a madman and begins to prohibit the habitual and calming rituals of the patient. In these cases, the patient cannot calm down and all this leads the person to various difficult situations.

Although, in some cases, it also happens that relatives encourage these rituals, which ultimately leads to the fact that the patient begins to believe in their necessity.

How is this disease diagnosed and treated?

Diagnosing a person with OCD is a difficult task for a specialist because its symptoms are very similar to those of schizophrenia.

It is for this reason that in most cases a differential diagnosis is made for the diagnosis (especially in cases where the patient's obsessive thoughts are too unusual, and the manifestation of compulsion is clearly eccentric).
For diagnosis, it is also important to understand how the patient perceives incoming thoughts: as his own or as imposed from the outside.

One more must be remembered important nuance: Depression itself is often associated with OCD.
And in order for a specialist to be able to determine the severity of this disorder, an OCD test or the Yale-Brown scale is used. The scale has two parts, each with 5 questions. The first part of the questions helps to understand the frequency of occurrence of obsessive thoughts and determines whether they correspond to OCD, and the second part of the questions provides an opportunity to analyze the patient's compulsions.

In cases where this disorder is not so strongly pronounced, a person is able to cope with the disease himself. To do this, it will be enough not to dwell on these thoughts and turn your attention to other things. You can, for example, start reading, or watch a good and interesting movie, call a friend, etc.

If you have a desire, the need to perform a ritual action, try to postpone it for 5 minutes, and then gradually increase the time and reduce the performance of these actions more and more. This will make it possible to understand that you yourself can calm down without any stereotyped actions.

And in cases where a person has this disorder in moderate severity and above, then the help of a specialist is needed: a psychiatrist, psychologist or psychotherapist.

In the most severe cases, the psychiatrist prescribes medication. But, unfortunately, medications do not always help treat this disorder, and their effect is not permanent. So, after the course of drugs ends, the disorder returns again.

It is for this reason that psychotherapy has become widespread. Thanks to her, to date, about 75% of patients with OCD have recovered. The psychotherapist's tools can be very different: cognitive-behavioral psychotherapy, exposure, or hypnosis. More importantly, they all provide good help and help to achieve good results.

The best results are obtained with the exposure technique. Its essence is that the patient is "forced" to face his fears in situations where he is in control of the situation. For example, a person who is afraid of germs is "forced" to poke the elevator button with his finger and not run to wash his hands right away. And so every time the requirements become more complicated, and as a result, the person realizes that this is not so dangerous and it becomes habitual for him to do things that previously frightened him.

Something in the end

It is important to understand and accept the fact that OCD is as serious a personality disorder as all other disorders. That is why the attitude and understanding of relatives and friends is very important for patients. Indeed, otherwise, hearing ridicule, cursing and not receiving understanding, a person may close even more, and this will lead to an increase in tension, which will bring a bunch of new problems.

To do this, we advise you not to seek help from a psychologist alone. Family therapy will help family members not only understand the patient, but also understand the causes of the disease. Thanks to this therapy, relatives will understand how to behave correctly with the patient and how to help them.

It is also important for every person to understand that in order to prevent obsessive-compulsive syndrome, you need to follow simple preventive tips:

• Do not overwork:
• Do not forget about rest;
• Apply techniques to deal with stress;
• Resolve intrapersonal conflicts in a timely manner.

Remember, OCD is not a mental illness, but a neurotic disorder and does not lead to personality changes. Most importantly, it is reversible and, with the right approach, can easily overcome OCD. Be healthy and enjoy life.

Anxiety is common to one degree or another in all people, and many of us sometimes perform rituals of varying degrees of irrationality, designed to insure us from trouble - banging our fist on the table or putting on a happy T-shirt on significant event... But sometimes this mechanism gets out of hand, causing serious mental illness. Theory and Practice explains what tormented Howard Hughes, how obsession differs from schizophrenic delusions, and what magical thinking has to do with it.

Endless ritual

The hero of Jack Nicholson in the famous film "It Can't Be Better" was distinguished not only by a complex character, but also by a whole set of oddities: he constantly washed his hands (and every time with new soap), ate only with his cutlery, avoided other people's touch and tried not to step on cracks on the asphalt. All of these "eccentricities" are typical signs of obsessive-compulsive disorder, a mental illness in which a person is possessed by obsessive thoughts that make him repeat the same actions on a regular basis. OCD is a real find for the screenwriter: this disease is more common in people with high intelligence, it gives the character a personality, noticeably interferes with his communication with others, but at the same time it is not associated with a threat to society, unlike many other mental disorders. But in reality, the life of a person with obsessive-compulsive disorder cannot be called easy: constant tension and fear are hidden behind innocent and even funny, at first glance, actions.

In the head of such a person, it is as if a record is seizing: the same unpleasant thoughts that have little rational basis come to his mind on a regular basis. For example, he imagines that there are dangerous germs everywhere, he is constantly afraid of hurting someone, losing some thing or leaving the gas on when leaving home. A leaking tap or an asymmetrical arrangement of objects on the table can drive him crazy.

The flip side of this obsession, that is, obsession, is compulsion, the regular repetition of the same rituals that should prevent an impending danger. A person begins to believe that the day will go well only if, before leaving the house, he read the children's rhyme three times, that he will protect himself from terrible diseases if he washed his hands several times in a row and uses his own cutlery. After the patient performs the ritual, he feels relief for a while. 75% of patients suffer from both obsessions and compulsions at the same time, but there are times when people experience only obsessions without performing rituals.

At the same time, obsessive thoughts differ from schizophrenic delusions in that the patient himself perceives them as absurd and illogical. He is not at all happy to wash his hands every half hour and zip up his fly five times in the morning - but he simply cannot get rid of the obsession in another way. The level of anxiety is too high, and the rituals allow the patient to achieve temporary relief from the condition. But at the same time, the love of rituals, lists or putting things on the shelves in itself, if it does not bring discomfort to a person, is not a disorder. From this point of view, the aesthetes diligently arranging carrot peels along lengths in Things Organized Neatly are absolutely healthy.

Most of the problems in people with OCD are caused by obsessions of an aggressive or sexual nature. Some become afraid that they will do something bad to other people, including sexual assault and murder. Obsessive thoughts can take the form of individual words, phrases, or even lines of poetry - a good illustration is an episode from the movie "The Shining", where main character going crazy, starts typing the same phrase "all work and no play makes Jack a dull boy". A person with OCD experiences tremendous stress - he is simultaneously horrified by his thoughts and tormented by a sense of guilt for them, tries to resist them, and at the same time tries to make the rituals performed by him go unnoticed by others. At the same time, in all other respects, his consciousness functions completely normally.

It is believed that obsessions and compulsions are closely related to the "magical thinking" that arose at the dawn of mankind - the belief in the ability to take control of the world with the right attitude and rituals. Magical thinking draws a direct parallel between a mental desire and a real consequence: if you draw a buffalo on the wall of a cave, tuning in to a successful hunt, you will certainly be lucky. Apparently, this way of perceiving the world arises in the deep mechanisms of human thinking: neither scientific and technological progress, nor logical arguments, nor sad personal experience proving the uselessness of magical passes, do not relieve us of the need to look for the relationship between random things. Some scientists believe that it is embedded in our neuropsychology - an automatic search for patterns that simplify the picture of the world helped our ancestors to survive, and the most ancient parts of the brain still work according to this principle, especially in stressful situation... Therefore, with an increased level of anxiety, many people begin to fear their own thoughts, fearing that they may become reality, and at the same time believe that a set of some irrational actions will help prevent an undesirable event.

Story

In ancient times, this disorder was often associated with mystical reasons: in the Middle Ages, people obsessed with obsessions were immediately sent to exorcists, and in the 17th century the concept changed to the opposite - it was believed that such states arise due to excessive religious zeal.

In 1877, Wilhelm Griesinger, one of the founders of scientific psychiatry, and his student Karl-Friedrich-Otto Westphal found out that the basis of "obsessive-compulsive disorder" is a disorder of thinking, but it does not affect other aspects of behavior. They used the German term Zwangsvorstellung, which, having been translated differently in Britain and the United States (as obsession and compulsion, respectively), has evolved into the modern name for the disease. And in 1905, the French psychiatrist and neurologist Pierre Marie Felix Janet isolated this neurosis from neurasthenia as a separate disease and called it psychasthenia.

There were divergent opinions about the cause of the disorder - for example, Freud believed that obsessive-compulsive behavior refers to unconscious conflicts that manifest themselves in the form of symptoms, while his German colleague Emil Kraepelin referred to it as a "constitutional mental illness" caused by physical causes.

Famous people also suffered from obsessive disorder - for example, the inventor Nikola Tesla counted steps when walking and the volume of food portions - if he could not do this, lunch was considered spoiled. And Howard Hughes, an entrepreneur and pioneer of American aviation, was afraid of dust and ordered his employees to "wash four times, each time using a large amount of foam from a new bar of soap."

Defense mechanism

The exact causes of OCD are not clear now, but all hypotheses can be roughly divided into three categories: physiological, psychological, and genetic. Proponents of the first concept associate the disease with either the functional and anatomical features of the brain, or with metabolic disorders (biologically active substances transmitting electrical impulses between neurons, or from neurons to muscle tissue) - primarily serotonin and dopamine, as well as norepinephrine and GABA. Some researchers have noted that many people with obsessive-compulsive disorder had birth trauma at birth, which also confirms the physiological causes of OCD.

Proponents of psychological theories believe that the disease is associated with personality traits, temperament, psychological trauma and an incorrect response to the negative impact of the environment. Sigmund Freud suggested that the occurrence of obsessive-compulsive symptoms is associated with the protective mechanisms of the psyche: isolation, elimination and reactive formation. Isolation protects a person from disturbing affects and impulses, forcing them into the subconscious, elimination is aimed at fighting the emerging repressed impulses - in fact, the compulsive act is based on it. And, finally, reactive education is the manifestation of patterns of behavior and consciously experienced attitudes opposite to the arising impulses.

There is also scientific evidence that genetic mutations contribute to OCD. They were found in unrelated families with members suffering from OCD - in the serotonin transporter gene, hSERT. Studies of identical twins also confirm the existence of a hereditary factor. In addition, people with OCD are more likely to have close relatives with the same disorder than healthy people.

Maksim, 21 years old, suffers from OCD since childhood

I started it at about 7-8 years old. The neurologist was the first to report the probability of OCD, and even then there was a suspicion of obsessional neurosis... I was constantly silent, running various theories in my head like “mental chewing gum”. When I saw something that caused me anxiety, obsessive thoughts about it began, although the reasons were seemingly quite insignificant and, perhaps, would never have touched me.

At one time there was an obsession with the idea that my mother might die. I was turning over the same moment in my head, and it captured me so much that I could not sleep at night. And when I ride in a minibus or in a car, I constantly think about the fact that now we will have an accident, that someone will crash into us or we will fly off the bridge. A couple of times the thought arose that the balcony below me would fall apart, or someone would throw me out of there, or I myself would slip in the winter and fall.

We never really talked with the doctor, I just took different medications. Now I am moving from one obsession to another and doing some rituals. I constantly touch something, no matter where I am. I walk from corner to corner throughout the room, adjusting the curtains, wallpaper. Maybe I'm different from other people with this disorder, each with their own rituals. But it seems to me that those people who accept themselves as they are are more fortunate. They are much better off than those who want to get rid of it and are very worried about it.

OCD stands for obsessive-compulsive disorder. We are talking about a neurosis associated with obsessive compulsions. The habits that many people have and are considered even useful can cross an invisible line, turning into real mental disorders that interfere with a person's normal life and require psychotherapeutic help.

OCD suggests obsessive-compulsive neurosis

Along with phobias, OCD is referred to as obsessive states (phobias and compulsions are part of the structure of this syndrome), but unlike phobic manifestations, they include obsessions (obsession) and compulsions (compulsion).

Most often, these diseases are encountered at the age of 10-35. It can take several years from the onset of the disease to the appearance of its initial pronounced symptoms. Among adults, OCD occurs in every third (in a more or less pronounced form), among children, every second in half a thousand is sick.

At first, a person is aware of the irrationality of his obsessive state, but if he does not receive any psychological and, possibly, medical assistance, a further exacerbation of this disorder occurs. The patient is no longer able to adequately assess the situation.

Causes of neurosis

Scientists fail to name the exact factors leading to the occurrence of the described mental illnesses. But most theories agree that the reasons can be traced back to:

• impaired metabolism;
• craniocerebral trauma;
• genetic predisposition;
• complications of infectious diseases;
• dysfunction of the autonomic system.

The likelihood of such causes of obsessive-compulsive neurosis should also be noted:

• strict rules of education (often associated with religion);
• lack of normal relationships with colleagues and bosses at work;
• regular stress.

The engine for the development of panic fear can be negative experiences or experiences imposed by social circumstances.

Often, people who have reviewed crime news bulletins have similar troubles. To overcome the fears that have arisen, the patient performs actions that, in his opinion, prove the opposite:

• checks a dozen times whether he has closed the apartment;
• counts banknotes received at the ATM more than once;
• vigorously washes his hands, despite the fact that they have been clean for a long time.

But these actions performed by a person, like rituals, do not help - with their help it is possible to achieve only short-term relief.

Over time, the disease can literally "swallow" the human psyche. Children have to deal with this ailment less often than adults. The symptoms of obsessive-compulsive disorder are not least dependent on the age of the patient.

OCD sufferers' rituals bring only temporary relief

Symptoms of the disorder

The diagnosis of OCD suggests different types of the disorder, but the overall clinical picture is almost the same. First of all, it comes about painful thoughts and fantasies associated with:

• sexual abuse;
• an early death;
• loss of financial well-being, etc.

Even realizing the groundlessness of such ideas, the patient still cannot get rid of them on his own. It seems to him that these fantasies will one day become reality.

The main symptoms of this mental disorder are associated with repetition of the same movements. Someone is counting the steps everywhere, someone does not get tired of washing their hands several dozen times a day. It is hard for those around you - colleagues, friends and relatives - to notice this behavior.

Often, people with OCD keep their workplace in perfect order: the symmetrical arrangement of all objects catches the eye. The books in the bookcase can be sorted alphabetically or by color.

When the patient is in a crowd, the signs of his disorder intensify, and panic attacks begin. There may be a fear of infection with some terrible virus, fear of losing personal belongings or their theft. Accordingly, such people should visit public places as little as possible.

Possibly low self-esteem. In general, suspicious individuals often have to suffer from compulsive-obsessive disorder: with a tendency to control everything they do, they suddenly realize that certain changes are taking place and they have no way of influencing it.

Childhood neurosis

Obsessive neurosis is rarely found in children. A few examples can be cited:

• Fear of suddenly being alone in a crowd - because of this, the child strongly clings to the hand of an adult, checks the strength of the grip of the fingers.
• Fear of being in orphanage(often due to the fact that parents or older brothers scare the kids with an orphanage as an incentive to do or not do something).
• Panic caused by lost thing... Some children even wake up at night to count their belongings and school supplies.

Of the signs of such a disease in children, it can be noted:

• gloominess;
• tearfulness;
• unimportant mood;
• loss of appetite;
• bad dream.

Some symptoms are rare, others are more frequent. Parents who observe similar signs in their children should seek help from a psychotherapist.

Diagnosis: visit to the doctor

People suffering from obsessions and compulsions do not always suspect about their own illnesses. However, those around them - relatives, acquaintances, colleagues - should carefully point out this to them: one should not expect that the disease will go away on its own.

Diagnostics can only be carried out by a professional psychologist. The diagnosis of OCD and the determination of the degree of the disorder is made according to special rating scales, the decoding of which is within the power of a qualified specialist.

OCD should be treated by a trained healthcare provider

Here's what the therapist should look for in the first place:

• The presence of pronounced obsessive obsessions (which are already a sign of the disorder).
• Signs of compulsive neurosis, which the patient, nevertheless, tries to hide.
• Violation of the normal rhythm of life.
• Difficulty communicating with colleagues and friends.

A symptom is considered significant for an accurate diagnosis if it is repeated 50 percent of the time for a couple of weeks.

The doctor examines the patient, conducts a conversation with him, gives special tests and makes a diagnosis. He must explain to the person:

• what is obsessive-compulsive disorder;
• by what symptoms it can be determined;
• what are the causes of this problem;
• what should be the treatment - medical and psychological.

You should not think that the disease is incurable - in fact, many people manage to successfully cope with their disorders and return to normal life, not burdened by obsessive compulsions.

Is it realistic to cure the described disease at home? Theoretically, it is possible to cope with the problem if it is detected at a very early stage of development, the patient himself has realized it, accepted it and does everything necessary to recover.

Here are the therapy options that you can do yourself:

• Learn more about OCD and its symptoms and causes. For this there is specialized literature, the Internet (this site, in particular). Write out symptoms of particular concern. Drawing up a strategy to deal with these symptoms.
• Look fear in the eye. Most patients are aware of the irrationality of obsessive states, their "invented" nature. And if you want to once again wash your hands or check if the door is closed, you need to remind yourself of the uselessness of such actions and psychologically force yourself not to perform them.
• You should be praised for every successful step, even if it was insignificant.

Although, of course, it is better to consult a qualified medical specialist in psychotherapy. There may be certain difficulties during the first visit to the doctor, but once he is diagnosed, prescribed treatment, and everything will be much easier.

Some folk remedies help patients calm down: these are decoctions of lemon balm, valerian and other sedative herbs.

Breathing exercises are also considered beneficial. All that is required is to correctly change the strength of the breath. Gradually, this restores a normal emotional state and makes a person's assessment of everything that happens in his life more sober and adequate.

Psychotherapeutic methods

Based on the symptoms of OCD, doctors may prescribe the following treatment options:

• Cognitive behavioral techniques. Designed by Dr. Jeffrey Schwartz. To begin with, a person must realize that he has a disorder, and then begin to resist. Gradually, the patient acquires skills, thanks to which he independently cope with obsessions.
• "Stop thought." The author of this method is Joseph Wolpe. The patient recalls a recent attack of OCD, and himself determines its significance in his life (thanks to the therapist's leading questions). Gradually, the patient must understand how unreal all his fears are.

There are other therapeutic techniques, but the above are considered the most effective and in demand.

Psychotherapists use different methods to treat OCD

Medication treatment

When it comes to medication for OCD, the most commonly prescribed serotonin reuptake inhibitors are prescribed by doctors. In particular, this applies to Paroxetine, Fluvoxamine, tricyclic antidepressants.

Scientists' study of obsessive emotions in this disease, including hatred and aggression, is ongoing. Today, you can read in sufficient detail about this disorder on Wikipedia, look through many informational articles on this site.

The fact that ongoing research is not in vain proves new discoveries of researchers in this area: for example, agents that release the neurotransmitter glutamate can perform a therapeutic function. Thanks to them, neurotic manifestations are mitigated. True, full recovery, thus, will not work. These agents can be found in Lamotrigine and Memantine.

Antidepressants help, but only to cope with symptoms: relieve tension and relieve neurosis.

By the way, almost all of these medicines are sold in pharmacies, but they are dispensed with a prescription. One way or another, you should not prescribe them on your own - this should be done by the doctor, based on the current state of the patient and his individual characteristics... The duration of this syndrome is also important: the doctor should find out exactly when OCD started.

There are many effective psychotherapeutic methods for treating obsessive-compulsive disorders, but often medication is indispensable.

Rehabilitation after treatment

When the course of treatment is over, the patient still needs social rehabilitation. Without normal adaptation, OCD symptoms will come back again.

Therapeutic activities carried out for support are associated with training in productive interaction with colleagues at work, relatives, and society. It is important that relatives and friends help to rehabilitate.

Rehabilitation is not just one event, but a whole complex of procedures aimed at ensuring that a person can adapt to everyday life, control his own behavior, and become sufficiently self-confident.

It is important that loved ones support the person who is treating and recovering from OCD

In psychiatry, OCD is given a lot of place today, because the danger of such disorders cannot be underestimated, nor can their treatment be delayed. The sooner a person learns (most often people around him tell him about it) that he has obsessive states, see a doctor and begins to be treated, the more opportunities he has to cope with all this as soon as possible, easier and avoiding consequences.

The famous German philosopher Arthur Schopenhauer argued that nine-tenths of our happiness depends on health. Without health, there is no happiness! Only complete physical and mental well-being determines human health, helps us to successfully cope with diseases, adversities, lead an active social life, reproduce offspring, and achieve our goals. Human health is the key to a happy, fulfilling life. Only a person who is healthy in all respects can be truly happy and capable ofTo fully experience the fullness and diversity of life, to experience the joy of communication with the world.

They talk about cholesterol so unflattering that they just fit to scare children. Do not think that this is a poison that only does what destroys the body. Of course, it can be harmful, and even hazardous to health. However, in some cases, cholesterol is extremely necessary for our body.

The legendary star balm appeared in Soviet pharmacies in the 70s of the last century. It was in many ways an indispensable, effective and affordable drug. They tried to treat everything in the world with an "asterisk": acute respiratory infections, insect bites, and pains of various origins.

The tongue is an important human organ, which not only can chat incessantly, but without saying anything, can tell a lot. And there is something to tell him, especially about health.In spite of small size, the language performs a number of vital functions.

Over the past several decades, the prevalence of allergic diseases (AD) has become an epidemic. According to the latest data, more than 600 million people worldwide suffer from allergic rhinitis (AR), about 25% of them in Europe.

For many people, there is an equal sign between the bath and the sauna. And a very small number of those who realize that there is a difference can easily explain what this difference is. Having considered this issue in more detail, we can say that there is a significant difference between these pairs.

Late autumn, early spring, periods of thaw in winter are a period of frequent colds, both for adults and children. From year to year, the situation repeats itself: one member of the family falls ill and after him, as in a chain, everyone carries the respiratory viral infection.

Some popular medical weekly magazines contain odes to sala. It turns out that it has the same properties as olive oil, and therefore can be consumed without any reservations. At the same time, many argue that it is possible to help the body "cleanse" only by fasting.

In the 21st century, thanks to vaccination, the prevalence infectious diseases. Vaccines prevent two to three million deaths a year, according to the WHO! But, despite the obvious benefits, immunization is shrouded in many myths that are actively discussed in the media, and in general in society.

A prominent role among mental illnesses is played by syndromes (complexes of symptoms), united in the group of obsessive-compulsive disorder (OCD), which got its name from the Latin terms obsessio and compulsio.

Obsession (lat.obsessio - taxation, siege, blockade).

Compulsions (lat. Compello - I force). 1. Obsessive drives, a kind of obsessions (obsessions). Irresistible drives that arise in spite of reason, will, feelings are characteristic. Often they turn out to be unacceptable for the patient, contrary to his moral and ethical properties. Unlike impulsive drives, compulsions are not realized. These drives are perceived by the patient as wrong and painfully experienced by him, especially since their very appearance, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsion is also used in a broader sense to denote any obsessions in the motor sphere, including obsessive rituals.

Currently, almost all obsessive-compulsive disorders are combined in the International Classification of Diseases under the concept of "obsessive-compulsive disorder".

ROC concepts have undergone a fundamental reassessment over the past 15 years. During this time, the clinical and epidemiological implications of OCD have been completely revised. If it was previously thought that this is a rare condition observed in a small number of people, now it is known that OCD is common and gives a high incidence, which requires urgent attention of psychiatrists around the world. In parallel, our understanding of the etiology of OCD has expanded: the fuzzy psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm exploring the neurotransmitter disorders underlying OCD. Most significantly, pharmacological interventions specifically targeting serotonergic neurotransmission have revolutionized the recovery prospects of millions of OCD sufferers worldwide.

The discovery that intense serotonin reuptake inhibition (SSRI) is the key to effectively treating OCD was the first step in a revolution and stimulated clinical trials that showed the effectiveness of such selective inhibitors.

As described in ICD-10, the main features of OCD are repetitive obsessive thoughts and compulsive actions (rituals).

In a broad sense, the core of OCD is obsessional syndrome, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, memories that arise apart from the desire of patients, but with awareness of their pain and a critical attitude towards them. Despite the understanding of the unnaturalness, illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessive motives or ideas are recognized as alien to the person, but as if coming from within. Obsessive behaviors can be rituals designed to relieve anxiety, such as hand washing to combat "pollution" and to prevent "contamination." Trying to drive away unwelcome thoughts or impulses can lead to intense internal struggles accompanied by intense anxiety.

Obsessions in ICD-10 are included in the group of neurotic disorders.

The prevalence of OCD in the population is quite high. According to some data, it is determined by an indicator of 1.5% (meaning "fresh" cases of diseases) or 2-3%, if episodes of exacerbations observed throughout life are taken into account. Obsessive-compulsive disorder sufferers account for 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally.

CLINICAL PICTURE

The problem of obsessive compulsions attracted the attention of clinicians as early as the beginning of the 17th century. They were first described by Platter in 1617. In 1621 E. Barton described the obsessive fear of death. Obsessions are mentioned in the works of F. Pinel (1829). I. Balinsky proposed the term "obsessive representations", which took root in Russian psychiatric literature. In 1871 Westphal coined the term agoraphobia to denote the fear of being in public. M. Legrand de Sol, analyzing the features of the dynamics of OCD in the form of “insanity of doubts with delusions of touch, points to a gradually complicating clinical picture - obsessive doubts are replaced by absurd fears of“ touching ”surrounding objects, motor rituals are added, the fulfillment of which obeys the whole life of patients. However, only at the turn of the XIX-XX centuries. the researchers managed to more or less clearly describe the clinical picture and give a syndromic description of obsessive-compulsive disorders. The onset of the disease, as a rule, occurs in adolescence and adolescence. The maximum of clinically outlined manifestations of obsessive-compulsive disorder is observed in the age range of 10 - 25 years.

The main clinical manifestations of OCD are:

Obsessive thoughts - painful, arising without will, but recognized by the patient as his own, ideas, beliefs, images that in a stereotyped form forcibly invade the patient's consciousness and which he tries to resist in some way. It is this combination of an inner feeling of compulsive urge and efforts to resist it that characterizes obsessive symptoms, but of the two, the degree of effort is more variable. Obsessive thoughts can take the form of single words, phrases, or lines of poetry; they are usually unpleasant to the patient and can be obscene, blasphemous, or even shocking.

Obsessive imagery is vividly presented scenes, often violent or disgusting including, for example, sexual perversion.

Obsessive impulses are urges to take actions that are usually destructive, dangerous, or disgraceful; for example, jumping out into the road in front of a moving car, injuring a child, or shouting obscene words in public.

Obsessive rituals include both mental activity (for example, repeating counting in some special way, or repeating certain words) and repetitive but meaningless acts (for example, washing your hands twenty or more times a day). Some of them have an understandable connection with previous obsessive thoughts, for example, repeated hand washing - with thoughts of infection. Other rituals (for example, regularly laying out clothes according to some complex system before putting them on) do not have such a connection. Some sufferers feel an irresistible urge to repeat these actions a certain number of times; if this does not work, they have to start all over again. Patients are invariably aware that their rituals are illogical, and usually try to hide them. Some fear that these symptoms are signs of incipient insanity. Both obsessive thoughts and rituals inevitably lead to problems in daily activities.

Obsessive ruminations ("mental gum") are internal debates that endlessly revise the arguments for and against even the simplest of everyday activities. Some obsessive doubts concern actions that may have been improperly performed or not completed, such as turning off the gas stove tap or locking the door; others relate to activities that could harm other people (for example, being able to drive past a cyclist and run over him). Sometimes doubts are associated with a possible violation of religious precepts and rituals - "remorse."

Compulsive actions are repetitive, stereotypical actions that sometimes take on the character of protective rituals. The latter are aimed at preventing any objectively unlikely events dangerous to the patient or his relatives.

In addition to the above, in the series of obsessive-compulsive disorders, a number of outlined symptom complexes stand out, and among them obsessive doubts, contrasting obsessions, obsessive fears - phobias (from the Greek phobos).

Obsessive thoughts and compulsive rituals can intensify in certain situations; for example, obsessive thoughts about harming other people often become more persistent in the kitchen or some other place where knives are stored. Because patients often avoid such situations, there may be superficial similarities with the characteristic avoidance pattern found in phobic anxiety disorder. Anxiety is an important component of obsessive-compulsive disorder. Some rituals reduce anxiety, while others increase it. Obsessions often develop as part of depression. In some patients, this looks like a psychologically understandable response to obsessive-compulsive symptoms, but in other patients, there are recurrent episodes of depressive mood that occur independently.

Obsessions (obsessions) are divided into figurative, or sensual, accompanied by the development of affect (often painful) and obsession with affectively neutral content.

Sensory obsessions include obsessive doubts, memories, representations, drives, actions, fears, obsessive feelings of antipathy, obsessive fear of habitual actions.

Obsessive doubts are an intrusive uncertainty arising in spite of logic and reason in the correctness of the performed and committed actions. The content of doubts is different: obsessive everyday fears (whether the door is locked, whether the windows or water taps are tightly closed enough, whether the gas or electricity is turned off), doubts related to official activities (whether this or that document is correctly written, whether the addresses on business papers, whether inaccurate numbers are indicated, whether the orders are correctly formulated or executed), etc. Despite the repeated verification of the committed action, doubts, as a rule, do not disappear, causing psychological discomfort in a person suffering from this kind of obsession.

Obsessive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a feeling of shame and remorse. They dominate the mind of the patient, despite efforts and efforts not to think about them.

Obsessive drives are impulses to commit one or another harsh or extremely dangerous action, accompanied by a feeling of horror, fear, confusion with the inability to get rid of it. The patient is seized, for example, by the desire to throw himself under a passing train or push a loved one under him, to kill his wife or child in an extremely cruel way. At the same time, patients are painfully afraid that this or that action will be implemented.

The manifestations of obsessive ideas can be different. In some cases, it is - a vivid "vision" of the results of obsessive drives, when patients imagine the result of a committed cruel act. In other cases, obsessive notions, often called overwhelming, appear in the form of implausible, sometimes absurd situations that patients take for real. An example of obsessive notions is the patient's conviction that the buried relative was alive, and the patient painfully imagines and experiences the suffering of the deceased in the grave. At the height of obsessive ideas, the consciousness of their absurdity, implausibility disappears and, on the contrary, confidence in their reality appears. As a result, obsessions acquire the character of overvalued formations (dominant ideas that do not correspond to their true meaning), and sometimes delirium.

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) is an unjustified antipathy driven away by the patient from himself to a certain, often to a loved one, cynical, unworthy thoughts and ideas in relation to respected people, among religious persons - in relation to saints or ministers of the church.

Obsessive actions are actions performed against the wishes of the sick, despite efforts to contain them. Some of the compulsive actions weigh on the patients until they are realized, others are not noticed by the patients themselves. Obsessive actions are painful for patients, especially in those cases when they become the object of attention of others.

Obsessive fears, or phobias, include obsessive and meaningless fear of heights, large streets, open or confined spaces, large crowds of people, fear of sudden death, fear of contracting one or another incurable disease. Some patients may experience a wide variety of phobias, sometimes acquiring the character of a fear of everything (panphobia). And finally, obsessive fear of the emergence of fears (phobophobia) is possible.

Hypochondriacal phobias (nosophobia) - an obsessive fear of any serious illness. Most often, cardio, stroke, syphilo and AIDS phobias are observed, as well as the development of malignant tumors. At the peak of anxiety, patients sometimes lose a critical attitude towards their condition - they turn to doctors of the appropriate profile, require examination and treatment. The implementation of hypochondriac phobias occurs both in connection with psycho- and somatogenic (general non-mental diseases) provocations, and spontaneously. As a rule, as a result, hypochondriacal neurosis develops, accompanied by frequent visits to doctors and inappropriate medication.

Specific (isolated) phobias are obsessive fears limited to a strictly defined situation - fear of heights, nausea, thunderstorms, pets, treatment by a dentist, etc. Since contact with situations that cause fear is accompanied by intense anxiety, the desire of patients to avoid them is characteristic.

Obsessive fears are often accompanied by the development of rituals - actions that have the meaning of "magic" spells that are performed, despite the patient's critical attitude to the obsession, in order to protect against one or another imaginary misfortune: before starting any important business, the patient must perform some specific action to eliminate the possibility of failure. Rituals can, for example, be expressed in snapping fingers, playing a melody by the patient, or repeating certain phrases, etc. In these cases, even those close to you are not aware of the existence of such disorders. Rituals combined with obsessions represent a fairly stable system that usually exists for many years or even decades.

Obsessions with affective-neutral content - obsessive philosophizing, obsessive counting, remembering neutral events, terms, formulations, etc. Despite their neutral content, they burden the patient, interfere with his intellectual activity.

Contrasting obsessions ("aggressive obsessions") - blasphemous, blasphemous thoughts, fear of harming oneself and others. Psychopathological formations of this group relate mainly to figurative obsessions with a pronounced affective saturation and ideas that take possession of the consciousness of patients. They are distinguished by a sense of alienation, an absolute lack of motivation in the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions and complain of an irresistible desire to add to the just heard cues endings that give the said an unpleasant or threatening meaning, repeat after others, but with a touch of irony or anger, phrases of religious content, shout out cynical words that contradict their own attitudes and generally accepted morality , they may feel fear of losing control over themselves and possible committing dangerous or ridiculous actions, injuring themselves or their loved ones. In the latter cases, obsessions are often combined with phobias of objects (fear of sharp objects - knives, forks, axes, etc.). The contrast group also includes obsessions with sexual content (obsessions like forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals).

Obsessions with pollution (misophobia). This group of obsessions includes both the fear of pollution (earth, dust, urine, feces and other sewage), and the fear of the penetration of harmful and poisonous substances into the body (cement, fertilizers, toxic waste), small objects (shards of glass, needles, specific species dust), microorganisms. In some cases, the fear of contamination can be limited, remain for many years at the preclinical level, manifesting itself only in certain features of personal hygiene (frequent changes of linen, repeated washing of hands) or in the manner of housekeeping (careful processing of food, daily washing of floors , "Taboo" on pets). This kind of monophobia does not significantly affect the quality of life and is evaluated by others as habits (exaggerated cleanliness, excessive disgust). Clinically manifested variants of misophobia belong to the group of severe obsessions. In these cases, the progressively more complex protective rituals come to the fore: avoiding sources of pollution and touching "unclean" objects, processing things that could get dirt, a certain sequence in use detergents and towels, allowing you to maintain "sterility" in the bathroom. The stay outside the apartment is also furnished with a series of protective measures: going out into the street in special clothes that cover the body as much as possible, special handling of worn items upon returning home. In the later stages of the disease, patients, avoiding pollution, not only do not go outside, but do not even leave their own room. In order to avoid dangerous contacts and contacts in terms of contamination, patients do not even admit their closest relatives. Misophobia is also associated with the fear of contracting any disease that does not belong to the categories of hypochondriacal phobias, since it is not determined by the fear of the person suffering from OCD with one or another disease. In the foreground is the fear of a threat from the outside: the fear of pathogenic bacteria entering the body. Hence the development of appropriate protective actions.

A special place in the series of obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, in contrast to organically conditioned involuntary movements, are much more complex motor acts that have lost their original meaning. Tics sometimes give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures. Patients suffering from tics can shake their heads (as if checking if the hat fits well), make hand movements (as if throwing away interfering hair), blink their eyes (as if getting rid of a speck). Along with obsessive tics, pathological habitual actions (biting lips, grinding teeth, spitting, etc.) are often observed, which differ from the intrusive actions themselves by the absence of a subjectively painful feeling of obsession and experiencing them as alien, painful. Neurotic conditions characterized only by obsessive tics usually have a favorable prognosis. Appearing most often in preschool and primary school age, tics usually fade towards the end of puberty. However, such disorders may turn out to be more persistent, persist for many years and only partially change in manifestations.

Course of obsessive-compulsive disorder.

Unfortunately, it is necessary to indicate chronization as the most characteristic trend in the dynamics of OCD. Cases of episodic manifestations of the disease and complete recovery are relatively rare. However, in many patients, especially with the development and maintenance of one type of manifestation (agoraphobia, compulsive counting, ritual hand washing, etc.), long-term stabilization of the state is possible. In these cases, there is a gradual (usually in the second half of life) mitigation of psychopathological symptoms and social readaptation. For example, patients who have experienced fear of traveling by certain types of transport, or public speaking, cease to feel inferior and work alongside healthy ones. In milder forms of OCD, the disease is usually benign (on an outpatient basis). The reverse development of symptoms occurs after 1 - 5 years from the moment of manifestation.

More severe and complex OCD, such as phobias of infection, pollution, sharp objects, contrasting representations, numerous rituals, on the contrary, can become persistent, resistant to treatment, or show a tendency to relapse with disorders that persist despite active therapy. Further negative dynamics of these conditions indicates a gradual complication of the clinical picture of the disease as a whole.

DIFFERENTIAL DIAGNOSIS

It is necessary to distinguish OCD from other disorders that cause obsessions and rituals. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when obsessive thoughts are unusual in content (for example, mixed sexual and blasphemous topics) or rituals are extremely eccentric. The development of a sluggish schizophrenic process cannot be ruled out with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity (inconsistency of thinking and actions), the monotony of emotional manifestations. Protracted obsessive states of a complex structure must be distinguished from the manifestations of paroxysmal schizophrenia. In contrast to neurotic obsessive states, they are usually accompanied by a sharply increasing anxiety, a significant expansion and systematization of the circle of obsessive associations that acquire the character of obsessions of "special significance": previously indifferent objects, events, random remarks from others remind patients of the content of phobias, offensive thoughts and thereby acquire in their view, a special, threatening meaning. In such cases, it is necessary to consult a psychiatrist in order to exclude schizophrenia. Differentiating between OCD and generalized disorders, known as Gilles de la Tourette's syndrome, can also pose a challenge. Tics in such cases are localized in the area of ​​the face, neck, upper and lower extremities and are accompanied by grimaces, opening the mouth, protruding tongue, and intense gestures. To exclude in these cases this syndrome is helped by its characteristic roughness of movement disorders and more complex in structure and more severe mental disorders.

Genetic factors

Speaking of a hereditary predisposition to OCD, it should be noted that obsessive-compulsive disorders are found in about 5-7% of parents of patients with such disorders. Although this rate is low, it is higher than that of the general population. While the evidence for an inherited predisposition to OCD is uncertain, the psychasthenic personality traits can be largely attributed to genetic factors.

In about two-thirds of cases, OCD improves within a year, more often by the end of that period. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of improvement in health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic personality with severe symptoms of the disease, or if there are continuous stressful events in the patient's life. Severe cases can be extremely persistent; for example, a study of hospitalized patients with OCD found that three-quarters of them remained symptomatic after 13–20 years.

TREATMENT: BASIC METHODS AND APPROACHES

Despite the fact that OCD is a complex group of symptom complexes, the principles of treatment for them are the same. The most reliable and effective method of treating OCD is drug therapy, during which a strictly individual approach to each patient should be manifested, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of a history of other diseases. In this regard, we must warn patients and their relatives against self-medication. If any disorders similar to mental ones appear, it is necessary, first of all, to contact the specialists of the psycho-neurological dispensary at the place of residence or other medical institutions of the psychiatric profile to establish the correct diagnosis and prescribe competent adequate treatment. It should be remembered that at present a visit to a psychiatrist does not threaten any negative consequences - the notorious "registration" was canceled more than 10 years ago and replaced by the concepts of counseling and medical care and dispensary observation.

When treating, it should be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement in the condition). The apparent suffering of the patient often seems to require vigorous and effective treatment, but the natural course of this condition should be remembered to avoid a typical mistake, consisting in overly intensive therapy. It is also important to consider that depression is often associated with OCD, and that depression is often associated with amelioration of obsessive symptoms when effectively treated.

Treatment for OCD begins with educating the patient about the symptoms and, if necessary, believing that they are the initial manifestation of insanity (a common concern for obsessive-compulsive patients). Sufferers of these or those obsessions often involve other family members in their rituals, so relatives need to treat the patient firmly but sympathetically, softening the symptomatology if possible, and not aggravating it by excessive indulgence of the sick fantasies.

Drug therapy

The following therapeutic approaches exist for the currently identified types of OCD. From pharmacological preparations Serotonergic antidepressants, anxiolytics (mainly of the benzodiazepine series), beta-blockers (for the relief of autonomic manifestations), MAO inhibitors (reversible), and triazole benzodiazepines (alprazolam) are most commonly used in OCD. Anxiolytic drugs provide some short-term relief of symptoms, but they should not be prescribed for more than a few weeks at a time. If treatment with anxiolytics is required for more than one to two months, small doses of tricyclic antidepressants or minor antipsychotics sometimes help. The main link in the OCD treatment regimen, overlapping with negative symptoms or ritualized obsessions, is atypical antipsychotics - risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants, or with other antidepressants - moclobemodiene, or tianopentiene-producing alprazolam, clonazepam, bromazepam).

Any comorbid depressive disorder is treated with an adequate dose of antidepressant medication. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms, but the results of a controlled clinical trial showed that the effect of this drug is insignificant and manifests itself only in patients with distinct depressive symptoms.

In cases where obsessive-phobic symptoms are observed within schizophrenia greatest effect has intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram). In some cases, it is advisable to use traditional antipsychotics (small doses of haloperidol, trifluoperazine, fluanksol) and parenteral administration of benzodiazepine derivatives.

Psychotherapy

Behavioral psychotherapy

One of the primary goals of a healthcare professional in treating OCD is to establish a fruitful relationship with the patient. It is necessary to instill in the patient confidence in the possibility of recovery, overcome his prejudice against the "harm" caused by psychotropic drugs, convey his conviction in the effectiveness of treatment, subject to systematic adherence to prescribed prescriptions. The patient's faith in the possibility of healing must be supported in every possible way by the relatives of the sufferer of OCD. If the patient has rituals, it must be remembered that improvement usually occurs when using a combination of the method of preventing the reaction with placing the patient in conditions that aggravate these rituals. Significant, but incomplete, improvement can be expected in about two-thirds of patients with moderately severe rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts also recede. With panphobia, behavioral techniques are mainly used, aimed at reducing sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases where ritualized phobias predominate, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for obsessive-compulsive thoughts that are not accompanied by rituals. For many years, some specialists have used the method of "stopping thoughts", but its specific effect has not been convincingly proven.

Social rehabilitation

We have already noted that obsessive-compulsive disorder has a fluctuating (fluctuating) course and over time the patient's condition can improve, regardless of which treatment methods were used. Until they recover, sufferers can benefit from supportive conversations that provide ongoing hope of recovery. Psychotherapy in a complex of therapeutic and rehabilitation measures in patients with OCD is aimed at both correcting avoidant behavior and reducing sensitivity to phobic situations (behavioral therapy), as well as family psychotherapy with the aim of correcting behavior disorders and improving family relations. If marital problems exacerbate symptoms, spouse interviews are indicated. Patients with panphobia (at the stage of the active course of the disease), due to the intensity and pathological persistence of symptoms, require both medical and social and labor rehabilitation. In this regard, it is important to determine the adequate terms of treatment - long-term (at least 2 months) therapy in a hospital with the subsequent continuation of the course on an outpatient basis, as well as carrying out measures to restore social connections, professional skills, intra-family relationships. Social rehabilitation is a set of programs for teaching patients with OCD methods of rational behavior both in everyday life and in a hospital setting. Rehabilitation is aimed at teaching social skills to properly interact with other people, vocational training, as well as the skills required in Everyday life... Psychotherapy helps patients, especially those experiencing a sense of their own inferiority, to better and correctly relate to themselves, to master ways of solving everyday problems, to gain faith in their own strength.

All of these methods, if used judiciously, can increase the effectiveness of drug therapy, but are not able to completely replace drugs. It should be noted that explanatory psychotherapy is not always helpful, and some people with OCD may even get worse, as such procedures induce painful and unproductive reflections on subjects discussed during treatment. Unfortunately, until now, science has not known ways to heal mental ailments once and for all. OCD often tends to recur, requiring long-term prophylactic medication.