Obsessive compulsive disorder

OCD: Description

Obsessive Compulsive Disorder (OCD) is a severe mental disorder that puts a heavy strain on those affected. Already Charles Darwin and Martin Luther are said to have suffered from an obsessive-compulsive disorder. OCD includes a wide range of behavioral problems and other mental characteristics. For example, the person concerned is pursued by obsessive thoughts or is under pressure to perform certain actions again and again in a ritualized form. This can be the compulsion to wash according to a certain pattern or to count things. Others have the compulsive notion of committing acts of violence or sexually undesirable actions.

Waschzwang

For more information on signs and treatment of washing compulsion, see the article Washing Compulsion.

An obsolete term for obsessive-compulsive disorder is obsessional neurosis. The obsessive-compulsive neurosis definition suggests that people who are obsessionally neurotic-unlike people with psychosis-do not lose touch with reality. They know that their compulsive thoughts and actions are irrational, but they still can not turn you off.

The thoughts and actions are called coercion, because those affected try to fight against them. The inner resistance to refrain from actions or thoughts costs a lot of strength and creates ever-increasing tension and anxiety. Only when they yield to the constraints and perform the particular ritual, or get external confirmation that their fears and worries are unfounded, the pressure eases. Similar to addicts, a kind of habituation effect occurs over time: The ritual usually becomes more and more complex and protracted until it brings the hoped-for relaxation. The constraints therefore take more and more time and energy.

A little coercion is normal

There is a bit of compulsion in every human being – superstitious ideas are as much a part of it as harmless rituals. So some otherwise rational people feel a slight discomfort when they sign an important contract on Friday the 13th.

The transition from normal behavior to obsessive-compulsive disorder is fluid. For example, some people might feel compelled to double-check before sleeping to see if the stove is off – even if they did not cook at all. Others, on the other hand, have to undergo a several-hour washing ritual before they can leave the house. Basically, an obsessive-compulsive disorder is considered to exist only when the person affected suffers or is severely restricted in his or her everyday life.

How many are affected?

People who suffer from obsessive-compulsive disorder are often ashamed of their irrational behavior. The dark figure is therefore high. Experts estimate that about one to three percent of the population are affected by obsessive-compulsive disorder during their lifetime. In men, more frequent control restrictions occur, whereas women more often suffer from washing or cleaning. In addition to obsessive-compulsive disorder, there are usually other psychological disorders such as depression or anxiety disorders.

forced control

How a Kotrollzwang expresses and how it is treated, you will learn in the contribution control compulsion.

Constraints in children

Obsessive-compulsive disorder often begins in childhood or adolescence. In about half of those affected, the first symptoms of obsessive-compulsive disorder appear before the age of 15. Children and adolescents often strive to keep these constraints a secret. Boys are more affected than girls. The constraints then manifest themselves massively in life crises or conflict situations. OCD in children as well as adults is treated as part of cognitive-behavioral therapy. If the pressures are severe, medicines, especially selective serotonin reuptake inhibitors (such as fluoxetine), can also be used in children.

OCD: symptoms

The main feature of obsessive-compulsive disorder is recurrent obsessions or compulsive acts. Often, these symptoms also occur together. The obsessive thoughts and compulsions create a strong inner tension and are usually associated with anxiety.

compulsions

Forced actions are irrational actions performed by those affected. Often it is about averting a possible misfortune. The content of the actions need not be rationally related to the fears. For example, a mother might fear that something bad will happen to her children if she forgets to turn off the light. Out of fear for her children, she constantly checks the light switch.

Frequent forms of compulsive behavior include the compulsory cleaning and the compulsory order. When cleaning the people affected must clean the apartment or objects again and again. Order constraints are accompanied by a compulsive desire for uniformity and symmetry. For example, the pens on the desk may need to be exactly parallel, or the shirts folded to exactly the same size. The deviation from this requirement is unbearable for those affected.

Many also suffer from a number and repetition compulsion, in which they feel the compulsion to perform certain actions in a certain frequency. If the sufferers make a mistake in their rituals or have the impression that they have not been thorough enough, they must start all over again. Due to the increasing complexity of the rituals, a compulsive act can take several hours at a time.

Forced thoughts or compulsive acts – those affected are well aware of the folly of their thinking and behavior and they are ashamed of it. They try again and again to oppose the constraint resistance, which succeeds only in the short term and with great force application.

obsessions

Compulsive thoughts express themselves in the form of intrusive ideas, ideas or impulses. Often, they have violent, sexual or blasphemous content. For more information on the signs and treatment of obsessive thoughts, see the post compulsive thoughts.

OCD: causes and risk factors

How obsessive-compulsive disorder develops is not yet clear. Family and twin studies show that, as with most mental illness, there is a hereditary burden on OCD. For it to break out, however, additional factors must be added. These include, for example, childhood experiences that have led to a person being less confident and in need of greater control. Most of the obsessive-compulsive disorder is preceded by a particularly stressful experience or life crisis. With the help of the forced ritual, the affected person regains the lost sense of security. The external uncertainty is compensated by an internal structure. But this security is deceptive: If the ritual is not performed, the fear comes back with power. In the long term, it becomes more and more powerful – which in turn increases the obsessive-compulsive disorder – a vicious circle.

Overactive brain lobe

It is now known that in people with obsessive-compulsive disorder, the frontal lobe of the brain is overactive. Among other things, he controls the so-called basal ganglia – these are brain structures that are responsible for the motor processes. This hypothesis is substantiated by the fact that people whose basal ganglia are affected by tumors or head injuries often develop obsessive-compulsive disorders. Moreover, in people with obsessive-compulsive disorder, the serotonin balance in the brain appears to be disturbed. Many patients use medications that increase serotonin levels.

environmental influences

In conjunction with the personality and the biological conditions, education can contribute to the development of obsessive-compulsive disorder. Children who are more anxious, are additionally unsettled by over-protective behavior of the parents. They learn from parents to avoid threatening situations rather than face them. Even parents who are very critical of the children or have perfectionist claims can promote OCD.

An obsessive-compulsive disorder is often triggered by stressful events. Any excessive demand generates the desire for control. However, when the person can not cope with the situation, compulsive thoughts and compulsions act as a distraction. On the other hand, compulsive thoughts and actions give people who are anxious and have an increased need for security the illusion of being able to control basically uncontrollable events. For example, they hope to be able to avert disaster through certain rituals.

Obsessive-compulsive disorder: examinations and diagnosis

Frequently, those affected are ashamed of their compulsions, because they perceive them as nonsensical. It is difficult for them to confide in a psychologist or doctor. However, sufferers should be aware that the odd thoughts and actions are part of an obsessive-compulsive disorder and many people struggle with the same or similar constraints. Above all, constraints usually do not disappear again by themselves. It is therefore important to be open and honest with the doctor or psychologist so that he can identify and treat the obsessive-compulsive disorder.

For the diagnosis of obsessive compulsive disorder, the therapist orients himself to the ICD-10 classification of mental disorders. The following criteria must apply:

1. Those affected have obsessive thoughts or coercive actions (or both) on most days over a period of at least two weeks.
2. The obsessions and actions show the following features:

• those affected know that the thoughts / actions are their own and are not generated by external influences
• the thoughts / actions repeat themselves constantly, are perceived as unpleasant and recognized as exaggerated or nonsensical
• those affected try to resist the obsessive thoughts or actions
• the execution of the compulsive thoughts or actions feel the affected as unpleasant

1. Those affected suffer from obsessive-compulsive disorder and the enormous amount of time they spend in their professional and social life.

In a first interview, the doctor or therapist will determine by asking if these criteria apply to the person. The following questions could ask the expert on OCD:

• Do you often have unpleasant thoughts that impose themselves on you?
• Do you feel an inner pressure to carry out certain actions over and over again?
• Do you find these thoughts or actions nonsensical?
• Are you worried that something bad could happen if you did not take action?
• Do you need a long time for everyday activities?

Obsessive-compulsive disorder: treatment

The best treatment results show the cognitive behavioral therapy. The therapist discusses the concrete procedure with the patient at the beginning of the therapy. One method in cognitive behavioral therapy is exposure exercises that are considered to be particularly effective. In these exercises, the patient is confronted with the stimulus that normally triggers his compulsive behavior without allowing him to yield to the inner pressure. For example, someone who has an order constraint must bring disorder into his wardrobe and not be allowed to sort the clothes. The exposure can be carried out in such a way that the challenges are increased from time to time or the person concerned is confronted with his greatest anxiety at the beginning of the therapy.

While the urge to follow the usual ritual seems initially overpowering, the patient experiences how the pressure slowly subsides, even without giving in to compulsion. Through this conscious experience, he regains some control over his behavior. However, at the beginning of OCD therapy, it may take several hours for this effect to appear.

To overcome obsessional thoughts, patients are encouraged to allow unpleasant thoughts. Because suppressing causes them to occur more frequently. If those involved get involved and deal directly with the thoughts, they can defeat their constraints.

In addition, the behavioral therapist explains to the patient how constraints arise and helps him to change unfavorable mental patterns. Supportive methods include stress reduction such as autogenic training, progressive muscle relaxation or a mindfulness training.

Obsessive-compulsive disorder: medication

A large proportion of those suffering from the disease are assisted by so-called selective serotonin reuptake inhibitors (SSRIs) – a special group of antidepressants. They usually need to be dosed significantly higher than in the treatment of depression. Ingestion reduces the inner tension for most sufferers. The obsessive-compulsive symptoms diminish, but usually do not completely disappear and increasingly return after discontinuing the medication. An accompanying cognitive behavioral therapy is therefore always recommended.

Tips for relatives

Obsessive-compulsive disorder is not only a burden for the patient, but also for all who live with it. The time-consuming compulsory acts are also at the expense of the partner and family. Sometimes they are even required to submit to coercion, for example, by complying with exaggerated hygiene rules.

The following tips can help to cope with the difficult situation:

• The forced ritual can be deliberately limited and controlled by the patient only with great effort. The call to pull yourself together, or discussions about the futility of doing so does not help. The only really helpful is a therapy.
• Encourage your family members to seek therapeutic help.
• Do not support your sick relative in his ritual. For example, do not help him check all the electrical appliances or count things for him before leaving the house to reassure him. In the long term you only stabilize the obsessive behavior.
• Praise him for progress, but do not criticize him if the symptoms increase again – for example, when the person is under pressure. Such variations in symptom severity are normal.
• Do not let the coercion of your loved one convince you. Continue to pursue your hobbies, make friends, and try to do something with the person with the problem as much as possible.
• Give your diseased loved one clear boundaries to what you are willing to accept and what not.
• If you are sometimes unnerved and angry – and that is unavoidable – make it clear that this is related to the symptoms and not to your loved ones.

OCD: disease progression and prognosis

OCD usually runs chronic. Under stress, the symptoms get worse. Nevertheless, with the current state of psychotherapy and certain drugs, the chances of improving the symptoms have increased significantly. A worse prognosis is those who additionally suffer from depression.

In the past, obsessive-compulsive disorder was considered barely treatable. In the meantime, the symptoms can usually be reduced to a bearable level. The sooner the therapy starts, the better the prognosis.

Long-term studies have shown that the condition of about two-thirds of the treated patients is still improved or greatly improved compared to the past two to six years after the end of treatment. A complete cure of Obsessive compulsive disorder is very rare.