Do you have any of the following behavioral symptoms?
When one or more of the following symptoms persist and interfere with normal life, it is time to consider seeking counseling and treatment from a psychiatrist.
Frequent sensitivity to germs and various diseases and unnecessary worry;
Washing hands repeatedly and for longer periods of time than is normally necessary;
Sometimes repeating the same words several times for no reason;
Feels that he or she has to dress, wash, eat, and walk in a particular order;
Repeats things unnecessarily, such as checking windows, doors, switches, gas, money, papers, forms, letters, etc;
To be suspicious of most things you do;
Often unconsciously think of unpleasant memories or thoughts that one cannot get rid of;
Often think that their small mistakes will cause catastrophic consequences;
Often worrying about a certain disease for no reason;
Counting or singing a certain song many times for no reason;
Fear of doing something embarrassing in certain situations;
Feel distracted when seeing knives, daggers and other sharp objects;
Trouble remembering unimportant things completely;
Sometimes destroying objects or hurting others for no reason;
On some occasions, even if you are sick at the time, you may want to overeat;
When hearing about things like suicide, crime or illness, it is hard to stop thinking about it because it can be distracting for a long time.
There are manifestations of cleanliness, fantasy, email syndrome, excessive masturbation, etc.
When the mind appears to hear or see a certain idea or a certain phrase, it involuntarily associates with another idea or phrase.
Understanding Obsessive-Compulsive Disorder
Obsessive-compulsive disorder (OCD) is a neurological disorder that is characterized by obsessive-compulsive thoughts and actions. It is characterized by the co-existence of conscious self-compulsions and conscious counter-compulsions. The patient knows that the persistence of obsessive-compulsive symptoms is meaningless and irrational, but he or she cannot restrain their recurrence. If the disease is prolonged, ritualistic movements may be the main manifestation, and although the mental pain is significantly relieved, the social function is seriously impaired.
The prevalence in the general population is reported to be 0.05-1%, accounting for 0.1-2% of the total number of psychiatric patients. The prevalence of this disorder at the time of the domestic epidemiological survey is 3 per 1,000. It usually starts in young adulthood and there is no significant difference in gender distribution.
OCD in children is a type of obsessive-compulsive disorder, which is a kind of idea, emotion or behavior that is repeatedly presented, knowing that it is unnecessary, but cannot be shaken off. The younger the child, the more compulsive behaviors there are than compulsive ideas, and the more pronounced the tendency, the more common the disorder is in children between the ages of 10 and 12, most of whom have normal intelligence.
For a more visual representation of the symptoms, watch the character played by Nicolas Cage in the American movie “Matchstick Men”.
Causes of obsessive-compulsive disorder
OCD is a psychological disorder with a complex etiology. Many researchers have explored the causes of this phenomenon from neurobiological, genetic and psychological perspectives, but so far, there is no convincing explanation. Several major hypotheses and influencing factors are listed below.
I. Psychodynamic hypothesis
According to psychodynamic principles, OCD originates in the anal phase of psychosexual development, i.e., at the time of initiation of bowel training. At this time, the unequal dichotomy between parent and child, requiring each other to be submissive on the one hand and unrestrained on the other, causes internal conflict and anxiety in the child, which makes the psychosexual development stay at this stage and becomes the basis for later psychological behavior degeneration. Once the individual encounters external pressure, the conflict and personality traits of the anal phase are reproduced.
II. Observation learning hypothesis
According to learning theory, observation is a conditioned stimulus that causes anxiety. The actual anxiety is acquired as a result of the original anxiety-evoking stimulus association (unconditioned reflex), which is stimulated by observation and thought. In this way, the individual has, in fact, acquired a new drive. Although compulsions can be acquired based on different pathways, once acquired, the individual finds that some activities with the help of compulsive ideas can help reduce anxiety, and whenever anxiety occurs, the individual’s anxiety is relieved by employing compulsions, a result that reinforces the individual’s compulsions. And, because of this useful approach, the individual’s acquired internal drive (anxiety) was successfully exorcised and thus gradually stabilized as part of the learned behavior.
III. Systemic family hypothesis
This hypothesis assumes that the disorder expresses a disruption of the system, which exists among interpersonal relationships, where the interaction between members knit together to form a certain system. Here, the individual’s behavior is due to the influence of the actions of others and, in turn, he influences others in a circular way. This is a mutual cause-and-effect relationship, with no clear head and tail, and the interaction is based on the principle of “mutual attraction”.
Rachman-Hodgson Hypothesis
Rachman & Hodgson, based on the analysis of some past studies, suggested that the causes of OCD may include a combination of four factors: 1. genetic factors; 2. emotional disorders; 3. social learning; and 4. learning about particular experiences. They hypothesized that OCD is a pattern of behavior that develops in successive changes, due to the successive action of the above-mentioned aspects in different situations, leading the individual to eventually evolve into OCD.
V. Psychoanalytic doctrine
Freud believed that OCD is a further development of the pathological obsessive-compulsive personality and that it is the result of the anxiety that develops as a result of the inability of defense mechanisms to deal with the obsessive-compulsive personality, which gives rise to obsessive-compulsive symptoms.
VI. Conditioned Reflexes
Pavlov explained the physiological mechanism of the disorder in terms of isolated foci of pathological inert excitation in the cerebral cortex.
VII. Qualities, especially pre-morbid personality, play an important role in the etiology of the disorder
About 2/3 of patients with OCD have a pre-morbid obsessive-compulsive personality or psychotic disorder. The main manifestations are: trying to maintain close control of themselves and the environment, they pay attention to detail, do everything to strive for accuracy and perfection, but even so there is still a sense of “imperfection”, “insecurity” and “uncertainty”. They either behave as a rule-following, lack of decision, indecisive, dependent and submissive; or behave as stubborn, stubborn, stick to the rules, rather than bend and short-tempered.
Eight, psychosocial factors are important triggering factors for OCD
Such as changes in work, life environment, increased responsibility, difficult situation, fear of accidents, family discord or the loss of loved ones, sudden shock, etc.. Some normal people occasionally have obsessive-compulsive ideas but do not persist, but they can be reinforced by social factors and persist, thus forming OCD.
Nine, genetics may play a role in the occurrence of the disease
For example, the prevalence of OCD in parents of patients is 5-7%, which is much higher than the prevalence in the group. There are also more siblings, parents and children of patients with obsessive-compulsive personalities.
X. Biochemical studies
It is suggested that enhanced 5-hydroxytryptamine (5-HT) system function is associated with the development of the disorder, so 5-HT reuptake inhibitors such as chlorpromazine, fluoxetine, and fluvoxamine have been shown to be effective for OCD. Some other studies suggest a cascade between the onset of the disorder and depression, e.g., 25%-40% of patients with the disorder do not inhibit to flumioxazin inhibition test (DST), and some patients show shortened rapid eye movement sleep (REM) latency on polysomnography, etc.}
Obsessive-compulsive symptoms are diverse and can be either one symptom alone or several symptoms at the same time. The symptom content can be relatively fixed for a period of time, and it can change over time.
I. Obsessive-compulsive ideas
In other words, a certain association, idea, memory or suspicion recurs stubbornly and is difficult to control.
(a) Obsessive-compulsive association: repeatedly recalling a series of unfortunate events will occur, although knowing that it is impossible, but can not restrain, and provoke emotional tension and fear.
(ii) Compulsive recollection: repeatedly recalling irrelevant things that have been done, although knowing that there is no meaning, but cannot be restrained, and must be recalled repeatedly.
(c) Compulsive doubts: unnecessary doubts about the correctness of their actions, to verify repeatedly. For example, after leaving the house, I wonder if the doors and windows are really closed, and I go back several times to check. If not, then feel anxious.
(iv) Compulsive exhaustion: repeatedly thinking about natural phenomena or events in daily life, knowing that it is meaningless, but cannot restrain it, such as repeatedly thinking: “Why does the house face south but not north.”
(e) Forced oppositional thinking: two opposing words or concepts repeatedly appear in the mind one after another, and feel distressed and nervous, such as thinking “pro”, immediately appear “against”; talking about “good people When you think of “good people”, you think of “bad people”, etc.
Second, forced action
(A) forced washing: repeatedly washing hands or objects, the mind can not get rid of the “feel dirty”, knowing that the clean, but can not control and must be washed.
(b) Obsessive-compulsive examination: usually occurs at the same time as obsessive-compulsive doubts. The patient is not sure about what he knows has been done, and repeatedly checks, such as repeatedly checking locked doors and windows, repeatedly checking written bills, letters or manuscripts, etc.
(iii) Compulsive counting: Uncontrollable counting of steps and poles, doing a certain number of actions, or feeling uneasy if you miss something and have to count it up again.
(iv) compulsive ritual action: before the daily activities, first to do a set of actions with certain procedures, such as bedtime to a certain procedure to take off clothes and shoes and placed according to a fixed rule, otherwise feel uneasy, and re-dress, shoes, and then take off according to the procedure.
Compulsive intention
In a certain situation, the patient appears a kind of thought that he knows is contrary to the situation at that time, but he cannot control the appearance of this intention and is very distressed. For example, when a mother carries a child to the river, she suddenly has the idea of throwing the child into the river, although no corresponding action occurs, but the patient is very nervous and fearful.
Obsessive-compulsive emotion
The specific expression is mainly compulsive fear. This fear is the fear of losing control of their emotions, such as the fear that they will go crazy, will do something that violates the law or social norms or even harm to God, rather than the fear of special objects, situations, etc., as in the case of phobias.
V. Compulsive oppositional thinking
This fear is associated with the patient’s compulsive thinking, and the patient fears that he or she will have a strong emotional reaction to oppositional thinking. For example, the patient fears that he or she will be compulsive on certain occasions and feels fearful, thus trying to avoid participating in such occasions.
Obsessive-compulsive behavior
The specific manifestation of obsessive-compulsive behavior can be submissive, such as repeatedly checking whether the gas is turned off and the door is locked; it can be confrontational obsessive-compulsive behavior, such as repeatedly admonishing oneself not to turn the compulsive intention into actual action; it can also be compulsive ritual actions, such as entering the house and having to cross the left leg first, and having to dress up in order before going out. It can also be compulsive counting, compulsive hand washing, compulsive blinking, compulsive head shaking, compulsive nail biting, etc.
Diagnosis basis
I. Uncontrollable recurrence of certain ideas, actions or intentions, accompanied by anxiety and painful emotional experiences.
The patient knows that these symptoms are unreasonable and unnecessary, but it is difficult to get rid of them and urgently requires treatment.
Third, the patient’s work and study efficiency are significantly reduced, and there is an adverse effect on daily life.
Pre-morbid personality traits and the course of the disease can help in the diagnosis. The duration of the disease can be long or short, and the duration of the study case is at least three months.
V. Exclude schizophrenia, depression and compulsive symptoms associated with organic brain diseases.
Diagnosis and treatment of obsessive-compulsive disorder
I. Diagnosis
The main points of diagnosis are.
To make a positive diagnosis, compulsive symptoms or compulsive actions, or both, must be present on most days of two consecutive weeks, and these symptoms cause distress or hinder activities. Obsessive-compulsive symptoms should have the following characteristics.
(1) They must be perceived as the patient’s own thoughts or impulses;
(2) There must be at least one thought or action that is still being futilely resisted by the patient, even if the patient is no longer resisting the other symptoms;
(3) The idea of performing the action itself should be unpleasant (simply to relieve tension or anxiety is not considered pleasant in this sense)
(4) The idea, representation, or impulse must be unpleasantly recurrent.
II. Treatment methods
Psychotherapy: supportive psychotherapy is the main treatment, compulsive actions can be behavioral therapy, the better the efficacy of the response blocking method.
1.Psychodynamic treatment
Psychodynamic therapy emphasizes the analysis and explanation of conflicts between various psychological phenomena through epiphanies, changing emotional experiences and strengthening the ego, so as to achieve the purpose of treatment. Explanation, empathy analysis, self-association, and self-reconstruction techniques are used extensively in the treatment process.
2. Behavioral therapy
Behavioral therapy is divided into two basic schools of thought in the understanding of OCD. The first view is that people with OCD rely on a variety of behaviors and rituals to relieve anxiety, called the “drive reduction model. According to this model, the therapist focuses on eliminating inappropriate behaviors and rituals by eliciting situations that reduce anxiety. The second perspective is based on the operational model, which emphasizes the regulation of the consequences of compulsive behaviors and therefore makes extensive use of punishment and model learning in this model.
(1) The main method of treatment using the drive reduction model is a variety of anxiety reduction techniques, the most commonly used of which is systematic desensitization. This is done under the guidance of a psychotherapist (ideally in combination with cognitive psychotherapy).
(2) Role model learning techniques are also frequently used in the treatment of OCD, mainly participant demonstration and passive demonstration, with participant demonstration being the most frequently used. As with systematic desensitization, the implementation of participatory modeling requires the establishment of a stimulus hierarchy. From the lowest to the highest level, the therapist gradually demonstrates exposure to the situation, and then the patient gradually confronts the situation on his or her own until he or she is able to face it completely independently. Passive modeling also allows the patient to observe the therapist’s exposure to the situation from low to high, but without the patient’s involvement in the situation. In addition, both treatments use response blocking. For example, in the treatment of obsessive-compulsive cleanliness, the therapist may resort to some sort of protocol to prevent all hand-washing behavior in the child. Based on the available information from abroad, it is generally believed that participatory modeling is more effective than reactive modeling. In addition, modeling learning can often be used in combination with exposure therapy for better results.
(3) Exposure therapy techniques have been valued and used by many over the past few decades, especially for exposing patients gradually to a variety of anxiety situations, both imagined and real, with good results. Since the duration of exposure is mainly based on whether or not it allows the child-adolescent to eliminate anxiety and return to tranquility, the duration of treatment with this method is a bit longer, around 2 hours.
(4) Exposure therapy can be accompanied by the response blocking method. This method lies in reducing the frequency of ritualistic actions and compulsive ideas.
3. Family interpersonal relationship therapy
This approach emphasizes the interpersonal factor and avoids studying isolated individual behaviors alone. This idea focuses on studying the overall meaning of the behavioral problem, and it emphasizes counseling the patient’s family members while treating the patient. The specific methods are as follows.
(1) Training family members to become counselors of the patient’s psychoanalysis, or assistants in euphoria therapy, to assist in the implementation of response-blocking training programs;
(2) Conducting intensive “self” counseling with the patient in conjunction with psychoanalytic or behavioral therapy;
(3) To influence and improve family relationships;
(4) family interaction skills training;
Medication: Anti-compulsive drugs are mainly antidepressant drugs, there are many such drugs to choose from, and the efficacy is certain; sometimes it is also necessary to add anti-anxiety treatment, anti-anxiety drugs can reduce anxiety, which helps psychotherapy and behavioral treatment.
Other: electroconvulsive therapy is suitable for those with strong compulsive ideas and accompanied by strong negative emotions. For patients with stubborn symptoms, ineffective long-term treatment and extreme pain, psychosurgery can be tried.