I. Definition
Obsessive-compulsive disorder (OCD): is a neurological disorder with symptoms such as obsessive-compulsive ideas or compulsive behaviors as its main manifestation. Obsessive-compulsive ideas are thoughts, imaginations and impulses that appear involuntarily in the patient’s mind; compulsive behaviors are outwardly manifested behaviors or hidden confrontational thoughts, and compulsive behaviors are various activities taken to reduce the anxiety caused by obsessive-compulsive ideas, or to explain the obsessive-compulsive ideas in some way. Patients are aware that these compulsive symptoms are irrational and unnecessary, but they are unable to control or get rid of them and are therefore anxious and distressed, but after the chronic prolongation of the disease, the patient’s feelings of anxiety and distress are reduced and replaced by stereotyped behaviors. In addition, OCD that begins in children and adolescents has less pronounced counter-compulsions.
Counter-compulsions: the patient
There are several questions to consider.
1. Theoretically, obsessive-compulsive ideas and compulsive behaviors should appear in pairs, but in practice, very few patients only show obsessive-compulsive ideas or compulsive behaviors.
2, compulsive ideas lead to pain and cause anxiety, compulsive behavior to eliminate or reduce anxiety, ritualized actions or stereotyped behavior is the chronic state of compulsive behavior, its reduction of anxiety is ineffective, but the patient’s anxiety is significantly reduced at this time, how to explain?
3. The compulsive notion without compulsive behavior is called compulsive exhaustion, which should be the strongest in terms of pain experience, but why does the patient not activate its defense mechanism to eliminate these painful feelings through compulsive behavior?
II. Diagnostic criteria
The existing diagnosis of OCD is based on the following three major diagnostic systems, which I will introduce below.
1. Criteria of the American Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).
(1) Having obsessive-compulsive ideas or compulsive behavior: The definition of obsessive-compulsive ideas is as follows: ① Recurrent and persistent thoughts, impulses, and imagery that are experienced as intrusive and inappropriate at certain times during the course of the illness and cause significant anxiety or distress. (ii) The thoughts, impulses, and imagery are not merely excessive apprehension about real-life problems. ③The patient attempts to ignore or suppress these thoughts, impulses, and imagery, or neutralize them with other thoughts or actions. ④The patient recognizes that these thoughts, impulses, and imagery are the product of his or her own mind (not imposed by an outside party as in the case of thought insertion). Compulsive behaviors are defined as follows: (1) repetitive behaviors (e.g., washing hands, placing objects, checking) or mental operations (e.g., praying, counting, repeating silent readings) that the patient feels compelled to perform as a response to compulsive ideas or in accordance with rules that must be strictly followed. ②The purpose of these acts or mental operations is to prevent or reduce distress or to prevent the occurrence of some terrible event or situation. However, these behaviors or spiritual operations lack a realistic connection to or are clearly excessive in relation to the event or situation intended to be neutralized or prevented.
(2) At some point in the course of the illness, the patient recognizes that these obsessive-compulsive ideas or compulsive behaviors are excessive and unconscionable. Note: This does not apply to children.
(3) These obsessive thoughts or compulsive behaviors cause significant distress, are also time-consuming (spending more than 1 hour per day), or significantly interfere with the patient’s daily life, occupational (academic) functioning, social activities, or interpersonal relationships.
(4) If there is another Axis I disorder, the content of obsessive-compulsive ideas or compulsive behaviors is not limited to all of that disorder (e.g., preoccupation with food in eating disorders; preoccupation with hair pulling in hair pulling mania; preoccupation with one’s appearance in somatoform disorders; addiction to addictive drugs in substance use disorders; preoccupation with suffering from a serious illness in hypochondria; preoccupation with sexual desire or sexual fantasies in sexual inversions; recurrent major depressive disorder in guilt).
(5) The disorder is not due to the direct physiological effects of the substance (e.g., addictive substance, prescription drug) or somatic condition. Labeling: Poor self-awareness: the patient is unable to recognize that these obsessive-compulsive ideas or compulsive behaviors are excessive and unconscionable for most of the current episode.
2. WHO’s International Classification of Diseases, 10th Revision (ICD-10) criteria.
The basic characteristic of this disorder is recurrent obsessive-compulsive thinking or compulsive actions (for simplicity, obsessive-compulsive (obsessional) is used instead of compulsive-compulsive (obsessive-compulsive) when referring to symptoms. Obsessive thoughts are ideas, representations, or impulses that repeatedly enter the patient’s mind in stereotyped form, and they are almost always distressing (because the content is violent, obscene, or simply because the patient perceives their content as meaningless). Patients often try to resist, but are unsuccessful. However, although these thoughts are involuntary and repulsive, the patient believes that it belongs to him or her. Compulsive actions or rituals are stereotyped behaviors that occur repeatedly. Fundamentally, these behaviors are neither pleasant nor helpful in accomplishing meaningful tasks. Patients often perceive them as being able to guard against certain events that are objectively unlikely and that they perceive as harmful to the patient or as harmful events caused by the patient. This behavior is usually (but not always) perceived by the patient as meaningless or ineffective and is repeatedly attempted to be resisted. In cases with a prolonged illness, resistance may be very weak. Symptoms of vegetative anxiety are often present; however, a distressing sense of internal tension or psychological tension without significant vegetative arousal is also common. Obsessive-compulsive symptoms, especially obsessive-compulsive thinking, are closely related to depression. Individuals with obsessive-compulsive disorder often have depressive symptoms, and those suffering from recurrent depressive disorder can also have obsessive-compulsive thinking during depressive episodes. In either case, an increase or decrease in depressive symptoms is generally accompanied by parallel changes in the severity of obsessive-compulsive symptoms.
Obsessive-compulsive disorder occurs equally in both sexes, and the personality of the patient is often characterized by prominent obsessive-compulsive reactivity. Onset tends to be in childhood or early adulthood; the disorder is variable. In the absence of significant depressive symptoms, the likelihood of turning chronic is greater. Diagnostic points To make a positive diagnosis, compulsive symptoms or compulsive actions, or both, must be present on most days of two consecutive weeks. These symptoms cause distress or impede 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 thought itself that carries out the action should be unpleasant (mere relief of tension or anxiety is not considered pleasant in this sense).
(4) The thoughts, representations, or impulses must be unpleasantly recurrent. Contains: obsessive-compulsive (anankastie) neurosis obsessive-compulsive-compulsive neurosis Differential diagnosis: Because depressive disorders and obsessive-compulsive disorders often coexist, the distinction between the two can be difficult. For acute onset disorders, priority is given to the first presenting symptom; if both sets of symptoms are present and neither is predominant, it is generally best to consider depression as the primary. For chronic disorders, the most frequent of the group of symptoms present alone should be the preferred diagnosis. Occasional panic attacks or mild phobic symptoms do not hinder the diagnosis. However, obsessive-compulsive symptoms seen in schizophrenia, Tourett’s syndrome, and organic psychiatric disorders should be considered part of these disorders. Although obsessive thoughts and compulsive actions often coexist, it is useful in some individuals to identify which group of symptoms is predominant, as both respond differently to different treatments. Predominantly obsessive thinking or exhaustive thinking May manifest as impulses of ideas, mental representations, or behaviors. The content can be highly variable, but almost always distressing to the patient. For example, a woman is distressed by the fear that she will eventually be unable to resist the urge to kill her beloved child, or she is tormented by recurring obscene or profane self-incompatible mental representations. Sometimes, the ideas involved are completely meaningless, such as endlessly thinking on an almost philosophical level about choices that cannot be conclusive. This inability to decisively consider choices is also an important feature of many other compulsive rituals, and is often accompanied by an inability to make the necessary decisions about the details of daily life. Obsessive-compulsive rumination is particularly closely related to depression, and the diagnosis of obsessive-compulsive disorder tends to be made only when the presence or continuation of rumination is present in the absence of a depressive disorder. Compulsive actions [compulsive rituals] predominate Most compulsive actions involve washing (especially hand washing), repeated checking to guard against potentially dangerous situations, and staying organized and tidy. Implicit in the external behavior is fear, either of being in danger or of causing danger by oneself. Compulsive ritual actions can take up hours of the day and are sometimes accompanied by marked indecision and slowness. Overall, it occurs equally in both sexes, but hand-washing rituals are more common in women, and unrepeated slowness is more common in men. Compared with obsessive thoughts, obsessive-compulsive ritual actions are less strongly associated with depression and are more likely to improve with behavioral treatment. Mixed obsessive-compulsive thoughts and actions Most patients with OCD show both obsessive-compulsive thoughts and obsessive-compulsive behaviors, and if the two groups are of equal prominence, this subcategory should be used, which is the general case. However, since obsessive-compulsive thinking and compulsive action are suitable for different treatment methods, it is useful to label them separately if there is a clearly dominant group of symptoms.
3.The Chinese Classification and Diagnosis of Mental Disorders, Third Edition (CCMD-3) criteria.
It refers to a neurological disorder with mainly obsessive-compulsive symptoms, which is characterized by the coexistence of conscious self-compulsion and counter-compulsion, and the strong conflict between them makes the patient feel anxious and distressed; the patient experiences that the idea or impulse originates from the self, but it is against his own will, and he cannot control it although he tries to resist it; the patient is also aware of the abnormality of the obsessive-compulsive symptoms, but he cannot get rid of it. The patient is also aware of the abnormality of the symptoms, but cannot get rid of them. Those with prolonged illness can have mainly ritualistic movements and reduced mental suffering, but social function is severely impaired.
Symptom criteria] (1) Meet the diagnostic criteria of neurosis, and compulsive symptoms are predominant, with at least one of the following: (1) compulsive thoughts, including compulsive ideas, memories or representations, compulsive oppositional ideas: exhaustion, fear of losing self-control, etc.; (2) compulsive behavior (action), including repeated washing, checking, examining, or questioning, etc.; (3) mixed forms of the above; (2) the patient claims that the compulsive The symptoms originate from within oneself and are not imposed by others or external influences; (3) the compulsive symptoms recur, and the patient finds them meaningless and feels unpleasant, even painful, and therefore tries to resist, but cannot be effective.
[Severity criteria] Impaired social function.
(1) Obsessive-compulsive thinking and obsessive-compulsive action are interrelated. Obsessive-compulsive thinking is defined as thoughts, impulsive ideas or imaginations that cause significant anxiety or distress; obsessive-compulsive action is defined as an external (behavior) or internal (mental) activity that is forced to reduce the distress caused by obsessive-compulsive thinking. Ninety percent of people with OCD complain that their compulsive actions are designed to prevent the emergence of obsessive thoughts or to reduce the distress caused by them. A combination of clinical and previous research has found that more than 90% of OCD patients have symptoms of both obsessive-compulsive thoughts and compulsive actions. When investigating obsessive thoughts, only 2% of patients complained of purely obsessive thoughts without compulsive actions (Foa et a1. 1995). Whether it is ritual behavior or ritual mental activity, the function of both is the same, and their purpose is to prevent or reduce the difficult to get rid of pain caused by obsessive thinking, and both are aimed at reducing fear and seeking a sense of security. Therefore, the traditional view that compulsive thinking is only a mental aspect activity and compulsive action is only a behavioral aspect activity, and that the two are distinct from each other, now seems to be inaccurate. Although all compulsive thinking is a mental activity, compulsive action includes both mental activity and behavior. (2) The diagnostic criterion of introspection (inight) is no longer emphasized. Some researchers believe that introspection and belief intensity are actually a continuum that better represents the actual situation of clinical OCD patients. The previous view was that all OCD patients were able to realize that they were not aware of their obsessive thoughts and compulsive actions. Currently, the clinical community is more consistent in emphasizing that this introspection is a continuum and is not absolutely dichotomous. This diagnostic criterion is able to include patients who are not very aware of their symptoms.