The basic symptoms of OCD are obsessive-compulsive thoughts, including obsessive-compulsive thoughts, obsessive-compulsive emotions and obsessive-compulsive intentions, and obsessive-compulsive actions or behaviors, which can be one predominant or several co-existing.
1. The clinical phase dominated by obsessive-compulsive thoughts. Commonly, there are.
(1) compulsive doubt is the patient’s repeated doubts about the correctness of their words and actions, knowing that it is unnecessary, but it is difficult to get rid of. For example, when sending a letter, doubting whether it has been signed, and then doubting whether the wrong address has been written after throwing it into the mailbox.
(2) Compulsive association refers to seeing a sentence or a word, or having an idea in mind, and then involuntarily associating it with another idea or word or phrase. If the associated idea or word or phrase is opposite to the original meaning, it is called compulsive oppositional idea.
(3) Compulsive exhaustive thinking refers to repeatedly thinking about something in daily life or natural phenomena, asking questions about the root of the problem, knowing that there is no realistic meaning and no need, but cannot control it. For example, repeatedly thinking about why the leaves are green, why 1+1 equals 2, etc.
(4) Obsessive-compulsive recollection refers to the patient’s involuntary recurrence of events that have been experienced in the mind, which cannot be gotten rid of and is distressing, and if such recollection reaches the level of appearance, it is called obsessive-compulsive appearance.
2.Obsessive emotion: unnecessary worry or disgust about something, knowing it is unnecessary, but unable to get rid of it.
3.Compulsive intention: repeatedly experiencing a strong inner urge to make some kind of action or behavior against one’s will. And know that it is not necessary, and try to control themselves not to do, but it is difficult to get rid of this impulse, also known as compulsive fear of loss of self-control.
4, compulsive actions and behaviors: often involuntary compliance behavior caused by compulsive ideas, in an attempt to thereby reduce the anxiety caused by compulsive ideas. Clinically common.
(1) repeated washing.
(2) compulsive examination.
(3) Compulsive questioning.
(4) compulsive ritual actions, such as ritual actions or behaviors that lead to slow action called compulsive retardation, such as repeatedly reading the first line of a book and not being able to continue to read.
(5) self-awareness: the patient has some self-awareness of the compulsive symptoms, knows that such thinking or behavior is irrational or unnecessary, and tries to control and fails to do so.
6, compulsive symptoms should have the following characteristics.
(1) They must be seen as the patient’s own thoughts or impulses.
(2) There must be at least one thought or action that the patient is still trying in vain to resist.
(3) The idea of performing the action itself is unpleasant.
(4) The compulsive thoughts or impulses must be unpleasantly recurrent. Obsessive-compulsive symptoms seen in schizophrenia, Tourett’s syndrome, and organic mental disorders should be considered part of these disorders. Patients with predominantly obsessive thoughts or obsessive-compulsive thinking may present with impulses of ideas, mental representations, or behaviors. The content varies, but is always distressing to the patient. Obsessive-compulsive exhaustive thoughts are particularly closely related to depression, and the diagnosis of OCD can only be made if exhaustive thoughts occur or continue to exist in the absence of depression. Most compulsive actions involve washing (especially hand washing), repeated checking to guard against potentially dangerous situations, keeping organized and tidy. There is often a fearful mood, such as the fear of being in danger or of causing danger by oneself. Compulsive ritual actions can take up several hours of the day and are sometimes accompanied by significant indecision and slowness, occurring equally in both sexes. Compared to obsessive thinking, obsessive-compulsive ritual actions are less closely related to depression and are more likely to improve with behavioral treatment.
7, personality traits: most have obsessive-compulsive personality traits, performance of rules, indecisive, overly careful, perfection, strive for accuracy. However, 16% to 36% of patients do not have obsessive-compulsive personality.
8, the course of the disease and prognosis: OCD mostly in adolescents or early adulthood without obvious reasons for the slow onset of the disease, the course of the disease is prolonged, symptoms can be aggravated by certain stress factors. Symptoms fluctuate over time and rarely remit spontaneously if there is a lack of appropriate treatment. There is often moderate to severe impairment of social functioning and a reduced quality of life. Patients are rarely able to establish and maintain normal interpersonal relationships and suffer from disruptions in academic and occupational functioning. Approximately 15% of patients show progressive deterioration in occupational and social functioning. In general, about 2/3 of patients have remission of symptoms after one year, and the disease tends to fluctuate in those who have been ill for more than one year. Follow-up of patients hospitalized with very severe symptoms revealed no change in 3/4 of patients after 13-20 years.
The main influencing factors for poor prognosis are.
1. severity of symptoms.
2. the presence of severe pre-morbid personality deficits
3. the presence of persistent psychosocial stress.