Obsessive-compulsive neurosis (OCD) is a type of neurological disorder characterized by recurrent obsessive-compulsive thoughts and actions. OCD accounts for 0.1% to 0.46% of psychiatric patients and about 0.05% of the general population. The disease mostly develops before the age of 30, more in men than in women, and is common in brain workers.
Certain strong mental factors as the cause of the disease, strong and unbalanced type of people are prone to the disease, their character subjective, capricious, impatient, aggressive, poor self-control, a few patients have a mentally weak character, since childhood timid, afraid of making mistakes, lack of confidence in their own abilities, very cautious, repeated thoughts, afterwards constantly muttering and repeated checks, always hope to achieve perfection.
Very formal in front of people, easily embarrassed, excessive restraint on themselves, strict requirements, more rigid habits, stick to the rules, not many interests and hobbies, not enough attention to specific things in real life, but special attention to what may happen, and even long worry about it, work seriously and responsibly, but the initiative is often insufficient.
In the past, most people believed that the disease originated from mental factors and personality defects; in recent years, genetic factors have been found to be more obvious.
(1) Genetic: Family lineage surveys have found that about 5% to 7% of the patient’s parents have OCD, far higher than the general population. In addition, since personality traits are mainly influenced by heredity, and personality traits play a role in the development of OCD, it is also suggested that OCD is genetically related. It has also been observed clinically that about 2/3 of patients with OCD have an obsessive-compulsive personality prior to the disease. The obsessive-compulsive personality is characterized by timidity, caution, indecisiveness, seriousness, orderliness, meticulousness, attention to detail, and a love of cleanliness.
(2) Psychosocial factors: The psychoanalytic school believes that OCD is a further development of the obsessive-compulsive personality. Behaviorists, on the other hand, believe that OCD arises due to excessive repetition of stimulus-response leading to anxiety, causing dysregulation of excitation and inhibition in the central nervous system, which leads to the formation of abnormal habits, the establishment of pathological perceptions and reflexes, and the constriction of impulses, thinking and actions to fixed patterns of behavioral learning.
In adolescents in the developmental period, the rapid physical development and maladjustment in social interaction with the competitive society can cause compulsive symptoms. Work tensions, family disharmony and unsatisfactory conjugal life can cause chronic tension and anxiety and eventually induce the emergence of obsessive-compulsive disorder. The content of symptoms is related to the content of psychosocial factors faced by the patient. Accidents, deaths of family members and major blows also make patients anxious, nervous and fearful, and induce the emergence of OCD. The manifestation of symptoms is directly related to the content of mental trauma.
(3) Biochemical: It is believed that the reduced activity of the 5-HTergic nervous system in OCD patients leads to the generation of OCD, and that OCD can be treated with drugs that increase the 5-HT biochemical transmitters.
Clinical manifestations of obsessive-compulsive disorder
The basic symptoms of OCD are obsessive-compulsive ideas and compulsive actions, and patients may have only obsessive-compulsive ideas or compulsive actions, or both obsessive-compulsive ideas and compulsive actions. The patient is fully aware that the obsessive thoughts and compulsive actions are unnecessary, but cannot control them with subjective will. Due to the presence of obsessive-compulsive symptoms, the patient may be accompanied by significant uneasiness and annoyance, but has a strong desire to seek treatment, and self-awareness remains intact. Based on its manifestations, OCD can be broadly classified into two categories: obsessive-compulsive ideas and compulsive behaviors.
(1) Obsessive-compulsive ideas are repeated and persistent ideas, thoughts, impressions or impulsive thoughts. The compulsions can be tried to get rid of, but the compulsions are not removed from the mind, and there are some physical symptoms such as stress, distraction, anxiety and anxiety. Obsessive-compulsive thoughts can take the following forms.
Compulsive thoughts: compulsive suspicion, the patient is always relieved about what has been done, and has to repeatedly check several times to make sure it is correct before he can put down his mind. For example, if the doors and windows are closed, if the letters to be delivered are addressed, if the gas is turned off, etc., there is often obvious anxiety while doubting; compulsive memories, the patient repeatedly recalls past experiences, past events, etc., although he knows that there is no real meaning, but always repeatedly haunts in his mind, and cannot get rid of it, so he feels extremely bored.
When the patient hears, sees or thinks of something, he involuntarily recalls some unpleasant or ominous scenarios, such as seeing someone smoking and thinking of a fire; compulsive exhaustion, the patient always thinks endlessly about some problems that have no real meaning, although the patient’s logical reasoning is normal and his self-knowledge is complete. Although the patient’s logical reasoning is normal, self-awareness is complete, and he knows that there is no need to investigate deeply, but he cannot restrain himself. For example, why does it rain? Why do people need to eat? Why is the earth round? Why is the earth round?
Compulsive intent: The patient often appears to go against his or her inner will when there is a normal psychology, and although the contrary will is very strong, it is never acted upon. For example, when crossing the street, the idea of rushing to the car that is passing, etc.
(3) Obsessive-compulsive emotion: The patient feels disgusted or worried about something, knowing that it is not necessary at all but cannot restrain it. For example, worrying about hurting others, worrying about saying the wrong thing, worrying about being contaminated by toxic substances or bacteria, etc.
(2) Compulsive action Also known as compulsive behavior.
(1) Forced washing: Commonly, there is forced hand washing, laundry, etc. For example, there is a hospital registration clerk who thinks that she can “infect” some tumor patients by touching their clinic cards, and if her hand touches the door handle of her home, she thinks she will indirectly infect her family. So every time she comes home from work, she always calls her family to open the door, and then she enters with her hands up high, and then washes her hands repeatedly, and changes all her clothes inside and outside, and does not go to bed until late at night with some evening meal.
②Compulsive checking: It is a measure taken by the patient to reduce the anxiety caused by compulsive suspicion, such as repeatedly checking whether the doors and windows are closed when going out, repeatedly checking the contents of the letter when sending it to see if the wrong word is written, etc.
(3) Compulsive ritual actions: Patients always perform fixed actions with symbolic blessings and misfortunes in an attempt to alleviate or prevent anxiety caused by obsessive-compulsive ideas, such as clapping their hands on their chests to show that they can turn good fortune into good fortune, etc.
Compulsive counting: When patients see certain specific objects (such as electric poles, steps, cars, license plates, etc.), they cannot restrain themselves from counting, and if they do not count, they feel anxious.
The compulsive symptoms are sometimes severe and sometimes reduced. They are more severe when the patient is in a bad mood, in the evening, when he/she is tired or when he/she is weak and sick. In female patients, obsessive-compulsive symptoms can be aggravated during menstruation. When the patient is happy, energetic or nervous at work or school, the obsessive-compulsive symptoms can be reduced.
There is a relationship between a person’s personality and the development of OCD. Many scholars have reported that about 1/3 to 1/2 of OCD patients have a pre-morbid obsessive-compulsive personality. Some people divide the obsessive-compulsive personality into two types.
(1) Doubtful, lack of decisiveness, indecisive in matters, similar to mild OCD.
(2) Stubborn, stubborn, easily agitated, bad-tempered, and lacking in decisiveness.
Both types have kindness, attention to detail, accuracy, and neatness in common. The first type is slow and indecisive. The latter type is stubborn and strives for perfection. The formation of obsessive-compulsive personality is not only related to heredity, but also the influence of family education and social environment plays an important role. In particular, parents with obsessive-compulsive personalities have a subtle influence on the patient. Inappropriate education of children, such as overly demanding, too rigid requirements for the system of life, so that they form a cautious, indecisive, overly trivial and meticulous. They are meticulous, perfect, repeatedly deliberate beforehand, and regretful and self-critical afterwards. Excessive seriousness, stubbornness and stubbornness in interactions with others.
In life, excessive demand for a regular system of rest and hygiene habits, everything is required to be in order, even the books in the bookcase, drawers, clothes in the closet are required to be arranged neatly and cleanly. He seems to be serious and meticulous in his work. For this reason, it often takes time to organize, which affects the completion of other tasks and personal rest.
Pre-morbid personality traits were also significantly associated with treatment outcome. Those who have a good personality and no obsessive-compulsive personality traits before the disease have better treatment results. In contrast, those with pre-morbid obsessive-compulsive personality traits are relatively difficult to treat. Therefore, it is necessary to pay attention to the development of personality from childhood. Not to give too much, too stereotypical requirements, to prevent the occurrence of obsessive-compulsive disorder is very helpful, especially if the parents themselves have a bad personality should pay attention.
In our daily life, some of us will encounter some people repeat some meaningless actions, such as repeatedly checking whether the door is closed, whether the lock is locked, repeatedly washing hands, washing a piece of clothing many times still too unclean, some people repeatedly consider some meaningless problems, such as why people have two legs, why are arranged according to 1, 2, 3, 4, 5… This behavior and concept, medically known as OCD, belongs to the category of neurosis. Do normal people also experience obsessive-compulsive behavior? Most normal people also have compulsive ideas, such as involuntarily thinking about a certain problem repeatedly, or reading a certain sentence or two, or singing a song or two, repeatedly, but they do not affect normal mental activities and behavior, so they cannot be regarded as obsessive-compulsive disorder, and can be corrected by psychological methods so that they do not develop further. The existence of obsessive-compulsive disorder can be confirmed as long as the obsessive-compulsive ideas and behaviors interfere with the patient’s normal mental activities and affect his or her ability and behavior, interpersonal relationships or family well-being.
Self-prevention methods for OCD
A combination of psychotherapy and medication can have a good therapeutic effect.
(1) Psychotherapy: Interpretive psychotherapy is one of the means of treatment. Patients should calmly analyze their personality characteristics and the causes of the onset of the disorder, including the presence of childhood trauma that produces obsessive-compulsive disorder. If the cause can be identified, confidence in winning should be established and every effort should be made to overcome psychological triggers in order to eliminate anxiety. Be strong-willed to overcome unconventional behaviors and thinking. To correct obsessive-compulsive behavior and thinking should be gradual and persistent, and constantly summarize successful experiences, while participating in more collective activities and cultural and sports activities, engaging in more desirable and interesting work, and cultivating hobbies in life to establish new foci of excitement to suppress pathological excitement.
Morita therapy is currently well received, please refer to the article “Morita Therapy”.
Biofeedback therapy, behavioral therapy such as systematic desensitization therapy, aversion therapy, exposure therapy, etc., all have some effect.
Family members should have a correct attitude towards the patient, do not worry too much, and try to avoid reasoning with the patient, especially not to pursue the root of the problem. To the patient’s questions, it is best to give a reply according to common sense, say it once, no need to repeat.
(2) Medication: It should be selected for use under the guidance of a psychiatrist.
(3) Psychosurgical treatment: not recommended at this time.