The most negative disease in the world is depression, and the most painful disease in the world is obsessive-compulsive disorder. Please pay attention to people with OCD and understand their pain, and I hope that people with OCD and their families will understand this disease – this is the author’s long-term clinical inner experience.
For quite some time in the past, obsessive-compulsive disorder was considered a rare disease. It has not been attracting the attention of clinicians. The fact that patients have partial self-control over their symptoms, rarely cause excessive social harm, social functioning and life skills are partially maintained, and clinical treatments are relatively lacking has delayed clinicians’ understanding of this disorder. However, in the last decade or so, with the continuous development of society, the increase of people’s life stress and the importance of their health, the understanding of OCD has changed in many aspects. This ancient disorder has regained clinical attention.
Obsessive-compulsive disorder is a type of neurological disorder characterized by recurrent obsessive-compulsive ideas and compulsive actions, which is characterized by complex etiology, diverse manifestations, and prolonged course.
Currently, obsessive-compulsive disorder is recognized as a neurological disorder that is characterized by recurring, unreasonable ideas, emotions, intentions or behaviors that lack realistic meaning and that the patient tries to restrain but is unable to get rid of. The patient himself or herself experiences the impulses and ideas as coming from the self and is aware that the obsessive-compulsive symptoms are abnormal, but struggles to get rid of them.
Obsessive-compulsive disorder usually has two main types of symptoms.
One is obsessive-compulsive ideas.
One is compulsive behavior.
Obsessive-compulsive thoughts are impulses, intentions or imaginations, or ideas experienced over a period of time that repeatedly or persistently intrude into the person’s consciousness to the point of causing recurrent and significant anxiety or stress. These ideas are usually of contamination, harm to self or others, disaster, molestation of spirits, violence, or other distressing content. These ideas are the patient’s own and not inserted from outside.
The patient may find the thought so distressing that he tries to suppress it, but it keeps reappearing, causing the patient to fall back into greater distress. The compulsive behavior is the result of the patient’s usual submission to the obsessions and attempts to reduce the internal anxiety. It is also a means to alleviate the stress and fear that comes with not engaging in the behavior. Patients use repeated behaviors or mental activities to stop or reduce anxiety and distress.
Common compulsive actions include repeated hand washing, checking, and counting. Often compulsive behaviors are considered to be extrapyramidal actions. There are now individual views that compulsive behaviors can also be thoughtful, such as repeated recollections, counting, and praying. In addition to obsessive-compulsive thoughts and compulsive behaviors, patients with OCD may experience many emotions in combination, such as severe generalized anxiety, recurrent panic attacks, feelings of powerless avoidance, and severe depressive experiences.
All of these emotional and compulsive symptoms occur in conjunction with the symptoms of the obsessive-compulsive disorder, and there is a tendency for these mood disorders and compulsive symptoms to interact with each other and exacerbate each other. The overlap of the two types of symptoms makes the patient miserable. Therefore, it is very difficult for people with OCD to establish even a little control and anticipation of dangerous events in their lives, and they may hesitate to do things that normally seem simple to others.
This may be the most outwardly normal, but internally extremely painful picture of OCD patients. The typical person with OCD typically has multiple obsessive-compulsive thoughts and often has multiple routines, for example, people with obsessive-compulsive thoughts about dirt usually have a hand-washing routine, and people with aggressive obsessive-compulsive thoughts tend to have a habit of checking. There are different combinations of symptoms between the various ideas and behaviors, and there is a partial pattern between the combinations of symptoms.
In addition, people with OCD have an avoidance of things or situations because of obsessive-compulsive symptoms (such as fear of not locking the door and avoiding the action of locking the door or even not daring to leave the house at all), which has an impact on social life. Furthermore, the repetition of various repetitive actions and the overlapping of various emotional experiences can hinder the patient’s social life. On the one hand, the patient fears that others will see his abnormalities and is anxious, and on the other hand, the patient is unable to predict many facts because of the internal obsessive-compulsive symptoms, which affects his life. When symptoms are severe, they can significantly affect the patient’s ability to work and live, and in some cases, they cannot even carry out normal personal life self-management.
For example, some patients prefer not to clean their personal hygiene and choose to live with dirt because they are afraid of the repeated cleaning action after unclean cleaning. This may seem unbelievable to normal people, but it is indeed a sign that the patient chooses to stay away from the interference of obsessive-compulsive symptoms. Some patients prefer to hold their urine and settle within their clothes because they are afraid of missing some auspicious time when they encounter the need to use the toilet. Such a quality of life is imaginable. There are countless examples of compulsive disorders that have a relatively mild impact. Some patients need time to repeat compulsive actions, and some are too afraid to engage in their own work or social interactions because of fear.
The results of the U.S. National Co-Occurring Disorders Survey indicate that OCD is the fourth most common psychological disorder after depression, alcohol dependence, and phobias, and that the lifetime prevalence of OCD is approximately 2.6%. The majority of cases have a slow onset with no apparent cause, and 2/3 of patients have an onset before the age of 19, making adolescents the main victim group of OCD.
It is generally believed that OCD is a chronic disease, often with moderate to severe social dysfunction, and that timely diagnosis and treatment with psychological and pharmacological therapy can improve the prognosis of the disease. However, due to some characteristics of the disease itself, the average age of patients is usually more than 10 years after the onset of the disease, resulting in a prolonged course of the disease, so obsessive-compulsive disorder is one of the relatively serious and difficult to treat neurological disorders.
The obsessive-compulsive symptoms of OCD can be severe or mild, and these symptoms can be manifested during the course of a patient’s illness or between patients. The same symptom can become more severe during the course of the same patient’s illness when the patient is in a bad mood, in the evening, when he or she is tired or weak. In female patients, obsessive-compulsive symptoms can worsen during menstruation.
In contrast, obsessive-compulsive symptoms can decrease when the patient is in a happy mood, energetic or at work or study. This fluctuation can be more pronounced throughout the course of the disease, for example, patients can have one period where one symptom is more prevalent and another period where several other symptoms are manifested altogether. Some symptoms can remain associated throughout life, while others may only appear once in a lifetime. Therefore, each patient has a different symptom experience over a lifetime long evolution of symptoms.
Of course, it is understandable that the same symptom can vary in severity from patient to patient, with some cleansings being just a few times and others being several hours or even a whole day. Therefore, the evaluation of a patient’s obsessive-compulsive symptoms requires both a horizontal and a vertical evaluation. The evaluation itself needs to pay attention to both the patient’s own symptom experience and the comparison with other patients in order to better understand a patient’s symptoms.
Overall, the course of OCD may be continuous or fluctuating. The type of symptoms can change throughout the course of the disorder, and sometimes they are more homogeneous. The disorder may fluctuate over several years, may appear after several years of stability, or may disappear spontaneously. Because of the chronic course of OCD and its high prevalence, the World Health Organization has defined it as one of the top 10 causes of disability due to illness.
Mild obsessive-compulsive symptoms are relatively common, such as having a song that keeps echoing in your head and wondering over and over again if the door was locked when you leave the house. In fact more than 80% of normal people will admit to having strange, intrusive thoughts at times, and are concerned with aspects much like those of people with OCD, many of which are about dirt or the possibility of suffering aggressive behavior.
Similarly, more than 50% of normal people admit to habits of compulsive behavior, and these manifestations do not differ substantially from those of people with OCD. This evidence suggests that the main difference between normal individuals and patients appears to be one of degree rather than substance. The occurrence of intrusive thoughts and compulsive behavioral habits can be found in all individuals with OCD, but those with OCD are more frequent, more severe, and under greater stress to the point of not being able to fully self-digest the symptoms and balance the associated social life.
If the obsessive-compulsive symptoms are only mild or temporary, and the person does not feel distressed and do not interfere with normal life and work, they are not considered pathological and do not require treatment. If, on the other hand, the obsessive-compulsive symptoms occur several times a day and interfere with normal work and life, the person may be suffering from obsessive-compulsive disorder and needs outside help to treat it. Therefore, in addition to paying attention to the symptom content of obsessive-compulsive disorder, the diagnosis of clinically significant obsessive-compulsive disorder should pay more attention to the frequency, duration and impact on social life of the patient’s symptoms.
In the past, the description of OCD characteristics emphasized the patient’s self-awareness of the symptoms and the ability to resist them, emphasizing that the patient must have a clear understanding of the “undesirability” of the symptoms and a clear intention to resist them. There is no longer an emphasis on introspection and resistance to OCD symptoms as a diagnostic criterion. In fact, the patient’s introspection and the intensity of the obsessive-compulsive beliefs are a continuum that better represents the actual situation of the person with OCD.
If the patient’s symptom beliefs are too strong, naturally the patient’s ability to recognize and critique the symptoms is inadequate; if the patient’s symptom beliefs are not very strong, the patient’s ability to self-identify is strong. Patients who are able to have no clear awareness of their symptoms are included when they go about evaluating OCD in this way. If the patient also suffers from other axially diagnosed disorders, the content of obsessive-compulsive ideas and compulsive behaviors will be expanded. In addition, the patient’s ability to resist varies depending on the severity of the symptoms, and as the disorder progresses, some patients prefer not to resist to reduce their suffering, because the more they resist, the more likely they are to fall into a cycle of symptoms.