Obsessive-compulsive disorder (OCD) is a neurological disorder in which obsessive-compulsive ideas and actions are the main manifestations. It is characterized by the co-existence of conscious self-compulsion and conscious counter-compulsion. Patients know that the persistence of obsessive-compulsive symptoms is meaningless and irrational, but they cannot restrain their recurrence, and the more they try to resist, the more nervous and painful they feel. 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. Clinical manifestations The symptoms are varied and can be either one symptom alone or several symptoms at the same time. The content of the symptoms can be relatively fixed for a period of time, but the content of the symptoms can change over time.
I. Obsessive-compulsive ideas
That is, a certain association, idea, memory or suspicion recurs stubbornly and is difficult to control.
(a) Obsessive-compulsive associations: repeatedly associate a series of unfortunate events will occur, although know that it is impossible, but can not restrain, and provoke emotional tension and fear.
(b) Compulsive memories: repeatedly recalling irrelevant things that have been done before, although knowing that they are meaningless, but cannot be restrained and must be repeatedly recalled.
(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 they are meaningless but cannot be restrained, such as repeatedly thinking, “Why does the house face south and 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 her 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.
Fourth, compulsive emotions
The specific performance 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 God, rather than the fear of special objects, situations, etc., as in the case of phobias. Precautions 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. The course and prognosis of the disease are usually slow and long, and the symptoms may last for many years or may be mild or severe at times. Those who have obvious personality traits before the onset of the disease, early age of onset and long duration of the disease have a poor cure. Symptoms gradually decrease with age; those with significant pre-morbid psychiatric factors, less pronounced obsessive-compulsive personality traits, and shorter duration of illness; and those without a positive family history may have spontaneous remission.
Population characteristics
Not every person with OCD has all of the following characteristics and cannot be generalized. Personality expressions are only a symptom; the focus is on the cause of their onset. People with OCD also have many excellent personality traits, and this is just a list of some of the personality traits of some patients. In addition, this paragraph is subject to consideration and judgment. It may not be correct.
OCD tends to develop before the age of 30, and is common in people who work in the brain. 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 muttered and repeatedly checked, always hope to achieve perfection. They are very formal in front of people, easily embarrassed, overly restrained, strict, and responsible for their work. The onset of the disease is usually slow, the course of the disease is long, the symptoms can last for many years, or sometimes light and heavy. The personality traits before the disease are obvious, and the healing process is not good for those with early onset and longer duration of the disease. Symptoms gradually decrease with age, and those with more pronounced pre-morbid psychiatric obsessive-compulsive personality traits do not have a significant duration of illness; those without a positive family history may also have spontaneous remission. Many researchers have explored the causes of this phenomenon from neurobiological, genetic and psychological perspectives, but so far, there is no convincing explanation.
Diagnostic basis
Uncontrollable recurrence of certain ideas, actions or intentions, accompanied by emotional experiences of anxiety and distress.
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.
Differential diagnosis
Paranoia and schizophrenia
Some individuals with OCD exhibit obsessive thinking that also has delusional features. Five percent of OCD patients are convinced that their obsessive-compulsive thoughts are real, and another 20% believe them, but not to the point of conviction. Therefore, the lack of “self-knowledge” must be considered as a criterion to diagnose patients who are convinced of their own thinking. The difference between delusional disorder and obsessive-compulsive disorder is that obsessive-compulsive disorder involves compulsive actions. Because in OCD, obsessive thoughts are often accompanied by obsessive actions.
Obsessive-compulsive thinking versus depressive rumination
It is difficult to make a clear distinction between obsessive-compulsive thinking and depressive rumination. The difference between the two lies in the content of the thoughts and the degree of resistance to them. Unlike obsessive-compulsive thinking, the content of depressive rumination is pessimistic and ends in contemplation. Also, people with depressive rumination are less likely to make an effort to suppress these thoughts, whereas people with OCD make an effort to suppress them. When a patient suffers from both OCD and depression is, he will exhibit both symptoms, but only the obsessive-compulsive symptoms are dealt with in the exposure association. In clinical practice, we also find that patients suffering from depression believe that treatment is ineffective. Such a view affects the patient’s positive evaluation of treatment progress and affects the patient’s motivation, although it is not related to OCD, but it needs to be addressed in the treatment. Temporal lobe epilepsy: Occasionally, obsessive-compulsive ideas and behaviors may appear in the form of seizures and other symptoms of temporal lobe epilepsy, and EEG and EEG topography may help to identify them.
Generalized anxiety disorder.
Generalized anxiety has many similarities to OCD in terms of excessive worrying, but, unlike obsessive-compulsive thinking content, excessive worrying, the specific content of which is generally present in real life, and the patient does not agree that their worrying is inappropriate (self-coordination ego
syntonic), they do not feel that they should not worry about those things. In contrast, the content of obsessive-compulsive thoughts is generally fictitious and the patients do not agree that these thoughts are inappropriate (ego dystonic) and they do not feel that they should not occur. In addition, both patients with generalized anxiety disorder and patients with obsessive-compulsive disorder worry about things in their daily lives, such as worrying that their child will get sick, while patients with generalized anxiety disorder worry about the long-term consequences of illness (e.g., academic regression, physical weakness, etc.) and patients with obsessive-compulsive disorder pay attention to the germs of illness (e.g., their child’s cold virus will multiply). For those patients who do not have compulsive actions, but only compulsive thinking, it is especially important to distinguish between apprehension and compulsive thinking.
Phobias.
Specific phobias and obsessive-compulsive disorders are very similar if ritual behaviors are not taken into account. For example, patients with germs and rats are often able to reduce their anxiety by successfully avoiding rats, but a patient with OCD who has the obsessive-compulsive thought of the “rat virus” may still feel infected with germs even after knowing that a rat appeared in a certain place only a few hours ago. The patient may feel infected even when he knows that a place was only infected a few hours ago. These problems usually lead the patient to subsequently adopt avoidant behaviors (e.g., heavy laundry. bathing, etc.). These behaviors do not usually occur in patients with specific phobias.
Hypochondria and body dysmorphic disorder
Hypochondria is characterized by a particular concern for one’s health, and body dysmorphic disorder is concerned with what deformities there are in one’s body, both of which are also elements of obsessive thinking in OCD patients. The best way to distinguish OCD from them is in terms of both of these aspects of content. Most hypochondriacs and body dysmorphic disorders focus on only one aspect of the problem. Also, while OCD patients fear contracting a disease in the future, hypochondriasis and body dysmorphic disorder usually focus on something that is already present, such as the hypochondriac fear that they have already contracted some disease.
Treatment of Tourette’s syndrome and other tic disorders
(1) Psychotherapy: Interpretive psychotherapy is one of the means of treatment. For patients to calmly analyze their personality characteristics and the causes of the onset, including the presence of childhood trauma that produced 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 inhibit pathological excitement.
Biofeedback therapy, systematic desensitization therapy, aversion therapy, exposure therapy, etc., all have certain effects.
When the patient wants to engage in obsessive-compulsive actions or thoughts, the family will distract him/her by talking or inviting him/her to participate in some activities to stop the obsessive-compulsive actions and thoughts. The psychiatrist is also asked to explain the principles of treatment and to give the patient encouragement and prizes. In the second stage, the patient is then gradually exposed to stimuli that can trigger compulsions, preventing the appearance of symptoms on the one hand and escalating the stimuli on the other. Practice has shown that most of the difficult-to-treat patients who have been treated with a variety of treatments have been able to obtain good results with this method.
For those with obsessive-compulsive ideas, the effect is also more satisfactory when the obsessive-compulsive ideas appear and are interfered with by sound.
Family members should have a correct attitude toward the patient, do not worry too much, and try to avoid reasoning with the patient, especially not to pursue the root of the problem. It is best to give a reply to the patient’s questions according to common sense, saying it once, without repeating it.
(2) Medication: tricyclic antidepressants and monoamine oxidase inhibitors can be used for treatment.
(1) Chlorpromazine: It has good efficacy on obsessive-compulsive symptoms, and also has therapeutic effect on concomitant depressive symptoms. The therapeutic dose of chlorpromazine is 150-300 mg/day, divided into two oral doses. The dose should be small at the beginning and gradually increased.
②Fluoxetine (Prozac): It has good effect on obsessive-compulsive symptoms, and the therapeutic dose of fluoxetine is 20-80mg/day.
③Clorazepam: It also has certain effect on compulsive symptoms. The therapeutic amount of fluoxetine is 1~2mg/day.
(3) Psychosurgery: For a small number of patients with severe and untreated OCD, certain parts of the patient’s brain, such as the inferior frontal lobe and cingulate gyrus, can be destroyed, which can help to reduce obsessive-compulsive symptoms and social adaptive functions, but the target must be strictly controlled.
Prevention
Some people’s lives are manipulated by thoughts and behaviors, such as thinking about the same problem over and over again or doing the same thing over and over again. Although they know that these thoughts and behaviors are unnecessary, they cannot stop them. When these thoughts and behaviors interfere with a person’s normal life, they may suffer from a serious but treatable disorder that psychiatrists call obsessive-compulsive disorder, or OCD, or OCD for short.
Patients with OCD are often troubled by persistent, repetitive thoughts or compulsive actions that cause unfounded, excessive, and unnecessary anxiety or fear. They have constant doubts about their behavior and often need to question others and obtain confirmation from them. Thus, OCD is characterized by patients who know that these compulsive thoughts and ritual behaviors are unnecessary, but go through with them anyway.
Prevention of obsessive-compulsive disorder
It is essential to pay attention to the development of personality from a young age. Not giving too much and too stereotypical demands can help a lot in preventing OCD, especially if the parents themselves have a bad personality.
Participate in group activities and sports and cultural activities, engage in more work with aspirations and interests, and develop hobbies in life to create new excitement to suppress pathological excitement.
Adopt a natural attitude. When there is compulsive thinking, do not fight or use the opposite idea to “neutralize”, but do what should be done with “uneasiness”. When you have a compulsive action, understand that it is a form of overreaction that is contrary to nature, and gradually reduce this type of action response until it is the same as normal. Persistent practice will certainly be beneficial.
Pay attention to mental health, and strive to learn positive methods and techniques to deal with various kinds of stress, increase self-confidence, do not avoid difficulties, and develop the psychological quality to withstand hardships and setbacks, is the key to prevention.