In recent years, I have been envisioning to establish a way to let more people know something about mental health to help those who have mental problems but do not know how to deal with them, expecting them to get proper treatment as soon as possible and come out from the pain as soon as possible to go back to normal life, study and work. Many of my friends have asked me such questions: Is it OCD to check if the door is locked when you forget it from time to time? Is it OCD to always worry that the gas is not turned off? Is it OCD to always worry about the house being dirty here and there? 1. What is OCD? Obsessive-compulsive disorder (OCD, also known as obsessive-compulsive neurosis) is a neurological disorder characterized by obsessive thinking and compulsive behavior. The symptoms are characterized by the coexistence of conscious self-compulsions and self-anti-compulsions, and the acute conflict between the two causes anxiety and distress to the patient. The patient experiences ideas or impulses that originate from the ego, but against his or her will, and resists and rejects them with great effort, but is unable to control them. This is the definition given in the textbook. You can simply interpret the symptoms of OCD as being characterized by repeated doing or thinking, knowing that it is wrong, not doing it, and being upset (anxiety). Here, I present a screening questionnaire for OCD, which everyone can use to make an initial self-judgment. If you answer “yes” to any of items 1-11, plus “yes” to items 12-14, you are advised to see a psychiatrist. 2. Hypotheses related to the etiology of OCD The understanding of the etiology of OCD is mainly based on the belief that a variety of factors are related to the development of OCD, including biological factors, such as changes in the level of specific neurotransmitters in the brain; changes in the level of metabolism in specific brain regions (supraorbital gyrus, hippocampus, basal ganglia). There are also psychological, social, and environmental factors. The more consistent view in psychology is that OCD has a personality basis (or cognitive-behavioral traits) such as stubbornness, stereotypes, and the pursuit of perfection. Behavioral theories suggest that compulsive behaviors are learned to reduce anxiety associated with the compulsion. Cognitive psychology suggests that the etiology of OCD is related to the patient’s misconception of perfectionism. When the patient is unable to satisfy this notion, anxiety ensues, which in turn leads to compulsive behaviors designed to relieve anxiety. Some people (including professionals) sometimes overstate the role of psychological traits in OCD, for example, some patients will say: I strive for perfection; some doctors will say to their patients: Your compulsions are closely related to your personality. In my opinion, it is understandable for a patient to say this, but for a doctor to say this is to pass the buck (the subtext is: I am not to blame for your OCD, it is your pursuit of perfection), because many people seek perfection, but only a few will actually suffer from OCD. For example, is it perfection for students to get 100 points on a test? But more than 98% of students are not OCD sufferers. Therefore, I do not advocate exaggerating the role of this psychological trait (restraint, pursuit of perfection) in OCD. 3. Treatment methods based on the above hypotheses and clinical observations Currently, the first-line treatments for OCD are medication and cognitive-behavioral therapy (CBT). In general, clinical outcomes are not seen until after 12 weeks of medication, and 60% of patients with OCD treated with medication have poor outcomes. Cognitive-behavioral therapy is the main psychological treatment for OCD, which started in the mid-1960s and has evolved to “conquer” OCD and reduce obsessive-compulsive symptoms by 48%. However, cognitive-behavioral therapy is not without its problems, with up to 40% of adult patients and 50%-75% of non-adult patients failing to improve significantly after completing cognitive-behavioral therapy. In addition, 25% of patients refuse exposure and 20-30% refuse treatment or drop out. Furthermore, cognitive-behavioral therapy is time-consuming and its cognitive treatment effects are poor. Another problem is that treatment can significantly increase the patient’s anxiety level. Due to the limitations of the above treatments, scholars in China and abroad have been exploring ways to treat OCD. These include inner-view therapy (mindfulness), Schwartz’s four-step therapy (Four-Step), and acceptance and commitment therapy, which lack clear evidence from randomized controlled clinical studies. For patients with refractory OCD (the above methods are ineffective), deep brain stimulation is a last resort, but its effectiveness is only 40%-50%. 5, OCD treatment of new methods – cognitive – coping therapy In recent years, I have proposed that fear (or worry) about the occurrence of negative events (related to themselves or their loved ones) plays an important role in the etiology of OCD. In terms of cognitive psychology and mental activity processes, individuals recognize their surroundings through perception, process and analyze perceptual information (thinking), store it (memory) and influence their cognitive evaluation system. The individual reacts emotionally depending on whether the environment or the object meets his or her needs, and on the basis of emotions, he or she forms motivation, which leads to the corresponding behavior. Therefore, obsessive-compulsive perception itself does not directly lead to compulsive behavior; it needs to pass through the two intermediate stages of emotion and motivation formation. Based on clinical practice, I believe that when an individual is confronted with a certain situation and cognitively evaluates the situation under the influence of his or her own experience as harmful to himself or herself or a loved one, if the individual perceives the harmful consequence as serious, he or she will develop fear (or worry) about the consequence, even accompanied by anxiety. This will lead to the motivation to eliminate that serious consequence and the behavior corresponding to it, and compulsive symptoms will appear. Otherwise, no compulsive symptoms will occur.