How OCD works
At its core is a vicious circle of anxiety. First, an obsessive thought or image appears - an obsession: for example, about infection, about the fact that the door is not locked, about possible harm to loved ones. The thought causes intense anxiety and a sense of responsibility. To remove it, a person performs a compulsion: washes his hands, checks, counts, repeats certain phrases to himself. The anxiety does subside, but the brain concludes that the danger was real and the ritual helped. The next time the obsession returns stronger, and the rituals become longer and more complex.
- Obsessions - obsessive thoughts, images, doubts
- Compulsions - actions or mental rituals
- Avoiding situations that trigger compulsions
- Seeking reassurance from loved ones as a hidden ritual
- Increase in rituals over time
Basic forms of obsessions
The content of obsessions varies, but the pattern is always the same. The most common fear is contamination and infection with repeated washing and cleaning. The second common form is obsessive doubts with endless checks of gas, locks, and electrical appliances. A separate group consists of aggressive, religious and sexual obsessions, which frighten a person the most because they contradict his values. It is important to understand: such thoughts do not mean a desire to fulfill them, and it is the aversion to them that confirms that this is a symptom and not an intention.
- Fear of pollution and infection
- Obsessive doubts and checks
- Striving for symmetry and order
- Aggressive intrusive images
- Religious and moral obsessions
- Hoarding and inability to throw things away
Causes and risk factors
OCD develops due to a combination of biological and psychological factors. A significant role is played by hereditary predisposition and characteristics of the functioning of brain areas responsible for assessing errors and inhibiting actions. Psychologically, the disorder supports the belief that there is excessive personal responsibility and that thought itself is equivalent to action. Exacerbations are often associated with stress, overwork, pregnancy and childbirth. In children, a sudden onset of obsessions has been described after a streptococcal infection, which requires a separate examination.
- Hereditary predisposition
- Features of the functioning of brain inhibitory circuits
- Belief about increased responsibility for thoughts
- Perfectionism and anxious personality
- Stressful events and fatigue
- Pregnancy and postpartum period
- Past streptococcal infections in children
Diagnostics
The diagnosis is made by a psychiatrist or psychotherapist based on a conversation. The doctor clarifies the content of obsessions, the amount of time the rituals take, the degree of disruption of daily life and the presence of attempts to resist. For objective assessment, special scales are used, which also help track dynamics during treatment. It is important to distinguish OCD from anxiety disorders, eating disorders, personality disorders, and from non-critical psychosis. Sometimes concomitant depression is identified, requiring special attention.
- Clinical interview assessing obsessions and compulsions
- Calculating the time rituals take
- Special severity rating scales
- Identifying comorbid depression and anxiety
- Rule out psychotic disorders
- Examination for sudden onset in a child
Treatment
The most effective method is cognitive behavioral therapy with exposure and response prevention. The point is, under the guidance of a specialist, to gradually face a frightening situation and not perform the ritual: anxiety, contrary to expectations, itself decreases, and the brain retrains. Drug therapy is based on certain groups of antidepressants, which are used for OCD in higher doses and for longer than for depression: the effect is assessed after 8–12 weeks. In severe cases, the methods are combined. It is better to gently stop asking loved ones to confirm safety, as they support the disorder.
- Cognitive Behavioral Therapy with Exposure
- Gradual abandonment of rituals instead of abrupt
- Antidepressants prescribed by a psychiatrist for a long course
- Evaluation of the effect no earlier than 8–12 weeks
- Refusal of loved ones to participate in rituals and assurances
- Working with stress, sleep patterns and workload
- Continue maintenance therapy after improvement