Obsessive-compulsive disorder (OCD)
Obsessive-compulsive disorder (OCD) is a type of neurotic disorder in which a person has obsessive thoughts (obsessions) against his will.
Obsessive thoughts are burdensome for the person because in most cases they contradict his life rules and beliefs. In an attempt to cope with anxiety, people with obsessive-compulsive disorder begin to regularly undertake various, often illogical actions (compulsions), which are called rituals.
Depending on the frequency with which the obsessions and compulsions occur, there are three conventional types of OCD. In the first type of disorder, obsessive thoughts predominate; in the second, rituals predominate. There is also a form of obsessive-compulsive disorder in which obsessions and compulsions are equally manifested.
Symptoms of OCD
OCD is manifested by a triad of symptoms that occur in a specific sequence and are interrelated. The first sign of the disorder are negative thoughts, the second are various ritualistic actions. The third and later manifestation of the disorder includes avoidant behavior, which is a method of adjustment to the first two symptoms.
The nature of intrusive thoughts in OCD
Obsessive thoughts in OCD may take a variety of forms (individual words, phrases or sentences), but they always have a negative content that provokes anxiety in the individual.
Depending on the content, the following types of obsessions in obsessive-compulsive disorder are distinguished:
- Fears. This may be a fear of some disease or infection; a fear of an accident or other forms of fear (for example, a person may be afraid of open or enclosed spaces).
- Images. Vivid pictures that arise in the imagination, which are often sexual or violent in nature and disgust the person.
- Impulses. Motivations to do something obscene, such as using foul language or hitting someone. Such impulses are never realized.
- Doubts. Can be associated with any action a person takes (did I turn off the gas, did I close the door, did I do my work report correctly).
- Perceptions. Often follow compulsive impulses and depict what will happen if the person commits them. Also, perceptions can be associated with other, often absurd situations. For example, there is a case in medical practice where a man with OCD constantly imagined that he would mistakenly mail a parcel to his cat. Despite understanding that this would not happen, the man worried that his inattention would result in the death of his beloved animal.
- Memories. The man is constantly trying to remember some information (the author of a book, the name of a city, a recipe for a dish). Often intrusive memories provoke feelings of guilt.
- Thinking. With this type of obsessive thoughts, the person is constantly speculating about some illogical things that may suddenly happen.
- Antipathy. Expressed in dislike towards other people, with the feeling not justified by anything.
How obsessive compulsive behaviors manifest in OCD
In order to cope with anxiety, a person begins to take certain actions. Some actions are logically connected to the intrusive thoughts that preceded them. For example, if a person is afraid of germs, he begins to wash his hands frequently (in some cases, 20 to 30 times a day). But there are also rituals that have no connection to the obsessions. For example, a common form of compulsion is the laying out of things in an intricate scheme that has no obvious explanation. Some people, when they have compulsive thoughts, believe they have to snap their fingers 25 times to deal with them. Compulsions may also involve some kind of mental activity, such as counting to 10 or repeating certain words. At the same time, the person is always aware that the rituals performed are illogical, so he or she tries to hide them from those around him or her.
The most common ritual activities in OCD are:
- Frequent hand washing, use of antiseptics;
- Obsession with cleanliness (in the house, at the workplace);
- checking the actions performed (whether the stove is off, whether the front door is closed);
- a tendency to count (steps, passing cars of a certain color, telegraph poles)
- arranging items (books, personal belongings, dishes) in a certain order.
Avoidant behavior in OCD
One of the important characteristics of obsessive-compulsive disorder is the cyclical nature of its manifestation, and the increasing severity of its symptoms. Obsessive thoughts become more negative each time, and rituals cease to bring relief, even as they become more difficult.
In order to get rid of fears, the person begins to avoid situations which, from his or her point of view, provoke them. For example, with a fear of pollution, people start to go out less often, and in the later stages of the illness, they stop leaving the confines of their room. Fearing compulsive impulses or other types of obsessive disorders, the person stops communicating with friends and colleagues. It can go so far that people with OCD forbid even the closest relatives to approach them.
In the absence of competent and timely help, obsessive-compulsive disorder reduces the quality of a person’s life and leads to the development of various psychological and physiological problems. Establishing the true causes of obsessive thoughts and their correction is the key to successful management of OCD.
Causes of obsessive-compulsive disorder
Specialists identify three categories of causes that can provoke the development of obsessive-compulsive disorder. The first group includes physiological factors, the second group includes external circumstances, and the third group includes character traits.
The most important physiological factor in the development of OCD is heredity. According to medical statistics, the predisposition to this disorder is greatly increased if any of the person’s relatives have already experienced obsessive thoughts and ritualistic behavior.
It should be clarified here that heredity itself is rarely the primary cause of OCD. In most cases, the disorder manifests itself when this factor is supplemented by stress and character traits.
This refers to events in the person’s life that entailed negative emotional experiences, i.e. stress.
Stress may be of both short-term influence (death of a close person, an accident), and long-term influence (regular conflicts at home and at work).
The most common factors that lead to OCD:
- Family and domestic conflicts. Family problems are among the most common causes of this disorder. An unhealthy family atmosphere is also a leading cause that contributes to the development of this disorder in children and adolescents.
- Problems at work. Conflicts with superiors, lack of career advancement, team changes, demotions or layoffs – these factors can also trigger the development of OCD.
- The birth of a child. Moral and physical fatigue at the appearance of a new member of the family, often leads to excessive tension and anxiety, which contributes to the emergence of obsessive thoughts.
- Tragedies. Loss of a loved one, experienced violence, an accident, a catastrophe – each of these situations is a powerful psychotraumatic factor.
- Intrapersonal conflicts. This implies a discrepancy between the person’s desires and reality.
It should be noted that this or that stress factor alone cannot cause the development of symptoms of this disorder. The psychotraumatic event is the trigger mechanism under the influence of which “dormant” problems, often acquired by the person in childhood, are exacerbated.
Many people have negative thoughts several times a day, but only some of them turn into obsessions that become a serious problem and prevent them from living a full life. For example, many women who are raising children are occasionally visited by thoughts that they will fail in their parenting or will unknowingly harm their child. If such assumptions develop on the background of other problems “hidden” in the subconscious, the woman begins to exaggerate the importance of her own thoughts and to think that she really is a threat to her baby. Obsessions begin to arise more and more often, and under their influence she may begin to perform certain actions (the same rituals) in order to get rid of the obsessions and somehow protect the baby.
To a greater extent, obsessive-compulsive disorder affects people with certain character traits, the basis for which is laid as early as childhood.
Character traits that increase the likelihood of developing OCD:
- a desire to control everything,
- exaggerated responsibility.
As it is obvious from the above, OCD develops under the influence of not one but a group of various factors. Therefore, the key to a successful fight is a complex approach which touches on both current situations and the circumstances which the person has experienced in childhood.
Consequences of OCD
The consequences of obsessive-compulsive disorder manifest themselves both emotionally and physically, affecting all significant aspects of a person’s life. Compulsive rumination (mental gumption) leads to decreased intellectual ability. A person becomes less attentive, loses the ability to concentrate and make good decisions. All this leads to problems at work, in personal relationships and other areas of life.
Obsessions are often accompanied by feelings of guilt, shame, anxiety, and often lead to depression. Since all processes in the body are interconnected, emotional disorders entail deterioration of the physical condition.
Help for Obsessive-Compulsive Disorder
The key to successfully combating this disorder is a comprehensive approach, which requires working through many aspects of a person’s life. The leading method of therapy for OCD is work with a psychotherapist. In some cases, consultation with a psychiatrist and the prescription of medication is required.
The work of the psychotherapist consists of several steps and begins with making contact with the person who has sought help. Then the specialist determines the true causes of intrusive thoughts and conducts work on their correction. The psychotherapist also trains the person suffering from OCD in various techniques which increase their resistance to stress.
As intrusive thoughts and the rituals associated with them arise against the background of difficult life situations, family conflicts and character traits – all of which can be the object of work at meetings with a specialist.
An adolescent with OCD came to the Center for Psychological Aid. During the work, it was revealed that the reason for the disorder was psychological trauma and bullying of the boy by his classmates. Unable to find support in the family because, in the words of his father “real men do not whine and solve their own problems”, 16-year-old Alyosha (let us call our hero) was left alone with his anxiety and tension, thoughts of school literally haunted him, soon appeared strange rituals. Her mom was frightened by the changes in her son’s behavior and emotional state, so she brought him to the psychotherapist.
Work was done on relationships in the family, on ways and methods to de-stress and on the set of attitudes which prevented the young man from seeking help from adults. After several months of work, OCD was successfully resolved, the significant role in it was played by the fact that with the counseling of the therapist, the father revised his position and expressed readiness to support the son in difficult situations.
The therapist’s work with clients suffering from OCD can also focus on
- Experienced traumatic situations, stresses that triggered the emergence of the disease;
- traumatic experiences and personality traits that contributed to the obsessive thoughts (anxiety, insecurity, etc.)
- subconscious and conscious ways of relieving tension and solving difficult problems in life,
- stabilization of relations with others (in the family and at work),
- attention is necessarily paid to teaching the client to find effective replacements for rituals.
Only this multilevel approach to work with obsessive-compulsive disorder yields positive and stable results. It should also be noted that the success of therapy is greatly influenced by the timeliness of referral to a psychotherapist.
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Disgust. Shame. Guilt. Remorse. Pity. Disappointment
Disgust is a persistent feeling of irritation, squeamishness, nastiness. It arises when, overpowering himself and losing interest, the individual is forced to do something or communicate with someone for a long time. It is also called mental satiety, by analogy with the satiety of some food, which causes disgust, and many years later. Overprotective mothers, forcing their children to eat something all the time, often cause them to become anorexic about different kinds of food. Something similar is sometimes done by teachers: unwilling, unable to stimulate a student’s interest in a subject, they impose memorization to the point of total disgust; some school leavers confess that they “can’t stand math” or are “sickened” by classic literature. Disgust is accompanied by vagoinsular hyperactivation, resulting in nausea, vomiting, slowed heart rate, fainting, and other autonomic symptoms. Disgust and hostility toward a person who has done something unworthy is defined as contempt.
Shame is the fear or fear of being disgraced, disgraced, it is “Fear of Notoriety” (Aristotle). The ashamed person avoids contacts because of fear that others will learn about his/her bad deed, and if he/she thinks that people guess or know about his/her indecent affairs and intentions, he/she blushes, than he/she actually attracts attention to himself/herself. The ashamed himself does not internally condemn his reprehensible actions or desires, and on occasion, when no one is around, he carries them out without a moment’s remorse. He is only afraid that no one will find out about it. Shyness and confusion are usually characteristic of sensitive people, especially if they feel that something in them is not as it should be.
|||Emotional disorders are called affective illnesses. These include depression, mania, and some other illnesses|
Guilt is an individual’s self-recrimination for deviations from a standard of moral behavior that he or she has accepted, as well as for violating a rule of law if he or she believes it is just. In other words, guilt is shame before oneself, remorse. Z. Freud calls guilt the anxiety of conscience, and G. Mandler (1975) identifies guilt and anxiety. Some psychologists mistake guilt for fear of punishment. E.P. Ilyin believes that feelings of guilt are severe punishments in themselves, as they cause an individual to suffer and thereby reduce anxiety and the likelihood of a mental disorder. Torment of conscience, if the individual closes in on it, rather than trying to get rid of or overcome it, is in itself a rather serious disorder, since it entails lowered self-esteem, depression, suicidal tendencies, sensitized ideas of attitude; sometimes guilt is processed into hatred of the victim, into aggression toward him and self-justification. It is said, not without reason, that the people we hate the most are those we have wronged.
|||Affective disorders are best treated comprehensively in a psychiatric clinic|
In order to dislike the victim, one must find something evil and vicious in him or believe such rumors. A normal conscience should not lead to self-injury and pathological processing of guilt, it simply does not allow a person to go against its demands; a normal person always listens sensitively to the “voice of Socrates” – his conscience. In order to overcome the anguish of conscience, the person himself or with the help of a psychologist needs to understand what has made him transgress the boundary of what is allowed. Certainly there will be problems with which the individual will have to work hard. The next step is to have the courage to apologize to those who have been hurt.
Generous people may understand and forgive. But even if this doesn’t happen, an important step will still be taken, and the conscience will appreciate it. It may also make sense to take a moment to help those affected in some important way; whether they find out or not, it is better if they do not, so that they do not reproach themselves for the good deed done in a bargain with their conscience. A guilty conscience requires repentance, as Raskolnikov did in Dostoyevsky’s book. Sometimes even hardened criminals, over whom “the image of God has not yet dimmed,” do so. They repent even on the scaffold. In doing so, they not only incriminate themselves, but subject themselves to the condemnation of many people. And that is a punishment so severe that there is little to compare it with. Finally, guilt can be overcome by seeking, finding the best qualities in oneself and embodying them in appropriate, unselfish deeds. For believers, repentance before the Almighty can help, if they honor Him sacredly.
Repentance is a sincere and unselfish admission of one’s guilt. Let punishment follow, but the perpetrator himself will participate in it. He will thereby feel that he has joined with justice, and will accept the punishment with dignity and self-esteem that elevates him – perhaps for the first time he will feel like a human being and not a misfit in society. In addition, he wants to remain in people’s memory not as a criminal, but as a man who has not lost his conscience. People are ready to forgive a lot for this: the sword will not cut a guilty head. In depressed patients, remorse sometimes turns into serious self-punishment. For example, a patient confessed to his wife that he had dated a woman about 20 years ago. The wife, completely unaware of what was going on with her husband, quickly brought the case to divorce, effectively abandoning the sick man.
Pity is ostentatious compassion, the purpose of which is to feel moved by one’s kindness. It is a form of narcissism, where real help is substituted for cheap philanthropy, so-called charity. For example, a Hollywood actress is auctioning off the dress she wore to the Academy Awards. The proceeds, the lady announced, she intends to send to help the starving in Africa. The Empress of England in April every year gives money to the poor, and the nouveau riche of Russia recently splurged so much that bestowed 200 thousand dollars on the development of education in the country.
And this despite the fact that in 2006 there were 800,000 such good people. This is why self-respecting people perceive pity as humiliation. Self-pity is not uncommon, it usually manifests itself in a flood of tears. Such pity comes from resentment toward other people, “soulless, callous, unable to appreciate the good I did them. Pity has no real morality or spiritual nobility under it; it is merely a manifestation of “love” for oneself. Such people are little respected, appreciated, and repulsed by insincerity and falsity.
“He who loves himself alone usually has no rivals,” Seneca seems to have remarked. There are plenty of pityful ones, all of them eager to please themselves, because they have nothing else to do. Petty crooks deftly use and accept such pity with no less feigned gratitude, sweetening the hearts of their benefactors. Pity is typical of hysterical natures and of all narcissistic egoists in general. Almsgiving in the pews of the church is another matter. Many believers, who are not rich, donate to the poor and homeless out of their hearts. Their almsgiving is no small part of a very modest family budget, not even a hint of the narcissism of the Queen of England.
Disappointment is the feeling of depression associated with the discrediting of values, the loss of faith in oneself, or the transformation of expectations of something very important into a melting mirage in the sky. It is experienced as mental devastation with oppression and a feeling of a deep crisis of values, the loss of the pillars of existence. Disappointment with something that is not very important is experienced relatively easily. When the very foundations of life are undermined, frustration can lead to depression. In turn, many depressed patients suffer from the collapse of the foundation of their existence and the fading of the meaning of all life. The severity of feelings of disillusionment varies greatly with personality; some people simply don’t know what they are talking about or don’t give them serious consideration.