OCD: obsessive thoughts, states and actions

What is OCD?

Intrusive thoughts are persistent, unwanted thoughts about a specific topic. Obsessive actions (compulsions) are repeated physical or mental actions that the patient considers himself obligated to perform. Patients diagnosed with obsessive-compulsive disorder (OCD) often act out their obsessions.

For example, a person may constantly worry that his house will be robbed. To cope with anxiety, a person checks the locks on his doors ten times a night. These behaviors may not actually prevent a robbery or break-in, but the person experiences significant distress if they do not follow these steps.

These conditions usually appear around the age of 19, although in a quarter of cases the onset begins before the age of 14. OCD can affect people of all ages, social classes and ethnic groups.

OCD can last a lifetime if left untreated. Symptoms can interfere with work, relationships, and overall well-being. A psychotherapist can help patients get rid of symptoms and learn to cope with difficulties.

How to get rid of obsessive thoughts?

You cannot fight obsessive thoughts by constantly thinking about them and trying to drive them away - this will only lead to increased experiences and even greater fear of them. The first step is to understand the reasons for the occurrence of these thoughts, identify them in yourself and, using the methods suggested below, stop this internal dialogue, which resembles an endless “mental chewing gum”.

Method 1: Catch the idea at the very beginning

To stop negative thoughts, it is important to identify them first. It seems easy, but in reality it can be difficult. We need to recognize these thoughts and “catch” them, because often we get stuck in a cognitive loop, including a long-standing and firmly established habit that does not allow us to cope with it.

This is similar to physical neurotic habits such as biting your nails, twirling your hair, nervously tapping your fingers, or checking social media every few minutes—all of which happen unconsciously. As a rule, you come to your senses when obsessive thoughts have already exhausted you, and not when the first one has visited your mind. The next time you catch yourself racing in your thoughts, think: “Stop! Stop that"

Method 2: Name your fears, say them out loud

Voice, or better yet, write down a recurring thought, so you can explore the real fear that underlies it. For example, let's say you're worried about your test grade. And you scroll through disturbing thoughts over and over again. Think about whether you are really afraid of failure, whether it is possible that you are dissatisfied with the way your studies are going in general and the prospects that will or will not open after graduating from university.

Method 3: Give up control

The next step to stopping thoughts is acceptance. Remember that fears are just thoughts, a series of impulses between neurons in the brain, and nothing more. When we learn to accept suffering, recognizing that it does not come from the outside, but is a consequence of the physiological functioning of the brain, we will be much more likely to completely stop it and cope with it.

IMPORTANT Acceptance, not “omnipotent” control and avoidance, is the key to success. By “acceptance” we do not mean giving up or refusing to work with the problem, but rather accepting the nature of these thoughts and realizing that they themselves are harmless and do not require much “chewing.” When you allow your thoughts to be, they will allow you to be.

When you find yourself obsessing over the past or worrying about the future, trying to cope with feelings, suppress emotions and stop thoughts from racing, ask yourself the following question: “Can I do something about this right now, can I get rid of the problem at this moment? ? If the answer is yes, determine what you can do and do it. If the answer is no, do your best to accept what is.

Method 4: Meditation and Mindfulness

You feel so bad from obsessive thoughts because they are accompanied by unpleasant emotions. Our brain is not able to distinguish between reality and thoughts in this regard: both actually being in an unpleasant situation and painful thinking about such a situation cause the release of stress hormones and are accompanied by unpleasant depressing emotions.

Mindfulness practice and meditation are aimed at learning con. This helps you avoid being trapped by thoughts and gain control over them easily. You can choose what to think about and when.

Here are a couple of grounding exercises:

- When an obsessive thought appears, try doing deep breathing exercises on your own, inhale slowly for a count of four, hold your breath for a count of four, and then exhale for a count of four. Repeat this at least four times. Focus on breathing and counting.

- Ground yourself in the present by focusing on the sensation of your feet firmly on the ground or your buttocks resting on the seat of a chair. Turn on the perception of all senses to the maximum, identify and fixate on five channels: what you see, hear, smell, touch, what you feel in your mouth. Focus on your feelings in the moment.

Advice from a psychologist You can find many methods, courses, and meditation groups on the Internet. Also consider taking one-on-one meditation classes to learn different techniques in a supportive environment with an experienced guide.

Method 5: Listen not to thoughts, but to sensations

Determine exactly when and what sensations come to you. Perhaps irritation, anger, sadness, joy or objections. Don't be afraid of them, accept and live these emotions.

Method 6: Ignore intrusive thoughts

Fighting internal dialogue is highly discouraged, as by doing so you are driving yourself into the trap of panic and anxiety. You need to realize the presence of these thoughts in your head, acknowledge their fact, and try, as if from the outside, to observe them. But the slightest analysis of them, for example, “Why do they appear?”, “Where does this nonsense come from in my head?” will lead to a new round of negative thoughts. It is important to remember that these are just thoughts, you do not have to believe in them.

OCD symptoms

OCD symptoms fall into two categories: obsessions and compulsions. Intrusive thoughts ( take the obsession test ) are recurring thoughts or urges that cause anxiety. These thoughts may be rooted in disgust, guilt, or fear. Obsessions often involve one of the following themes:

Cleanliness: frequent thoughts about illness, dirt, etc. Patients overestimate the threat of contamination.
Lack of order: Obsessions are often related to symmetry and completeness. The person may feel that something is out of order or “out of balance.” These are exaggerated perfectionistic tendencies and the need for control.
Fear of harm. Often thoughts arise about accidents, injuries, etc. A person may be afraid of harming himself or loved ones. Patients may feel responsible for preventing tragedies by acting out their compulsive behaviors.
Forbidden thoughts: This category includes intrusive thoughts about committing some taboo. For example, one person may be afraid of losing control and at the same time mentally swear during a business meeting. Another may imagine setting a building on fire, even though he doesn't want to do it.

Someone may have obsessions in multiple categories. Themes of obsession may change over time. When a person's obsessions are united by a religious theme, it is called religious OCD or obsession.

Obsessions can cause serious distress when they conflict with a person's ethics and character. However, such thoughts do not coincide with intention. A person with obsessive thoughts about hitting pedestrians is unlikely to commit murder. On the contrary, he is likely to be a more careful driver than the average person because the idea of harming others bothers him greatly.

Symptoms and manifestations of the disease

Unpleasant ideas that have not left your head for a long time have plagued everyone at least once. And everyone is familiar with the feeling of forgetting something or not turning it off. This unpleasant anxiety that annoys a person can be leveled out if you check what you are worried about or ask one of your relatives. But not for the individual with obsessive ideas. No matter how many times he double-checks, everything remains just as incomprehensible and emotional, he is simply unable to cope on his own or make an effort and not think about this obsession. In addition, these experiences greatly interfere with everyday life, completely taking away all attention.

A person with obsessive ideas is constantly carried away by his obsessive ideas, which completely fill him, not allowing him to rest. And if with normal anxiety or obsessive thoughts an individual can be distracted or busy with important things, then with obsessive ideas - not. A person with obsessive ideas is completely in their power; they fill the mental sphere forcibly, against the will of the individual.

Sometimes, when you get tired of a song, but it’s spinning in your head, it’s terribly annoying and disturbing. How difficult it is for a person with such obsessive ideas, given the inability to get rid of them. Delusional obsessions are like a bad habit and fill the patient’s entire time. A person with obsessions is completely critical and consciously wants to get rid of it, but delusional obsessions are characterized by a lower level of criticism, since they follow the structure of delusions.

Clarity of consciousness is preserved in this mental disorder. This is a type of obsessive experience that, in addition to ideas, can manifest itself as fears and similar thought processes. Cognitive processes are not impaired during neuroses; clarity of consciousness may only be impaired. Due to the criticality and presence of a sense of obsession, this pathology is very painful for the individual. Often the obsessions themselves are unacceptable for a person, and in severe cases they are accompanied by compulsive actions.

Delusional obsessions often have accompanying symptoms in the form of hyperanxiety and ritual actions that are designed to avoid these symptoms. Sometimes there may be depressive states that occur in the structure of obsessions, and apathy will appear due to a state of hopelessness and the inability to get rid of obsessive symptoms. In addition, with this combination, ideas of self-accusation and self-humiliation always appear.

There are always attempts to combat obsessions, this is what distinguishes them from any other disorders, they are alien to the patient, like something foreign. He can passively fight them, while he avoids everything that could provoke his obsessions. This naturally leads to isolation, decreased social status and instability of the nervous system. These methods do not help avoid the disorder, but only aggravate the patient’s anxiety. With active avoidance, the patient tries to act contrary to ideas, he is angry and irritated, constantly confronting some unspoken enemy.

Compulsive symptoms in OCD

People with OCD often use compulsive behaviors ( take an OCD test ) to control their obsessions. For example, an anxious patient checks the smell of his breath. Some actions are taken to relieve stress (although there are more effective methods), others are aimed at preventing a dangerous event. A compulsive action does not necessarily have a logical connection with an obsession. For example, a child may count steps to prevent the death of a parent. However, if actions and thoughts are related, the action will be very disproportionate to the risk.

Obsessive-compulsive behavior is frequently and excessively repeated. It almost always interferes with everyday life. Some people feel forced to spend hours on their compulsive needs. Others may go out of their way to avoid certain triggers. Many people with OCD know that their behavior is not “logical”, but they still feel anxious and confused until they complete the necessary “ritual”.

Symptoms of Obsessive Ideas

As with other forms of mental disorders, only a doctor can diagnose obsessions. But there are symptoms of obsessive ideas, from which one can guess that a loved one is not just an alarmist, but suffers from a certain disease and needs the help of qualified doctors:

Trade with yourself. Patients with obsessive ideas sincerely believe that if they repeatedly check the progress of their actions, they will finally be able to calm down. But this opinion is devoid of any basis, because biochemical reactions associated with the object of fear arise in the brain at a subconscious level. Regular anxiety attacks convince the patient that the danger is real, and there is indeed a reason for fear.
Feeling the need to perform some rituals. When a person agrees not to check a locked door every couple of minutes if he is offered to pay a certain amount, most likely he is simply more afraid of burglars than others, but does not suffer from obsessive ideas. For a patient with obsession, performing rituals is comparable to a matter of life and death, which cannot be assessed with money.
It is difficult to convince a person that his fears have no logical basis. With OCD, a syndrome of obsessive ideas, the patient cannot be 100% sure of something.
Full awareness of the problem. Most patients who are registered with a psychologist due to obsessions can clearly answer when the feeling of anxiety visited them for the first time. At first, a person experiences an incomprehensible mild anxiety, which later transforms into a specific form of fear. For healthy people, such experiences go unnoticed and disappear over time on their own when the irritating factor is eliminated. Patients with OCD cannot cope with panic on their own; it gradually becomes part of their life.

Any fears that torment a person during an obsession have a clear basis. There really are a lot of germs on your hands, and no one is safe from a flood - with obsessive idea syndrome, it’s all about the intensity of fear. If a person can live normally while sometimes feeling some uncertainty, it most likely has nothing to do with OCD. You should panic if anxiety has completely consumed your thoughts and is preventing you from functioning normally.

Compulsive behavior may include:

Check: A person may get up several times a night to make sure the iron is turned off. May also reread each email or text a dozen times to check for typos.
Cleaning: People with OCD can wash their hands until the skin cracks. They can also disinfect household items after each use (instead of following the instructions in the owner's manual).
Repositioning/Repetition: A person may press a light switch a certain number of times or straighten clothing until it is perfectly straight.
Withdrawal: A person may repeat the same phrase to “cleanse” themselves of sexual thoughts or unpleasant images.

When a person's obsessive feelings are not obvious to observers, they are said to have pure obsessive OCD (also called pure OCD). For example, a person may silently count to 100 after completing certain tasks to ensure that they end with a “safe” thought. Another, for example, may mentally recite strings of words to make sure he doesn't lose his memory. Compulsions can interfere with a person's functioning, even if they are not visible to others.

Treatment of OCD (Obsessive-Compulsive Disorder) and Obsessive Thoughts

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Obsessive-compulsive disorder (OCD) is characterized by the presence of recurrent, persistent, unwanted and intrusive thoughts, urges or images (obsessions) and/or repetitive behaviors or mental actions that patients feel an urgent need to perform (compulsions) to try to reduce or prevent anxiety , which is caused by obsessions. The diagnosis is made based on the medical history. Treatment for OCD consists of psychotherapy (namely exposure and response prevention techniques), drug therapy (namely SSRIs—selective serotonin reuptake inhibitors—or clomipramine), or, in particularly severe cases, both.

OCD is slightly more common among women than men, with a prevalence of approximately 1 to 2% of the population. The average age of onset of OCD is 19–20 years; In approximately 25% of cases, the onset of OCD is observed by age 14. Up to 30% of people with OCD also have or are suffering from a tic disorder.

Clinical manifestations of OCD

Obsessions are unwanted, intrusive thoughts, urges, or images, the presence of which typically causes significant discomfort or anxiety. The dominant theme of intrusive thoughts may be harm or risk to self and others, danger, contamination, doubt, loss, or aggression. For example, patients may be haunted by thoughts of contracting bacteria from dirt if they do not wash their hands every 2 hours or more often. Obsessions are unpleasant for the patient. Therefore, patients try to ignore and/or suppress these thoughts, urges, or images. Or neutralize them by committing compulsions.

Compulsions (often called “rituals”) are excessive, repetitive, goal-oriented behaviors that sufferers feel an urgent need to engage in to prevent or reduce the anxiety caused by intrusive thoughts, or to neutralize the intrusive thoughts themselves. Examples:

Washing (eg, hand washing, showering)
Checking (for example, if the stove is turned off, if the doors are locked)
Counting (for example, repeating a certain behavior a number of times)
Organizing (for example, organizing your desk or kitchen utensils in a specific pattern)

Most rituals, such as washing hands or checking locks, are obvious, but some rituals, such as silent calculations or silent statements, go unnoticed by others. Typically, compulsive rituals must be performed in a certain way and strictly according to strict rules. Rituals may or may not actually be associated with the feared event. If they are truly related (eg, bathing to be clean, checking the stove to prevent a fire), then the compulsions are clearly excessive: for example, the patient showers for many hours every day or checks 30 times before leaving the house. whether the stove is turned off. In any case, the obsessions and/or compulsions must be time-consuming (eg, > 1 h/day, often much more) or cause the patient significant discomfort or difficulty in functioning in various areas; in their extreme forms, obsessions and compulsions can lead to disability.

The extent to which patients understand their own problems varies. Most people with OCD admit to some degree that the beliefs underlying their obsessions are unrealistic (for example, that they won't actually get cancer if they touch an ashtray). However, sometimes understanding is completely absent (ie, patients believe that the beliefs underlying their obsessions are true and that their compulsions are reasonable).

People with this disorder may fear awkward situations or social judgment, so they often hide their obsessions and rituals. Relationships may be damaged, and performance at school or productivity at work may decline. Depression is a common secondary symptom.

Many people with OCD have co-occurring mental disorders, including

Anxiety disorders (76%)
Depressive disorder or bipolar disorder (63%; most common is major depressive disorder [41%])
Anancastic personality disorder (23-32%)

About half of people with OCD have suicidal thoughts at some point, and a quarter of them attempt suicide. The risk of attempting suicide increases if people also have clinical depression.

Diagnosis of OCD

Clinical criteria

The diagnosis of obsessive-compulsive disorder is clinical, based on the presence of obsessions, compulsions, or both. Obsessions or compulsions must be time consuming (eg, > 1 hour per day) or cause clinically significant discomfort or problems with functioning.

Treatment of OCD

Body-Focused Therapy and Ritual Prevention Therapy
SSRI or clomipramine

Exposure therapy and ritual avoidance therapy are often effective in patients with obsessive-compulsive disorder; their most important element is gradually increasing contact with situations or people that cause anxious obsessions and rituals, while contact is accompanied by a request not to perform these rituals. For example, a patient with a soiling obsession and a hand-washing obsession might be asked to touch the toilet seat without subsequently washing their hands. This approach reduces exposure-induced anxiety through habituation. Remission can persist for many years, especially in patients who use psychotherapeutic skills even after the formal end of treatment. However, some patients have an incomplete response to therapy (as some do to drugs).

Cognitive therapy techniques may also be effective in combating some OCD symptoms.

SSRIs and the drug clomipramine (a tricyclic antidepressant with potent serotonergic effects) are often very effective. Patients often require higher doses than typically used for depression and most anxiety disorders. Many experts consider the best treatment to be a combination of exposure therapy and ritual avoidance therapy with drug therapy, especially in severe cases.

Key points

Obsessions are intrusive, unwanted thoughts, images, or urges that typically cause significant discomfort or anxiety.
Compulsions are excessive, repetitive rituals that people feel compelled to perform in order to reduce the anxiety caused by their obsessive thoughts or to neutralize their obsessions.
Obsessions and/or compulsions must be time consuming (eg, > 1 hour/day, often much more) or cause significant distress or impairment to patients.
Treatment of OCD consists of gradually increasing contact of patients with situations that cause anxious obsessions and rituals; this contact is accompanied by the requirement not to perform these rituals.
Taking an SSRI or clomipramine may also help.

What Causes OCD?

There are many factors that can contribute to obsessive compulsive behavior. Both biochemistry and environment may play a role.

Important: OCD is closely related to other disorders , so differential diagnosis should be carried out by a psychotherapist. Self-diagnosis and self-medication are unacceptable!

Although many people sometimes have intrusive thoughts, patients with OCD believe that these thoughts reflect their inner character or affect the outside world. Additional attention may increase the perceived importance of thoughts, increasing obsessions. Compulsions may develop as inappropriate attempts to block these sad thoughts.

Trauma can also lead to obsessions and compulsions. Children who are physically or sexually abused are more likely to develop OCD. Traumatic events (such as a car accident) can also contribute to this.

Daily stress may not cause OCD (in adults), but it can worsen existing symptoms. The family environment may play a role. If children have a close relative (such as a parent or sibling) with OCD, their own risk of developing OCD doubles. If a relative developed OCD as a child, they are 10 times more likely to develop OCD than others.

A study from the National Institute of Mental Health (USA) linked OCD to two genetic mutations. Mutations make it difficult for serotonin to move properly in the brain. Serotonin promotes feelings of satisfaction and well-being. If serotonin levels are low, a person may experience anxiety.

OCD is also associated with dysfunction in one of the brain circuits. The circuit is activated when a person receives an impulse. After someone performs the appropriate action, the neuron's signals usually stop and the person feels satisfied. In the case of OCD, the neurons continue to fire. The person still has momentum and may have to perform the action several times before they discover the same satisfaction that others get from a single action.

Experts estimate that 1 in 2,000 children may develop obsessive-compulsive behavior after a streptococcal infection. This condition is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, or PANDAS. Many experts believe that PANDAS is an immune reaction. When a streptococcal infection occurs, the antibodies sometimes affect parts of the brain. This may cause a sudden development of obsessive ideas and actions.

Other studies show that streptococcal infection does not cause OCD symptoms. Instead, the infection may cause symptoms in children who were already predisposed to the disease.

Causes of obsessive-compulsive disorder and risk factors

Psychiatrists have still not come to a consensus on why people develop obsessive-compulsive disorder. But, despite the fact that the reasons for its appearance are unknown, there are several main risk factors that can, to a certain extent, influence its formation.

Genetics

Twin and family studies have shown that people who have a first-degree relative with obsessive-compulsive disorder are at higher risk of developing and developing obsessive-compulsive disorder [National Institute of Mental Health, 2021].

Brain structure and functioning

Imaging studies have shown differences in the frontal cortex and subcortical brain structures in patients with obsessive-compulsive disorder. There appears to be a link between OCD symptoms and abnormalities in certain areas of the brain, but the link is not yet clear.

According to some neuroscientists, people with obsessive-compulsive disorder do not have enough of a chemical called serotonin in their brains [Cedars Sinai, 2021]. Research is still ongoing, and understanding the causes will help identify specific, individualized treatments for the disorder [National Institute of Mental Health, 2021].

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Some studies have reported a link between the environment in which a person grew up and the occurrence of obsessive-compulsive disorder symptoms. There are suggestions about the influence of psychological trauma received in childhood on the formation of neurosis. However, more research is needed to better understand this relationship [National Institute of Mental Health, 2021].

In some cases, children may develop OCD symptoms after a streptococcal infection. This is called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections [National Institute of Mental Health, 2021].

How to detect OCD in children?

Some parents may struggle to distinguish OCD from typical child behavior. Some rituals, such as bedtime prayers or toy placement, may simply be age-appropriate. However, when habits interfere with school or friendships, there may be cause for concern.

Common signs of OCD in children include:

Irritability
Difficulty making decisions
An inexplicable desire to be alone
Refusal to communicate with friends
Required to stay home or at school to complete assignments
Excessive time spent on daily tasks, trouble sleeping
Extreme reactions to minor changes in daily life

Children and adolescents are more likely to experience harm-related symptoms than adults. Typically, children obsessively ask adults to calm them down. They often crave routine and consistency.

Gender and ethnic differences in OCD

Adult women tend to have higher rates of OCD than men. However, men are more likely to develop obsessions and compulsive behaviors during childhood. Women are more likely to have cleaning-related symptoms. Symptoms in men more often fall into the categories of symmetry or taboo. Men are also more likely to have comorbid disease than women.

The prevalence of OCD is similar across ethnic groups. Internationally, prevalence rates range from 0.3% (Brazil) to 2.7% (Hungary). The age of onset and the nature of symptoms are usually the same in different countries. However, the culture of a region may influence which topics are more common.