Treatment of obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder or, in other words, “obsessive neurosis” is a fairly common mental illness, which is a clear manifestation of borderline mental disorders. The approved medical name for this disease has two Latin roots: obsession and compulsion.

Obsession, translated from Latin, means “possession”, and in the aspect of this disease - an obsessive thought or idea. Obsessive thoughts of an OCD sufferer most often contain a scary, unhealthy and unpleasant idea in their content, and can also be aggressive in nature.

Compulsion is interpreted as an “obsessive action”, and according to its symptoms, it consists of permanent double-checking of everything: whether the door is closed, whether the appliances are turned off, whether hands have been thoroughly washed.

In simpler terms, OCD implies obsessions of any pathogenesis that literally prevent a person from living. Sick thoughts lead the patient to the need to constantly repeat the same actions, bringing the situation to the point of absurdity. For example, a patient with an internal fear of infection may “wash his hands” until he wipes them until they bleed. A patient with a compulsion to double-check may return home many times to check household appliances, or read the same page of a book a million times in an effort to find out how much time he spends on it. Of course, such a scheme of being reduces the quality of life, exhausts and torments a person, and ultimately leads to stressful conditions and neuroses.

We will look at how to live with this and what self-help methods you can use below in this article. In the meantime, let us pay attention to the etiology of the formation of this disease. What can serve as a trigger for the development of obsessive-compulsive syndrome.

Reasons for the development of OCD

The formation of the disorder is essentially based on three factors:

1. A biological factor, including disturbances in the functioning of neurotransmitters, cellular metabolism of the brain or autonomic nervous activity, traumatic brain injury and heredity, and the latter is not the underlying cause.
2. Social, which implies strict boundaries and norms imposed on the child in childhood in the family or any other system in which he lived or communicated.
3. Psychological includes both character accentuations (pronounced traits that influence the behavioral aspect), as well as traumatic circumstances.

From the point of view of Gestalt psychology, the formation of the disorder is perfectly demonstrated in the famous film “The Aviator”, which, by the way, is highly recommended for viewing by patients with this syndrome. In the case of the main character, two factors were involved: biological (genetic predisposition passed on from the mother) and social (an unhealthy pattern of behavior imposed by her). Every time she washed her child, she said, like a mantra, that there was an infection everywhere, from which everyone was dying. Thus, she transferred her anxiety and overprotection to the child. Thus, in light of the social aspect, the boy grew up in an artificially created environment in which any stressful situation triggered an increase in symptoms with accentuation.

OCD in children

Most often, the disorder manifests itself in children during adolescence. The incidence rate up to 12 years is 1%.

Its causes are gene mutations, infectious diseases, disorders in the metabolism of neurotransmitters, features of the development of the central nervous system, as well as the costs of education, the atmosphere in the family and relationships in society.

Thus, overly strict upbringing, excessive demands on the child, strict moral principles, violence and quarrels in the family, and a religious cult contribute to the development of obsessive-compulsive neurosis.

OCD is mostly manifested by anxiety and fears. For preschoolers, the most common type of OCD is phobias, for children 6–8 years of age – compulsions. And teenagers are most often overcome by obsessions.

Common manifestations of OCD in childhood and adolescence are:

1. Thoughts about cleanliness. Children constantly wash their hands and wipe door handles, including in public spaces.
2. Fears of harm - getting sick with a dangerous disease, going to hell, hurting someone.
3. Counting - chewing food a certain number of times, counting objects. Example: I need to count to 30, and then my grandfather will not die.
4. Thoughts about safety. Checking the door, iron, gas, spitting over my shoulder 3 times - then nothing bad will happen.
5. Symmetry. Children arrange books, notebooks, and clothes in a certain sequence, by size, and color.
6. Thoughts about your appearance. At the same time, teenagers spend too much time in the bathroom or in front of the mirror.
7. Children double-check their homework or class assignments many times, afraid of making a mistake. Or they do it very slowly.
8. Constant, annoying repetition of certain questions that require answers: Will I be late? Will the bus definitely come? Could we have a tsunami?

Children are frightened by their obsessive thoughts and actions, so they try to hide them from others. They become withdrawn, nervous, anxiety increases, and school performance decreases.

How OCD is formed

In each of us there live instinctive impulses, called by Freud “the unconscious”, and the superego - the “superego”, which, under certain circumstances, come into conflict, giving rise to internal contradictions in the individual. Primordial animal instincts and social censorship, the concepts of “want” and “need”, “possible” and “impossible”, enter into the struggle. And when the confrontation of motives under the influence of the factors stated above gets out of control, the person’s level of anxiety increases and neurosis begins to form. From a psychological point of view, it is increased anxiety that leads a person to obsessive-compulsive disorder. What is anxiety?

In its pathogenesis, it is the fear of the unknown, which in the case of this disorder is associated with the suppression of feelings and emotions in childhood. But the task of the brain is to protect the body from what it cannot cope with, therefore, against the background of anxiety, compensatory mechanisms are activated, ultimately leading to the fact that the patient understands what he is afraid of and is aware of his fear. For example, if a person is afraid of germs, then he goes to wash his hands and as a result of this process he calms down, but obsessive-compulsive syndrome is a kind of addiction, that is, each time a person needs to wash his hands more thoroughly and more often.

Why is this happening? In order to protect itself, the psyche deliberately takes a person to the external, so as not to give him the opportunity to look deep into himself. In a cyclical useless process, the patient's attention is directed to the external ritual process, and is not immersed in the problem and sadness that live inside him. It is so impossible for a patient with this syndrome to be immersed in pain that the psyche transfers it to external details.

Diagnostics

To make a diagnosis, doctors are usually guided by typical symptoms that act as criteria for obsessive-compulsive disorder:

• frequently repeated thoughts and actions;
• the patient’s assessment of thoughts and images as their own;
• attempts at unsuccessful resistance;
• negative attitude towards these phenomena in the patient;
• the appearance of signs of distress against the background of obsessions and compulsions.

In order to refine the diagnosis, special tests are used, during the assessment of which a psychiatrist or psychotherapist determines for himself the following basic aspects of pathology:

• the nature of thoughts and actions;
• frequency of their occurrence;
• the extent to which they interfere with the patient's daily life;
• the amount of time they take;
• the strength of a person’s desire to suppress the manifestations of the disease.

This test allows you to determine the presence and severity of obsessional neurosis. It is also used during treatment of the problem, repeating once a week to evaluate the effectiveness of the prescribed therapy.

It is mandatory to differentiate with other mental illnesses, which may be accompanied by similar symptoms, but require a slightly different approach to providing assistance. Obsessions occur in some types of depression and early schizophrenia.

When delirious, a person does not have a tendency to resist his thoughts and wishes, he shows solidarity with them, and in this case, treatment for schizophrenia is required. Obsessive neurosis is accompanied by the patient’s rejection of his obsessive obsessions and the presence of a critical attitude towards this problem.

In some cases, obsessive-compulsive disorder has concomitant neurotic abnormalities. Therefore, along with obsessive states, it may be necessary to treat depression, relieve excessive anxiety, and get rid of attention deficit disorder.

How OCD manifests itself

As noted above, the main symptomatology is the presence of debilitating, repetitive strange thoughts or ideas in the patient, leading, accordingly, to a series of repeated meaningless actions. It is worth noting that a “stray” isolated thought enters a person’s head completely unexpectedly, and at first glance for no reason. But the problem is that it remains there, as if “hanging” and does not go anywhere.

Sometimes the patient begins to feel that he can harm others: push someone under a car on the street, hit someone, cut someone with a knife. Moreover, he tends to constantly double-check whether he was at the scene of any incident, which is due to the fact that a person may not remember the details and sequence of his actions. This is due to the fact that one of the manifestations of the obsession syndrome is the individual’s being in “deep sleep.” Suppressed feelings and emotions immerse the patient in his inner space, which is comfortable and safe for him. That is, a person can walk down the street, ride in public transport or in an elevator and not remember what he did or saw at that moment. The level of awareness in the “here and now” is practically zero, which consequently leads to an obsessive need to double-check everything.

Types and symptoms of obsessive-compulsive disorder

OCD comes in many forms, but most cases fall into at least one of four general categories:

• Checks: for example, whether the lock is closed, whether the alarm system is on, whether the oven or switches are turned off; suspect the presence of any disorder or disease and check its diagnostic criteria.
• Contamination: Fear of things that may harbor bacteria/infections or a compulsion to clean. May include feeling like you are being treated like dirt.
• Symmetry and order: the need for everything to be arranged, lined up in a certain way.
• “Soap gum” and obsessive thinking: obsessive thoughts and thoughts. Some of them may be aggressive, violent, religious or disturbing in nature.

OCD symptoms

Patterns of behavior of patients depending on the form of manifestation of neurosis.

Adult symptoms essentially represent a single clinical picture in which fears and obsessions, by their essence and the clinical picture of manifestation, can be divided into the following categories:

• Contrasting obsessions : terrible, very vivid pictures that the mind persistently “throws” at the patient. These obsessions may include thoughts about sexual perversion, about killing someone or violence against those who have not done anything wrong to the patient, blasphemous ideas. The patient himself is aware of the horror and irrationality of his thoughts, but is unable to cope with them, take control and get rid of the fear of their translation into reality.
• Fear of infection or disease . Often, the patient sees dirt and pathogenic bacteria everywhere. Theoretically, he realizes that he will not die from this, but the very thought of dirt is unbearable for him. It is this fear that leads to the obsessive desire to constantly wash your hands, rub them with soap and alcohol, and do this countless times. This category also includes agoraphobia or fear of crowds. For patients who are afraid of infection, anxiety increases many times in crowded places, so they try to avoid them.
• “Rechecking” belongs to the category of compulsions and includes a set of such actions that are constantly repeated. The patient may return several times to check again and again whether the appliances are turned off, whether the door is closed, whether he took the change.
• The pursuit of symmetry . A person can spend hours arranging books in alphabetical order or clearing the table every half hour. All these actions serve as a kind of ritual for getting rid of an obsessive state. However, if the patient’s desire to lay out and organize everything around him in a symmetrical order is absolutely uncontrollable and irresistible, then the help of a specialist is simply necessary.

In addition to the above manifestations, symptoms can be conditionally grouped into the following groups:

• physical manifestations - weakness, sleep disturbance, headaches;
• emotional – hypochondriacal neurosis, depression, phobias;
• cognitive – amnesia, memory disorders, problems with diction;
• behavioral – aggressive or apathetic behavior, obsessive actions;
• perceptual – delusions of grandiosity against the background of hallucinosis.

Symptoms of obsessions and compulsions

Treatment of obsessive-compulsive disorder in Moscow at Dr. Isaev’s clinic is carried out successfully, since an individual approach is taken to each patient and only modern techniques are used. Therapy begins with identifying symptoms of deviation. The main signs of a violation are:

• presence of obsessions (obsessive thoughts);
• anxiety, tension and fear associated with them;
• compulsions (the same actions that allow you to get some relief).

All these manifestations form a single cycle, which repeats from time to time. Some patients have a predominance of obsessions, others have a predominance of compulsions, and there are also patients with the same severity of obsessive thoughts and actions.

Since the manifestations of the disease are not always typical, diagnosis requires consultation with an experienced psychiatrist and psychotherapist. To make an appointment, you can call or leave a request on the clinic’s website.

Mental symptoms

The disease is a mental disorder and is accompanied by characteristic symptoms. The patient's obsessive thoughts may include the following:

• fear of getting infected, getting dirty;
• unreasonable concern for the life and health of loved ones;
• fear of discovering that you are gay;
• sexual images and fantasies;
• constant desire for order and symmetry;
• excessive superstition, passion for ritual and cult phenomena.

With obsessive compulsive disorder, the thoughts and images that constantly come to him are perceived by the patient himself as his own. This disease differs from split personality, when the patient hears “voices” from the outside or from his “other self.” With neurosis, a person tries to control thoughts and movements, but he fails to do this. The more he resists, the more anxiety and desire to perform the ritual grows.

The most common compulsive movements associated with this disease are:

• plucking or pulling out body hair;
• constant washing of hands and body;
• nail biting;
• wiping door handles and other objects;
• checking the stove, iron, door lock;
• arranging things in strict order;
• accumulation of unnecessary trash;
• frequent utterance of prayers, mantras and other phrases.

Doing these actions itself does not bring much pleasure, but it can reduce the level of tension, fear and anxiety. But this only lasts for a while, and then obsessions arise again and the phobia grows, and the cycle repeats. Compulsions may outwardly look like normal work, this applies to putting things away or cleaning the house. In some cases, they have no rational basis, for example, jumping over asphalt cracks. But for the onset of calm, a person performs them without fail, but at the same time is fully aware of their uselessness and absurdity.

Physical signs

Treatment of obsessive-compulsive disorder in Moscow at Dr. Isaev’s clinic includes providing assistance to relieve mental symptoms and eliminate physical signs of pathology. Patients with obsessional neurosis often experience dysfunction of the autonomic nervous system. And this leads to the following deviations:

• insomnia;
• dizziness;
• heartache;
• headache;
• frequent blinking;
• seizures and tics;
• pressure surges (hypo- and hypertensive crises);
• loss of appetite;
• dyspepsia;
• increased sweating and chills;
• tachycardia;
• dyspnea;
• dry mouth;
• decreased libido, impotence.

All these disorders are complications of the underlying pathology. And with proper complex therapy they go away on their own. In some cases, additional treatment is required to speed up the restoration of autonomic functions.

The method of providing assistance also depends on the type of neurosis. It happens:

• chronic (from 2 months or more);
• recurrent (with periods of exacerbation and “bright” intervals);
• progressive (continuous manifestation with gradual deterioration).

When the disease becomes chronic, and the reason for this is often the lack of professional therapy, the type of obsessive states expands. If at the beginning of the disease a person could check that the stove or iron was turned off 2-3 times a day, then later this action begins to be repeated 5-6 times. With a progressive form of pathology, performing rituals can take the patient most of the day and there is no time left for other types of activity.

Stages of OCD

Unlike many other mental disorders and neuroses, the stages of obsessive-compulsive disorder relate more to the level of perception of them by the patient, rather than to the aggravation of symptoms. Thus, almost everyone suffering from OCD goes through three conditional stages:

1. Misunderstanding . A state of generally not understanding what is happening. A person begins, out of nowhere, to be disturbed by strange thoughts, and sometimes previously unusual actions spontaneously appear. Of course, all this is extremely frightening and provokes the highest level of anxiety, especially since most likely the person knows nothing about this disorder, and certainly does not allow the possibility of its development in himself.
2. Understanding without awareness . OCD is considered an independent unified diagnosis, which is disclosed to the patient. So, a person knows for sure that he has developed this form of neurosis, but he categorically refuses to believe in it, believing that everything will go away by itself, this is how the work of compensatory mechanisms manifests itself. Next, a person often enters into a struggle with his obsessions, to win, which is quite difficult alone; at this stage, it is very important not to lose faith in oneself and to seek help in time. tries to resist his strange
3. Adoption . The key period of the disease is when the patient realizes that he has abnormalities and acknowledges their presence, understanding that obsessions are a symptom of a disorder in the functioning of the brain, which needs to be treated using the method of deeper awareness and elaboration.

Of great importance in the treatment of OCD for the patient himself is his possession of information about the pathogenesis, etiology and trigger mechanisms of action of this type of neurosis. The ability and ability to apply self-help methods in the presence of this disorder play a big role, giving a person the opportunity to understand the essence of their fears, and therefore, take control of them and become able to manage their condition.

Diagnosis of obsessive-compulsive disorder

Differential diagnosis is used to properly evaluate the disorder, taking into account the similarity of symptoms and possible overlap with other disorders. Differential diagnosis is a purely clinical assessment and is carried out only by appropriate specialists and in no case by the patient himself or his relatives. In addition to consulting a psychotherapist, a medical examination may be performed and blood tests may be prescribed to ensure that there are no other disorders or diseases that are causing the symptoms.

Self-help methods

In the previous paragraph, considering the behavior patterns of patients suffering from obsessive-compulsive neurosis, we classified the forms of the disorder into categories. Based on the nature of obsessions or compulsions, as well as background symptoms, the psychotherapeutic community recommends the following exercises:

The first and fairly common method is internal independent awareness of one’s sick thought (obsession) and recognition of it. The patient can say to himself: “Yes, this is my sick thought, which arose for a number of reasons that I need to neutralize.” How can you neutralize obsession? The awareness-acceptance technique involves an approach of the “knock out a wedge with a wedge” type, when it is proposed to turn your gaze inward and, through visualization, strengthen the situation that causes fear. If a person is afraid of dirt, then he needs to imagine that dirt is literally everywhere, and it is terrible. It is necessary to remain in this state for as long as possible, strengthening and thereby overcoming anxiety. The technique is used in the treatment of obsessions associated with fear of infection.

In a situation with contrasting obsessions and re-checking compulsions, psychotherapy offers a method of total acceptance of being. The patient is advised to imagine what will happen in the worst case scenario and accept it. For example, the iron is still on, which means the apartment will eventually burn down. In other words, you need to accept the finitude of any situation and its consequences.

Anything can happen, whether you think about it or not. The main thing is to be prepared for this.

The approach, by the way, is good in all other cases: whether a person is healthy or sick, whether he is treating neuroses and stress, or whether he feels quite comfortable. Accepting the existential theme that today may be the last day brings high awareness and brings us closer to accepting any circumstances.

Another great DIY method is keeping a journal of feelings and self-reflection, which is a simple way of working with yourself. It consists in the fact that a person writes down everything that happens to him: with whom he communicated, what he said, what he felt, what dreams he had. Details can be written down or drawn, whichever is more convenient for you. Thus, problems are brought into the field of conscious perception and, accordingly, independent control.

How can we help?

If you have discovered some of the described symptoms, this may indicate the development of a mental disorder. In this case, it is worth contacting a psychiatrist for diagnosis and initiation of timely treatment. In addition to face-to-face appointments , we offer a remote consultation service (online) , which is not inferior in quality to a personal meeting. Thus, you can receive qualified assistance from a high-level specialist, no matter where you are.

Our clinic, near the Eastern Administrative District of Moscow, in Reutov, employs specialists who have extensive experience in treating mental disorders. We use the most modern and advanced techniques, guided by the principles of evidence-based medicine. Effective assistance and confidentiality of information constituting medical confidentiality are guaranteed.

Treatment of OCD

As with any other neurological disorder, in severe cases it is necessary to involve a team of specialists (psychotherapist, neurologist, psychiatrist) capable of applying a range of measures, including drug therapy.

During stress caused by an obsessive-phobic state, nerve cells are destroyed much faster, and the functional centers of the brain begin to work less and less. It is impossible to normalize and facilitate this process without the use of medications, which is why patients are prescribed drugs from the class of tranquilizers and antidepressants. When brain activity is more or less restored, the use of a psychotherapeutic approach, which plays a major role in treating the disorder, turns out to be more effective.

Psychotherapy methods

The essence of psychotherapy is awareness and acceptance of your suppressed feelings and emotions. It is important to note that psychotherapeutic treatment is quite multifaceted and includes a number of different techniques. For example, cognitive behavioral therapy leads the patient to recognize the irrationality of his behavior and beliefs. It involves increasing the irritating stimulus by gradually immersing the patient in a stressful situation until the level of reaction decreases. This approach, which we have already touched upon in self-help methods, is called the “exposure method” and has proven itself very well. Behavioral exposure tasks can have different mechanics depending on the symptomatology. When treating obsessions, a person is asked to reproduce a thought intentionally and a certain number of times. If the obsession comes 5 times, then it should be deliberately repeated 10 times, or even better, prescribed. The situation with rituals is similar. By increasing the irritating and frightening factor and deliberately immersing oneself in it, the patient’s symptom goes away, but, unfortunately, the problem itself is not solved. That is why at one stage of cognitive behavioral therapy the techniques of gestalt and psychoanalysis are used.

Gestalt therapy

It consists of a dialogue between the individual and the subpersonality, which encourages deviance from within. A conversation with a subpersonality is a kind of acquaintance with oneself, which can provide answers to many internal questions, gradually revealing unspoken grievances and suppressed feelings that torment the patient. With this technique, the intrapersonal conflict that lies on the surface is revealed quite simply, but there is also a deeper layer.

Psycholysis or depth psychotherapy

Finding the source of stress and working with it. Most often, the root cause lies in close relationships in which the patient’s sphere of feelings is suppressed. For example, a child in childhood was forbidden to express his feelings, denied affection or empathy, hence, accordingly, anxiety arose, and therefore obsession and its symptomatic manifestations.

Internal dialogue

This is another method of treatment that is mandatory, since through it the patient becomes able to distinguish between a sick thought and a healthy one in his head, beginning to influence the sick part with his healthy part. Fear is a manifestation of the inner child, with which the adult part is able to work.

In general, any psychotherapeutic technique aims to help in recognizing the problem and in externalizing internal obsessions. As soon as the unconscious enters the plane of awareness, it becomes under our control, we can control it.

Causes of obsessive-compulsive disorder and risk factors

There can be several causes of OCD. The disorder is very individual; to determine the causes, you need to consult a psychotherapist or medical psychologist. The following risk factors are identified:

• Family history: first degree relatives (father, mother, brother, sister, child) with OCD
• Depression, anxiety, anxiety, nervous tics
• Experience of psychological trauma
• Presence of psychological, physical or sexual abuse
• Neurological infections, brain injuries.
• Severe or chronic stress usually makes symptoms worse.
• OCD is more common in women than in men.
• Symptoms are more likely to appear in teenagers or young adults. However, OCD can also appear in adults as well as children, especially under severe or chronic stress.

What should the patient's relatives do?

The most important thing is not to reinforce the painful state of your loved one. On the contrary, this disease should be actualized and brought to the surface. Talk about it and guide the person to solve the problem on their own, but offer support. The key emphasis is on the fact that you are nearby and ready to back up: “I am with you, and we will do this together.” Another important factor is the development of the patient’s emotional intelligence. Encourage him to express and express feelings and emotions, even the most insignificant ones. Show your loved one how to show feelings.

Obsessive Disorder Therapy

OCD is treated with medication and psychotherapy.

Among medications, antidepressants are primarily prescribed. They use 3rd generation drugs – serotonin reuptake inhibitors. It is on their effectiveness in eliminating OCD that the neurotransmitter theory of the occurrence of the disorder is based.

To enhance the effect of antidepressants, mood stabilizers are prescribed - mood stabilizers.

In addition, tranquilizers are used to relieve anxiety. If there is no effect from antidepressants, atypical antipsychotics are prescribed, but with caution, since some of their types increase the manifestations of the disease.

Of the psychotherapeutic methods, the most effective is cognitive behavioral therapy. It enables the patient to recognize his problem and confront it. To do this, use the exposure method. A person is deliberately immersed in an unpleasant situation and taught how to reduce anxiety and resist obsessions.

Another effective method is stopping thoughts. It consists of several stages:

• identifying obsessive thoughts and actions;
• switching to positive images and thoughts with the help of a psychotherapist;
• stopping disturbing thoughts by saying the word stop out loud and then mentally;
• finding positive aspects in obsessions. For example, if a person is overcome by an obsession to hit someone on the head, then he imagines having a nice conversation with his “victim” or walking with her. That is, the situation seems to turn in the other direction, becoming diametrically opposite.

Additionally applicable:

• family therapy;
• auto-training;
• hypnosis;
• rational therapy.

Sometimes aversive therapy methods are used. They consist in causing painful sensations in the patient when he is visited by obsessions or compulsions.

Psychoeducational therapy allows you to teach a person how to ignore obsessions, how to switch to a more pleasant activity or thoughts.

Prevention of OCD and other neurotic conditions

Paradoxically, a scientifically proven fact is that the neuroticism of the population increases not only due to external stress factors, but also due to the highest level of comfort that modern society provides. Automation, digital technologies, cars - all this takes a person away from interacting with his body. Agree, when someone needs to do 1,000,000 things in a day, there is simply no time left for neurosis and depression. Therefore, as a preventive measure, it is advisable to strive for the present, for nature, for communication, for physical activity, and of course, for work. After all, by passionately doing what you love, you can even miss the apocalypse.

Forms of the disease

Obsessive-compulsive neurosis manifests itself in 2 main forms – obsessions and compulsions.
Obsessions are annoying thoughts that regularly visit a person. However, he cannot control them or get them out of his head. In one case, they are periodic and do not overly absorb a person’s consciousness, in the other, they terrorize him almost all the time. At the same time, the person tries hard to overcome them, to get them out of his head, but nothing comes of it.

For example, a girl is overcome by the idea that she might be seduced by a woman and become a lesbian. Because of this, she tries not to let women touch her.

Such obsessions manifest themselves in several categories:

• doubts. In this case, the patient constantly questions his actions and seeks confirmation of their correctness in everything. At work, while fulfilling his duties, he asks to be rechecked. When leaving the house, he returns several times to make sure that the gas is closed;
• fear. A person is afraid that he will not be able to perform any action correctly or will do something dangerous for him. This includes fear of public speaking;
• attractions. A person's desire to commit an obscene or dangerous act. For example, when a passionately loving mother has a pathological desire to kill her child. Or a respectable, moral girl has a super-urge to commit depraved acts. The peculiarity of such drives is that they are never realized;
• memories. Images of a past event, lyrics of a song, phrase, etc. constantly pop up in a person’s mind;
• thoughts. Implausible thoughts about an important event that has happened. This often happens to parents who have lost a child. Disbelief that he was dead or the belief that he was buried alive may prompt them to exhume the body.

Obsessions also include meaningless philosophizing. This is a process of fruitless thinking, without specific goals and results. For example, while walking down the street, a person may reason about whether a red car will pass by. If so, what shade will it be: light or dark? Where she is going, will she turn or go straight. How many people will be in the car, what brand will it be, etc.

Such philosophizing differs from reasoning in the critical attitude of the patient himself to it.

Some experts also include phobias in this group - a pronounced, hypertrophied fear of something. The most common:

• cancerophobia – fear of getting cancer;
• Cardiophobia – heart disease;
• algophobia – fear of pain;
• thanatophobia – fear of death;
• nyctophobia – fear of the dark;
• phobophobia – fear of fear;
• Panophobia is the fear of everything in the world.

Obsessions do not affect the patient’s logical thinking. In addition, some try to fight such obsessive thoughts. In case of active opposition, a person can take actions in defiance of obsessive thoughts. If he has doubts about a locked door and is tempted to go back and double-check it, he deliberately does not return and follows in the designated direction.

In case of passive opposition, a person tries to switch to other thoughts or actions.

Compulsions are obsessive actions that appear regardless of a person’s will. At the same time, he is accompanied by an irrepressible desire to perform them repeatedly in such a way that they acquire the character of a ritual. If the patient tries to refuse to commit them, then he develops anxiety and a feeling of fear. They will accompany him until the person completes the ritual.

The girl is forced to press the switch 3 times. At the same time, she is sure that if she stops doing this, something terrible will happen.

Examples of compulsions also include pathological overeating, excessive exercise - several hours several times a day, and by fairly slim people whose physical form does not require it. They play sports so much because they simply have an irresistible need for it. Having completed the ritual, they calm down, but the next day the impulse to train returns.

Workaholism, the need to constantly do some kind of work and not sit idle, is also classified as compulsions.

Obsessive actions can visit a person in one instance, or can be combined in several forms. Thus, there is a well-known story of one girl whose obsessive-compulsive disorder first appeared at the age of 10. It all started with a craving for symmetry, to achieve which she cut her eyelashes repeatedly. Then came the need to count steps, wash hands many times, and avoid cracks in the road. Gradually, self-traumatic rituals were added: cutting, burning, etc.

But most often, compulsions and obsessions occur simultaneously, forming obsessive-compulsive disorder.

It all starts with the emergence of an obsessive, frightening thought. For example, about the accumulation of pathogenic bacteria on the hands, which can cause a terrible, fatal illness. A person is looking for a way out of the situation, how to avoid this. He begins to wash his hands, and not like a normal person: before eating, when he comes home from the street, and several more times between “normal” washings. Several dozen times. But it’s not just the banal thing of washing your hands with soap.

Before performing the ritual, a person decides how many times he should soap his hands. 2 times 3 sets, but not 3 times. 3 is the Holy Trinity, there is no need to involve it in such a banal matter. Then it’s better to do 5 times 5 repetitions. He lathers his hands 5 times, rinses and repeats the action 4 more times. This brings relief for a while, but soon the annoying thought arises again. And the person begins to wash his hands again a certain number of times. At the same time, he understands the absurdity of the situation, but is unable to refuse it.