Compulsions: causes, symptoms, treatment

Probably, every person at least sometimes performs some actions just to calm themselves and their imagination. But in some cases, such actions are classified as pathologies - for example, if they occur regularly and are accompanied by obsessive thoughts. In psychiatry, systematic certain actions are called "compulsion". Compulsions are classified as obsessive-compulsive neuroses - they can progress, prompting a person to perform more frequent and different actions.

The disease may manifest itself episodically, for example, under the influence of certain circumstances, or be chronic.

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Epidemiology

Psychologists consider compulsion as a sign of "the return of what is repressed": the patient tries to "escape" from his own thoughts and aspirations, assuming their incompatibility with his own way of life and principles. This leads to the formation of subconscious disorders. Compulsion can manifest itself as a failed attempt to displace his thoughts from his head: the patient does not agree with certain of his own personal characteristics.

Compulsions are considered common types of disorders all over the world. They are present to some extent in 2-3% of the planet's inhabitants. Patients are most often people with a fairly high level of intelligence - they, due to bright and active brain activity, cannot resist the problem, therefore they lose their ability to work faster than others, fall into depression.

Compulsion is most common among the following population groups:

• people with high intellectual development;
• people with several higher educations;
• people with high social status;
• single men and women;
• persons dependent on alcohol;
• people suffering from constant lack of sleep;
• teenagers.

The prevalence of certain compulsive types is reflected as follows:

• fear of getting dirty or infected, fear of dirt is found in 45% of patients suffering from compulsions;
• 42% of patients are tormented by constant painful doubts;
• fear of somatic diseases is determined in 33% of patients with convulsions;
• fear of asymmetry and disorder is present in 32% of patients;
• fear of aggression, or a desire for it, is observed in 26% of patients;
• Concerns related to the sexual sphere are identified in 24% of patients.

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Causes compulsions

In many cases, compulsion arises against the background of the patient’s attempts to eliminate his own feeling of anxiety that arises under certain circumstances:

• in case of increased fatigue syndrome, excessive emotional stress, repeated stress;
• as a consequence of the appearance of obsessions - uncontrollable and unwanted thoughts, conclusions and fantasies that increase the state of anxiety and stimulate vegetative symptoms;
• in case of anankastic personality disorder (in case of weakness of individual brain structures, in case of significant hormonal changes in the body, in case of certain features of upbringing, in case of unfavorable heredity).

Many different studies and experiments have been conducted regarding the etiology of the appearance of compulsions, but it has not yet been possible to identify the exact cause of the disease. Therefore, specialists tend to "blame" both human physiology (for example, chemical changes in neurons) and the psychological component for the pathology.

We will consider the probable reasons in more detail below.

• The reason is genetics.

Scientists have discovered that in some cases, the tendency to develop compulsions can be inherited from close relatives. When studying the pathology in twins, it was found that compulsions have a moderate heredity. At the same time, it was not possible to clearly identify the gene that provokes the problem. Specialists have identified only a couple of genes that can affect to one degree or another - these are hSERT and SLC1A1, but their "guilt" has not been proven.

• The causes come from autoimmune reactions.

Such causes are more likely when the disease develops in children – for example, against the background of streptococcus A infection, which damages the basal ganglia. Some specialists also suggest a negative impact of prophylactic antibiotic therapy, which is used everywhere. Pediatricians apply the term "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection" to such pathologies.

• Neurological root causes.

New technologies in brain diagnostics have helped scientists study the activity level of many of its zones. It has been discovered that some zones are more active than others. For example, when compulsions appear, the basal ganglia, striatum, orbitofrontal cortex, caudate nucleus, anterior cingulate gyrus, and thalamus are involved in the process. A chain that affects all of the listed links controls primitive behavioral ability - for example, aggression, sexual desire, and sweat gland function. Stimulation of the chain gives an impetus to a certain type of behavior: for example, a person vigorously washes his hands after touching something unpleasant. In a mentally healthy person, after washing his hands, the desire to wash them again is exhausted, so he freely switches to another activity. But in a subject suffering from a compulsion, the brain does not "switch", since communication disorders arise in the above-mentioned brain zones. Thus, the patient continues to perform the obsessive action, copying his own behavior. The exact etiology of such a moment has not yet been determined by specialists. Probably, the problem can be explained by biochemical disorders in the brain (decreased activity of glutamate and serotonin).

• Behavioral psychological reasons.

One of the main theses of behaviorism in psychology indicates that repetition of any act in behavior makes it possible to reproduce it further. Patients suffering from compulsion try to avoid moments associated with the phobia, “fight” with their thinking, or perform repetitive actions to reduce anxiety. Such “rituals” relieve the uncomfortable feeling for some time, but increase the risk of obsessions in the future.

It turns out that the cause of compulsions may be hidden in the avoidance of one's fears. Often the pathology is found in people who enter a stressful state: they move to a new position, lose a loved one, suffer from chronic fatigue syndrome. For example, a subject who previously visited a public toilet without problems, in a stressful state begins to go to extremes and engage in negative self-hypnosis: "the toilet is unwashed, you can get infected, etc."

Associative phobia also extends to other similar situations: touching door handles, handrails, etc. If the patient begins to avoid public places, or uses complex actions to neutralize “pollution”, then this condition can transform into a full-fledged pathology.

• Reasons of a cognitive nature.

The above behavioral reasons indicate that compulsion arises as a result of "incorrect" behavior. But there is also a cognitive hypothesis, according to which obsession with actions arises against the background of an incorrect assessment of one's own thoughts.

Almost all people have some unwanted thoughts. Unlike others, subjects prone to compulsions significantly exaggerate the value of such conclusions. The emergence of fear of one's own thinking causes attempts to avoid situations in which unpleasant thoughts appear: this is how the corresponding "rituals" or conspiracies are born.

Experts tend to believe that patients with compulsions exaggerate the importance of their thoughts, based on a false conviction acquired in childhood. What is this conviction:

1. in overestimating the sense of one's own responsibility;
2. in the conviction of the materiality of thoughts (which forces a person to establish complete control over them);
3. in overestimating the sense of danger (overestimating the possibility of danger occurring);
4. in hypertrophied perfectionism (denial of the possibility of mistakes, idealization of one’s own actions).

• The reasons are in a person’s environment.

If a subject has a tendency to develop compulsions, this mechanism can be triggered by almost any stress or psychological trauma. Research has enabled scientists to understand that 50-70% of patients develop pathology against the background of negative environmental influences. Specialists have presented a number of the most common potentiating aspects that influence the emergence of compulsions:

• rudeness, violent actions;
• change of residence;
• serious illness;
• loss of a loved one (relative, friend);
• problems in a professional or other area;
• problems in personal life.

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Risk factors

Compulsions are closely related to the subject's attempts to get rid of his own anxiety. And anxiety, in turn, arises in the presence of certain risk factors:

• Chronic fatigue, mental exhaustion, psycho-emotional overload, regular stress.
• Dominant conclusions and ideas that lead to increasing anxiety and stimulate vegetative manifestations.
• Anankastic personality disorders, perceived by a person as an immediate component of his personality. The root causes of such disorders are:

1. failure or disorder in the functioning of brain structures;
2. hormonal changes;
3. some points in education;
4. heredity.

• Biological factors:

1. brain abnormalities and injuries;
2. metabolic disorders in neurotransmitter systems;
3. severe infections;
4. birth injuries;
5. epilepsy.

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Pathogenesis

To effectively deal with compulsions, you need to know not only the causes of this condition, but also the mechanisms of its development. This is the approach that doctors consider more successful.

• Each time the patient tries to avoid performing the "rituals", such behavior is "fixed" by a certain chain of neurons in the brain structures. When the same situation is repeated, the brain will react by analogy, which will prevent the severity of the neurotic problem from decreasing.

The compulsion has the property of being fixed. If the patient feels relief after checking the switched off iron, then he will continue to act in the same way.

Attempts to avoid a certain action "work" at first, causing temporary relaxation in the patient. However, later on, anxiety only increases, and obsessions become the cause.

• With compulsions, a person tends to exaggerate his abilities. Often, patients sincerely believe in their own ability to prevent various circumstances with only mental power. The "magic" of thought is that following various rituals will help avoid something terrible.

Such belief in "magic" gives a person an illusory sense of comfort and ubiquitous control over the situation. As a result, the patient turns to rituals more and more often, due to which the pathology progresses.

• The patient is convinced of the extreme importance of his own thoughts. The meaning of obsessive conclusions comes from certain individual values that are important for a specific person. Usually, the deepest personal fears are expressed in thoughts. For example, every mother worries internally about the health and life of her baby. It is for this reason that obsessive thoughts are especially characteristic of young parents.

However, the point is that people suffering from pathological compulsions have obsessive states more often than healthy people. It is all about excessively attributing “importance” to one’s own thoughts. Experts say: if you pay too much attention to your conclusions, they will seem even more negative. In healthy people, obsessive states are ignored and passed “by”.

• Patients with compulsion overestimate the situational danger and do not tolerate uncertainty. Most patients claim that they need to be sure that there is no danger. Therefore, compulsion often acts as a kind of "insurance". However, in reality, too much zealous performance of ritual actions only increases the feeling of uncertainty and makes the patient doubt even more.
• Perfectionism has a huge impact on the development of compulsions. Patients are convinced that they need to solve any problem perfectly, and if some mistake occurs along the way, it will definitely become fatal. Therefore, mistakes should not be allowed under any circumstances. A similar mechanism of disease development is typical for patients with nervous anorexia.
• “Winding yourself up” is another way to make anxious feelings worse. The thoughts of people with compulsions are often negative: “Everything is bad,” “It will only get worse!” Patients lose their tolerance for disappointment: any kind of anxiety becomes “unbearable” and “catastrophic.”

With compulsions, a person initially feels constant and intense anxiety because of his own thoughts. At the next stage, he attempts to escape from obsessions, suppress their occurrence, or cope with them by following certain actions. Of course, in this way the patient only “feeds” the obsessions.

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Symptoms compulsions

The clinical picture of compulsions is characterized by the following symptoms:

• increased anxiety;
• obsessive desires for certain actions, under the influence of dominant obsessions;
• hypertrophied suspiciousness;
• paranoid symptoms;
• the presence of pronounced fears, phobic disorders;
• impulsive actions with manic features, against the background of general relative well-being.

Some common examples of compulsive episodes include:

• Food compulsions – “nervous hunger”, painful attacks of overeating, or, on the contrary, refusal to eat, despite visible and significant weight loss.
• Hypertrophied gambling, gambling addiction.
• Workaholism, which denies a person’s participation in other links in the chain of life.
• Obsessive racing, passion for winning by any means necessary.
• Intimate compulsions, constant thirst for sex, pathological polygamy.
• Shopaholism is an obsessive need for unexplained purchases.
• The desire to find idols, idolatry.
• Simple compulsive behaviors: nail biting, finger snapping, lip biting, repeated hand washing, nose scratching, checking closed valves, as well as obsessive rituals (going around obstacles only on the right or left, walking only on the edge of the sidewalk, etc.).

Unlike ordinary movements or actions, compulsions are accompanied by an increase in anxiety, the emergence of fears when it is impossible or impossible to perform certain rituals. The development of vegetative symptoms (increased heart rate, increased sweating) is possible.

Usually the patient does not pay attention to the first signs of the disease until the symptoms become more pronounced, or until someone points out strange painful manifestations to the patient.

Experts identify several symptom complexes that are usually interconnected:

• fear of getting dirty, getting infected;
• fear of harming oneself or someone else;
• fear of being punished for an imperfect act or action;
• maintaining an ideal order, a certain arrangement, a routine;
• cautions associated with superstition;
• obsessive sexual ideas;
• eating disorders, eating disorders;
• maintaining your own classification, recounting windows, houses, cars, etc.

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Stages

Compulsions do not always proceed in the same way: disorders have their own characteristics and features. For ease of recognition and diagnosis, the pathology is divided into several stages:

1. A temporary or isolated compulsion occurs once every few weeks or even every few years.
2. Episodic compulsion is an alternation of compulsive attacks and periods of remission.
3. Chronic compulsion – occurs continuously, with periodic increases in clinical manifestations.

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Forms

Compulsive conditions are:

• simple, consisting of obsessive movements or tics;
• complex, including certain rituals created independently.

In addition, compulsions can be physical (for example, constantly checking gas valves or a switched-off iron) or mental (counting windows in houses, mentally scrolling through a particular phrase).

Tic-like compulsion

The term "tic-like compulsion" is often used in relation to pediatric patients. Such disorders are often diagnosed from 2-3 years of age.

Clinically, tic-like compulsions are manifested by repetitions of seemingly ordinary movements. This could be blinking, pursing or licking the lips, touching the chin or nose, coughing, etc.

In children with compulsions, by the age of 4-7 years, obsessive movements become similar to rituals, and can already include complex combinations of movements: repetition of morning or evening preparatory acts, changing clothes, maintaining a certain order of arranging objects. If compulsions affect the speech aspect, then the patient begins to repeat certain words or sentences, asks the same questions several dozen times, etc.

By about 10-11 years of age, compulsions can transform, with the development of obsessive-compulsive disorder.

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Complications and consequences

Compulsions can negatively affect the quality of a person's daily life. Uncontrollable thoughts and obsessive actions can seriously complicate relationships with family, colleagues, friends, and even with oneself: patients often note that they are tired of themselves.

Among patients suffering from compulsions, many lead a solitary life, do not work and do not visit public places. Some patients try to leave their home as little as possible.

Personal relationships suffer and families break up.

A far-reaching compulsive condition can leave its mark on the physical and emotional sphere of life. Over time, in the absence of treatment, the patient becomes inattentive, "fixated" on his problem, weak-willed, apathetic.

Often, compulsions are accompanied by a feeling of guilt, shame, anxiety, which in some cases causes depression. If we consider that everything is interconnected in the human body, then problems in the emotional plane are reflected in the physical state of a person.

Among the main complications, they name the addition of other mental disorders. For example, if you ignore the presence of compulsions, then in the future the problem may be aggravated by the appearance of depression, anxiety disorders, and suicide attempts. In most cases, such complications are explained by the inability of the patient to cope with compulsions.

In addition, there are often recorded cases of patients self-medicating with tranquilizers and other psychoactive medications, which only worsens the course of the pathology.

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Diagnostics compulsions

At the initial stage, the doctor conducts a complete mental diagnosis, assessing the patient’s mental balance, the likelihood of developing psychopathologies and, as a consequence, the emergence of compulsions.

In order to voice the diagnosis of compulsive disorder, the Yale-Brown scale is first used. This is a fairly indicative and common psychological method for determining the presence and severity of obsessive syndrome.

Further diagnostics are carried out according to generally accepted standards, corresponding to the International Classification of Diseases.

The diagnosis of compulsions is made:

• if compulsive attacks occur for at least two weeks and last more than half of the stated term;
• if compulsions negatively affect the patient’s life and become the cause of stress;
• if the patient agrees that compulsions are determined by his own thoughts, and obsessive actions do not bring satisfaction;
• if there is at least one compulsion that cannot be resisted successfully;
• if obsessive thoughts and actions are repeated regularly and cause unpleasant sensations to a person.

A compulsion does not necessarily have to arise after a certain obsessive thought: a particular action can be performed by the patient spontaneously, against the background of a sudden anxious or uncomfortable feeling.

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Differential diagnosis

Compulsions should be differentiated from a separate obsessive-compulsive personality disorder. Compulsions are characterized by an egodystonic nature, which means that the disorder does not correspond to the patient's personal idea of himself. Since there is this contradiction, the clinical picture includes a pronounced depressed state. In obsessive-compulsive personality disorder, the pathology is predominantly ego-syntonic. This means that the patient's behavioral and other characteristics correspond to his personal idea of himself. As a result, the patient often realizes that his behavior is not within the framework of "correct". He expresses dissatisfaction with the compulsions, but, regardless of this, continues to feel the need to perform them, even if he then experiences an anxious state. In obsessive-compulsive disorder, on the contrary, patients do not agree with their "abnormality". They enter into an argument, trying to prove that they perform only correct actions. Moreover, such patients experience satisfaction from obsessive thoughts and compulsive actions.

People with compulsive disorders in most cases do not want to perform their obsessive actions and do not feel comfortable from their implementation.

Treatment compulsions

If the compulsion is expressed insignificantly, or is just entering the patient's life, then the patient can try to independently establish control over his actions. It is necessary to master the technique of switching attention, from one action to another. For example, you can get carried away by watching a program or reading a magazine, you can go for a run or dance.

Experts advise trying to delay the ritual, for example, by a quarter of an hour. If this is successful, the delay time should be increased in the future, while simultaneously reducing the number of ritual repetitions. This allows the patient to understand that he can get satisfaction without performing compulsive actions.

If the compulsion does not respond to self-treatment, then it is imperative to contact specialists in the field of psychotherapy, psychology, and psychiatry.

As a rule, if the symptoms of the pathology are pronounced, the doctor prescribes drug treatment - mainly these are the following drugs:

• antidepressants – Fluoxetine, Clomipramine, Sertraline;
• antipsychotic neuroleptics - Aminazine, Truxal;
• tranquilizers-anxiolytics – Phenazepam, Relanium, Clonazepam;
• for signs of nervous exhaustion – Nootropil.

However, it should be taken into account that even correctly prescribed medications for compulsions do not have a permanent effect. When the course of treatment ends, the return of symptoms of the disease is possible. Therefore, psychotherapy is considered more effective in terms of curing compulsions: according to statistics, it helps 75% of patients.

Cognitive treatment allows the patient to see the irrationality of their phobias, understand their mental images and admit their mistakes. The specialist will explain how to correctly switch attention and control the reaction to compulsions.

Family treatment is one of the components of complex therapy. Such treatment enables the patient's close people to better understand the problem, learn to respond adequately and help the sick person.

Group treatment with a psychotherapist allows the patient to get rid of the feeling of inferiority and “abnormality” and to gain motivation for recovery.

Prevention

There is no definition of specific prevention of compulsions, since there is no single reason for their occurrence. Based on this, prevention advice concerns the general prevention of personality disorders. Such measures can be divided into primary and secondary.

Primary prevention includes measures to prevent the development of compulsions. For this purpose, it is necessary to avoid any potential psychotraumatic situations and conflicts, both in the family and at work. It is important to devote enough time to active recreation: walking, playing with children, doing sports.

Secondary prevention is aimed at preventing relapses of compulsive symptoms. This can be achieved in the following ways:

• visit a psychotherapist - often conversations with a specialist allow the patient to form an adequate attitude towards various psychotraumatic situations;
• fully adhere to the recommendations given by the doctor;
• periodically carry out general strengthening treatment, get enough rest and sleep;
• avoid drinking alcohol and using drugs;
• make some changes to your dietary principles.

Nutrition also plays an important role in preventing the development of compulsions. For prevention purposes, it is recommended to give up coffee and other stimulating drinks (strong black tea, energy drinks, etc.). The menu should include foods rich in tryptophan: fatty fish, liver, colored vegetables and fruits, hard cheese, mushrooms, bananas, beans, seeds and nuts.

If you are prone to mental disorders, you should regularly visit a doctor and consult with various specialists in psychology and psychopathology. A qualified doctor will be able to detect deviations in time and eliminate them before the patient loses control over them.

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Forecast

The quality of the prognosis largely depends on the duration of the disease and how timely and complete the treatment was. If the disorder lasted less than a year, then the prognosis is positive in almost 60% of cases: one can hope for a complete recovery, without subsequent relapses.

If the treatment is too late, the compulsion can become chronic. In this case, the disease can last for several years.

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