Compulsions: causes, symptoms, treatment

Probably, every person at least sometimes does something to calm himself and his imagination. But in a number of cases, such actions belong to the category of pathologies - for example, if they occur regularly and are accompanied by obsessive thoughts. In psychiatry, systematic certain actions are called the term "compulsion". Compulsions are classified as obsessive-compulsive neuroses - they are able to progress, prompting a person to conduct more frequent and other actions.

A painful condition can manifest itself sporadically - for example, under the influence of certain circumstances, or have a chronic course.

[1]

Epidemiology

Psychologists view compulsions as a sign of "the return of what has been ousted": the patient tries to "get away" from his own thoughts and aspirations, suggesting that they are incompatible with their own way of life and principles. This leads to the formation of subconscious disorders. Compulsion can manifest itself as an unsuccessful attempt to displace its thoughts from the head: the patient does not agree with certain personal characteristics.

Compulsions around the world are considered common types of disorders. They are more or less present in 2-3% of the world's inhabitants. Patients most often become people with a fairly high level of intelligence - they, because of their bright and active brain activity, can not counteract the problem, so they lose their efficiency quickly, fall into depression.

The most widespread compulsion was in such groups of the population:

• people with high intellectual development;
• people with several higher educations;
• people with high social consistency;
• non-family men and women;
• alcohol-dependent persons;
• people suffering from constant lack of sleep;
• teenagers.

The prevalence of certain compulsive types is reflected as follows:

• fear of getting dirty or getting infected, a fear of dirt is found in 45% of patients suffering from compulsions;
• Constant painful doubts torment 42% of patients;
• the fear of somatic diseases is determined in 33% of patients with convulsions;
• The fear of asymmetry and disorder is inherent in 32% of patients;
• fear of aggression, or aspiration to it is observed in 26% of patients;
• The fears associated with the sexual sphere are determined in 24% of patients.

[2], [3], [4], [5], [6], [7], [8], [9], [10]

Causes of the compulsions

Compulsion in many cases arises against the background of the patient's attempts to eliminate his own sense of anxiety, which occurs under certain circumstances:

• with a syndrome of increased fatigue, with excessive emotional stress, multiple stresses;
• as a consequence of the emergence of obsessions - uncontrollable and undesirable thoughts, inferences and fantasies that enhance the state of anxiety and stimulate vegetative symptoms;
• with anankastny personal impairment (with the weakness of individual brain structures, with significant hormonal changes in the body, with certain characteristics of education, with adverse heredity).

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

Probable reasons will be discussed in more detail below.

• The reason is in genetics.

Scientists have found that in some cases the propensity to the appearance of compulsions can be inherited from close relatives. When studying the pathology of twins, it was found that compulsions have moderate heredity. At the same time, it was not possible to clearly identify the gene provoking the problem. Specialists have identified only a couple of genes that can affect to some extent - this is hSERT and SLC1A1, but the "fault" is not proven.

• The causes come from autoimmune reactions.

Such reasons are more likely in the development of the disease in children - for example, against the background of streptococcus A, which damages the basal ganglia. Some experts also suggest a negative effect of preventive antibiotic therapy, which is applied everywhere. Pediatricians apply to such pathologies the term "pediatric autoimmune neuropsychiatric disorders, combined with streptococcal infection.

• Neurological root causes.

New technologies in the diagnosis of the brain helped scientists to study the degree of activity of many of its zones. It was found that some zones are more active than others. For example, when compulsions appear in the process, the basal ganglia, the striatum, the orbitofrontal cortex, the caudate nucleus, the anteroventral gyrus, the thalamus are involved. The chain, which affects all listed links, controls the primitive behavioral capacity - for example, aggressiveness, sexual attraction, the work of sweat glands. Stimulation of the chain gives impetus to a certain type of behavior: for example, a person is intensively washing his hands after touching something unpleasant. In a mentally healthy person after washing hands, the repeated desire to wash them is exhausted, so he freely switches to another occupation. But in the subject suffering from compulsion, the brain does not "switch", as there are communicative disorders in the above-mentioned brain zones. So, the patient continues to perform an obsessive action, copying his own behavior. The exact etiology of such a moment experts have not yet figured out. Probably, the problem can be explained by biochemical disorders in the brain (decreased activity from glutamate and serotonin).

• Behavioral psychological causes.

One of the main theses of behaviorism in psychology indicates that the repetition of an act in behavior makes its further reproduction accessible. Patients suffering from compulsion try to avoid moments associated with a phobia, "fight" with their thinking, or perform repetitive actions to reduce anxiety. Such "rituals" for some time relieve an uncomfortable sensation, but increase the danger of obsessions in the future.

It turns out that the reason for compulsions can hide in the avoidance of their fears. Often pathology is found in people who are in a stressful state: they move to a new position, lose a loved one, suffer from a syndrome of chronic fatigue. For example, a subject who previously visited a public toilet without problems, starts to go to extremes in stressful situations and engage in negative self-hypnosis: "the toilet is dirty, you can get infected, etc.".

Associatively, the phobia spreads to other similar situations: touching the door handles, handrails, etc. If the patient begins to avoid public places or uses complex actions to neutralize "contamination", then this condition can be transformed into a full pathology.

• Causes of cognitive nature.

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

Almost all people have any unwanted thoughts. Unlike others, subjects inclined to compulsions, greatly exaggerate the value of such inferences. The emergence of fear of one's own thinking provokes attempts to avoid situations in which disagreeable thoughts arise: the corresponding "rituals" or conspiracies arise.

Experts are inclined to believe that patients with compulsions exaggerate the importance of their thoughts, based on false conviction obtained as early as childhood. What is such a conviction:

1. in overestimation of the sense of one's own responsibility;
2. in the conviction of the materiality of thoughts (which causes a person to establish complete control over them);
3. in overstating the sense of danger (reassessing the possibility of danger);
4. in hypertrophied perfectionism (denial of the possibility of errors, idealization of one's own actions).

• The reasons are surrounded by man.

If the subject has a tendency to create compulsions, then this mechanism can be launched by almost any stress or psychotrauma. Studies have given scientists the opportunity to understand that in 50-70% of patients pathology develops against the backdrop of negative environmental influences. Specialists present a number of the most common potentiating aspects that affect the appearance of compulsions:

• rudeness, violent actions;
• changing of the living place;
• a serious illness;
• loss of a loved one (relative, friend);
• problems in the professional or other sphere;
• problems in his 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 it, in turn, arises in the presence of certain risk factors:

• Chronic fatigue, moral exhaustion, psycho-emotional overload, regular stress.
• Dominant conclusions and ideas, leading to increased anxiety, and stimulating vegetative manifestations.
• Anankast personality disorders, perceived by man, as an urgent component of his personality. The root causes of such violations are:

1. insolvency or frustration in the work of brain structures;
2. hormonal transformation;
3. some moments in the upbringing;
4. heredity.

• Biological factors:

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

[12], [13], [14], [15], [16], [17]

Pathogenesis

To qualitatively cope with compulsions, you need to know not only the causes of this state, but also the mechanisms for its development. This is the approach that physicians consider more successful.

• Every time when a patient tries to avoid "rituals", such behavior is "fixed" by the type of a certain chain of neurons in the brain structures. If you repeat the same situation, the brain will react by analogy, which will prevent the decrease in the severity of the neurotic problem.

Compulsion has the property of being fixed. If the patient feels relief after checking the iron is turned off, then further it will act the same.

Attempts to avoid a certain action at first "work", which causes a temporary relaxation in the patient. However, in the future anxiety only increases, and the blame for this is obsessions.

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

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

• The patient is confident in the extreme importance of his own thoughts. The meaning of compulsive reasoning comes from certain individual values that are important to a particular person. Usually the most profound personal fears are expressed in thoughts. For example, each mother is internally worried about the health and life of her baby. It is for this reason that the obsession of thoughts is especially characteristic of young parents.

However, the essence is that in people suffering from pathological compulsions, obsessive conditions occur more often than in healthy individuals. Here it is all about excessive attribution of "importance" to one's own thoughts. Specialists say: if you dedicate too much attention to your conclusions, they will appear even more negative. In healthy people, obsessive states are ignored and skipped past.

• Patients with compulsions overestimate the situational hazard and do not tolerate uncertainty. Most patients claim that they need to be sure that there is no danger. Therefore, compulsion often plays the role of a kind of "insurance". However, in fact too zealous fulfillment of ritual actions only increases the sense of uncertainty and makes the patient doubt even more.
• Perfectionism has a huge influence on the development of compulsions. Patients are convinced that they need to ideally solve any problem, and if there is any mistake on the way, then it must necessarily become fatal. Therefore, you can not make mistakes in any case. A similar mechanism of the disease development is characteristic for patients with anorexia nervosa.
• "Twisting" yourself is another way to exacerbate anxiety. Thoughts of patients with compulsions are often negative: "Everything is bad", "It will only get worse!". Patients lose resistance to frustration: any kind of anxiety becomes "unbearable" and "catastrophic".

With compulsions, a person first feels a constant and strong anxiety because of their own thoughts. In the next stage, he makes attempts to escape from obsessions, to suppress their appearance, or to cope with them by following certain actions. Of course, in this way the patient only "feeds" obsessions.

[18], [19], [20]

Symptoms of the compulsions

The clinical picture of compulsions is characterized by such symptoms:

• increased anxiety;
• obsession with the desires of any action, under the influence of dominant obsessions;
• hypertrophied suspiciousness;
• paranoid signs;
• presence of expressed fears, phobic disorders;
• impulsive actions with manic features, against the background of general relative well-being.

Strong examples of compulsive episodes are:

• Food compulsions - "nervous hunger", painful bouts of overeating, or vice versa - refusal of food, despite the apparent and significant loss of weight.
• Hypertrophied gambling, gambling.
• Workaholism, which denies the participation of man in other parts of the life chain.
• An obsessive race, a passion for victory in any way.
• Intimate compulsions, a constant thirst for sex, pathological polygamy.
• Shopoholizm - obsessive need for inexplicable purchases.
• The desire to search for idols, idolatry.
• Simple compulsive manifestations: nail-biting, finger-clicking, lip-biting, repeated washing of hands, scratching of the nose, checking closed gates, and obsessive rituals (avoiding just the right or left, walking just along the edge of the sidewalk, etc.).

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

Usually, the patient does not pay attention to the first signs of the disease, until the symptoms become more pronounced, or until the patient from the side is not pointed to strange painful manifestations.

Specialists identify several symptomatic complexes, which are usually related:

• fear of getting dirty, getting infected;
• fear of harming yourself or anyone;
• fear of being punished for an imperfect act or act;
• observance of the ideal order, a certain arrangement, order;
• caution associated with superstition;
• obsessive sexual ideas;
• food disorders, eating disorders;
• maintaining their own classification, recounting windows, houses, cars, etc.

[21], [22], [23], [24]

Stages

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

1. Time, or a single compulsion - happens once every few weeks or even a few years.
2. Episodic compulsion - is an alternation of compulsive seizures and periods of remission.
3. Chronic compulsion - proceeds continuously, with periodic enhancements of clinical manifestations.

[25], [26], [27], [28]

Forms

Compulsive states are:

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

In addition, compulsions can be physical (for example, constant monitoring of gas valves or an iron off), or mental (converting windows in houses, mentally scrolling a separate phrase).

Tick-like compulsion

The term "tick-like compulsion" is often used in relation to children of childhood. Such violations are often diagnosed with 2-3 years.

Clinically tick-like compulsions are manifested by repetitions of ordinary, at first glance, movements. It can be blinking, pressing lips or licking them, touching the chin or nose, coughing, etc.

In children with compulsions, by the age of 4-7, 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 arrangement of objects. If compulsions affect the speech aspect, then the patient begins to repeat certain words or sentences, repeatedly several times asks the same questions, etc.

Approximately to 10-11-year-old age, compulsions can be transformed, with the development of obsessive-compulsive disorder.

[29], [30], [31]

Complications and consequences

Compulsions can adversely affect the quality of a person's daily life. Uncontrolled thoughts and compulsive actions can seriously complicate relations with relatives, colleagues at work, with friends, and even with themselves: often patients note that they are tired of themselves.

In the environment of patients suffering from compulsions, many lead an isolated lifestyle, do not work and do not visit public places. Some patients try to leave their home as rarely as possible.

Personal relations suffer, families break up.

A far-gone compulsive state can impose an imprint on the physical and emotional sphere of life. Over time, in the absence of treatment, the patient becomes inattentive, "fixated" on her problem, weak-willed, apathetic.

Often, compulsions are accompanied by a sense of guilt, shyness, anxiety, which in some cases becomes the cause of depression. If we take into account that everything in the human body is interconnected, then the emotional problems also affect the physical condition of the person.

Among the main complications is the addition of other disorders of the psyche. For example, if you do not pay attention to the presence of compulsions, then in the future the problem can be aggravated by the appearance of depressions, anxiety disorders, suicidal attempts. In most cases, such complications are due to the inability of the patient to cope with compulsions.

In addition, cases of self-medication of patients with tranquilizers, other psychoactive medicines are often recorded, which only worsens the course of pathology.

[32], [33], [34], [35], [36]

Diagnostics of the 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 occurrence of compulsions.

In order to sound the diagnosis of compulsive disorder, the Yale-Brown scale is preliminarily used. This is a rather revealing and common psychological way to determine the presence and severity of the compulsive syndrome.

Further diagnosis is carried out according to generally accepted standards corresponding to the International Classification of Diseases.

The diagnosis of compulsions is put:

• if compulsive attacks occur for at least two weeks, and last more than half of the voiced term;
• If compulsions negatively affect a patient's life and cause a stressful condition;
• if the patient agrees that the compulsions are determined by his own thoughts, and the obsessive actions do not bring satisfaction;
• if there is at least one compulsion whose resistance is not successful;
• if the obsession of thoughts and actions is repeated regularly and gives the person unpleasant sensations.

Compulsions do not necessarily arise after a certain obsession: this or that action can be performed by the patient spontaneously, against a background of a sharply arisen disturbing or uncomfortable sensation.

[37], [38], [39], [40], [41]

Differential diagnosis

Compulsions should be differentiated from a separate obsessive-compulsive personality disorder. Compulsions are characterized by an egocentric character - this means that the violation does not correspond to the patient's personal idea of himself. Since this contradiction exists, there is a pronounced oppressed state in the clinical picture. With obsessive-compulsive personality disorder, the predominantly egosyntonic nature of pathology is noted. This means that the patient's behavioral and other characteristics correspond to his personal self-image. As a result, the patient often realizes that his behavior is not within the "right". He is displeased with compulsions, but, regardless of this, he continues to feel the need to carry them out, even if later he experiences an anxious state. In obsessive-compulsive disorder, on the contrary, patients do not agree with their "abnormality". They enter into a dispute, they try to prove that they carry out exclusively correct actions. Moreover, such patients experience satisfaction from obsessive thoughts and compulsive actions.

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

Treatment of the compulsions

If compulsion is expressed only slightly, or only enters into the life of the patient, the patient may try to independently establish control over his actions. You need 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 arrange a jog or dance.

Experts advise trying to delay the conduct of the ritual, for example, for a quarter of an hour. If this succeeds, further delay should be increased, while reducing the number of ritual repetitions. This enables the patient to understand that he can be satisfied without compulsive action.

If compulsion does not lend itself to self-treatment, then it is necessary to turn to specialists in the field of psychotherapy, psychology, psychiatry.

As a rule, with severe symptomology of the pathology, the doctor prescribes medication - mostly these are the drugs:

• antidepressants - Fluoxetine, Clomipramine, Sertraline;
• antipsychotic non-optic drugs - Aminazine, Troxal;
• tranquilizers, anxiolytics - Phenazepamum, Relanium, clonazepam;
• with signs of nervous exhaustion - Nootropil.

However, it should be borne in mind that even properly prescribed medications for compulsions do not have a permanent effect. When the course of treatment is over, it is possible to return the symptoms of the disease. Therefore, psychotherapy is more effective in curing compulsions: according to statistics, it helps 75% of patients.

Cognitive treatment allows the patient to be convinced of the irrationality of his phobias, to understand the mental images and admit his mistakes. The specialist will explain how to correctly switch attention and monitor the response to compulsions.

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

Group treatment of the therapist allows the patient to get rid of the feeling of inferiority and "abnormality", gain motivation for recovery.

Prevention

There is no definition of a specific warning of the development of compulsions, since there is no single reason for their appearance. Proceeding from this, advice on prevention refers to the general prevention of personality disorders. Such activities 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 traumatic situations and conflicts, both in the family and at work. It is important to devote enough time to active rest: to walk, play with children, play sports.

Secondary prophylaxis is directed to the prevention of relapses of symptoms of compulsions. This can be achieved in the following ways:

• visit a psychotherapist - often conversations with a specialist allow you to form an adequate attitude of the patient to various psychotraumatic situations;
• fully adhere to the recommendations given by the doctor;
• Periodically conduct general restorative treatment, sufficiently rest and sleep;
• to prevent the use of alcoholic beverages and the use of narcotic drugs;
• make some changes in the principles of nutrition.

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

If you are inclined to the disorder of a mental state, you must regularly visit a doctor, consult with various specialists in the field of 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 forecast largely depends on the duration of the disease and on how timely and complete the treatment was. If the disorder lasted less than a year - then the forecast is almost 60% of the cases positive: you can hope for a complete recovery, without subsequent relapse.

If treatment is overdue, then compulsion can go into a chronic form. With this development of events, the disease can last for several years.

[43], [44]