Obsessive-compulsive disorder: symptoms

Symptoms of obsessive-compulsive disorder

According to DSM-IV, obsessive-compulsive disorder is a variant of an anxiety disorder characterized by obsessively repeated undesirable, unpleasant thoughts, images or impulses (obsessions) and / or repetitive actions that a person performs compulsorily and according to certain rules (compulsions). To establish the diagnosis is not necessarily the presence of both obsessions and compulsions. However, in most patients, they are combined, and only a small number of cases are observed separately from each other. The patient usually tries to actively suppress or neutralize the obsessions, convincing himself of their irrationality, avoiding provocative situations (if they exist) or realizing compulsions. In most cases, compulsions are performed to alleviate anxiety, but often they only increase anxiety, since they require considerable energy and time.

Frequent types of obsessions include fears of the possibility of contamination or contamination (eg, obsessive fear of dirt, microbes, non-hazardous waste), concern for one's own safety, the ability to harm (for example, cause a fire), impulsively commit aggressive acts (for example, damage your beloved grandson ), unacceptable thoughts on sexual or religious topics (for example, sacrilegious images of Christ from a devout person), striving for symmetry and impeccable accuracy.

Frequent compulsions include hypertrophied cleanliness (for example, ritualised hand washing), rituals associated with checking and putting things in order, arranging items in a certain sequence, an obsessive account, repetitive daily activities (for example, entering or leaving the room), collecting (for example, collecting useless newspaper clippings). Although most compulsions can be observed, some of them are internal ("mental") rituals - for example, uttering meaningless words about themselves in order to drive away a frightening image).

In most patients with obsessive-compulsive disorder, multiple obsessions and compulsions are detected. For example, a patient who actively complains only of obsessive fear of asbestos contamination, in a detailed conversation, other obsessions, for example, an obsessive account of floors or collection of unnecessary mail items, can be revealed. Therefore, the initial study recommends the use of special questionnaires to identify the patient's entire complex of symptoms, for example, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).

The key sign of the disease is that at a certain stage of its development the patient realizes the senselessness or at least the redundancy of his thoughts and actions. Thus, the presence of criticism makes it possible to distinguish obsessive-compulsive disorder from a psychotic disorder. Although the symptoms are sometimes very bizarre, patients realize their absurdity. For example, one of the patients feared that he would accidentally mail his 5-year-old daughter by mail, so he checked the envelopes several times before throwing them in the mailbox, making sure that there was no inside. He knew with his mind that it was impossible, but he was so caught up in painful doubts that he could not cope with the growing alarm until he checked. The degree of criticism is expressed in varying degrees in different patients and may even change over time in the same patient, depending on the situation. With this in mind, DSM-IV allows the diagnosis of obsessive-compulsive disorder in a patient who at the moment does not take his symptoms critically (as defined as "insufficient criticism") if the criticism was noted earlier.

Where is the boundary between normal concerns about the correctness of the performance of their actions and the intrusive verification of their actions? The diagnosis of obsessive-compulsive disorder is established only when the symptoms of the disease cause concern to the patient and require considerable time (more than one hour per day) or significantly impair his ability to live. If a certain person who, having left the house, must check six times, if the door is locked, but does not have any other manifestations, then he can state compulsions, but not obsessive-compulsive disorder. Disorders of life associated with obsessive-compulsive disorder range from mild, minimally affecting the level of social adaptation, to severe ones, when a person is literally disabled.

There are several additional conditions necessary to diagnose obsessive-compulsive disorder in childhood, although in general the clinical manifestations of obsessive-compulsive disorder in children and adults are similar. Although most children are aware of the undesirable nature of the symptoms, it is more difficult to identify their critical attitude to obsessive manifestations than adults. Not all rituals observed in children can be regarded as pathological, since the need for uniformity and consistency can be dictated by a sense of security, for example, when going to sleep. Many healthy children have certain rituals when preparing for bed: for example, they fit in a special way in bed, make sure that their legs are closed or check to see if there are "monsters" under their bed. In the presence of children's rituals, obsessive-compulsive disorder should be suspected only if they disrupt adaptation (for example, take a long time or cause patients anxiety) and persist for a long time.

Conditions indicating the possibility of obsessive-compulsive disorder and related disorders

• Anxiety
• Depression
• Concern about the presence of the disease (eg, AIDS, cancer or poisoning)
• Tiki
• Dermatitis of unknown origin or alopecia of unknown origin (trichotillomania)
• Excessive concern with appearance (dysmorphophobia)
• Postpartum Depression

Abuse of psychostimulants (eg, amphetamine or cocaine) can induce repetitive actions that resemble rituals in obsessive-compulsive disorder. "Panding" - a term taken from the slang of Swedish drug addicts, means a state where the patient, on the background of intoxication with psychostimulants, compulsively performs purposeless actions - for example, collects and disassembles household devices. In laboratory animals, stereotyped actions can be induced by the introduction of psiostimulants and dopamine receptor agonists.

One explanation for why obsessive-compulsive disorder often remains unrecognized is that patients often hide their symptoms, fearing that they will be deemed "crazy." Many patients eventually acquire the ability to mask their symptoms, compulsively acting alone with themselves or avoiding situations that can provoke them. In the same cases, when compulsions can be performed only in a public place, they give them the appearance of expedient actions, "integrating" them into their daily activities. Patients with obsessive-compulsive disorder often do not dare to admit to having embarrassing thoughts that are unacceptable to them, unless they are specifically asked about it. Therefore, the physician should be actively interested in the presence of obsessive-compulsive symptoms in patients with depression or anxiety - two conditions that often occur in patients with obsessive-compulsive disorder (comorbid) and can act as his "masks". Obsessive-compulsive disorder can be suspected in patients who do not have risk factors for AIDS, but insist on conducting repeated studies on HIV infection. Persistent unreasonable fears about possible toxins and other dangers in the environment can also signal the presence of pollution fears. Somatic manifestations of obsessive-compulsive disorder are rare. These include unexplained dermatitis due to continuous hand washing or the use of detergents, or alopecia of an unknown origin, which may indicate obsessive pulling of the hair. Individuals who often turn to plastic surgeons, but who are never satisfied with the results of surgery, may suffer from dysmorphophobia and obsessive-compulsive disorder. Well-known postpartum depression, which is a very serious complication. However, along with depression after childbirth, obsessive-compulsive disorder can also occur, and its recognition is extremely important for proper treatment.

Comorbid states

The most frequent comorbid psychiatric disorder in patients with obsessive-compulsive disorder is depression. In two-thirds of patients with obsessive-compulsive disorder, a major depression is diagnosed during life, and in a third of patients with obsessive-compulsive disorder, depression is detected already at the first examination. It is often the development of depression that prompts a patient with obsessive-compulsive disorder to consult a doctor. There is also a significant clinical "overlap" between obsessive-compulsive disorder and other anxiety disorders, including panic disorder, social phobia, generalized anxiety disorder, separation anxiety disorder (fear of separation). In patients with obsessive-compulsive disorder, neural anorexia, trichotillomania and dysmorphophobia are more common than in the population.

On the other hand, the symptoms of obsessive-compulsive disorder can manifest themselves within another primary mental disorder. Thus, it has been established that obsessions and compulsions are observed in 1-20% of patients with schizophrenia. It is noted that when some new-generation neuroleptics, such as clozapine or risperion, are taken, a portion of patients with schizophrenia have an increased obsessive-compulsive symptomatology. Data from the literature indicate that obsessive-compulsive symptoms in schizophrenia respond favorably to drugs that are commonly used to treat obsessive-compulsive disorder, but these drugs can exacerbate psychotic symptoms. Symptoms of obsessive-compulsive disorder are often detected in patients with autism and other general (pervasive) developmental disorders. They are traditionally not referred to ROC because it is impossible to assess the level of criticism of a patient to their condition.

[1], [2], [3], [4], [5], [6]

The course of obsessive-compulsive disorder

Obsessive-compulsive disorder is most often manifested in adolescents, adolescents and young adults. At the age of over 35 years, the first symptoms appear in less than 10% of patients. The earliest described age of onset is 2 years. Almost 15% of cases of obsessive-compulsive disorder appear before puberty. In boys, obsessive-compulsive disorder is more common than in girls, and on average, obsessive-compulsive disorder develops earlier. In adult patients with obsessive-compulsive disorder, the sex ratio is approximately 1: 1. This contrasts with depression and panic disorder, which are more common in women than in men. During life, obsessive-compulsive disorder develops in 2-3% of the population.

The course of the disease is usually chronic, and in 85% of patients there is a wavy development with periods of deterioration and improvement, and in 5-10% of patients - a steadily progressing course. Only 5% of patients have a true remitting flow, when the symptoms periodically disappear completely. But even more rarely are persistent spontaneous remissions. It should be noted that these data were not obtained from an epidemiological study, but with prolonged observation of a group of patients who could initially have a tendency to chronization. Perhaps many patients who experience spontaneous remissions do not get into the field of view of the doctors or go out of their sight. In most cases, the clinical debut of obsessive-compulsive disorder is not associated with any external events.