Obsessive compulsive disorder
Obsessive compulsive disorder is a kind of mental disorder in which the patient suffers from obsessions and compulsions. In obsessive compulsive disorder obsessive thoughts or compulsive acts may occur separately, or may emerge in succession. The synonyms of obsessive compulsive disorder are obsessive-compulsive a neurosis, obsessive neurosis, and anancastic neurosis. The interrelation with depression is more characteristic for this disorder than for other types of anxiety disorders.
Obsessions are reiterated or importunate thoughts, visions, or urges that assault the patient’s consciousness in spite of his efforts to pay no attention to them, his trying to use the mechanisms of suppression, or to control them. Obsessional thoughts are often gloomy, disgraceful, disgusting, or boring. Obsessional thoughts are accompanied by anxiety. Ordinary obsessions include thoughts about committing aggressive actions, fears about contamination, apprehension and misgivings.
Obsessions go together with compulsions. Compulsions are urges or impulses to perform repetitive, pointless, automatic, or ritual acts. Compulsive acts may include constant hand washing, numbering, controlling, touching, or the repeating of habitual words and expressions. The patient with compulsion usually knows that his actions are worthless, but trying to avoid or deny carrying them out induces an increasing anxiety that is only alleviated when the act is executed.
Particularities of clinical presentation
The basic attributes of the obsessive compulsive disorder are obsessive ideas and compulsive actions:
- repeating, occurring almost every day within at least 2 weeks,
- causing distress or preventing the patient from performing social or individual activities usually due to meaningless waste of time.
Obsessions (ideas, thoughts or images) and compulsions (actions, rituals, stereotyped acts) include the following attributes, all of which should be present:
- They are perceived by the patient as arisen in his own mind and are not imposed by surrounding influences or persons (even if they arise involuntarily and are intolerable).
- They are repetitive and unpleasant (burdensome); at least, one obsession or compulsion should be understood by the patient as excessive or senseless (they may be also aggressive or obscene).
- The subject tries to resist (unsuccessfully) to them but if they exist for a long time, resistance to the some obsessions or compulsions may be insignificant. At least there should be one obsession or compulsion to which resistance proved to be unsuccessful.
- The carrying out of compulsive acts and obsessive ideas does not lead to pleasant sensations. Patients continue to experience severe internal tension. This feature should be separated from temporary alleviation of anxiety and tension.
Differential diagnosis:
Obsessions or compulsions are not the result of other mental disorders, such as:
- Schizophrenia and the disorders connected to it;
- Organic mental disorder;
- Gilles de la Tourette’s syndrome;
- Depressive disorders.
Variants:
- Mainly compulsive thoughts or reflections (intellectual cud).
- Mainly compulsive actions (rituals). They may take the form of the continuous control over prevention of potentially dangerous situation or the control over order and accuracy. The basis for this behavior is the fear of some danger. Sometimes compulsions are combined with indecision and sluggishness. Compulsive actions are less closely connected to depression than compulsive thoughts and respond easier to behavioral psychotherapy.
- Mixed obsessive ideas and actions. Obsessions and compulsions are equally expressed.
- Other obsessive compulsive disorders, see causes of anxiety attacks
- Unspecified obsessive compulsive disorder.