What is obsessive-compulsive disorder?
Obsessive-compulsive disorder is a mental disorder that occurs in the form of obsessive thoughts and/or compulsive actions. Those affected experience a constantly recurring compulsion to think about certain things or carry out certain actions. Even if they consider the compulsions they experience to be pointless, they are unable to resist them. When trying to suppress the compulsions, sufferers often develop anxiety or tension.
Obsessive thoughts are expressed in certain ideas or fears that keep recurring. Those affected cannot switch off these thoughts and are ashamed of them to themselves. This is because such thoughts are often unpleasant or revolve around sexual or violent motives. Embarrassing situations, disgust or hurting other people are also common fears.
Compulsive behaviors include certain behaviors that those affected must constantly repeat. For example, they repeatedly check whether the hob is switched off or wash their hands over and over again. In most cases, the actions are designed to avoid an accident. However, they do not bring the sufferer any relief in this respect.
Both forms of obsessive-compulsive disorder can severely restrict people's everyday lives. However, therapeutic measures can reduce the symptoms and significantly improve quality of life.
What forms of obsessive-compulsive disorder are there?
There are numerous different forms of obsessive thoughts and compulsive actions. Some examples of common obsessive-compulsive disorders are:
Compulsive cleaning or washing
Any kind of dirt, bacteria or bodily fluids causes disgust and fear in those affected. Touching them or the mere thought of them leads to compulsive washing rituals. The same applies to the home or objects that have to be cleaned again and again in a compulsive manner.
Repetition and counting compulsions
Those affected are under the compulsion to repeat everyday actions and only stop after a certain number of repetitions. If the number is not reached, those affected fear misfortune.
The compulsion to brood
There are certain trains of thought that those affected have to follow again and again without finding solutions or making decisions.
Control compulsions
The fear of a stove that is not switched off or a window that is left open leads to the obsessive idea that this will cause an accident. Those affected therefore have to keep checking the stove or window.
Compulsive collecting
They are popularly known as "messies": people who feel compelled to keep even worthless objects such as old newspapers, bottles or broken appliances.
Compulsive tidiness
For example, those affected are under pressure to fold and stack their clothes perfectly or to sort books according to size, color or thickness.
Verbal compulsions
Certain words, sentences or even melodies have to be spoken or thought out loud again and again.
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Obsessive-compulsive disorder manifests itself in obsessive thoughts or compulsive actions, which can also occur in combination. Depending on the form of obsessive-compulsive disorder, very specific symptoms may occur, for example excessive cleaning in the case of compulsive cleaning or unrestrained collecting in the case of compulsive collecting.
The central overarching symptom of all types of disorder is the insurmountable and recurring compulsion to do or think certain things, even though they are irrational or even dangerous. Other common symptoms are:
- Those affected try unsuccessfully to defend themselves against obsessive thoughts and compulsive actions, thereby further intensifying the compulsions
- Thoughts of misfortune or catastrophe dominate the mind and lead to severe anxiety or restlessness
- Certain ideas are thought over and over again without being able to resolve them definitively
How can I tell if I suffer from obsessive-compulsive disorder?
- I am constantly tormented by the same thoughts that I cannot defend myself against or control
- If I resist these thoughts, I become even more tense and anxious
- I often think about possible misfortune or disasters and then get very scared
- I have to keep checking things, for example whether I have really turned off the hob, otherwise I get nervous, start shaking, sweating or get a racing heart
- I feel a strong compulsion to keep things tidy, my books always have to be organized in a certain way, my laundry has to be perfectly folded and stacked
- I can't let go of certain sexual ideas, I have to think about them all the time
- I am afraid of losing control in the presence of others and of harming them. As a precaution, I withdraw from my social contacts
How does a doctor recognize whether I suffer from obsessive-compulsive disorder?
The basis of the diagnosis is a detailed interview. The doctor will check whether the affected person has suffered from tormenting obsessive actions or obsessive thoughts for at least two weeks and at least one hour a day. The resulting impairments in everyday life are also taken into account.
The discussions usually take the form of interviews in which symptoms and complaints are asked about. This form of conversation makes it easier for those affected to talk about their illness. At the same time, doctors rule out other mental illnesses such as psychosis or depression. This also applies to physical illnesses, such as organic diseases of the brain. Therefore, appropriate examinations of the body may also be carried out.
Those affected by obsessive-compulsive disorder initially present relatives and friends with a great puzzle. The symptoms of the disorder seem strange and senseless - when a sufferer washes their hands in one go, collects masses of empty bottles in the home or makes sure a dozen times that the stove is really switched off.
Instead of getting angry about this behaviour, relatives and friends should recognize it as an illness and react appropriately. First of all, this means that they should not support those affected in giving in to their compulsions. This would allow them to become entrenched and subsequently dominate the lives of their relatives. Family and friends should convince those affected to seek professional help as soon as possible. This is because OCD will not disappear if left untreated, whereas the chances of success with treatment are very high.
Obsessive-compulsive disorder is treated psychotherapeutically with cognitive behavioral therapy in combination with medication. Cognitive behavioural therapy helps those affected to recognize the thought patterns that cause compulsive behaviour. It also aims to change these thought patterns. Behavioral therapy, on the other hand, attempts to treat those affected by directly confronting their compulsions.
Starting therapy at an early stage ensures that the restrictions associated with the illness are prevented. However, OCD can also be treated very successfully after a long period of illness. It can be helpful for the treatment to involve family or friends.
So-called selective serotonin reuptake inhibitors (SSRIs), which are also used for depression, are recommended for the medicinal treatment of obsessive-compulsive disorder. If the desired effect is not achieved, it can be enhanced by adding a low dose of an atypical antipsychotic.
There is still no real explanation as to how obsessive-compulsive disorder develops. As with many mental illnesses, a genetic predisposition is one of the triggering factors. However, heredity alone is usually not enough to trigger the onset of the disorder.
Another factor could be a disease of the brain, particularly due to changes in metabolism. However, it is not clear whether these actually cause the disease or merely accompany it. However, it has been shown that they disappear after successful treatment. It is also assumed that psychological factors play a role in OCD. These include upbringing, traumatic childhood experiences, negative later life events and a personality predisposition.
Obsessive-compulsive personality disorder is a different clinical picture to obsessive-compulsive disorder. In obsessive-compulsive disorder, sufferers experience recurring compulsions to do or think a certain thing. They can hardly resist them, even though they are aware of the futility of the compulsions.
Personality disorders relate to facets of the personality that are intensely pronounced, but at the same time not very helpful for a healthy, unencumbered life. Obsessive-compulsive personality disorder falls under this category. Those affected are driven by exaggerated perfectionism, a desire for control and excessive orderliness. Due to their excessive demands on themselves, they get bogged down and bogged down in many tasks and activities. They are very concerned with order and rules and follow them strictly. As a result, they lose flexibility and quality of life and develop stress and/or other illnesses.