Obsessive compulsive disorder

The obsessive compulsive disorder It is an anxiety disorder that affects 2% of the world population, with the same incidence in men and women, and that usually appears in adolescence or throughout youth. There may be previous personality disorders, especially of the obsessive type, although an association has also been seen with the previous existence of dependent, avoidant or histrionic personality disorders. It is also frequently associated with depression and / or social phobia.

How is it produced?

It has been observed that in 60% of cases there is usually a triggering factor. In the same way, it has been seen that there is a clear family aggregation.

Various possible explanations for its origin have been studied, both from a neurological and psychological point of view.

It has been seen, through the techniques of, that there may be alterations at the level of the frontal lobe of the brain, as well as anatomical variations also in the distribution of the gray matter in certain basal ganglia, in the depth of the brain. In these same patients, an alteration of serotonin levels has been seen, which acts throughout the brain but especially at the level of the aforementioned frontal lobes and basal ganglia.

From a psychoanalytic point of view, it has been considered that there could be a regression to the sadistic anal phase of psychosexual development.

Symptoms of obsessive compulsive disorder

Obsessions consist of images, ideas or thoughts that are recurrent and intrusive, that is, the patient who suffers them has the feeling that they have entered his brain but that no one has imposed on him from outside but that it is his own mind that has created them and that despite knowing them absurd and Trying to oppose them can do nothing to stop or avoid them. This sense of occupation is clothed with a degree of anxiety that increases as the patient tries to get rid of these obsessions.

The most frequent obsessions are:

• Illness
• Cleanliness and contamination
• Doubt and insecurity
• Order and symmetry
• Harm to others
• Morality and sexuality

Compulsions are motor or mental acts of a voluntary nature that the patient with obsessions carries out to avoid the anxiety that the obsession produces, since when performing these acts it is totally or partially ceded. These compulsions can become very elaborate, constituting truly complex and variegated rituals. Compulsions may be related to obsession They try to avoid, although in a very exaggerated way, or not to have the least correlation with the triggering idea or to be any thought or action that in a reliable but exaggerated way can avoid the obsession.

Common compulsions can be:

• Wash and clean frequently and diligently.
• Check things constantly.
• Order and reposition things symmetrically or following a certain pattern.
• Repeat things several times or repeat actions to avoid something.
• Excessive perfectionism.
• Superstitions and magical rituals.
• Count and list things constantly.

It is evident that all people have and customs to a greater or lesser degree and that sometimes we allow ourselves to be carried away by impulsive acts, but in the case of the patient with obsessive compulsive disorder or OCD obsessions are something that is experienced negatively and that the patient tries to avoid, tries to restrain, with which he suffers an anxiety that is only released when performing the compulsion, which unlike an impulse it is also something that is fought against, It is not an unthinking act but is made at the level of the cerebral cortex.

Diagnosis

The diagnosis will be based on the suspicion of a patient or his close environment that he has repetitive attitudes and thoughts, sometimes absurd and that are clothed with anxiety and interfere with activities of daily life to a greater or lesser extent.

In order to establish the diagnosis, the following must be given:

• The existence of obsessions as intrusive ideas that the patient wants to avoid and that he knows are absurd but originated by his own mind.
• The existence of compulsions that seek to avoid the anxiety caused by the obsession or to prevent what may happen.
• The patient must recognize at some point given that the obsessions and compulsions are excessive.
• Obsessions and compulsions must be lived badly and interfere with daily life.
• There should be no simultaneous physical or psychiatric disorder that can explain these symptoms.

Unless there are other associated symptoms suggestive of neurological disease, no imaging test is usually performed in the study of OCD.

Obsessive compulsive disorder treatment

The treatment of, like that of many other psychiatric pathologies, must be approached from a multiple, pharmacological and psychological point of view.

At the level of medical treatment of patients with obsessive compulsive disorder and given the existence of an alteration in serotonin values, serotonin reuptake inhibitor drugs (SSRIs) such as fluoxetine, sertraline or paroxetine, usually give good result. Other drugs such as venlafaxine or mirtazapine are also given. In case of associated excessive anxiety, anxiolytic drugs such as benzodiazepines can also be administered.

From a psychotherapeutic point of view, behavioral, cognitive or psychoanalytic therapies can be applied to work in depth on the patient's obsessions and compulsions, to be able to analyze them and help him little by little to live without being aware of the obsessions and desecrate them, as well as mechanisms both to avoid obsessions to control and curb compulsions.

With medication and appropriate therapy, successful results can be achieved in controlling the disorder in up to 75% of cases.

Precautionary measures

There are no preventive measures to avoid obsessive compulsive disorder. In the event that oneself or a close person shows attitudes that may correspond to an obsessive compulsive disorder, it is important to put yourself in the hands of the specialist as soon as possible.

WHAT YOU SHOULD KNOW

• It is characterized by the presence of obsessive ideas that lead to actions to stop the anxiety they cause.
• The most frequent obsessions are: illness, order, cleanliness, insecurities ...
• Treatment must be approached from a multiple, pharmacological and psychological point of view.