The obsessive-compulsive disorder or DOC (in English obsessive-compulsive disorder or OCD), also called obsessive-compulsive disorder, or SOC (in English or obsessive-compulsive syndrome OCS) in some texts known as obsessive-compulsive disorder, obsessive-compulsive or just as obsessive and obsessive and before the release of DSM-III-R as a (psycho) neurosis, obsessive-compulsive (psycho) neurosis, obsessive-compulsive or simply as a (psycho) neurosis and obsessive (psycho) neurosis compulsive, is a psychological disorder that manifests itself in a variety of forms, but is mainly characterized dall'anancasmo, consisting of symptoms associated with obsessive thoughts, compulsions (actions or special rituals to be performed) which attempt to neutralize the obsession.
The obsessive-compulsive disorder, although four of the classified version Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), including anxiety disorders (code 300.30), is widely regarded as rather nosographic autonomous entity, with a defined core psychopathology, with a particular course and symptoms and biological correlates of which are gradually taking shape.
According to the DSM-IV, it is characterized by obsessive symptoms and / or compulsions that are the source of marked distress for the patient, involving a waste of time (more than an hour a day) and interfere with normal daily activities.
order to be diagnosed with obsessive-compulsive disorder must be present or only obsessions or compulsions and obsessions.
DEFINITION OF OBSESSION.
thoughts, doubts, recurrent and persistent images or impulses that afflict the individual and that this will be perceived as intrusive and inappropriate (or annoying) and causing a sharp pain. The difference with personality disorders lies in this: while in DOC obsessions are perceived as intrusive in obsessive-compulsive personality (or OCPD) they take ego syntonic.
The individual realizes that the thoughts, impulses or images are the result of his own mind. If the obsessions were considered real, then it would fall in the field of schizophrenia (see " schizotypal personality disorder " that is sometimes associated with DOC).
The individual tries (unsuccessfully) to ignore or suppress such thoughts, impulses or images, or to neutralize (Equally unsuccessfully) to other thoughts and behaviors (compulsions "in some texts are also called" psychic self-defense "and older" coercion ").
DEFINITION Compulsion.
repetitive behaviors or mental acts that the individual feels compelled to perform, as a kind of ritual stereotyped (which can be used to "repair" a "harm" or to reduce the anxiety caused a thought), to defend a certain obsession.
behaviors or mental acts are aimed to combat the obsessions, and often these behaviors or mental acts are clearly those excessive and / or do not seem, by an outside observer, associated with the obsession to be really trying to neutralize.
Compulsions may cover different issues such as contamination, perfectionism, order and control.
symptoms and signs.
Research has shown that the DOC is much more common than previously thought. About 1 in 50 teenagers and adults suffering from obsessive-compulsive disorder. Because of the very personal nature of this disorder, and also because of fear of being judged, there may be many people afflicted with OCD who are hiding, and the percentage could be higher.
RITUALS ANANCASTICI
DOC The patient does not complain in particular anxiety, but rather of obsessions and compulsions. Anxiety manifests itself only if it interferes in the rituals put in place to guard against obsession. For others, these rituals, these rituals anancastici, seems strange and unnecessary, but for the individual such actions are profoundly important and must be performed in particular ways to avoid negative consequences and to prevent anxiety to take over. Examples of these actions are:
repeatedly check that the car is parked well-locked before leaving it,
the lights turn on and off a number of times before exiting a room,
climb a ladder or walk into a room only ever with one foot rather than the other,
continually raise and lower the volume of a radio or TV because we are convinced that no shade is adequate,
repeatedly washing hands at regular intervals during the day or unable to stop once lavarsele soapy,
The exact symptoms can include, more specifically, some or all of the following:
continuously repeated actions "remedial" (washing hands)
a system of special account (count in groups of four, put things in groups of three, placing objects sets in even or odd)
protracted and repeated checks, designed to repair or prevent serious accidents or misfortunes
set specific limits for actions in progress (to reach their cars with twelve steps),
precisely align objects together in Angola perfect (this symptom is also in the personality disorder and can be confused with this condition), or
turn its gaze to the objects in the direction of the corners of the room,
in a composite floor, avoid trampling the separation of the joints, replace
"bad thoughts" with "good thoughts" (the vision of a sick child can force you to think of a happy child playing),
fear of contamination (such as fear of the human body secretions such as saliva, sweat, tears, mucus, urine and faeces: some cases of DOC also showed the fear that the soap that is used is contaminated) physical or metaphysical (contamination thought),
obsessive fear of illness (see hypochondria )
search of symmetry (trampling a piece of paper with the left foot may lead to the need to trample on another with your right foot, or return back and beat him again), or excessive superstition
thought "magic".
Even if the patient is convinced that the rituals are just an effect of disorder still can not ignore them.
There are many other symptoms. Everyone can take to avoid situations of "danger" or discomfort, and then affect the subject's life with the affection of avoidances so the symptoms themselves. It is important to remember that having some of the symptoms listed is not an absolute sign of DOC and vice versa and that the diagnosis of DOC should be made by a psychotherapist (possibly cognitive-behavioral) to ensure that they suffer from this disorder. Obsessions are ideas and thoughts which the patient can not stop thinking. Common obsessions include fear of some discomfort, of being hurt or cause pain to someone else. Obsessions are typically automatic, frequent and difficult to control or to delete itself.
Compulsions refer to actions executed by the person, usually on a repetitive basis, the purpose of opposing (unsuccessfully) to think or obsessive thoughts. In most cases, this behavior becomes so regular that the individual is not deemed a problem worthy of note. The common compulsions include, but are excessive behaviors such as washing, checking, touching, counting or place and order, others may be ritualistic behaviors that the individual performs as convinced that lower the probability that an obsession manifests itself. Compulsions can be observable (such as hand washing), but can also be mental rituals such as the repetition of words and phrases or account.
Given that all individuals who suffer from DOC are aware that these thoughts and behaviors are not rational and that, while fighting against them with all their hearts rational, can not in any way to get rid of, the untreated cases of DOC is one of the most frustrating and irritating anxiety disorders.
The disorder is recognized as such only if they affect the normal rhythm of daily activities and social and occupational functioning of the subject and if it can not be better accounted for by other anxiety disorders or diseases due to psychiatric conditions general medical.
Sometimes the patient has an agitated depression not recognized that exacerbates his obsessive-compulsive symptoms and a voltage-like state of meditation.
In view of the fact that often the patient's obsessive-compulsive disorder is imposed a strict moral and is deeply concerned about the contamination, sexuality is often hampered, or at least highly charged and confrontational.
TREATMENT.
now than in the past, the prognosis for OCD is definitely improved, as the therapeutic approach to disease has changed radically: the psychoanalysis is no longer considered standard care for these patients, while they are currently grade different forms of treatment, more effective and applicable on a larger scale. Among these, in particular, therapy psychopharmacological and cognitive-behavioral psychotherapy (PCC) have developed protocols and specific interventions for OCD, and the methods of assessment results that allow a clinical and experimental verification.
Before the advent of clomipramine, the psychopharmacological approach to obsessive-compulsive result was disappointing. In practice, it was established the effectiveness of any agent in this situation. The reason for this peculiarity is that the symptoms of OCD is often extremely aggravated by the occurrence of a " agitated depression" is not recognized. By virtue of this, it sometimes produces a significant widening of compulsions in the patient (so much so that the diagnosis may mistakenly regard this as tightening the central question psychopathology, thus leaving out the mess of 'basic emotions ") and then everything can alleviate or cure, such as phenothiazines or tricyclic antidepressants, reduces the acute symptoms coercive. However, the patient does not return anything but the dominant obsessive basis. Subsequent reports have shown instead
that clomipramine has a specific value in obsessive-compulsive beyond its antidepressant effect. And that this action is also present in obsessive anti SSRIs (Selective Serotonin Reuptake Inhibitors, read. "Selective serotonin reuptake inhibitors, also known as next-generation or atypical antidepressants), particularly fluoxetine, fluvoxamine, paroxetine and sertraline, when used at doses close to or equal to those limits (eg 60 mg / day for fluoxetine, 300 mg / day for fluvoxamine, 60 mg / day for paroxetine and 200 mg / day for sertraline). The drug tends to recognize the disease as a specific serotonin DOC. The latency of the effect of SSRIs is antiossessivo approximately ten to twelve weeks at the three or four of the antidepressant. The percentage of non-responders to this type of treatment is about 30-40%.
not yet established, however, if the effectiveness of SSRIs in obsessive-compulsive disorder is larger than the benzodiazepines (or more generally of the whole group of anti-anxiety drugs, even non-benzodiazepines) for which they are often prescribed in combination (also to alleviate the symptoms hyperthymic of " agitated depression" may be concurrent with the OCD). However, some authors advise against their use because, while giving an attenuation of anxiety, also create dependency and tolerance and prevent Cognitive-behavioral psychotherapy.
The combination of SSRIs with antipsychotics such as haloperidol and incisors clopentixolo (and also the one with the latest generation neuroleptics such as risperidone and olanzapine), supported by some psychiatrists. is not usually considered a rational practice except in the presence of DOC of considerable gravity, often with borderline personality disorder, early-onset or in those patients who also had a tic disorder.
part of behavioral psychotherapy is used in particular the technique of exposure and response prevention but also stop (suspension) of thoughts, imitation of models, systematic desensitization and paradoxical intention.
The cognitive therapy for this disease instead focuses his attention on modification in particular, the following automatic and dysfunctional thought processes: excessive sense of responsibility, excessive importance given to the thoughts, overestimation of the ability to control their thoughts and overestimation of the danger of anxiety .
The obsessive-compulsive disorder, although four of the classified version Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), including anxiety disorders (code 300.30), is widely regarded as rather nosographic autonomous entity, with a defined core psychopathology, with a particular course and symptoms and biological correlates of which are gradually taking shape.
According to the DSM-IV, it is characterized by obsessive symptoms and / or compulsions that are the source of marked distress for the patient, involving a waste of time (more than an hour a day) and interfere with normal daily activities.
order to be diagnosed with obsessive-compulsive disorder must be present or only obsessions or compulsions and obsessions.
DEFINITION OF OBSESSION.
thoughts, doubts, recurrent and persistent images or impulses that afflict the individual and that this will be perceived as intrusive and inappropriate (or annoying) and causing a sharp pain. The difference with personality disorders lies in this: while in DOC obsessions are perceived as intrusive in obsessive-compulsive personality (or OCPD) they take ego syntonic.
The individual realizes that the thoughts, impulses or images are the result of his own mind. If the obsessions were considered real, then it would fall in the field of schizophrenia (see " schizotypal personality disorder " that is sometimes associated with DOC).
The individual tries (unsuccessfully) to ignore or suppress such thoughts, impulses or images, or to neutralize (Equally unsuccessfully) to other thoughts and behaviors (compulsions "in some texts are also called" psychic self-defense "and older" coercion ").
DEFINITION Compulsion.
repetitive behaviors or mental acts that the individual feels compelled to perform, as a kind of ritual stereotyped (which can be used to "repair" a "harm" or to reduce the anxiety caused a thought), to defend a certain obsession.
behaviors or mental acts are aimed to combat the obsessions, and often these behaviors or mental acts are clearly those excessive and / or do not seem, by an outside observer, associated with the obsession to be really trying to neutralize.
Compulsions may cover different issues such as contamination, perfectionism, order and control.
symptoms and signs.
Research has shown that the DOC is much more common than previously thought. About 1 in 50 teenagers and adults suffering from obsessive-compulsive disorder. Because of the very personal nature of this disorder, and also because of fear of being judged, there may be many people afflicted with OCD who are hiding, and the percentage could be higher.
RITUALS ANANCASTICI
DOC The patient does not complain in particular anxiety, but rather of obsessions and compulsions. Anxiety manifests itself only if it interferes in the rituals put in place to guard against obsession. For others, these rituals, these rituals anancastici, seems strange and unnecessary, but for the individual such actions are profoundly important and must be performed in particular ways to avoid negative consequences and to prevent anxiety to take over. Examples of these actions are:
repeatedly check that the car is parked well-locked before leaving it,
the lights turn on and off a number of times before exiting a room,
climb a ladder or walk into a room only ever with one foot rather than the other,
continually raise and lower the volume of a radio or TV because we are convinced that no shade is adequate,
repeatedly washing hands at regular intervals during the day or unable to stop once lavarsele soapy,
The exact symptoms can include, more specifically, some or all of the following:
continuously repeated actions "remedial" (washing hands)
a system of special account (count in groups of four, put things in groups of three, placing objects sets in even or odd)
protracted and repeated checks, designed to repair or prevent serious accidents or misfortunes
set specific limits for actions in progress (to reach their cars with twelve steps),
precisely align objects together in Angola perfect (this symptom is also in the personality disorder and can be confused with this condition), or
turn its gaze to the objects in the direction of the corners of the room,
in a composite floor, avoid trampling the separation of the joints, replace
"bad thoughts" with "good thoughts" (the vision of a sick child can force you to think of a happy child playing),
fear of contamination (such as fear of the human body secretions such as saliva, sweat, tears, mucus, urine and faeces: some cases of DOC also showed the fear that the soap that is used is contaminated) physical or metaphysical (contamination thought),
obsessive fear of illness (see hypochondria )
search of symmetry (trampling a piece of paper with the left foot may lead to the need to trample on another with your right foot, or return back and beat him again), or excessive superstition
thought "magic".
Even if the patient is convinced that the rituals are just an effect of disorder still can not ignore them.
There are many other symptoms. Everyone can take to avoid situations of "danger" or discomfort, and then affect the subject's life with the affection of avoidances so the symptoms themselves. It is important to remember that having some of the symptoms listed is not an absolute sign of DOC and vice versa and that the diagnosis of DOC should be made by a psychotherapist (possibly cognitive-behavioral) to ensure that they suffer from this disorder. Obsessions are ideas and thoughts which the patient can not stop thinking. Common obsessions include fear of some discomfort, of being hurt or cause pain to someone else. Obsessions are typically automatic, frequent and difficult to control or to delete itself.
Compulsions refer to actions executed by the person, usually on a repetitive basis, the purpose of opposing (unsuccessfully) to think or obsessive thoughts. In most cases, this behavior becomes so regular that the individual is not deemed a problem worthy of note. The common compulsions include, but are excessive behaviors such as washing, checking, touching, counting or place and order, others may be ritualistic behaviors that the individual performs as convinced that lower the probability that an obsession manifests itself. Compulsions can be observable (such as hand washing), but can also be mental rituals such as the repetition of words and phrases or account.
Given that all individuals who suffer from DOC are aware that these thoughts and behaviors are not rational and that, while fighting against them with all their hearts rational, can not in any way to get rid of, the untreated cases of DOC is one of the most frustrating and irritating anxiety disorders.
The disorder is recognized as such only if they affect the normal rhythm of daily activities and social and occupational functioning of the subject and if it can not be better accounted for by other anxiety disorders or diseases due to psychiatric conditions general medical.
Sometimes the patient has an agitated depression not recognized that exacerbates his obsessive-compulsive symptoms and a voltage-like state of meditation.
In view of the fact that often the patient's obsessive-compulsive disorder is imposed a strict moral and is deeply concerned about the contamination, sexuality is often hampered, or at least highly charged and confrontational.
TREATMENT.
now than in the past, the prognosis for OCD is definitely improved, as the therapeutic approach to disease has changed radically: the psychoanalysis is no longer considered standard care for these patients, while they are currently grade different forms of treatment, more effective and applicable on a larger scale. Among these, in particular, therapy psychopharmacological and cognitive-behavioral psychotherapy (PCC) have developed protocols and specific interventions for OCD, and the methods of assessment results that allow a clinical and experimental verification.
Before the advent of clomipramine, the psychopharmacological approach to obsessive-compulsive result was disappointing. In practice, it was established the effectiveness of any agent in this situation. The reason for this peculiarity is that the symptoms of OCD is often extremely aggravated by the occurrence of a " agitated depression" is not recognized. By virtue of this, it sometimes produces a significant widening of compulsions in the patient (so much so that the diagnosis may mistakenly regard this as tightening the central question psychopathology, thus leaving out the mess of 'basic emotions ") and then everything can alleviate or cure, such as phenothiazines or tricyclic antidepressants, reduces the acute symptoms coercive. However, the patient does not return anything but the dominant obsessive basis. Subsequent reports have shown instead
that clomipramine has a specific value in obsessive-compulsive beyond its antidepressant effect. And that this action is also present in obsessive anti SSRIs (Selective Serotonin Reuptake Inhibitors, read. "Selective serotonin reuptake inhibitors, also known as next-generation or atypical antidepressants), particularly fluoxetine, fluvoxamine, paroxetine and sertraline, when used at doses close to or equal to those limits (eg 60 mg / day for fluoxetine, 300 mg / day for fluvoxamine, 60 mg / day for paroxetine and 200 mg / day for sertraline). The drug tends to recognize the disease as a specific serotonin DOC. The latency of the effect of SSRIs is antiossessivo approximately ten to twelve weeks at the three or four of the antidepressant. The percentage of non-responders to this type of treatment is about 30-40%.
not yet established, however, if the effectiveness of SSRIs in obsessive-compulsive disorder is larger than the benzodiazepines (or more generally of the whole group of anti-anxiety drugs, even non-benzodiazepines) for which they are often prescribed in combination (also to alleviate the symptoms hyperthymic of " agitated depression" may be concurrent with the OCD). However, some authors advise against their use because, while giving an attenuation of anxiety, also create dependency and tolerance and prevent Cognitive-behavioral psychotherapy.
The combination of SSRIs with antipsychotics such as haloperidol and incisors clopentixolo (and also the one with the latest generation neuroleptics such as risperidone and olanzapine), supported by some psychiatrists. is not usually considered a rational practice except in the presence of DOC of considerable gravity, often with borderline personality disorder, early-onset or in those patients who also had a tic disorder.
part of behavioral psychotherapy is used in particular the technique of exposure and response prevention but also stop (suspension) of thoughts, imitation of models, systematic desensitization and paradoxical intention.
The cognitive therapy for this disease instead focuses his attention on modification in particular, the following automatic and dysfunctional thought processes: excessive sense of responsibility, excessive importance given to the thoughts, overestimation of the ability to control their thoughts and overestimation of the danger of anxiety .
