Compulsions or obsessive-compulsive disorder are mental illnesses. The sufferer suffers from obsessive thoughts and mental stress, so that he unconsciously has to perform compulsive actions (for example, constantly washing his hands). It is also called a mental disorder. To determine its cause is not so easy, because it can be in the psychological as well as in the organic area. In addition to psychotherapy, obsessive-compulsive disorder can also be treated with medication.
What are compulsions and obsessive-compulsive disorder?
Obsessive-compulsive disorder is divided into obsessive thoughts and obsessive actions. Obsessive thoughts differ from normal thoughts in the way they are experienced and thought by the sufferer. The thoughts during obsessive-compulsive disorder are accompanied by the constant fear of causing harm to others or of getting into an embarrassing situation themselves. They cannot be consciously stopped or thought through to the end, so that they recur again and again, similar to a cycle, and finally end in despair. Obsessive thoughts are further subdivided into obsessions, compulsive impulses and brooding compulsions. In the imaginings and brooding, the sufferer relives a negative situation over and over again in his mind, e.g., that something might happen to his spouse or that he might have misunderstood something. The obsessive impulses drive him to perform certain actions, even though they may have negative consequences for the sufferer himself or for others. The obsessive-compulsive disorder is perceived as nonsensical, but any attempt to resist it causes even more anxiety and tension. In OCD, the sufferer is also unable to resist the compulsive actions. These actions are behaviors that must be repeated so often that they interfere with the daily routine. An example of behavior during an obsessive-compulsive disorder is constantly checking to see if the stove has been turned off. In this case, the affected person is subject to the compulsion to want to check this over and over again and thus does not get around to doing other things.
Obsessive-compulsive disorder can occur in different forms and in different contexts. Several factors play a role in obsessive-compulsive disorder. On the one hand, obsessive-compulsive disorder can be caused by an organic dysfunction on the other hand by psychological disorders. Obsessive-compulsive disorder often occurs in conjunction with other diseases. For example in connection with multiple sclerosis or epilepsy, but also together with depressive disorders, schizophrenia and alcohol abuse the obsessive-compulsive disorder can occur. However, one speaks of an obsessive-compulsive disorder only if it is particularly severe and no other mental illness exists. From a medical point of view, the cause of OCD is that certain regions in the brain are damaged. This can be the basal ganglia, the limbic system or the frontal brain. If there is already an obsessive-compulsive disorder in the family, this biological factor is often not excluded as a cause.
- Constant hand washing (cleanliness compulsion) after touching objects or people
- Control compulsions, for example, whether the stove is off or whether you really locked the door
- Counting compulsion – The sufferer must constantly count anything in his environment. For example, the plates on the sidewalk or steps of a staircase.
- Order compulsion – everything must be in its place in the apartment, nothing may be dirty or arranged differently
- Touch compulsion – patients must constantly touch a certain object or the opposite that patients can not touch a certain object at all
- Verbal and auditory constraints – For example, patients must always sing or whistle the same tune or repeat certain expressions
Symptoms, complaints and signs
Obsessive-compulsive disorder manifests itself in different ways, because there are different forms of this disorder. Classic, for example, is the washing compulsion, in which sufferers must wash their hands over and over again, because even the harmless use of a doorknob is suspected of contamination with dangerous bacteria. The control compulsion is also very common. Here, for example, sufferers repeatedly check whether a stove is really turned off, even if they have done so several times before.Counting can become a compulsion, as can the habit of walking the same paths over and over again or performing rituals. Compulsive thoughts, which have to be played through in the mind again and again, are also a wide field. All compulsions have in common that the person concerned often recognizes the nonsense of actions and thoughts, but cannot do anything against it. Often the thought that something bad could happen if the compulsion is not carried out correctly is connected with the resistance against a compulsion. Often the compulsions of those affected are accompanied by symptoms of anxiety and depressive mood, because the compulsion triggers shame and helplessness and also not infrequently drives the patients into social isolation. In obsessive-compulsive disorder, much time during the day is spent on compulsive actions and thoughts.
Diagnosis and course
Obsessive-compulsive disorder can be diagnosed when the sufferer lives with the obsessive thoughts or compulsive actions for at least two weeks and also describes this condition as an experience of unhappiness and must experience a reduced quality of life as a result of this situation, in other words: the obsessive-compulsive disorder significantly impairs his everyday life. Another aspect of the obsessive-compulsive disorder is that the affected person recognizes obsessive thoughts as his own and cannot resist them. The idea of carrying out the thought or ideas or impulses are coupled with unpleasant feelings. Obsessive-compulsive disorder can also cause physical damage, e.g. eczema is formed when washing hands frequently. If the obsessive-compulsive disorder is severe, suicidal thoughts are also possible.
Complications associated with obsessive-compulsive disorder can be very diverse. For example, the extent of possible complications depends, among other things, on whether the OCD also affects other people or even has self-injurious elements. Therapy reduces the risk of complications. For example, obsessive-compulsive disorder is often a cause of social isolation, as sufferers sometimes become unable to work or are very socially restricted. In combination with the high correlation of depressive moods, depression and other personality disorders associated with OCD, the risk of suicidal thoughts and actions increases. Furthermore, just the washing compulsion leads to skin damage (mostly to eczema), which can lead to other health problems. Obsessive-compulsive disorders always carry the risk that the affected person neglects other areas of life in favor of his disorder (especially in the case of the urge to constantly control certain things) and thus gets into negative situations. This is also the case when it comes to obsessive thoughts that primarily affect the immediate environment. Especially such thoughts, which consist in fantasies of violence or inappropriate sexual fantasies, put an immense strain on the relationship between the affected person and his environment. While there is no appreciable risk that these thoughts will be acted upon purely because of OCD, numerous other personality disorders can lead to a loss of impulse control.
When should you see a doctor?
Not every everyday ritual belongs to OCD that needs medical or psychotherapeutic treatment. However, sufferers should see a doctor or therapist if their daily life suffers from the unpleasant compulsive actions or thoughts and the compulsions last for at least two weeks. Everyday rituals that are positive and perceived as pleasant, on the other hand, do not constitute clinical compulsions. In general, it is recommended that individuals seek diagnostic clarification if they discover symptoms of obsessive-compulsive disorder in themselves and suffer from them. A diagnosis can be made by a physician, psychologist, psychotherapist or alternative practitioner. In particular, psychologists, psychotherapists and specialists in psychiatry and psychotherapy are trained to diagnose and treat mental illnesses such as obsessive-compulsive disorder. For this reason, it makes sense for those affected to preferably turn to these professional groups. The family doctor can also be a first point of contact and, if necessary, issue a referral. The subjective suffering pressure is very individual with an obsessive-compulsive disorder. Severe subjective distress is also a reason to seek medical or psychological help. In addition, professional advice may be required if the compulsive acts lead to physical or other problems – for example, skin problems as a result of compulsive washing.
Treatment and therapy
Early treatment of obsessive-compulsive disorder is recommended. First, the family doctor or a neurologist should be consulted, because damage to the brain regions can be treated with drugs that inhibit the uptake of serotonin. These are usually antidepressants or neuroleptics. Furthermore, it helps the person affected, as well as the relatives, to cope better with the obsessive-compulsive disorder if they seek therapeutic help. Conginitive therapy, in which the sufferer works towards the goal of changing his thought patterns, is very promising. In this context, the sufferer learns how to deal with stressful situations, a suitable strategy for coping with everyday life, and new behavioral patterns in the interpersonal sphere, among other things.
Obsessive-compulsive disorder usually comes unexpectedly. However, if the sufferer, together with the relatives, informs himself intensively about the OCD, a reoccurrence is best prevented, but for this purpose the OCD should be accepted.
If the obsessive-compulsive disorder has been successfully treated and is no longer openly recognizable to others, it is now up to the affected person to independently detect the first signs and immediately seek out a suitable (psycho)therapist in case of stronger suspicion, in order to prevent a protracted course of therapy. Furthermore, possible triggers, such as permanent, extreme stress situations (also at work) should be avoided and instead one’s own behavior and thoughts should be regularly controlled. Also, no casual, harmless habits should be developed out of affect for temporary calming, as these can later develop into an uncontrollable compulsion. However, if the compulsion is not cured and there is no prospect of cure, it is essential for the sufferer to accept his compulsion and, if possible, to avoid places or other places where the compulsion cannot be controlled. Not only in the case of verbal compulsions, but also in the case of thought or behavior compulsions, it is advantageous to inform acquaintances and friends about one’s own behavior in order to prevent unpleasant situations or misunderstandings. Furthermore, the compulsion should not be violently overridden – even in public – as this can cause not only a loss of control but also a strong discomfort of the affected person.
Here’s what you can do yourself
First, it is important to have a basic understanding of one’s OCD. This can make the situation easier for the sufferer. The sufferer needs to be aware of exactly how their disorder manifests itself and how it affects them and their life. In addition, it can be a great relief to know that he is not alone in his experience. Affected individuals need to accept stress and learn to embrace it as a part of life rather than a disruptive factor. They should adopt other strategies to deal with stress. For example, getting enough sleep, eating enough good food, meditating, and getting enough exercise can result in a reduction in symptoms. Running, in particular, can result in significant improvement. Using relaxation techniques (e.g.: deep breathing or meditative mindfulness exercises) is also helpful. The next step would be to accept and confront his fears. Verbalizing negative thoughts about OCD and putting them in positive terms has been shown to be an effective way to reduce the disorder and can be done without therapeutic help. It is often useful to confront one’s fears in an analytical and logical manner and to think of strategies for when the worst-case scenario occurs. All of these techniques are easy to incorporate into everyday life and leisure.