2023-11-17 11:02:49
Obsessive-compulsive disorder (OCD) is a common chronic disorder characterized by involuntary, uncontrollable, recurring thoughts (obsessions) that can lead people to engage in repetitive behaviors (compulsions). These rituals interfere with the life of those who suffer from them, but the person cannot control or stop them and they can cause significant emotional suffering.
But how (why) does this disorder arise? “As with almost all psychiatric disorders, the genesis must be sought in biological, psychological and environmental alterations. In the case of OCD, there is numerous biological evidence on the role that some brain circuits have in mediating the disorder – explains the psychiatrist and psychotherapist Giancarlo Cerveri -. They are circuits that have essential functions in the inhibition of responses and suppression of negative emotions. The hypothesis of some researchers is that obsessive-compulsive disorder causes the continuous control activity that our brain carries out on everything we do to become conscious and therefore paralyzing.
These are the behaviors that may indicate that you have OCD.
Wash your hands frequently
This obsession has its origin in the tendency to mentally repeat cognitive patterns related to behaviors to follow in relation to specific actions (an exam, a job interview, an encounter with a person we are attracted to). This is a way to reduce the stress associated with the event and, at the same time, improve reading of the surrounding world and the ability to provide efficient behavioral responses.
Therefore, for those who suffer from obsessive compulsive disorder (OCD), even a simple contact with the handle of a public bathroom is enough to trigger a series of uncontrolled thoughts that, in this specific case, have their roots in such an irrational fear of germs that push the individual to wash their hands up to 50 times a day for fear of contamination.
“In people who suffer from OCD, everything gets out of control – confirms the expert – and the presence of compulsions, or ritual behaviors that often present a semantic assonance with obsessions and are often a source of disability, are frequent and more easily recognizable to those who live with it.
Clean the house again and again
Being affected by obsessive compulsive disorder means being able to feel the need to clean the house from top to bottom not because it is really dirty, but because if you don’t do it someone could get sick and the fault would be precisely the lack of cleaning.
“Obsessions and compulsions can have different forms and intensities – Cerveri emphasizes – and, in the case of compulsions linked to cleanliness and order, any behavior of others that can create disorder or dirt generates anger and tension in the sick subject who, sometimes, it leads to verbally aggressive behavior, which considerably hinders the family climate.”
Check that doors and windows are closed
Among the most common OCD compulsions, repeatedly having to check something (whether it’s closed doors and windows, or the oven and toaster turned off, or the gas knob) can stem from the desire not to feel responsible if something terrible happens. to which is added the fear that someone else could get hurt due to carelessness.
“In the most serious forms, the impact on daily life can be very strong – comments the expert – as well as highly disabling. A classic example is the need to repeat gestures such as checking the door closure an enormous number of times, which which produces a significant loss of time throughout the day and great tension in the subject, who ends up feeling exhausted and without time.
Be an extreme perfectionist
Having high standards and wanting things to be done a certain way does not in itself indicate OCD. “When it is a symptom of obsessive-compulsive disorder, perfectionism stops being an advantage from a work point of view and becomes a detriment – Cerveri admits -. In fact, by being characterized by repeated and irrational behaviors aimed at repeating procedures and algorithms, since increasingly strict controls of irrelevant details, this behavior leads to a sharp drop in productivity, without forgetting that it is often requested in such an angry way by colleagues and employees making the work environment highly problematic.”
Need for constant reassurance and approval
Lack of self-confidence and fear of making mistakes that could later have serious consequences can trigger the compulsive need to always ask for the opinion of others before doing something or seeking approval from others.
“Obsessive insecurity in any situation or choice leads the subject to become paralyzed from the point of view of his own activities – Cerveri confirms -. Everything is postponed while waiting to obsessively ask others for advice or guidance, without ever being able to find help. real and decisive. Therefore, uncertainty remains the dominant reason, along with a continuous and irrational demand for reassurance, which soon goes even to people poorly qualified to provide the answers sought. And all this is evidence of how the subject lives in a constant state of doubt and the compulsion to ask for security represents only a ritual devoid of true meaning.
Having violent and unwanted thoughts
Unlike a person without any such disorder, someone with obsessive-compulsive neurosis does not simply indulge in an unusual thought that has crossed their mind, but must analyze it in detail. And this behavior triggers a series of disturbing questions, which can continue to torment you for many days in a row.
“The presence of unusual and sometimes unpleasant thoughts is a very widespread experience when they remain isolated – explains Cerveri – but some subjects who suffer from OCD present deeply distressing obsessions with respect to these phenomena, such as mothers who fear that “They can harm their children or women who are afraid of cheating on their boyfriend. And this thought triggers a doubt that does not disappear, but continues to grow in terms of anxiety and emotional involvement, to the point of leading the subject to a state of very serious anguish.” .
Obsess over a number
Whether it’s opening or closing a car door or buying something at the supermarket, performing a certain activity based on a number that is considered “good” or “safe,” regardless of what that number is, is the sign of a neurosis. . Breaking the pattern can not only make you feel uncomfortable, but also instill in you the idea that something could go wrong.
“Generally, people who suffer from the disorder are able to maintain a sufficient functional balance – Cerveri always emphasizes – but in periods of stress this tolerance decreases, while ritual behaviors increase, until reaching such an intensity that it produces marked discomfort in the body. everyday life”.
Align food perfectly
Although less common than other obsessions, the need to organize the pantry in a millimetric way, not only lining up jars and facing them all in the same direction, but even arranging them according to foods and colors, is based on an irrational need for order. and symmetry. And all it takes is for this order to be subverted for any reason or for one to realize that things are “no longer right” to trigger anxiety and worry.
“Order is an element similar to cleanliness – Cerveri concludes – which, however, can acquire different intensities and tones, to the point of being characterized in a complicated and highly limiting ritual for the subject and the family members themselves, with stages of very intense anxiety that, in some cases, can lead to violent reactions, both verbal and physical.
How can it be treated?
There are several proven effective interventions for this disorder. Regarding psychopharmacological intervention, there is data supporting selective serotonin reuptake inhibitors (SSRIs), but also data on less selective antidepressants such as amitriptyline (an older tricyclic antidepressant and newer serotonin and norepinephrine reuptake inhibitors such as venlafaxine). The most general clinical impression, supported by several expert consensus documents, sees the use of SSRIs for at least 10-12 weeks at maximum doses (with a gradual increase every 2-4 weeks) as the most appropriate therapeutic strategy.
Psychotherapeutic treatment has been and continues to be widely used in OCD. Own Freud recommended a psychoanalytic intervention for this disorder although to date there is insufficient data to consider it effective. Data regarding individual or group cognitive-behavioral psychotherapeutic interventions with a wide range of intensity, ranging from self-help interventions to digital interventions with specific applications to intensive treatment methods in a healthcare setting, are much more widespread and robust. Finally, in some cases benefits have also been observed through family psychotherapeutic intervention.
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