Treatment and diagnosis of obsessive-compulsive disorder
First, diagnosis and differential diagnosis
(1) according to the diagnostic criteria of ICD- 10 and DSM-3-R3-R.
According to ICD- 10 and DSM-3-R, the diagnosis of the disease is mainly the diagnosis of clinical symptoms. The patient's compulsive concept or behavior still exists, which brings him obvious distress and seriously affects the patient's study and life.
Clinical diagnosis is generally not difficult, but sometimes it needs to be differentiated from the following situations:
1. Schizophrenia: The manifestations of obsessive-compulsive disorder may be the main manifestations in the early stage of schizophrenia, but the manifestations of obsessive-compulsive disorder are often absurd and incomprehensible, and gradually accompanied by obvious characteristics such as withdrawal, alienation and indifference. With the further development of the disease, there will be thinking association obstacles, delusions and hallucinations, which are obvious manifestations of obsessive-compulsive disorder, so we must be cautious.
2. Autism: Stereotyped repetitive actions and conscious behaviors are common symptoms of autism, which are easily confused with the manifestations of obsessive-compulsive disorder. However, most patients have serious communication barriers, language dysfunction and intellectual development barriers, which are exactly what OCD patients do not have. Therefore, by carefully inquiring about the medical history and observing the language and behavior characteristics, it is not a big problem to make a diagnosis, but it needs to be further differentiated from high-functioning loneliness disorder and atypical autism by combining comprehensive information and examination such as development history, course of disease, social ability and language use level.
3. Tourette's syndrome: Some patients with Tourette's syndrome have involuntary, repetitive, rigid actions and behaviors or ritual actions and behaviors, and some also have obsessive-compulsive counting and repetitive language, similar to obsessive-compulsive disorder, but Tourette's syndrome rarely has obsessive-compulsive ideas at the same time, and they all have a history of twitching or twitching at the same time, so it is generally not difficult to distinguish.
(2) Diagnose according to CCMD-2-R standard.
Diagnostic criteria:
1. meets the diagnostic criteria of neurosis;
2. Obsessive-compulsive disorder (OCD) is the main clinical manifestation, which is a mixture of one or more of the following forms:
(1) The main clinical manifestations of obsessive-compulsive thinking are obsessive-compulsive concept, obsessive-compulsive appearance, obsessive-compulsive opposing concept, obsessive-compulsive exhaustion, obsessive-compulsive fear of losing self-emptiness ability, etc.
(2) The main clinical manifestation is compulsion, manifested by repeated washing, repeated examination, repeated questioning or other repeated ritual actions.
3. Rule out the possibility of other mental disorders secondary to obsessive-compulsive disorder, such as depression and schizophrenia.
In addition, OCD is called obsessive-compulsive disorder-10 in ICD, and its diagnosis points are as follows:
In order to make a definite diagnosis, obsessive-compulsive disorder or obsessive-compulsive behavior, or both, must be present for most of two consecutive weeks, causing pain or hindering activities. The manifestations of obsessive-compulsive disorder should have the following characteristics:
(1) must be regarded as the patient's own thinking or impulse;
(2) At least one thought and behavior must be resisted by the patient in vain, even if the patient no longer resists other symptoms;
(3) The idea of carrying out actions should be unpleasant in itself (just to relieve tension or anxiety is not considered pleasant in this sense)
(4) Ideas, appearances or impulses must be unpleasant reappearance.
Second, the treatment of obsessive-compulsive disorder
1. psychotherapy: supportive psychotherapy is the main method, and behavioral therapy is used for obsessive-compulsive disorder, and response inhibition method is better.
1. Psychodynamic therapy
Psychodynamic therapy emphasizes the analysis and explanation of contradictions and conflicts among various psychological phenomena through epiphany, changing emotional experience and strengthening self, so as to achieve the purpose of treatment. Interpretation, empathy analysis, self-association and self-reconstruction techniques are widely used in the treatment process.
2. Behavioral therapy
Behavioral therapy can be divided into two basic schools in understanding the treatment methods of obsessive-compulsive disorder. The first view is that patients with obsessive-compulsive disorder use various behaviors and ritual actions to relieve anxiety, which is called "drive reduction model". According to this model, the therapist mainly eliminates inappropriate behaviors and ritual actions by stimulating situations that can reduce anxiety, which is the performance behavior of obsessive-compulsive disorder. The second view is based on the operation mode, emphasizing the adjustment of the adverse consequences of obsessive-compulsive disorder, so punishment and demonstration learning are widely used in this mode.
(1) The main methods to adopt the driving force reduction model are various techniques to reduce anxiety, among which the most commonly used method is system desensitization. (The whole body desensitization technology has been introduced in detail in the treatment of terror disorder, so I won't repeat it here. )
(2) Case-based learning technology is often used in the treatment of obsessive-compulsive disorder, mainly including participation demonstration and passive demonstration, among which participation demonstration is the most used. As with desensitization of the system, participation in the demonstration also needs to establish the stimulation level. From the lowest level to the highest level, the therapist gradually demonstrates exposure to the corresponding situation, and then the patient gradually faces this situation until he can face it completely independently. Passive demonstration also allows patients to observe the therapist's contact with various situations from low to high, but the difference is that patients are not allowed to intervene in situations. In addition, both treatments use reaction prevention methods. For example, in the treatment of obsessive-compulsive disorder and cleanliness addiction, the therapist can use some kind of agreement to prevent all children from washing their hands. Judging from the existing data abroad, it is generally believed that the therapeutic effect of participating in the demonstration is better than that of passive demonstration. In addition, demonstration learning can often be combined with exposure therapy and the effect will be better.
(3) The technology of exposure therapy has been valued and applied by many people in the past decades, especially when patients are gradually exposed to various anxiety situations, whether imagined or realistic, the effect is very good. Because the duration of exposure mainly depends on whether children and adolescents can eliminate anxiety and restore tranquility, the treatment time using this method is longer, about 2 hours.
(4) Exposure therapy can be combined with reaction prevention. This method is to reduce the frequency of ritual actions and compulsive ideas.
3. Family interpersonal therapy
This method emphasizes interpersonal factors and avoids simply studying isolated individual behavior. This idea pays attention to the overall significance of studying behavior problems, and it emphasizes providing consultation for patients' families while treating patients. The specific method is as follows:
(1) Train family members to become counselors for patients' psychological analysis, or assistants for comfort treatment, and assist in the implementation of reaction prevention training programs;
(2) "self-strengthening" counseling for patients receiving psychoanalytic therapy or behavioral therapy;
(3) influence and improve family relations;
(4) training family communication skills;
Second, drug therapy: anti-anxiety drugs can reduce anxiety and contribute to psychotherapy and behavioral therapy.
3. Others: ECT therapy is suitable for people with strong obsessive-compulsive ideas and strong negative emotions. For patients with persistent symptoms, long-term treatment is ineffective and extremely painful, you can try psychiatric treatment.
Treatment and Adjustment of Obsessive-compulsive Disorder (Ⅱ)
Stories?
The girl Xiao finally couldn't stand it and walked into the psychological clinic. "I have obsessive-compulsive disorder. I want to classify everything I see before my eyes. " ?
Bin, 15-year-old boy, developed symptoms of obsessive-compulsive disorder five years ago. After finishing his homework, he always worried that he had made a mistake and checked it again and again. Since I accidentally saw a sentence last year, "Dusk is always sad, and at this time, something is always dying", I have been recalling that sentence: Why do you say that? What's the point? At this time, the situation of repeated inspection of the job is light. Although I know it is unnecessary to recall this sentence, I want to control it, but once I control my heart, I feel very uncomfortable and nervous, and finally give up control and let it continue to recall.
He Bin Jr. showed obsessive-compulsive disorder, and such cases are not uncommon in life. ?
Obsessive-compulsive disorder, also known as obsessive-compulsive disorder, is a high-incidence symptom of adolescence. Its remarkable feature is that patients will compulsively repeat certain ideas or behaviors. Different from other mental compulsive thoughts and behaviors, obsessive-compulsive disorder is characterized by the coexistence of conscious self-compulsion and conscious self-compulsion. Patients know that the persistence of obsessive-compulsive disorder symptoms is meaningless and unreasonable, but they can't restrain themselves from recurring. The more they try to resist, the more nervous and painful they feel. In fact, without conscious resistance, there would be no intense painful experience.
There are three characteristics of compulsion: ① Subjective compulsion experience; (2) Subjectively feel that we must consciously resist; ③ Symptom insight. All three exist at the same time, and one of them is not obsessive-compulsive disorder. Patients are struggling in the phenomenon of repeated attempts to control themselves and control failures. Because these repeated thoughts and behaviors are often considered abnormal or inappropriate by patients, patients will fall into the whirlpool of self-blame and inferiority, which will lead to abnormal mental tension, pain and anxiety. Teenagers, in particular, are in the period of physical and mental development, and the pressure of study and society is increasing, which is prone to obsessive-compulsive disorder. ?
Tracing back to the source?
The life of patients with obsessive-compulsive disorder has become a circular film. They are locked or stuck in a certain link and can't rush out. They seem to be standing in front of a door that can't be closed, hesitating painfully between voyeurism and closing the door. Repairing this out-of-control heart door is the key to the healthy growth of adolescents with obsessive-compulsive disorder. ?
Obsessive-compulsive disorder patients are characterized by obsessive-compulsive symptoms, with various manifestations. Generally speaking, there are two aspects, namely compulsive thinking and compulsive behavior. ?
Obsessive-compulsive thinking means that the patient loses control of a certain desire, impulse or an idea that he knows should not and is unnecessary. Although he tried to get rid of it, he couldn't stop to get rid of this involuntary repetitive thinking. Common compulsive thinking are:?
1? Forced memory and association?
It is to unconsciously repeat and associate some things that you have experienced or done and what you have said to yourself or others. It is very common for a certain past, a certain sentence and a certain song to appear repeatedly in your mind. Bin's symptom is forced memory. ?
2? Forced doubt?
Is that I have doubts about what I just did. For example, as soon as the door is locked, I doubt that it is unlocked. I just threw the letter into the mailbox and always suspected that there was no stamp; If you have just finished your homework, you suspect that you have missed it or made a mistake; Just washed my hands, but I always feel dirty. Patients with obsessive-compulsive doubts often show doubts and make some compulsive behaviors, such as repeated examinations and repeated hand washing. ?
3? Forced opposition?
Simply put, the more you want to control, the more you keep appearing. This kind of thought or concept is often bad, contrary to moral concept, and reflects the patient's potential desire. Therefore, the patient is deeply ashamed and nervous, afraid of being seen by others, and tries to control it. But the more he tries to control it, the greater the temptation, the higher the frequency of occurrence, and the increasing guilt and inferiority of patients. ?
4? Obsessive-compulsive thinking
This symptom is similar to drilling the bottom of a hole, and the patient will ponder over some meaningless problems and entangle them. A female student said in psychological counseling: "I am under great pressure because of my poor study, so I always force myself to figure out all the knowledge points. I have to think hard if I can't figure it out." But recently, I sometimes think about some strange questions, such as why 1+ 1=2 is not equal to 3? The more I think about it, the more I can't figure it out, so I entered a vicious circle. I was very nervous and began to think about loyal opposition, but I got deeper and deeper, and I couldn't even study normally. "This is a typical symptom of compulsive thinking. The patient's mind is like being forcibly pulled onto a never-ending train, and finally exhausted. ?
5? Forced intent?
Patients repeatedly experience a strong inner impulse to do something against their will. Although the patient knows this is an absurd idea and won't do it himself, he can't get rid of this inner impulse. If you stand on a bridge or take a train, you have the impulse to jump; Or have the urge to call names and shout reactionary slogans. ?
Forced behavior refers to repeated actions or activities according to certain rules or rigid procedures, mainly including forced washing, forced inspection, forced stereotypes and so on. ?
1? Forced washing?
The outstanding performance is compulsory hand washing, and patients keep washing their hands, sometimes more than 20 times a day. Especially when patients' hands or bodies come into contact with strangers or things used by strangers, they will wash their hands and bodies repeatedly uncontrollably. ?
2? Mandatory inspection?
Forced inspection is similar to forced flushing. The patient can't control what he has just done repeatedly. Some obsessive-compulsive disorder patients will
Repeat the inspection several times or even hundreds of times to confirm whether the door has been locked, the operation is correct, and the furnace has been extinguished. Most of these compulsive behaviors are caused by compulsive suspicion. ?
3? Forced action?
Compulsive action means that patients must follow a fixed order and repeat this series of actions when doing a certain behavior. If you make a mistake or are interrupted, you should start over until the patient is satisfied. ?
If forced to count, patients can't help but count something, forcing them to count trees, street lamps or roadside steps. When some patients walk, they must kick the stones on the road to one side or into the ditch. If they don't play, they will feel very uncomfortable. They have to turn around and clean up, almost every time they walk. ?
Some patients require symmetry in everything they do and follow a fixed ritual order. For example, when going out, you must first step out of the house with your left foot, and the shoes you take off after going home must face east; Or often repeat two steps forward and one step back; Or before going to bed, take off your clothes in a prescribed order and walk around the bed. If you don't do this, you will feel uneasy. Although I know that it is ridiculous and unnecessary to do so, it is very uncomfortable and anxious not to do so. But after doing it, although it eliminated the tension and anxiety, it wasted a lot of precious time. ?
Because of these ritualized behaviors, patients tend to move slowly. In rare cases, ritualization is relatively inconspicuous, but the action is slow but outstanding. It may take 1 hour to brush your teeth, 2 hours to eat, half an hour to walk from the bedside to the door, and several hours to stay in the toilet or bathroom. ?
It is observed that in obsessive-compulsive disorder, there are much more compulsive behaviors. The former is found in 75% of cases, while the latter is only found in 25% of cases. Among compulsive thinking, compulsive association (or compulsive thinking) is the most, followed by compulsive thinking. Among compulsive behaviors, compulsive ritual movements are the most, followed by compulsive hand washing. A person may also show more than two obsessive-compulsive symptoms, but according to the data, the proportion is only about 15%, and one symptom must be dominant. Rubin showed two symptoms: forced examination and forced recall. ?
Compulsive thinking and compulsive behavior often appear at the same time, and sometimes appear separately. These obsessive-compulsive symptoms can be alleviated when patients are in high spirits, concentrate on something or are threatened; It is more obvious when you are depressed, depressed and tired. ?
In fact, most normal people have had compulsive thinking, especially middle school students with great learning pressure, such as thinking too much about a certain problem, saying a few words or singing a song or two involuntarily. However, these behaviors do not affect normal psychological activities and behaviors, so they cannot be identified as obsessive-compulsive disorder. ?
Psychological police area?
Patients with obsessive-compulsive disorder generally have obsessive-compulsive personality. Obsessive-compulsive personality is a common personality disorder and the main catalyst of obsessive-compulsive disorder, which is mainly manifested in the following aspects:
Obsessive-compulsive disorder patients are generally timid, sensitive and lack of self-confidence. They are too formal and hesitant, so they often can't show their eloquence and performance. ?
Obsessive-compulsive disorder patients often pay too much attention to details and strive for perfection. When dealing with things, there is often a sense of insecurity, uncertainty or imperfection, and you will struggle with details and find fault. They are very afraid of criticism, mistakes, excessive self-concern and self-discipline. Therefore, when the situation is difficult or frustrated, obsessive-compulsive symptoms may be induced. ?
Due to the excessive pursuit of perfection and accuracy, such people require step by step, follow the rules, stick to the form, articles of association and order, and also require some details of life to be programmed and ritualized. ?
People with compulsive personality are inefficient, fail to seize the opportunity, and often regret and blame themselves afterwards. Although they may be expressionless on the surface, they are often very nervous, anxious and even full of resentment. ?
In this way, patients with obsessive-compulsive disorder often have "contradictions" between compulsive behavior and ideas. This uncontrollable psychological contradiction often makes patients fidgety, irritable, nervous, weak and tired. The bookworm among middle school students, students who are too introverted and have a sense of superiority are prone to obsessive personality. ?
It is normal for people to show the above mentality occasionally in some special circumstances, but once the above mentality becomes a habit, it needs to be adjusted. ?
It is worth noting that in adolescent cases, excessive pursuit of perfection and strong personality are the two main causes of obsessive-compulsive disorder. ?
Perfectionists tend to lead to obsessive personality, and insisting on perfection is the beginning of obsessive personality. Because there is no real perfection, perfectionists are always obsessed with the accuracy of some details, which cannot be determined by measuring them back and forth. ?
Xiao Wang is indecisive, cautious and always wants to be perfect. When reviewing lessons, the desk lamp was put up, and he felt that the lighting was not enough; Put it down, but he was afraid that the light would hurt his vision. He repeatedly raised and lowered the desk lamp ... Knowing that it was unnecessary, he had to adjust it for more than half an hour. In summer, when the shirt is put in his pants, the belt is tight, which affects his breathing. When it is loose, he feels that it is detrimental to his image. He will buckle his belt on the fourth eye, then the fifth eye ... often dozens of times.
Like self-distrust, overconfidence and strength can also lead to obsessive-compulsive personality. Once frustrated, patients will make various repetitive actions uncontrollably. ?
A boy from a middle school in Chengdu, he has very high requirements for learning. In class, he asked himself to remember every word of the teacher. When reading a book, he asked himself never to forget anything. His greatest happiness is that he can be affirmed by everyone in his studies, and the most unbearable pain is that someone has surpassed him in his studies. Everyone thinks that this boy will definitely be sent to Peking University or Tsinghua in the future, but at the age of 15, he has obsessive-compulsive disorder and his mind is blank when reading. Every day, he spends his time coping with his symptoms of obsessive-compulsive disorder, just like two people with completely opposite behaviors fighting in his mind all day, just like a "devil" controlling his behavior. The boy was depressed all day and tried to commit suicide several times, but he still couldn't do anything valuable.
Psychological self-help
Once forced thinking interferes with normal psychological activities, it will not only affect the exertion of intelligence level, but also cause psychological pressure, which will make patients feel more inferior, nervous and anxious and affect their normal life and study. ?
The essence of obsessive-compulsive disorder is psychological self-struggle, therefore, the treatment of obsessive-compulsive disorder should generally be based on psychotherapy, supplemented by medication. ?
◆ Psychotherapy. Such as flood therapy, systemic desensitization therapy, etc., most of them can achieve satisfactory results. ?
◆ Drug therapy. Mainly use drugs with central nervous system recovery blocking effect, as well as some
Antianxiety drugs, such as tricyclic antidepressants and monoamine oxidase inhibitors, should be taken under the guidance of experts. ?
◆ Surgical treatment. For a few patients with severe symptoms who need long-term treatment, they can be treated by brain surgery. ?
A lot of practice and research show that behavioral therapy in psychotherapy is the most effective method to treat obsessive-compulsive disorder. Behavioral therapy, mainly relaxation training, systematic desensitization or drowning therapy, combined with biofeedback and other treatment methods. ?
The so-called systematic desensitization method (desensitization method) is to let patients gradually reduce allergic emotional or behavioral reactions according to systematic procedures and the principle of "confrontation". ?
The basic principle of flood treatment is just the opposite of desensitization. Patients will suddenly face a large number of situations (objects) that they are afraid of, and even be overexposed to these fears. This "flood-like" stimulus will have a violent impact on patients, so that patients can not produce the usual "fear" psychological reaction. When they endured a short period of nervousness, they were no longer afraid. For example, if a person who is subjected to forced washing suddenly makes his whole body dirty, he will no longer worry about some subtle dirty things and may remove his fear of dirty things. However, because this kind of stimulation is suddenly faced, some patients will not be able to bear it, but will have extreme panic. Therefore, flood therapy should pay special attention to the selection of treatment targets, and patients should also be psychologically prepared. ?
In addition, catharsis therapy, that is, letting patients tell the reasons for their nervousness, is also an effective psychotherapy. ?
Treating obsessive-compulsive disorder according to the basis of the disease is the first principle. Many patients' obsessive-compulsive disorder is related to their past unfortunate experiences and psychological trauma. Venting your inner pain, fear and tension will reduce your fear and ease your tension. ?
In addition to the above three main psychotherapy methods, OCD patients also need to cooperate with doctors to adjust their personality and life. ?
1? Cognitive adjustment-obsessive-compulsive disorder is not terrible?
As we said, the essence of obsessive-compulsive disorder is psychological self-struggle, and the treatment of obsessive-compulsive disorder is to overcome fear with personal will, which is the so-called "know yourself and know yourself." The key to treatment is to have a correct understanding of obsessive-compulsive disorder. Many patients have the concept of hypochondriasis and are nervous about the symptoms of obsessive-compulsive disorder, which increases their psychological burden and aggravates obsessive-compulsive disorder. Therefore, patients should first understand the knowledge about obsessive-compulsive disorder, including etiology, nature, results and various treatment measures, so as to eliminate concerns, establish confidence in overcoming obsessive-compulsive disorder and actively cooperate with treatment. ?
2? Personality adjustment-think from another angle?
The symptoms of patients with obsessive-compulsive disorder are only superficial, and what really works is their obsessive-compulsive personality, that is, bad personality and way of thinking. Therefore, patients with obsessive-compulsive disorder should consciously try to overcome their willfulness, impatience and competitiveness, change their rigid and serious way of doing things, don't be too stubborn, think from another angle, and things will often take an unexpected turn. At the same time, build up confidence and face setbacks bravely and optimistically. ?
Xia will enter the university soon. She is often worried that she will not pass the exam. During recess, she always looks around the classroom to see if anyone is reading or doing homework. As long as one person is studying, she is in pain. She has been thinking about a problem in her mind-she has studied more than me 10 minutes. ?
This compulsive concept comes from the lack of confidence in one's ability to take exams. If you are confident, why should you care about other people's competition? Therefore, the treatment of obsessive-compulsive disorder needs to help them change their original bad personality, establish self-confidence, improve their psychological quality, and cultivate their optimistic, independent, open-minded and confident good personality. ?
1? Don't be a perfectionist-just believe in hard work?
There are no perfect people and things in the world. As long as you work hard, it is the best for yourself. Obsessive-compulsive disorder patients should admit and accept the possibility of making mistakes and not be too harsh on life and study. Pursuing the ultimate perfection can only backfire. At the same time, we should not look at the problem too absolutely. We should learn to compare relatively and keep an optimistic attitude. ?
2? Divert your attention-do something that interests you more?
When patients repeatedly engage in compulsive thinking and compulsive behavior, their thinking will focus on one point. At this time, the most important thing is to find a way to divert their attention and get rid of the real symptoms and pain as soon as possible. For example, once you are in an environment prone to forced association and memory, you start reading novels or listening to music that interests you. At this time, you may forget what you often associate with. ?
3? Adjust your life-learn to relax yourself?
Patients with obsessive-compulsive disorder should adjust their living conditions appropriately, such as actively participating in various cultural and sports activities. This not only enriches the boring daily life, but also reduces the pressure of life and study, which will gradually reduce the fear and anxiety of obsessive-compulsive disorder. ?
At the same time, patients can take a deep breath to relax every night before going to bed or when symptoms appear. While inhaling and exhaling slowly, they can count the times in their minds, that is, "counting their own breaths", so that they can get rid of other thoughts, be calm and achieve the purpose of relaxation. ?
One thing needs to be explained, the treatment of obsessive-compulsive disorder can not take hard countermeasures, but should be guided step by step. For example, in the primary stage, when patients force themselves to wash their hands constantly, don't stop them forcibly, which will only increase the psychological pressure of patients, and the severity of obsessive-compulsive disorder symptoms is directly proportional to the degree of depression. Doctors should let nature take its course and wash it if they want; When patients gradually understand the causes and essence of their symptoms and the treatment measures in the treatment process, they will gradually consciously reduce the number of hand washing. Therefore, when patients gradually recover their self-control ability, if they are properly persuaded, the effect will be better. ?
Obsessive-compulsive disorder (OCD) is a very hidden psychological disorder, and the onset time can be as long as 7 years. To avoid this kind of psychological problem among teenagers, parents and schools should pay attention to the psychological development of teenagers at all stages of growth, develop both intellectual and non-intellectual factors, pay attention to the training of rational thinking and the cultivation of irrational thinking, and keep their psychological development balanced.
Note: Because you didn't make it clear, I can only give you some information and cases here. If you feel the same way, I suggest you see a psychiatrist and then cooperate with the above treatment yourself!