It has been reported abroad that the prevalence rate in the general population is 0.05 ~ 1%, accounting for 0. 1 ~ 2% of the total number of mental patients. Domestic epidemiological survey shows that the prevalence rate of this disease is 0.3‰. It usually occurs in young adults, and there is no significant difference in gender distribution.
Children's obsessive-compulsive disorder (OCD) is a kind of obsessive-compulsive disorder, which is an idea, emotion or behavior that you know is unnecessary but can't get rid of. In childhood, there are more compulsive behaviors than compulsive ideas, and the younger you are, the more obvious this tendency is. This disease is common in children aged 10- 12, and most of them have normal intelligence.
A more intuitive symptom can be seen in the role played by Nicolas Cage in the American film stick figure.
Etiology and pathogenesis
Genetic factors, obsessive-compulsive personality characteristics and psychosocial factors all play a role in the pathogenesis of obsessive-compulsive disorder.
1. Genetic factors: The comorbidity rate of patients' close relatives is higher than that of ordinary residents. For example, the prevalence rate of this disease in patients' parents is 5-7%. The results of twin survey also support that obsessive-compulsive disorder is related to heredity.
Personality characteristics: 1/3 OCD patients have a certain degree of obsessive-compulsive personality before illness, and their siblings, parents and children also have obsessive-compulsive personality characteristics. It is characterized by caution, hesitation, frugality, caution, caution, too much attention to detail, thinking and perfection, but too rigid and inflexible.
Mental factors: 35% patients in Shanghai survey data had mental factors before getting sick. All social and psychological factors that can cause long-term mental stress and anxiety or accidents that bring heavy mental shock are the inducing factors of obsessive-compulsive disorder.
In the occurrence of obsessive-compulsive disorder, social and psychological factors are one of the pathogenic factors that can not be ignored. When the body is in poor health or long-term physical and mental fatigue, people with obsessive-compulsive personality can be prompted to have obsessive-compulsive disorder. There are also different explanations about the pathogenesis; Pavlov school believes that under the influence of strong emotional experience, the excitement or inhibition process of cerebral cortex is excessively tense or conflicts with each other, forming isolated pathological inert excitement focus, which is the pathophysiological basis of obsessive-compulsive concept. Psychodynamic school believes that obsessive-compulsive symptoms come from repressed aggressive impulses or "sexual desire". Some people use learning theory to explain that the concept of obsessive-compulsive disorder is the result of stimulating anxiety and establishing conditional connection between the concepts. There is no direct evidence that the excessive activity of cingulate gyrus may be related to obsessive-compulsive disorder.
According to principle psychology, the perceptual system itself has the function of configuration, and the prefrontal lobe has established a reference sample in the form of configuration. Reference samples can directly compare the samples produced by the original meaning system and analyze the relative meaning of objective things, so as to make appropriate responses according to the actual situation. When we are awake, frontal lobe samples can always illuminate the mound, which determines our state of consciousness and psychological environment at that time. Obsessive-compulsive disorder overemphasizes a certain sample or a certain type of configuration, resulting in obsessive-compulsive symptoms. If the symptoms of obsessive-compulsive disorder are treated as symptoms, it will strengthen the symptoms. If the subjects are convinced that this is not a disease, it is beneficial to learning and memory, and the subjects are forced to persist in learning and memory, the symptoms of obsessive-compulsive disorder will soon disappear, which has a significant effect on treating clinical obsessive-compulsive disorder.
incidence rate
Overseas 1980 reported that the incidence of obsessive-compulsive disorder was 0. 1-0.3%. In China, obsessive-compulsive disorder has always been listed as a disease unit in neurosis, and ICD- 10 still lists it as an independent type of neurosis; According to the national 1982 epidemiological survey, the prevalence rate of this disease is 0.3%, accounting for 1.3% of all neurosis. Tianjin reported 0. 13‰, accounting for 10% of all neurosis. In psychological counseling services, the proportion of this disease is relatively high: for example, Guangzhou reported 8.3%, Shanghai reported 16.2%. According to the epidemiological survey, there is no difference in the incidence of this disease between the two sexes (but it is reported that women are slightly higher than men in China). Among children with obsessive-compulsive disorder, the prevalence rate of boys is three times that of girls. The disease usually occurs in teenagers, and the prevalence rate in urban and rural areas is similar. About 10% of patients started to get sick at the age of 10- 15, and 75% patients started to get sick before the age of 30. Most patients have a slow onset, and sometimes the inducement is not obvious. Patients often have a course of several years when they see a doctor. More than half of the patients' condition develops slowly and gets worse gradually. About 1/4 patients' condition fluctuates. About1-1/4% patients have a complete remission period, and some patients have an automatic remission trend after entering 40-50 years old.
Clinical classification
There are many kinds of symptoms, which can appear alone for a certain symptom or exist simultaneously for several symptoms. The content of symptoms can be relatively fixed for a period of time, or it can change continuously with the passage of time.
First of all, the concept of coercion
It's just that some associations, ideas, memories or doubts are stubbornly repeated and difficult to control.
(1) Forced association: Repeatedly recalling a series of unfortunate events that will happen. Although you know it's impossible, you can't help it, causing emotional tension and fear.
(2) Forced memory: Repeated memory of unimportant things that have been done, although knowing that it is meaningless, cannot be restrained and needs repeated memory.
(3) Forced doubt: If you have unnecessary doubts about whether your actions are correct, you should check them again and again. If you doubt whether the doors and windows are really closed after going out, go back and check them several times. Otherwise, I will feel anxious.
(4) Compulsive fatigue: thinking repeatedly about natural phenomena or events in daily life, knowing that it is meaningless, but unable to restrain it, such as thinking repeatedly: "Why does the house face south instead of north?"
(5) Forced opposing thinking: Two opposing words or concepts appear repeatedly in my mind, making me feel distressed and nervous. If I think of "support", I immediately appear "opposition"; When it comes to "good guys", I think of "bad guys" and so on.
Second, compulsory action.
(1) Forced washing: washing hands or things repeatedly, unable to get rid of the state of "feeling dirty", knowing that you have washed, but unable to control yourself, so you have to wash.
(2) Compulsory inspection: it usually appears at the same time as compulsory suspicion. Patients feel uneasy about what they know, and check repeatedly, such as checking locked doors and windows, checking written bills, letters or manuscripts, etc.
(3) Forced counting: count steps and telephone poles uncontrollably, and do an action for a certain number of times, otherwise, if you feel uneasy, you must count again.
(4) Forced ritual actions: Before daily activities, do a set of actions with certain procedures, such as taking off your shoes according to certain procedures before going to bed and placing them according to fixed rules, otherwise you will feel uneasy, then put on your clothes and shoes again and take them off according to procedures.
Third, coercive intent:
On some occasions, patients will have an idea contrary to the situation at that time, but they can't control the appearance of this intention, which is very distressing. For example, when the mother walked to the river with her child in her arms, she suddenly had the idea of throwing her child into the river. Although there was no corresponding action, the patient was very nervous and scared.
Four. Compulsive emotion
The specific performance is mainly obsessive-compulsive disorder fear. This kind of fear is the fear of losing control of one's emotions, such as fear that one will go crazy, do things that violate laws or social norms, and even endanger the world, instead of the fear of special objects and special situations like phobia patients.
Verb (short for verb) is forced to fear.
This fear is related to patients' compulsive thinking, and patients are afraid of opposing thinking and strong emotional response. If you are afraid that you will be forced on some occasions, you will feel scared and try to avoid attending such occasions.
Imperative behavior of intransitive verbs
The specific performance can be Nuo Nuo's compulsive behavior, such as repeatedly checking whether the gas is turned off and whether the door is locked; It can be confrontational coercion, such as repeatedly telling yourself not to turn coercive intentions into practical actions; It can also be a compulsory ritual action, such as crossing your left leg before entering the house and dressing up in order before going out. In addition, it can be forced to count, wash hands, blink, shake its head and bite its nails.
Course of disease and prognosis
Generally, the onset is slow, the course of disease is long, and the symptoms can last for many years or sometimes light and sometimes heavy. The personality characteristics before illness are obvious, the onset age is early, and the prognosis of the elderly is poor. With the increase of age, the symptoms gradually decrease; There were obvious mental factors before illness, but no obvious obsessive-compulsive personality characteristics and course of disease; The symptoms of people who are short-lived and have no positive family history may also be relieved spontaneously.
Diagnostic basis
1. Some thoughts, behaviors or intentions appear repeatedly out of control, accompanied by anxiety and painful emotional experience.
Second, patients know that these symptoms are unreasonable and unnecessary, but they are hard to get rid of and urgently require treatment.
Third, the efficiency of patients' work and study is obviously reduced, which also has a negative impact on daily life.
Fourthly, the personality characteristics and course of disease before illness are helpful for diagnosis. The course of the disease can be long or short, and the course of the study case is at least three months.
5. Eliminate obsessive-compulsive symptoms related to schizophrenia, depression and brain organic diseases.
Types of obsessive-compulsive disorder
1. Schizophrenia: There may be obsessive-compulsive disorder in the early stage, but the content gradually becomes absurd and incomprehensible, and there is no corresponding emotional response such as anxiety and pain; Poor self-awareness, not actively asking for treatment or denying illness and refusing treatment; With the development of the disease course, the characteristic symptoms of schizophrenia are gradually revealed.
Second, depression: OCD patients may have depressed or even negative thoughts because of illness, but they never commit suicide, which is different from depression, such as lack of interest in the outside world, slow thinking, slow behavior and low mood.
Third, temporal lobe epilepsy: I may have obsessive-compulsive ideas and behaviors, which are paroxysmal and have other symptoms of temporal lobe epilepsy. EEG, EEG topographic map and other examinations are helpful to distinguish.
Etiology and pathogenesis of obsessive-compulsive disorder
Obsessive-compulsive disorder is a psychological disorder with complicated causes. Many researchers have explored the causes of this phenomenon from the aspects of neurobiochemistry, genetics and psychology, but so far, there is no very convincing explanation. Here are some major assumptions and their influencing factors.