Show your support
It can be extremely helpful to express to your family member or friend your belief that they can cope with OCD. You should support your loved one and help him concentrate on each intermediate goal. Our clients with OCD often complain that relatives do not realize how difficult it is for them to make even small progress in the fight against the disease. Therefore, your praise for “small” achievements (for example, reducing your time in the bathroom by 5 minutes) can be a strong motivator for further progress.
Persuasion can sometimes also work wonders, but only if used wisely. If you allow your support to develop into pressure and pressure, you can easily get the opposite of the desired result. A person may begin to resist such “help”, even to the point of completely refusing treatment.
Avoid the word "should"
One of the most influential psychologists of the 20th century, Albert Ellis, based his scientific worldview to a large extent on the criticism of the oughts that people create for themselves and present to others. He pointed out that in reality there are not many things that a person “should” or “shouldn’t” do. Of course, most of us would agree that no one should kill, steal or commit violence. However, people tend to use the word “should” in situations where the rigidity that this word carries is not at all required.
Watch to see if your speech is replete with similar demands when you address your loved one. It is advisable to minimize the indications of what he should feel, what he should be prepared for, or what he should do. Most often, you can choose other words that perform the function of the word “should”, but will not sound so demanding. Below are some examples.
- Requirement: “You must do this exercise for 30 minutes.”
- You can say: “23 minutes have passed. There are still 7 left. Try to hold on.”
- Demand: "You must not be afraid"
- You can say: “I understand how scared you are.”
- Requirements: “You shouldn’t think about these numbers all the time. It's just stupid."
- You can say: “You’re probably already so tormented by these obsessive numbers. It would be great if you made an exhibition for them.”
Try not to be dissuaded
Seeking reassurance from relatives (in order to gain reassurance) is just as harmful a compulsion as any other. It is harmful in that it does not allow a person to get used to the uncertainty that permeates our entire existence, and also deprives him of the ability to trust himself, his senses. But here a difficult question arises: how to refuse to dissuade a loved one who is gripped by fear and begs to calm him down? Most likely it won't work the first time. If you have been participating in this ritual for several years, then you have become part of a vicious circle, the exit from which will probably involve some stress for both of you.
In family psychotherapy sessions, we instruct relatives in detail on how to act if their loved one seeks reassurance.
Briefly, the basic rules here are as follows: a) dissuasions should be replaced with answers that contain uncertainty; b) refusal to dissuade must be planned in advance and agreed upon with the person you are helping.
| OCD theme | Search for dissuasion | Alternative answer |
| Pollution | Do you think this table is clean enough? | Bacteria are everywhere, most likely on this table too. |
| Double checks | Do you think that when I drove through the previous intersection, I couldn’t have hit someone? | Remember, the therapist said that while driving there is always a risk of hitting someone. I don't know anything else. |
| Sexual orientation | Tell me, if I evaluate a man’s appearance, does that mean I’m gay? | It is impossible to be one hundred percent sure of your orientation. |
| Religion | Will I go to hell? | I don't know. |
Alternative responses should preferably be agreed upon with the therapist and should not come as a surprise to the client. They should not contain sarcasm. The use of humor is quite acceptable here, but not mockery.
Diagnostics
Those who suspect that they have such a disease should consult a psychologist, because it is difficult to cure obsessive-compulsive disorder on your own, and the disease itself can progress for many years.
At the appointment, the doctor will determine:
- the presence of obsessive obsessions;
- hidden signs of compulsion;
- changing the patient’s habitual lifestyle;
- difficulties communicating with others.
Stopping thoughts. It is a kind of game in which the patient must abstract from the problematic situation and determine the significance of what is happening in his life.
Cognitive-behavioral techniques. Treatment according to the method begins with the patient’s awareness that he is sick. Gradually he is brought into a state in which his previous experiences cease to be a problem.
Treatment methods
The disease has a wide range of symptoms, but the general principles of treatment for OCD are the same as for neuroses and other mental disorders. Drug therapy provides the greatest effect and lasting results.
Treatment with medications begins after diagnosis, depending on the individual characteristics of the patient.
The doctor takes into account:
- age and gender of the patient;
- social environment;
- OCD symptoms;
- the presence of concomitant diseases that can aggravate the condition.
The main feature of obsessive-compulsive disorder is long periods of remission. The state of fluctuation is often misleading; the medication is stopped, which is absolutely forbidden to do.
It is not allowed to adjust the dosage of drugs without a doctor's prescription. A good result can only be achieved under the supervision of a specialist. Intensive therapy prescribed independently will not help get rid of the problem.
One of the companions of OCD is depression. Antidepressants used to treat it significantly alleviate the symptoms of OCD, which can confuse the overall picture of treatment. In addition, others should understand that there is no need to take part in the rituals of the patient.
Excellent results in the treatment of OCD have been demonstrated by:
- serotonergic antidepressants;
- benzodiazepine anxiolytics;
- beta blockers (to relieve vegetative manifestations);
- MAO inhibitors (reversible) and triazine benzodiazepines (Alprazolam).
In the first year of drug therapy, there may be no obvious signs of improvement; this is due to the undulating course of the disease, which usually confuses both relatives and the patient himself.
Because of this, they change the attending physician, the dosage of drugs, the drug itself, etc. Medicines used for the diagnosis of OCD have a “cumulative effect” - a long time must pass for a visible and lasting result. To cure a patient, tablets and injections such as Phenibut, Phenazepam and Glycine are often used.
Psychotherapy
The main task of a psychotherapist is to establish contact with the patient. Productive collaboration is the main key to success in therapy for any mental illness.
The psychiatrist addresses the patient, influencing the instinct of self-preservation, instilling the idea that it is necessary to fight, this is a joint work, for which it is necessary to strictly follow the doctor’s instructions.
The most difficult stage is overcoming the fear of medications; the patient is often confident in their harmful effects on the body.
If there are rituals, improvement can only be achieved by using an integrated approach. The patient is created with conditions that provoke the creation of rituals, trying to prevent the occurrence of a reaction to what is happening. After such therapy, 70% of patients with rituals and moderate phobias show improvement.
In severe cases, such as panophobia, this technique is used, aimed at reducing the perception of bad impulses that fuel the phobia, and complements the treatment with emotional support therapy.
Before improvement occurs from drug treatment, it is necessary to support the patient, instill in him thoughts of recovery, and explain his unhealthy condition.
Both psychotherapy and medication treatment set the main goal of behavior correction, willingness to cooperate, and decreased susceptibility to phobias. To improve mutual understanding, to correct the behavior of the patient and his environment, to identify hidden factors that provoke an exacerbation of the condition, family therapy is necessary.
Patients suffering from panophobia, due to the severity of the symptoms, require medical care, social rehabilitation, and occupational therapy.
Comprehensive work with a psychotherapist and accompanying activities can give excellent results and enhance the effect of drugs, but they cannot completely replace drug treatment.
There is a small percentage of patients with OCD who have demonstrated a deterioration in their condition after working with a psychotherapist; the techniques used awakened thoughts that provoked aggravation of rituals or phobias.
Refrain from criticism
Exposure requires a lot of effort. Sometimes it causes severe discomfort and fear. The last thing a person with OCD wants is to hear that they are doing something wrong. This does not mean that you cannot adjust the exercises, but any comments of this kind should be soft and careful. For example, instead of saying, “You didn't wait 30 minutes before washing your hands!”, you could say, “You waited 20 minutes, that's very good. The task takes 30 minutes, but I'm sure you can do it next time." The person you are helping is most likely doing the maximum of what he has the strength to do at the moment. Criticism undermines self-confidence.
Course of obsessive-compulsive disorder
This mental disorder extremely rarely manifests itself episodically and can be treated completely, until complete recovery. The most common trend in the dynamics of OCD is chronification.
Most patients with this diagnosis, when seeking help in a timely manner, achieved a stable condition; the general symptoms remained only mild manifestations of the disease (frequent hand washing, fingering buttons, counting steps or steps, fear of open or enclosed spaces, mild panic attacks). If it was possible to achieve a stable state, without deterioration, then we can talk about the likelihood of a decrease in the frequency of OCD manifestations in the second half of life.
After some time, the patient undergoes social adaptation, the symptoms of the psychopathological disorder soften. The syndrome of obsessive movements is the first to disappear.
A person adapts to life with his fears, finds the strength to maintain inner peace. In this situation, the support of loved ones plays an important role; the patient must stop feeling that he is different and learn to coexist with people and be socially active.
A mild form of OCD is characterized by a mild manifestation of the disease, without sudden changes in condition; this form does not require inpatient treatment; outpatient treatment is sufficient. Symptoms fade away gradually. It can take from 2 to 7 years from the moment the disease manifests itself to a stable good condition.
If the manifestations of a psychasthenic illness are complex, the course is unstable, aggravated by fears and obsessive phobias, with numerous and multi-stage rituals, then the chance of improving the condition is small.
Over time, the symptoms take root, become consistently severe, cannot be treated, the patient does not respond to medications and work with a psychiatrist, and relapses occur after active therapy.
Differential diagnosis
An important step in diagnosing OCD is to exclude other diseases with similar symptoms in the patient. Some patients showed symptoms of obsessive-compulsive disorder when initially diagnosed with schizophrenia.
People suffered from atypical obsessive thoughts, mixing religious and ritual themes with sexual fantasies, or exhibited unusual, eccentric behavior. Schizophrenia occurs sluggishly, in a latent form, and constant monitoring of the patient’s condition is necessary.
Especially if ritual behavioral formations grow, become persistent, antagonistic tendencies arise, the patient demonstrates a complete lack of connection between actions and judgments.
Paroxysmal schizophrenia is difficult to differentiate from protracted obsessive disorder with multiple structural symptoms.
This condition differs from obsessive neurosis by attacks of anxiety, each time the panic state is stronger and longer. A person panics because the number of obsessive associations has increased and they are illogically systematized.
This phenomenon becomes a purely individual manifestation of obsessions; what the patient could previously control has now turned into a chaos of thoughts, phobias, fragments of memories, comments from others.
The patient interprets any words and actions addressed to him as a direct threat and reacts violently in response, often the actions are unpredictable. This picture of symptoms is complex; only a group of psychiatrists can exclude schizophrenia.
Obsessive-compulsive disorder is also difficult to differentiate from Gilles de la Tourette syndrome, in which a nervous tic affects the entire upper body, including the face, arms and legs.
The patient sticks out his tongue, makes grimaces, opens his mouth, actively gestures, and waves his limbs. The main difference between Gilles de la Tourette syndrome is movement. They are more rude, chaotic, incoherent. The psychological disturbances are much deeper than in OCD.
Genetic factors
This type of disorder can be passed on from parents to children. Statistics show that 7% of parents with similar problems whose children suffer from OCD, but there is no clear evidence of hereditary transmission of OCD.
