Obsessive-compulsive personality disorder
Introduction
Introduction to obsessive-compulsive personality disorder Obsessive-compulsive disorder (referred to as obsessive-compulsive disorder), a type of neurological disorder characterized by repeated obsessions. The concept of obsession is a thought, representation or intention that repeatedly enters the field of patient consciousness in a rigid form. These thoughts, representations, or intentions are of no practical significance, unnecessary or superfluous to the patient; the patient realizes that these are his own thoughts, and he wants to get rid of it, but he is powerless and therefore very distressed. Forced action is a repetitive stereotype or ritual action that is the result of a patient's succumbing to a forced mind to reduce inner anxiety. Compulsive personality requires strict and perfect, easy to rationalize conflicts, and has strong self-control psychology and self-control behavior. Such people are insecure at ordinary times, excessive restraint on themselves, and excessive attention to whether their behavior is correct and whether their behavior is appropriate. Responsibility is particularly strong, and in dealing with things, too cautious. Their emotions are more anxious, nervous, and remorseful, and they are less happy and less satisfied. Can not be approachable, difficult to treat people with enthusiasm, lack of sense of humor. basic knowledge Sickness ratio: 5% Susceptible people: no specific population Mode of infection: non-infectious Complications: insomnia depression
Cause
Causes of obsessive-compulsive personality disorder
First, the cause of the disease
In the past, most of the disease was thought to stem from mental factors and personality defects. In the past 20 years, genetic and biochemical research, especially the widespread use of drugs, has shown a significant effect, suggesting that the disease has its biological basis.
1. Genetic factors: Family surveys showed that the risk of anxiety disorder among the first-degree relatives of the obsessive-compulsive proband was significantly higher than that of the control group. If the person with obsessive-compulsive symptoms but did not meet the diagnostic criteria was included, the patient group parents The risk of obsessive-compulsive symptoms (15.6%) was significantly higher than that of the control group (2.9%). Twin studies have shown that the same rate of twins is higher than that of twins. It suggests that the occurrence of obsessive-compulsive disorder may have a certain genetic predisposition.
2, biochemical changes: Some people think that 5-HT energy system may be related to the onset of obsessive-compulsive disorder, there are 5-HT reuptake blocking drugs, such as selective 5-HT reuptake inhibitor (SSRI) can be effective for obsessive-compulsive disorder . Some scholars have found that patients with obsessive-compulsive disorder have elevated serum prolactin or cortisol, and its role in the development of obsessive-compulsive disorder is still unclear.
3, anatomy and physiology: the relationship between the frontal lobe and the striatum is effective for refractory obsessive-compulsive disorder, presumably related to basal dysfunction.
4, psychology
(1) The psychodynamic theory of the Freudian school: The psychological mechanisms of the formation of obsessive-compulsive symptoms include: fixation, regression, isolation, release, reaction formation, and replacement of impermissible sexual and aggression impulses. This defense mechanism is unconscious and therefore not perceived by the patient.
(2) The learning theory of the behaviorist school: The behaviorist school believes that first, the patient causes anxiety due to a special situation. In order to alleviate anxiety, the patient produces an avoidance response, which is manifested as a forced ritual action. Some neutral stimuli such as thoughts and imaginations (such as language, words, representations, and thoughts) are accompanied by initial stimuli, which can further form a higher level of conditioning, which generalizes anxiety and ultimately leads to the formation of obsessive concepts.
Second, the pathogenesis
1. The results of the family survey showed that the risk of anxiety disorder in the first-degree relatives of patients with obsessive-compulsive disorder was significantly higher than that of the first-degree relatives of the control group, but their risk of obsessive-compulsive disorder was not higher than that of the control group. If patients with first-degree relatives who had obsessive-compulsive symptoms but did not meet the diagnostic criteria for obsessive-compulsive disorder were included, the risk of parental obsessive-compulsive symptoms in the patient group (15.6%) was significantly higher than that of the control group (2.9%) ( Black et al., 1992). This compulsive feature has a higher prevalence in monozygotic twins than in twin twins (Carey and Gottesman, 1981). These results suggest that certain qualities of compulsive behavior are heritable. Other reports indicate that obsessive-compulsive disorder can coexist with schizophrenia, depression, panic disorder, phobia, eating disorders, autism, and hyperactive slang syndrome.
2, clomipramine, fluoxetine, fluvoxamine, paroxetine, sertraline and other drugs that inhibit 5-HT reuptake, for obsessive-compulsive disorder Good results; and other tricyclic antidepressants that inhibit 5-HT reuptake, such as amitriptyline, imipramine, and imipramine, have poor therapeutic effects on obsessive-compulsive disorder. The reduction of obsessive-compulsive symptoms is often accompanied by a decrease in platelet 5-HT content and cerebrospinal fluid 5-hydroxyindoleacetic acid (5-HIAA) content. Pre-treatment platelet 5-HT and cerebrospinal fluid in patients with higher basal levels of 5-HIAA were better with clomipramine. Oral administration of a selective 5-HT agonist, methyl-chlorophenyl-piperazine (mCPP), can temporarily increase obsessive-compulsive symptoms. These all suggest that the increased function of the serotonin (5-HT) system is associated with the onset of obsessive-compulsive disorder.
3. Some clinical evidence suggests that the onset of obsessive-compulsive disorder may be related to the dysfunction of selective basal ganglia. For example, in the hyperactive slang syndrome, which is closely related to basal ganglia dysfunction, 15% to 18% of patients have obsessive-compulsive symptoms, which is much higher than the prevalence of obsessive-compulsive disorder in general residents (2%); head trauma, rheumatoid dance Symptoms, after Economo encephalitis, the basal ganglia is damaged and the patient has obsessive-compulsive symptoms; brain CT examination shows that some patients with obsessive-compulsive disorder have a reduced volume of bilateral caudate nucleus (Luxenberg et al., 1988); positron emission brain scans have been found In patients with obsessive-compulsive disorder, the bilateral caudate nucleus and the lateral metabolic potential of the frontal cortex are elevated (Baxter et al., 1987); patients with good results with 5-HT reuptake inhibitory or behavioral therapy have caudate nucleus, frontal lobe and Excessive activity of cingulate gyrus decreased (Baxter et al., 1992; Perani et al., 1995). Patients with active behavioral therapy also observed a significant decrease in synergistic activity between the detour and the caudate nucleus, suggesting that the dysfunctional brain circuit was severed (Schwartz et al., 1996). It has been suggested that the severity of the obsessive-compulsive concept is associated with the frontal and basal ganglia activities, and the accompanying anxiety reflects the hippocampus and cingulate cortex activity (McGuire et al., 1994), Brita et al. (1996), functional magnetic resonance imaging. Imaging (fMRI) showed that the behavioral-induced OCD symptoms in real-time showed a significant increase in the relative blood flow of the caudate nucleus, cingulate gyrus, and frontal cortex compared to resting state. Based on this type of research, the hypothesis is that the obsessive-compulsive disorder is caused by the dysfunction of the plaque-edge-basal ganglia. Resection of the frontal lobe and striatum is used to treat refractory obsessive-compulsive disorder and to reduce symptoms (Kettle and Marks, 1986), supporting this theory.
4. The Freudian school regards obsessive-compulsive disorder as a further development of the pathological compulsive character. Because the defense mechanism can't handle the anxiety of compulsive personality formation, it produces obsessive-compulsive symptoms. The psychological mechanisms of compulsive symptoms include: fixation, regression, isolation, release, reaction formation, and replacement of impermissible sexual and aggression impulses. This defense mechanism is unconscious and therefore not perceived by the patient.
The behaviorist school uses a two-stage learning theory to explain the mechanisms by which obsessive-compulsive symptoms occur and persist. In the first phase, anxiety is caused by a particular situation through classical conditioning. In order to alleviate anxiety, the patient develops an escape or avoidance response, which is manifested as a forced ritual movement. If the anxiety is alleviated by means of ritual actions or avoidance reactions, in the second stage, such compulsive behaviors are repeated and continued through operational conditioning. Neutral stimuli such as language, words, representations, and thoughts are accompanied by initial stimuli, which can further form a higher level of conditioning and generalize anxiety.
Prevention
Forced personality disorder prevention
1. Cultivate the whole body, including the development of brain function, and support it to be in a healthy state, so that the body is strong and full of spirit;
2. Cultivate healthy development of personality and strengthen exercise so as to adapt and integrate with the social environment.
Because the disease usually occurs in adolescents, about one-third of the cases start from 10 to 15 years old for the first time. Therefore, the main characteristics of the physiological psychology of adolescents and the basic content of mental health are highlighted.
Adolescence is a transitional period from childhood to adult, with sexual maturity as its physiological basis, often referred to as adolescence, but only physical maturity and reproductive capacity do not make a person an adult. Along with physiological maturity, adolescence also has a series of psychological changes, such as changes in sexual psychology, self-awareness and self-identity, cognitive changes, socialization, and so on. Therefore, the so-called transition period, rather than being understood as the stage of development of the body, is better understood as the stage of development of the mind. It is a childhood that is dependent, cared for, and regulated according to the special norms determined by adults. It is independent and responsible to adults. The transition process of life.
The development of adolescent body and psychological development are generally accompanied by each other, and the development of the body may be slightly earlier, depending on the individual's quality, family social background, parenting style, life experience, etc., one looks A 17-year-old boy who looks exactly like an adult may still stay in a stage of total dependence on his parents. An 11-year-old girl who has just begun to develop may have taken care of her younger siblings independently and dealt with the problems in her and her family's daily routine.
First, the physiological and psychological changes in adolescence
1. Physical changes and psychological reactions: When adolescence comes, young people have to experience rapid growth and changes in the body. Muscles, bones and other tissues grow rapidly, their height and weight increase rapidly, and with the maturity of the reproductive system. The second sexuality gradually appeared, the boy appeared a beard, the throat became bigger, the voice became thicker, the girl's breast development changed, the body fat increased, became full, and the chest and hips increased. In addition, both sexes grow pubic hair. These changes took about two years to reach the peak of youth, and were marked by the presence of live sperm cells in the girl's menstruation and boy urine. The age at which puberty arrives varies greatly from person to person. Some girls can go through as early as 11 years old, while others may go through 17 years of age, with an average age of 12 years and 9 months. Boys reach sexual maturity in the same age range, but on average the boy enters the peak and maturity stages 2 years later than the girl. Until the age of 11, the average height and weight of boys and girls are the same; at 11 years old, the girl suddenly surpasses the boy in both height and weight, the girl keeps the gap about 2 years away, then the boy exceeds the girl, and in the future Always stay ahead. This difference in body development speed is most pronounced in the junior high school stage, and it is often found that a "young woman" who is quite well-developed sits next to a group of undeveloped boys.
As the body develops, young people must adapt to the new self in development, and must also adapt to the reactions others have shown to his new image. For a developing teenager, neither is it like an adult nor a child. Their bodies may be slender, and the proportions of the parts may not match. This may make some young people feel uncomfortable, and some adverse reactions from people around them will aggravate their frustration. The young man is a "grass stalk", a boy with a thick beard and a "bearded beard", and a young man with a fast developing body and a slow head develops his comments as "developed limbs, simple mind" or "small head" Children" and so on.
The speed of development, sooner or later, also puts pressure on young people. For example, boys with late development face a particularly difficult situation of adaptation, because strength and bravery are very important in the activities of their peers. If they are shorter and thinner than their classmates, they may lose in some competitions and may never catch up with boys who develop early and who are dominant in physical activity. Research indicates that boys with late development are generally not as good as their classmates, and their self-concepts are poor. They often engage in behaviors that are less mature and look for attention. They feel that they have been abandoned by their peers and suppressed by their peers. On the other hand, children who develop early are often more confident and independent. These personality differences caused by early or late development may continue into adulthood, and the effect of developmental speed on personality is less obvious for girls. Some precocious girls may be disadvantaged because they are more like adults in the late primary school than their peers. However, in the early middle school, precocious children tend to be more prestigious among their classmates and lead in school activities. Late-matured girls, like late-matured boys, may have less appropriate self-awareness and are less closely related to their parents and peers.
Physical changes caused by sexual maturity are both a source of pride and a source of confusion. Whether young people feel comfortable with their new physique and the accompanying impulses depends to a large extent on the sexual development of their parents. Attitude. Parents' sexual privacy and taboo attitudes can cause anxiety among young people, and this anxiety may be gradually overcome by the fact that peers have a more realistic view.
2, to achieve the same: with the rapid changes in the body, the previous trust in the physical presence and physical function is seriously suspected, only through the re-evaluation of the self can be rebuilt. Young people struggle to find the answer "Who am I?" and "Where am I going?"
In the process of physical change and sexual maturity, young people have some new experiences and feel new reactions from people around them. They will try to find out what they are now and what they will become in the future. The interaction of partners and the emergence of new social relationships have also enabled them to expand their space for self-activity and self-exploration. They also need to understand what the world looks like. What is society? How do I relate to them?
Young people's early consciousness of their own characteristics developed from the various self-resident roles of children. The values and ethical standards of young children are mainly from parents. Their self-esteem basically comes from the parents' views on them. When young people come to the wider world of middle school, the values of peer groups are increasingly important, teachers and adults. The same is true for evaluations. They re-evaluate the original ethical standards and their own values and abilities, and try to combine these values and evaluations to form a stable system. When parents' opinions and evaluations are clearly different from those of peers and other important people, there is a high possibility of conflict. Young people try to play one role after another, and when they combine different roles into a single personality, they encounter difficulties, the so-called "role confusion."
3. Changes in attachment relationships: The emotional connection between parents and parents will be alleviated. They want independence and tend to associate with each other. They used to be family members. They are now becoming young people, both members of the family and members of the partner group. The shortening of time with the family and the expansion of the means of transportation and activities have led to the expansion of attachment and social relations. Their emotional connection with other adults may be close to their parents, such as relationships with teachers, leaders, and neighbors. From primary school to high school, a large number of partnerships are formed, and gender attraction is also an important reason for peer relationships. Dating often begins with group activities. In partnerships, peer-to-peer discussions of common issues and negative experiences can provide a wealth of problem-solving techniques.
Some young people are alienated by their families, in part because of the increase in their time away from home. In adolescence, there are several modes of communication that may occur in the family. There are two modes of alienation, one of which is the expelling mode, which involves ignoring or rejecting young people, and parents give up their care roles. No longer care for young people, encourage children to go out. The release mode is often used by some parents who are exhausted by their own life problems (such as marital problems). There is no energy to control the child, and the other is the delegating mode. Adolescents are implied to adopt a behavior that gives parents an alternative and enjoyable way to do what their parents want to do. Doing things also includes some bad habits that express parents.
4, cognitive changes: adolescence due to the emergence of formal computing to improve thinking, it got rid of the single concrete operation and simple image thinking in childhood, entered the stage of abstract thinking. 53% of teenagers between the ages of 16 and 20 can solve problems with abstract thinking, 65% between the ages of 21 and 30, and some people are lacking for life, but IQ is not solely based on abstract thinking, it is influenced by culture and experience. After using abstract thinking, young people find that they can make various assumptions arbitrarily and learn to test hypotheses. They learn to self-criticize, and each aspect demands themselves as an adult's standard and has the ability to listen to others' opinions. They can regard their own internal subjective experience as a real part. Abstract thinking also enables young people to consider more possibilities when dealing with problems, and the quantity and quality of thinking activities are greatly improved. But young people can't distinguish what they think is different from what others think, because he mainly cares about himself. He believes that what others care about is also his appearance and behavior. D. Elrind, the chief interpreter of Piaget's theory, called this phenomenon adolescent egocentricity and pointed out two consequences: an imaginary audience and a personal fable. The former refers to Young people will project their own concerns and interests to others, and believe that their behavior, appearance and self are being watched by others, so they pursue self-expression, chasing and dressing and rebellion against tradition. Because they think that they are the objects of concern to others, teenagers are prone to such a viewpoint that they and their emotions are unique, that is, personal deification. They are prone to some religious beliefs and believe that they are guided and supported by God. I am not subject to the laws of nature. If I believe that I will not die, I will not be pregnant if I dont use contraception to date my boyfriend. When I share their opinions, perceptions and experiences with my partners, my personal deification will diminish. Find yourself as a single person, not unique.
Second, the common social psychological factors affecting adolescent mental health
1. Cultural background: the traditional culture's totem for reading, the idea of "the scholar-officials", the concept of "all kinds of products, only high reading", the pursuit of high credits, high admission rate, and the expectations of parents for their children are too high. Strict phenomena make young people have excessive psychological pressure. In addition, Confucianism promotes rationality, reason, and etiquette, and promotes the socialization of young people, while at the same time causing the suppression of adolescents' personality, or rebelling against it and becoming a rebellion against society.
2. The problem of the only child: The "Four Two One" family model naturally biases the family's center of gravity toward the child. On the one hand, it causes the parents to overprotect the child so that the child's ability other than learning can not develop normally, forming a so-called " High scores and low energy." On the other hand, parents pay too much attention to their children and rely too much on their own happy sources to make their children bear more mental burdens. It is easy to form teenagers who are tired of learning, truancy, and anxiety and depression.
3. The pressure of entering a higher school: the traditional ideas of Jackie Chans thoughts and the tendency to pay more attention to grades in higher education have put children under too much learning pressure. This situation is expected to be improved in the reform of the education system and the rising wave of burden reduction. .
4. Family factors: Children's problems are often part of family problems, and family function disorders play a vital role in children's mental health. Children who grow up in unstable families are often prone to emotional and behavioral disorders. Parental disharmony, divorce, and fostering all contribute to the child's insecurity and mental health problems.
5, own personality factors: perfectionism tendencies, a single happy source makes young people think that "I must be stronger than others" "I can't have shortcomings" "must be tested first" "to get everyone's praise" Therefore, they have withstood Without frustration, swing back and forth between inferiority and arrogance. Insufficient socialization and self-centeredness make it difficult for adolescents to get along with others.
Complication
Compulsive personality disorder complications Complications, insomnia, depression
Insomnia and depression.
Symptom
Obsessive-compulsive personality disorder symptoms common symptoms compulsive personality obsessive-compulsive compulsive association
Repeated obsessions. The concept of obsession is a thought, representation or intention that repeatedly enters the field of patient consciousness in a rigid form.
Examine
Examination of obsessive-compulsive personality disorder
Obsessive-compulsive disorder is characterized by persistent, imposed, unwanted thinking and uncontrollable thinking. Compulsive thinking is often about polluting, hurting yourself or others, disasters, blasphemy, violence, sex or other painful topics. These thoughts are the patient's own, not inserted by the outside world (such as the "thinking insertion" of schizophrenia. This kind of thinking also includes the imagination or scene in the brain, which makes the patient very painful and can lead to Extremely upset.
The basic symptoms of the disease are obsession and compulsion. More than 90% of patients have both obsessive and compulsive behaviors; but according to Of et al. (1995), 28% of patients are mainly obsessive-compulsive, 20% are mainly forced, and 50% are very protruding. The patient has a certain degree of self-awareness about the obsessive-compulsive symptoms, knowing that such thinking or behavior is unreasonable or unnecessary, and trying to control is not successful. About 5% of patients do not think that their concept and behavior are unreasonable when they first get sick, and there is no treatment requirement, which is called obsessive-compulsive obsessive-compulsive disorder.
First, the concept of obsession
Refers to the thoughts, appearances, emotions or intentions that repeatedly enter the field of patient consciousness. These are of no practical significance to the patient, and are unnecessary or redundant. The patient can also clearly realize that this is not right, and know that these are his own psychological activities, and he wants to get rid of it, but he is powerless and therefore very distressed.
1. Obsessional thoughts: Some words, discourses, ideas or beliefs repeatedly enter the field of patient consciousness, interfere with the normal thinking process, knowing that it is not right and can not be controlled, can not get rid of, can have the following forms of expression.
(1) Forced suspicion: The patient repeatedly doubts the correctness of his words and deeds; knowing that it is unnecessary, but he cannot get rid of it. For example, when you go out, you suspect that the gas is closed; although it has been checked once, twice, three times... still not assured. Another example is whether the file is signed with its own name, whether it is wrong, whether the number of pages is correct, and so on. At the same time of suspicion, often accompanied by anxiety and anxiety, it prompts patients to repeatedly check their behavior, can not terminate, very painful.
(2) Compulsive and exhaustive thinking: The patient has some questions or natural phenomena in daily life, and he has to think about it in detail. He knows that there is no practical significance, but it is not necessary, but he cannot control himself. For example, thinking over and over again: Why is rice white, millet is yellow? And coal is black? Why are leaves green, not other colors? Sometimes they can't stop, so they can't eat, sleep, sleep, and can't be relieved. Some patients show that they are endlessly arguing with their own minds.
(3) Forced association: When a patient sees a sentence or a word, or a concept appears in his mind, he or she can't help but think of another concept or phrase. If Lenovos concept or statement is contrary to its original meaning, such as unity, it immediately associates with split; seeing the sky... immediately associates with underground... and so on, calling compulsive opposition (or compulsive opposition). thinking). Because the emergence of the concept of opposites violates the subjective will of the patient, the patient is often distressed.
(4) Forced representation: refers to the repeated visual experience (representation) in the mind, often with a disgusting nature, and can not be rid of.
(5) Forced recall: The patient's experienced events are involuntarily repeated in the mind, unable to get rid of, and feel distressed.
2, forced emotions: manifested as unnecessarily worried or disgusted with certain things, knowing that it is unnecessary or unreasonable, and that they cannot get rid of themselves. For example, worry that you will offend a colleague or boss, worry about the people around you, and worry that you will be irrational, fearing that you are contaminated with poison or bacteria. If you see a hospital, a mortuary, or someone, you immediately have a strong sense of disgust or fear, knowing it is unreasonable, but you can't control it, so you try to avoid it, called obsessional phobia.
3. Forced Intention: The patient repeatedly experiences and wants to make a strong inner impulse to act or act contrary to his or her wishes. It is absurd and impossible for patients to know that it is impossible to try to control themselves not to do it, but they cannot get rid of this inner impulse. For example, there is an inner impulse to jump down the window of a tall building; watching what his beloved wife wants to kill her. Although this kind of inner impulse was very strong at the time, it was never put into action.
Second, forced behavior: refers to recurring, rigid ritual movements, knowing that it is unreasonable, but has to do it. Often responsive to the anxiety caused by obsessive-compulsive attitudes, but these behaviors do not give a pleasant feeling, with forced examinations and forced cleansing (especially hand washing) most common. Patients often see that they can prevent certain objectively unlikely events and consider them to be harmful to patients, often secondary to forced suspicion.
1. Forced examination: It is the measure taken by the patient to alleviate the anxiety caused by compulsive suspicion. If you repeatedly check the doors, windows, gas and water pipes when you go out, check the contents of the file repeatedly when you send the documents to see if you have written the wrong words.
2, forced cleaning: the patient always suspects that the clothes or clothes touch the dirt, in order to eliminate the fear of contamination by dirt, odor or bacteria, often wash hands, bath or wash clothes. Some patients not only wash themselves repeatedly, but also those who want to live with him, such as spouses, children, parents, etc. must also be thoroughly cleaned according to his requirements.
3. Forced inquiry: OCD patients often do not believe in themselves. In order to eliminate doubts or to worry about the anxiety of patients, it is often repeated to ask others to give explanations or guarantees. Some patients can express themselves in their own minds, asking themselves and answering them repeatedly to enhance their self-confidence.
4. Compulsive ritual action: When a patient produces a strong, persistent, uncontrollable forced impulse or desire to perform certain behaviors, often leading to anxiety and extreme uneasiness, this can be temporarily mitigated by performing specific ritual actions. Uneasy. This ritual action is usually associated with forced thinking. For example, the patient thinks that "my hand is dirty", which in turn stimulates repeated hand washing. Other patients repeatedly imagine that electricity and gas can cause fires, thus triggering repeated inspections of power supplies, electrical appliances, outlets, and gas switches. Most common forced ritual movements are cleaning or inspection. Other ritual actions, including going out, must go two steps forward and then step back, before going out; otherwise the patient feels intense nervousness. Before taking a seat, you must first touch your seat with your finger to sit down; this action may be symbolic in eliminating the concept of obsession. Compulsive counting, counting stairs, counting panes or doing things have a specific and stereotypical order. These movements are repeated, others seem unreasonable or ridiculous, and have no practical meaning in themselves, but the patient has completed the ritual movement just to reduce or prevent the tension caused by obsession or avoid anxiety.
Some patients only count in their own mind, or repeat certain sentences to relieve anxiety, is a mental compulsion. This symptom is not uncommon and is often overlooked. Although ritual actions are intended to alleviate anxiety or restlessness, this reduction in anxiety is usually short-lived. Some patients will think it necessary to repeat this ritual many times. Because many obsessive-compulsive patients have more than one type of forced thinking and related ritual movements, many of the time will be occupied by these ritual actions. In addition, obsessive-compulsive disorder can lead to avoidance of some things or situations (such as dirt, leaving home to avoid locking the door), thus affecting life. The symptoms of obsessive-compulsive disorder are dominant, unhelpful, and annoying to patients, families, friends, and colleagues.
5, compulsive slowness (compulsive slowness) can be slow due to ritual movements; for example, repeated inspections of electrical appliances, gas, so that patients can not go out, or even go home to check, so often do not work on time . But it may also be original. For example, whenever a patient reads a book, his eyes often stop at a certain word in a certain line, and the following contents cannot be read smoothly. This phenomenon may stem from the fact that the patient is not sure whether he has seen or understood the line of words and is therefore stagnant. These patients often do not feel anxious.
The above-mentioned obsessive-compulsive symptoms often make the patient entangled in some unrealistic concepts and behaviors, hindering normal work and life, and making patients feel distressed.
The pre-morbid personality of patients with obsessive-compulsive disorder is often characterized by coercion. This personality trait will be described in the Personality Disorders chapter. There are two main manifestations of this disease:
1. Forced thinking is the main clinical symptom, including compulsive concept, forced recall, forced appearance, forced suspicion, compulsive opposition, forced obsessive thinking, compulsive fear, etc.
2, with forced movement as the main clinical symptoms, such as forced washing, forced check, forced inquiry, forced ritualized action.
Characteristics of obsessive symptoms:
His thoughts and actions belong to himself; at least one of his forced thinking and movements is still vainly resisted by the patient, and at the same time, he is accompanied by obvious anxiety because of the unsuccessful resistance; repeated thoughts, appearances or impulses make the patient very unhappy. These symptoms can make patients feel troubled by the fact that they are entangled in meaningless behaviors and behaviors that hinder normal work and life. Obsessive-compulsive patients have a pre-existing personality with compulsive characteristics.
According to the typical obsessive-compulsive symptoms, the patient recognizes that the obsessive-compulsive symptoms originate from oneself, rather than being imposed or influenced by others, recurring, meaningless, knowingly not correct, and unable to get rid of, disturbing their daily life and learning. And work, very anxious, distressed, trying to eliminate or confront, or urgently require treatment, the general diagnosis is not difficult. However, in chronic cases, after trying to get rid of the obsessive-compulsive symptoms, patients form a behavior that adapts to their pathological psychology, no longer feel distressed about their obsessive-compulsive symptoms, and instead insist on retaining their pathological behavior and no longer require treatment. About 5% of patients do not think that their concept and behavior are unreasonable, and there is no treatment requirement, which is called obsessive-compulsive disorder.
According to ICD-10, forced thinking or behavior (or both) makes the patient feel painful, life is affected, is the patient's own thinking or impulse, and at the same time, at least one kind of thinking or action must not be resisted, think or do these The ritual movement is unpleasant, reluctantly repeating forced thinking or ritual movements. Most of the time, symptoms exist for more than 3 months, at least 2 weeks, can be diagnosed as obsessive-compulsive disorder.
Diagnosis
Diagnosis and identification of obsessive-compulsive personality disorder
Differential diagnosis of obsessive-compulsive personality disorder:
1. Schizophrenia: Forced thinking of obsessive-compulsive disorder is sometimes mistaken for illusion of schizophrenia. However, patients with obsessive-compulsive disorder often have self-knowledge and believe that this forced thinking is unrealistic. They often feel painful and anxiety because they cannot avoid it. However, patients with schizophrenia may have obsessive-compulsive symptoms in the early stage, and their obsessive-compulsive symptoms lack obvious psychology. The incentive has the characteristics of bizarre content, variable form and incomprehensibility. Moreover, patients often do not feel distressed, without obvious anxiety, and have no strong desire for self-control and desire for treatment, and their self-knowledge is incomplete. And the emergence of obsessive-compulsive symptoms in patients with schizophrenia It is only a part of the symptoms of schizophrenia, and may be accompanied by other symptoms of schizophrenia, which can be used as a basis for identification. In patients with chronic obsessive-compulsive disorder, short-term psychotic symptoms may occur, but they may recover soon. It is not considered that schizophrenia has developed at this time. A small number of cases of schizophrenia can coexist with obsessive-compulsive disorder, and the next two diagnoses should be made.
2, depression: depression patients may have obsessive-compulsive symptoms, often can be expressed as excessive thinking or thinking about specific ideas. However, these thoughts of depressive disorder are not as meaningless as obsessive-compulsive disorder, and depression, which is usually accompanied by obsessive-compulsive symptoms, is still dominated by depressed mood disorders. People with obsessive-compulsive disorder are also often associated with depression. It should be analyzed from the pathogenesis process to analyze whether the main clinical symptoms are obsessive-compulsive symptoms or depression; whether the obsessive-compulsive symptoms are primary or secondary to depression. The obsessive-compulsive symptoms of depression patients can be eliminated with the disappearance of depression; and the depression of patients with obsessive-compulsive disorder can also be improved by the reduction of obsessive-compulsive symptoms. Two types of symptoms exist independently and should be diagnosed in the next two cases.
3. Phobia: The core symptom of phobia is fear of a special environment or object. The object of fear comes from objective reality, with obvious avoidance behavior, without obsessiveness; while forced thinking and behavior are derived from the subjective experience of patients. Its evasive behavior is related to forced suspicion and forced fear. Both diseases can also exist at the same time.
4, brain organic diseases: central nervous system organic diseases, especially basal ganglia lesions can also appear obsessive-compulsive symptoms. Identification based on medical history and physical signs.
5. Excessive repetitive behaviors with intrinsic pleasure, such as gambling, drinking or smoking, cannot be considered compulsive. The behavior of forced behavior is an unpleasant repetition.
6, obsessive-compulsive disorder in addition to schizophrenia and depression comorbidity, but also with hyperactive slang syndrome, tic disorder, panic disorder, simple phobia and social phobia, eating disorders, autism, etc. presence. All should be diagnosed according to the diagnostic criteria.
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is useful for understanding the characteristics of the symptoms, establishing a good doctor-patient relationship, and designing a behavioral treatment plan.
