People with obsessive-compulsive disorder (OCD) feel the need to release anxiety by performing rituals or repeating activities to prevent frightening phenomena from occurring. Usually they are aware of the absurdity of their behavior and are ashamed.
PRECISION, PERFECTIONISM OR COMPULSIVE OBSESSION?
When watching children's games, certain rituals come to mind: “If I get to the end of the street without stepping on the joints of the sidewalk, I will get a good mark on my piece of paper. » As adults, we haven't always given up on these habits. We sometimes organize rituals to ward off fate: "If I wear this jewel, my interview will go well." It is our participation in superstition, which is not pathological as long as it does not interfere with our daily life. "
Being a perfectionist, obsessed with organization or very demanding does not necessarily mean being compulsive. These behaviors often serve to improve one's own image and contribute to professional success. There is nothing pathological in this, as long as the time spent in these activities is reasonable and as long as the behavior does not cause anxiety, suffering, or harm to social and emotional life.
WHAT IS OBSESSIVE COMPULSIVE DISORDER?
Obsessive compulsive disorder, also known as OCD, is a form of anxiety disorder. People with OCD obsess over troubled thoughts that are hard to ignore, parasitize their minds, and cause strong feelings of guilt.
We all have disturbing ideas sometimes, but we know how to dismiss them as unreasonable. The person with OCD misinterprets these intrusive thoughts and sees them as signs of impending doom. A person with obsessive-compulsive disorder becomes exhausted fighting these dark thoughts and the fear and guilt they cause: this is called obsession. She is aware that these recurring ideas are unfounded and disproportionate, but that her attempts to counter them generate an unacceptable level of anxiety. The most common obsessions are dirtiness, fear of committing acts of violence, fear of outrageous behavior.
Faced with these obsessions, repetitive actions or compulsions are a way to escape fear. The sick person feels obliged to perform certain rituals to prevent frightening phenomena from occurring. However, he is aware that this is ridiculous. Gradually, the brain learns that this little trick quickly relieves anxiety, but this respite is only short-lived. This ritual is repeated more and more often and turns into an obsessive compulsive disorder, a trap living in secrecy and shame.
If, for some reason, an external element makes it impossible to perform the ritual, the anxiety reaches an unbearable level. The rituals can last several hours during the day, disrupting daily life and preventing access to normal social and professional life. They often cause the sufferer to live a life of secrecy and shame, which eventually leads to exhaustion and depression.
WHAT ARE THE SYMPTOMS OF THE DIFFERENT OCDs?
Rituals for calming anxiety can take several forms: checking rituals (constant checking that locks or gas are closed, household appliances disconnected from the power supply, turning off the power); repetition rituals (going through and through doors, repeated gestures, repeating a word or a number); ordering and ordering rituals or avoidance rituals (one never takes a specific path, one never touches a specific object).
The person is afraid to simply invoke an object or situation, even if it is not present (as opposed to a phobia). The most common obsession of this type is the fear of getting dirty, infected with germs or contaminated by radiation, toxic waste or household products. These obsessions are accompanied by excessive washing and cleaning rituals: washing your hands several times a day or showering several times, according to rules that may seem strange, such as taking and putting soap twelve times before use.
OBSESSIONS ON THE POINT OF ERRORS OR OMISSIONS
It is, for example, the constant and obsessive fear of forgetting to do something, of doing a bad job, of losing an article, of making a mistake in a letter. Obsessive thoughts focus on morality, religion, the idea of what is right
People are afraid of committing a criminal, perverse, sacrilegious or absurd act, or of killing unintentionally, for example by crossing a pedestrian with their car.
They cause an excessive need to accumulate worthless or completely useless objects. In some severe cases, the apartment may be completely covered in trash.
OBSESSIONS OF ORDER AND SYMMETRY
The patient believes that a serious event can happen to a loved one or to himself, if certain elements are not perfectly arranged or positioned in a certain way.
WHAT CAN HAPPEN WITH UNTREATED OCD?
Untreated OCD causes depression in more than half of cases. They can also cause social phobia associated with shame towards the symptoms of the disease and fear of judgment by others.
It is possible to live with OCD, which can be periodic or permanent. Sometimes this disorder decreases with age.
WHAT CAUSES OCD?
OCD seems to have multiple origins: genetic, biological and psychological. Genetic sensitivity has been demonstrated in particular by studies carried out on patients with identical twins: 60% of them also had an obsessive-compulsive disorder. Brain function research has shown that people with OCD experience changes in nerve activity in certain areas of the brain.
Psychoanalysts say that Obsessive Compulsive Disorder is an expression of the defense mechanism of the psyche against manifestations of unconscious aggression. This defense then takes the form of great mental rigidity and numerous prohibitions.
TOCS AFFECT WHO?
It is estimated that 2% to 3% of the population is affected by an obsessive-compulsive disorder. Two-thirds of patients suffer from the onset of the disease before the age of 25, sometimes in early childhood. While the proportion of men and women in the adult group is about the same (52% of women), boys are more likely to be affected than girls in adolescence.
Obsessive-compulsive disorder is the fourth most common psychological disorder in terms of frequency, after phobias, addictions and depression.
Certain personality traits seem to be present in people predisposed to this disorder: an exaggerated sense of responsibility, an inability to tolerate uncertainty, a tendency to overestimate the importance of others' opinions and the need to control them, for example.
HOW IS OCD DIAGNOSED?
The presence of obsessions, compulsions, or a combination of the two is not sufficient to make a diagnosis of OCD. If the obsessions and compulsions take up more than an hour a day and significantly interfere with work, social activities, and relationships, then OCD may be present. Time spent performing rituals is an indicator of disease severity. Obsessions should be repetitive, persistent, intrusive, and evoke obvious anxiety or distress, even in the absence of the feared object or situation. Compulsions are irresistible, but they are only relatively effective in relieving anxiety.
The time between disease onset and diagnosis is often long because people with OCD tend to hide their symptoms for as long as possible. They organize their lives so that their compulsion is invisible, even to those close to them.
Treatment for obsessive-compulsive disorder involves the use of psychotherapy techniques and possibly antidepressants. The goal of psychotherapy is to maintain social and emotional life, despite the possible persistence of certain symptoms after the end of treatment.
IS PSYCHOTHERAPY EFFECTIVE IN THE TREATMENT OF OCD?
Behavioral therapy is often used to treat OCD. During forty to fifty sessions, the person with OCD is voluntarily confronted with situations that cause anxiety, first mentally and then in everyday life. The person is strongly encouraged to develop other measures to control their anxiety.
Cognitive therapy can be started at the same time. It helps the patient to reinterpret his invasive thoughts more objectively, bringing out their irrational and unjustified side. These therapies are often effective. However, the disappearance of the OCD can sometimes lead to the appearance of another symptom of anxiety (ex: phobia, panic attack).
Psychoanalysis and analytic-inspired psychotherapy, which require a longer investment, are not very effective in relieving symptoms in the short term. However, they can help uncover the source of the conflict behind these disorders and thus lead to lasting well-being.
WHAT MEDICINES ARE USED TO TREAT THE SYMPTOMS?
Antidepressants are the main drugs used and are said to be effective in around 60% of cases. Often the symptoms lessen without the intensity disappearing completely.
Two types of antidepressants are used: certain serotonin reuptake inhibitors (SRIs) and the antidepressant imipramine clomipramine (Anafranil and its generics).
Antidepressants seem to be more effective with obsessive thoughts than with compulsive thoughts. The doses used are often higher than for the treatment of depression.
Sometimes treatment may not be effective for up to two months. This should not discourage patients from continuing their treatment. Discontinuation of treatment should be gradual and spread over several months.
CBD in Obsessive Compulsive Disorder Syndrome
People with OCD report that the severity of their symptoms were reduced by about half by using cannabis, according to a study from Washington State University.
The researchers analyzed computer data from people who self-identified as having obsessive-compulsive disorder, a condition characterized by intrusive, persistent thoughts and repetitive behaviors such as compulsively checking for door locks. After using cannabis, consumers reported that it reduced their symptoms by 60%, intrusive or unwanted thoughts by 49% and anxiety by 52%.
A study, published in the Journal of Affective Disorders, found that higher doses of cannabis with higher concentrations of CBD or cannabidiol were associated with reduced compulsion.
"The overall results indicate that cannabidiol may have a positive effect on OCD in the short term, but not in the very long term," said study author Carrie Cuttler, assistant professor of psychology at WSU. "For me, the results of CBD are promising because the cannabidiol molecule is non-psychotropic and non-addictive. This is an area that would really benefit from clinical research on changes in compulsions, and anxiety with pure CBD."
Current treatments for OCD include Behavioral therapy is often used to treat OCD, in which people's irrational thinking about their behavior is directly challenged, and medication with certain serotonin reuptake inhibitors (SRIs) and antidepressant. Although these treatments have beneficial effects for many patients, they do not cure the disorder and do not work for everyone with OCD.
"We're trying to learn more about the relationship between CBD consumption and OCD because that's an area that's really underestimated," said Dakota Mauzay, a doctoral student in Cuttler's lab and first author of the article.
In addition to their own research, the researchers found only one other study on the subject: a small clinical trial with 12 patients that found a reduction in OCD symptoms after consuming legal cannabis, but this did not was not much more than the reduction associated with placebo.
further research, especially clinical studies on the CBD cannabis component, may demonstrate therapeutic potential for people with OCD.
TOC , Health Insurance, 06/2018
Guide to psychiatric well-being, Vidal, 2008