Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by persistent, recurrent, and intrusive thoughts that cause restlessness, apprehension, fear, or worry, and behaviors repetitive actions called compulsions, aimed at reducing the associated anxiety. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, published in 2013, locates OCD and related conditions in a separate chapter, thus breaking with the tradition of including it in the chapter on anxiety disorders, as previous editions of the DSM did.

The symptoms and importance of OCD can occur at any age, and can cause significant disability. The WHO included it among the top 10 most disabling diseases and among the 5 most disabling mental illnesses, with a lifetime prevalence of 2.3%. Various scientific studies show that patients suffering from OCD have a quality of life very low, as this condition can be mentally and physically exhausting, and itself cause temporary or permanent incapacity for work. Common obsessions include fear of contamination, fear that self or others are in danger, need to maintain order and accuracy and excessive doubts. The most common compulsions performed in ritualistic response to these obsessions include washing hands, counting, hoarding, and fixing things.

It is characteristic that the person who suffers from OCD is reluctant to reveal their symptoms to others, which is why it is common for them to seek help many years after the appearance of the problem, as well as the presence of depression. co-occurring (in fact, about 34% of people with OCD suffer from depression at the time of diagnosis, while 66% will suffer from it throughout their lives).

If any of the symptoms are detected, it is important that the person is treated by a professional, since untreated OCD can be one of the most irritating and frustrating disorders. A person with OCD realizes that he has a problem, and his family and friends usually do as well. Patients often feel guilty for their abnormal behavior, and family members may become angry with them because they are unable to control their compulsions. Other times, in their desire to help them, they may pretend that the symptoms do not exist, justify them, or even collaborate in their rituals (an action that is considered counterproductive).^{[citation required]}

The discovery that some drugs are effective in the treatment of OCD has changed the view of this neurological problem. Today there are not only effective therapies, but there is also great research activity on the causes of this neurological problem and a search for new treatments. The pharmacological treatment of OCD is based on the use of antidepressants, whether they are the classic tricyclics or the more modern selective serotonin reuptake inhibitors (SSRIs).

Despite the severity of the problem and the disability it creates, only 35% to 40% of people with obsessive-compulsive disorder seek treatment and only less than 10% receive evidence-based treatment.

Definition

Obsessive-compulsive disorder (OCD) is a psychiatric syndrome belonging to the group of anxiety disorders characterized by:

• Obsessions: are recurring and persistent ideas, thoughts, images or impulses that are selfish, that is, they are not experienced as voluntarily produced, but rather as thoughts that invade the consciousness and are lived as exaggerated or meaningless, sometimes as repugnant. The patient makes attempts to ignore or suppress them, sometimes without getting it. It is then that compulsive behaviors aimed at reducing anxiety caused by obsession are initiated.

• Compulsions: They are repetitive behaviors, generally "capricious", and seemingly finalists that are performed according to certain rules in a stereotypical way and whose main function is to reduce the anxiety caused by obsession. Conduct is not an end in itself, but is designed to produce or avoid any future event or situation, related to the obsession in question, so its realization reduces the anxiety caused by the latter. However, or activity is not realistically connected with what is intended to prevent or provoke, or may be clearly excessive. The act is performed with a sense of subjective compulsion along with a desire to resist compulsion, at least initially. In general, the individual recognizes the lack of sense of behavior (something that does not always occur in young children) and does not get pleasure in doing this activity, although this decreases the anxiety caused by his obsession. The patient immediately notices that a single compulsion or "ritual" is not enough to reduce his anxiety, so he is forced to repeat or increase the ritual (vicious circle). Typical examples are to check the same things several times over and over, as in the repetition of patterns the patient gets an immediate reduction of discomfort, although clearly counterproductive, since with them he is reinforcing the dynamics of the disorder.

• Obsessions and compulsions are a significant source of discomfort for the individual or interfere in social, labor and daily activity, occupying much of the individual's time. Generally, the affected person is aware of the irrationality of his or her disorder, and may feel guilt and shame for it, or have "fear to go crazy". Each ritual, or pattern of rituals, is linked to the same obsession, and the sick man "haves" to perform several throughout the day, bringing all this a great waste of time and discomfort in his daily life.

• It should not be confused with the phobic disorders.

• It should not be confused with the "manies" or rituals that we can all have regarding some issues. Obsessions in the TOC invade the mind of the person, and this cannot feel quiet until it does not make the compulsion that calms. Unlike "manies" obsessions create anguish, are not controlable, are persistent and dysfunctional, and affect, to a greater or lesser extent, the normal functioning of the subject in his daily life. Likewise, repetitive and intrusive punctual concerns or thoughts, or compulsive-type routine behaviors are normal in the general population, and do not limit the individual's life. In TOC the intensity, frequency and duration of such thoughts and behaviors are exaggerated.

• Obsessive-compulsive disorder is statistically equal in men than in women.

Types of OCD and recurring obsessions

Types of OCD

Within OCD, the most common types can be distinguished:

• Washers and cleaners: They are people who are in possession of pollution-related obsessions or contagion through certain objects or situations (contaminated themselves or infected others). Obsessions in relation to the spread of the disease through dirt, microorganisms and toxic substances. They often wear gloves or disinfectants, wash and clean their hands, clothing, general house cleaning, a countless number of times a day, even though they never manage to feel clean or free of contaminants. Also included compulsive cleanersJust for the simple fact of having things perfectly clean, as if it were correct way.

• Verifiers: are people who inspect excessively with the purpose of preventing a certain catastrophe from happening; forced to check objects, such as door locks (to be assaulted by thieves), contract listings and appliances (gas, vitroceramics, heater, plugs). They review drawers, doors and electrical appliances to ensure that they are closed, safe or off; they live with excessive and irrational fear of causing harm to themselves or others because of a lack of control and constantly verify things; they visualize terrible catastrophes in which they are blamed for a lack of responsibility; they develop elaborate control rituals that make it difficult for them to complete daily tasks. They have a great need for double or triple verification Often, this obligation comes from the fear of not being able to trust in their memory; they can never be sure if they have done the task properly; they will be asked repeatedly if an action has been taken, for example, “Will I close the door?”, “I put the light off?”, “Will I close the gas key?”, etc.

• Somatic and hypochondriac verifiers: persistent obsessive intrusions in relation to your health; fear of developing a life-threatening disease (e.g. cancer) (they panic with strange somatic symptoms and relate it to a serious illness that may end your life); they verify various bodily functions, such as heart rate, breathing rate, body temperature, or various aspects of your body or anatomical image.

• Repeaters: are those individuals who commit themselves to the execution of repetitive actions.

• Computers: They are people who demand that the things around them be arranged according to certain rigid guidelines, including symmetrical distributions.

• Accumulators: They collect insignificant objects, from which they cannot be detached.

• Mental Ritualizers: they tend to appeal to repetitive thoughts or images, called mental compulsions, in order to counter their provocative anxiety of ideas or images, which constitute obsessions.

• Numerals: They seek meaning from the numbers that surround them; adding them, subtracting them, changing them until it gives them a significant number for them.

• Philosophers: with somewhat uncertain tendencies. They live in a metaphysical process that they can't get off.

• Pure tormented and obsessive: They experience repeated negative thoughts, which are uncontrollable and quite disturbing. However, unlike those suffering from other types of CTOs, they are not given to repeated physical behaviors (without compulsions), but to repeated mental processes only.

• Shareholders: self-executing, they care about minor and irrelevant details; compelling need to do the perfect tasks; extreme need to know or remember things that can be very trivial; to keep things in a perfect order.

• Superstitious (magic thinking): People who suffer from TOC have high levels of paranoia, disturbances of perception and magic thought, in particular "fusion of thought and action", the belief that negative thoughts or certain acts can cause damage. These people feel the strong urge to perform repetitive (local) tasks without apparent meaning, to counter their intrusive thoughts as if leaving the doors open could harm the loved ones. They have the feeling that if they don't do the ritual something bad can happen to them. They can dogmatically believe in various popular superstitions (or harbor obsessive doubt), and perform compulsive rites. Fear of facts or supernatural beings (e.g. black magic, good luck, evil eye, werewolves, vampires, ghosts, etc.), for example to think that the dead cannot rest in peace if a certain ritual is not done (conscientious scruple).

• Compulsive questioners: they have the need to be constantly asking themselves or others about anything for nimia, trivial or absurd.

• Dubitative and undecided (intolerance to uncertainty): patients with CTO usually have difficulties with ambiguous and uncertain situations, and with decision-making. They usually worry about mistakes and doubt about their actions. They need the certainty necessary to maximize predictability and control, and thus reduce the threat and thus alleviate their anxiety.

Recurring obsessions and compulsions

Some of the obsessions and compulsions described below are rarely reported in the officially recognized scientific literature. However, clinical psychologists in their practice discover a series of "non-classical" obsessions that recur with relative frequency:

• Contamination losses: worry about germs (virus, bacteria, fungi, etc.), dirt, pollution, or dangerous chemicals; concern about body secretions (orina, stool, saliva, etc.); concern about contracting transmission and venereal diseases (sida, hepatitis, etc.), developing mental diseases (alzheimer, schizophrenia, psychosis, etc.), cancer, non-farmothering).

• Obsessions on health and physical appearance: diet, exercise, lifestyle; fashion and personal image; obsession with aging; orthorexia, anorexia, vigorexia, dysmorphophobia.

• Sexuality-related obligations: persistent thoughts about the realization of repugnant or forbidden sexual acts, or of taboo behaviors, which lives with anguish; obsession and doubts about sexual orientation to extreme points, obsessed with the subject so that they cannot live their life normal; associated compulsions: ask obscenities, perform obscene gestures, compulsive masturbation, etc.

• Obsessive-compulsive relational disorder (TOCR): symptoms focused on intimate/close relationships themselves or on the defects of the couple. The focus of such symptoms can be the intimate couple of one, your child or your God.

• Obsessions of aggressive content: fear of causing some kind of harm to other people or to oneself; fear of committing crimes or appearing as responsible for errors, failures, imprudence, accidents or catastrophes; by their minds they cross horrible and violent images.

• Philosophical-Religious Obsessions: the need to confess non-existent or intimate sins that are supposed to have been committed and to be concerned about the resulting guilt; conscientious scruples: excessively concerned about the possibility of committing any sinful act as regards their religion or belief (such as thinking or saying something blasphemous, profesing obscenities or insults, worrying if certain religious ritual has been properly compulsed, fear of repenting

• Obsession with intelligence: they submit to continuous and diverse intelligence tests to verify their intelligence, fear of losing points in the intellectual quotient.

• Info-obsessives (accumulators): obsession to accumulate, grab, control and order as much information as possible; always be aware of the latest trends and advances; in all fields of knowledge or in some particular, becoming very compulsive and anxious for their need of control; to purchase, store and classify in a compulsive way magazines, newspapers, books, encyclopedias, to be subscribed to newsletters, bibliostinums, digital collectors

• Other: addicts to work (worked.- Ludopatas.

Cognitive variables

According to the Obsessive-Compulsive Cognitions Working Group (OCCWG), aimed at reaching a consensus on the definitions of certain cognitive concepts related to OCD, cognitive variables (also known as O variables) most important in OCD are:

• Intolerance to uncertainty: set of beliefs related to the importance of control in all aspects of life in order to achieve security and certainty, due to the difficulty of functioning properly in ambiguous situations and having little skills to cope with unpredictable changes.
• Overestimation of the threat: the likelihood of a catastrophic event happening is magnified.
• Perfeccionism: beliefs based on the idea that finding perfect solutions is possible and necessary. The inability to tolerate minimal errors or imperfections is added.
• Excessive accountability: based on certain cognitive schemes, with rules concerning the correct conduct and the responsibility that are activated from certain critical or specific events.
• Beliefs on the importance of thoughts: referring to the importance given to thoughts and to the meaning attributed to them. This characteristic is called by some authors as "disfusion thought-action".
• Beliefs on the importance of control of one's thoughts: need to control all thoughts at all times. They make earnest efforts to try not to think about certain things or to eliminate certain kinds of thoughts.
• Rigidity of ideas.

Causes of TOC symptoms

Several theories suggest a biological basis for the disorder, and a number of studies are currently exploring this possibility. Transaxial Positron Emission Tomography (TETP) and other brain imaging techniques have suggested that there may be some abnormalities in the frontal lobe and basal ganglia that influence OCD symptoms. Recent meta-analyses of voxel-based morphometry studies comparing people with OCD and healthy controls have found that people with OCD present a bilateral increase in gray matter volume in the lenticular nuclei, extending to the caudate nuclei, while decreased gray matter volume in the bilateral frontal medial dorsal/anterior cingulate gyri. This is in contrast to findings in people with other anxiety disorders, who have decreased (rather than increased) bilateral gray matter volume in the caudate/lenticular nuclei, while also decreased gray matter volume in the bilateral frontal medial dorsal/anterior cingulate gyri.

It is important to remember psychodynamic factors as the cause of symptoms that are triggered in a self-conversion pattern. On the other hand, the family and therapists feel forced to accommodate to the disease by responding to coercive behaviors of the patient, for which therapeutic success depends to a great extent on interactive dynamic factors.

Other studies suggest that abnormalities in certain neurotransmitters (the brain's messengers) may be involved. One is serotonin, which is believed to help regulate mood, aggression, and impulsivity. It is also in charge of sending information from one neuron to another, a process that seems to be "slowed down" in people with OCD. Neurons that respond to serotonin are found throughout the brain, but especially in the frontal lobes and basal ganglia.

The brain concentration of serotonin is higher in men than in women. This makes psychoactive drugs (such as a serotonin reuptake inhibitor, SSRI) work better in them.

Latest studies reveal that, although the serotonin level is higher in men, it is not reflected in OCD, since the incidence of this disorder has not been correctly analyzed under the IIS bases.

Current evidence demonstrates the involvement of the gut-brain axis in various neuropsychiatric disorders. New avenues of research include the possible relationship of OCD with alterations in the intestinal microbiota and with celiac disease or non-celiac gluten sensitivity, with cases Documented reports of remission of obsessive-compulsive symptoms with the gluten-free diet.

There are many theories that try to explain the causes of obsessive-compulsive disorder (OCD), so it is believed that it could be a combination of several of them. Observational twin studies, showing a high concordance for the disease in monozygotic twins (80-87%, versus 47-50% in dizygotic twins), point to strong genetic factors involved in its development., although the mode of transmission is still unknown. On the other hand, it is believed that the education received in childhood plays an important role in its appearance, especially if it is about too rigid ways of educating.

The truth is that the exact cause is not known, but the combination of biological factors (family history of OCD) and social factors (such as overprotective and controlling parents) can explain the alterations that have been found. Most people with OCD had excessively controlling and upright parents who never strengthened their self-esteem and who, from childhood, contributed to their increased anxiety, insecurity, and lack of self-esteem, which in the end will cause negative thoughts and negative thoughts to appear in the child. concerns and already in adolescence and adulthood obsessions and compulsions.

As Guidano and Liotti have pointed out, "insecure" and cold parent-child interactions make the child (in some cases even adults) insecure about the degree to which they are loved, wanted, or valuable, which It can lead to a continuous rethinking of the parent-child relationship. Perfectionism and compulsive behaviors arise as a means of securing approval and stabilizing one's perception of value. Such styles of parent-child interaction can cause a child to fear experiencing strong feelings, which is counterproductive to giving him the person's ability to deal independently with emotional experiences, in such a way that when they have no one to help them with their emotions, obsessive rituals will flourish as the only means of making their world safe. In adulthood this will have a very negative effect about the interaction of the Tokian with a potential partner. At an early age, Toquianos typically react to this anxiety through aggressive acts (depending on their age, the anxiety may not be effectively articulated or even recognized) towards members of their own family. As Miguel Martínez, a psychoanalyst doctor, points out OCD specialist, a direct relationship has been found between affective ambivalence towards parents and the origin of obsessive OCD rituals.

It is observed that in both sexes marriage is late and that the fertility rate of the same is very low. People with OCD commonly have an educational level and above average intelligence (in fact, nature itself disorder requires more complicated than usual mental patterns) and are professionally competent, but their personal and family lives are unsatisfactory, given the interference that OCD exerts on them. Because compulsive rituals are often tedious and they waste a lot of time, Tokians tend to be systematically late for work or school, which can cause work and family problems. On the other hand, and according to various studies, many Tokians are isolated and have very few (or perhaps none) friends, as the need to perform their obsessive-compulsive rituals often leaves them with very little time or energy to devote to friends or family. The obsessive lives in a "cell" that he himself has created, allowing himself few liberties and blaming himself, in order to be in his punishment cell, carry out his rituals and calm down. Despite rejecting his "cell", at the same time time also accepts it, since it fears freedom and confuses it with the lack of limits. A tendency of Toquians has been detected to need too much the figure of the mother -even at high ages- in order to satisfy a unconscious desire for protection, which leads to problems of personal and sexual maturity and ultimately supposes an exchange of this "defense" for a satisfying life.

Diagnosis

DSM-5

1. Presence of obsessions, compulsions or both.
   • Obsessions:
     1. Recurrent and persistent thoughts, impulses or images that are experienced at some point in the disorder, such as intruders or undesired.
     2. The subject tries to ignore or suppress these thoughts, impulses or images, or neutralize them with some other thought or act (compulsion).
   • Compulsions:
     1. Repetitive behaviors or mental acts that the subject performs as a response to an obsession or according to rules to be applied rigidly.
     2. The objective of mental behaviors or acts is to prevent or decrease anxiety or discomfort, or to avoid any events or feared situation; however, these behaviors or mental acts are not realistically connected with those intended to neutralize or prevent, or are clearly excessive.
2. Obsessions or compulsions require a long time or cause clinically significant discomfort or deterioration in the social, labor or other important areas.
3. Compulsive obsessive symptoms cannot be attributed to the physiological effects of a substance or another medical condition.
4. The alteration is not best explained by the symptoms of another mental disorder.

ICD-10

Guidelines for diagnosis:

For a definitive diagnosis, obsessive symptoms, compulsive acts, or both must be present and be a major source of distress or incapacitation on most days for at least two successive weeks. Obsessive symptoms must have the following characteristics:

1. They are recognized as thoughts or impulses of their own.
2. There is ineffective resistance to at least one of the thoughts or acts, even if others are present to which the patient no longer resists.
3. The idea or realization of the act should not be in itself pleasurable (the simple relief of tension or anxiety should not be considered pleasurable in this sense).
4. Thoughts, images or impulses must be repeated and annoyed.

Includes:

• Obsessive-compulsive neurosis.
• Obsessive neurosis.
• Ananastic neurosis.

F42.0

With a predominance of obsessive thoughts or ruminations:

They can take the form of ideas, mental images, or impulses to act. Their content is highly variable, but they are almost always accompanied by subjective discomfort. For example, a woman may be tormented by the fear that at some point she will not be able to resist the urge to kill her beloved child, or by the obscene or blasphemous quality and alien to herself of a recurring mental image. Sometimes the ideas are just banal around an endless and almost philosophical consideration of imponderable alternatives. This indecisive consideration of alternatives is an important element in many other obsessive ruminations and is often accompanied by an inability to make decisions, even the most trivial, but necessary in everyday life.

The relationship between obsessive ruminations and depression is particularly close and the diagnosis of obsessive-compulsive disorder will be chosen only when ruminations appear or persist in the absence of a depressive disorder.

F42.1

With a predominance of compulsive acts (obsessive rituals):

Most compulsive acts relate to cleanliness (particularly handwashing), repeated checks to make sure a potentially dangerous situation has been avoided, or neatness and order. Underlying overt behavior is generally a fear of being the object or cause of danger, and ritual is an ineffective or symbolic attempt to ward off that danger. Compulsive rituals can occupy many hours of each day and are sometimes accompanied by a marked inability to make decisions and slowness. Collectively, they are as frequent in one sex as in the other, but hand washing is more frequent in women and slowing without repetitions is more common in men.

Rituals are less closely related to depression than obsessive thoughts and are more responsive to behavior modification therapies.

F42.2

With a mixture of obsessive thoughts and acts:

Most people with obsessive-compulsive disorder have both obsessive thoughts and compulsions. This subcategory should be used when both are equally strong, as is often the case, although it is useful to only specify one when it stands out clearly, as thoughts and actions may respond to different treatments.

F42.8 and F42.9

Other obsessive-compulsive disorders and Obsessive-compulsive disorder no specification.

Comorbidity

Depression

Obsessive patients tend to have more severe depression than patients with other anxiety disorders. The incidence of depression in obsessive patients ranges from 17 to 35%. In most cases, depression is usually secondary to OCD. Depression is three times more likely to follow OCD rather than precede it. When obsessive symptomatology subsides, depression tends to disappear as well. Concomitant depression is of no relevant importance in the prognosis of OCD.

Obsessive-Compulsive Spectrum Disorders

Various psychological disorders have been correlated with OCD, classified and included in the so-called obsessive-compulsive spectrum, and which are sometimes concurrent with OCD. Body dysmorphic disorder, eating disorders, hypochondria, impulse control disorders, Tourette syndrome, social phobia, etc. can be highlighted.

OCD Treatments

A form of psychotherapy called "cognitive behavioral therapy" and psychotropic medications are the first-line treatment for OCD. The fact that many people do not seek treatment may be partly due to the stigma associated with OCD.

It has been generally accepted that psychotherapy in combination with psychiatric medications is more effective than either option alone.

Psychopharmaceuticals

Various clinical trials have shown that medications that affect the neurotransmitter serotonin can significantly reduce OCD symptoms. The first psychoactive drug approved for the treatment of OCD was the tricyclic antidepressant clomipramine.

The second-generation psychoactive drugs, which are the most widely used today, are called Selective Serotonin Reuptake Inhibitors (SSRIs). Some of them are fluoxetine, fluvoxamine, and paroxetine. Another that has been studied in controlled clinical trials is sertraline.

Recently, dual drugs called Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), such as venlafaxine, and specific drugs such as mirtazapine, have begun to be used, which would be effective for treating both OCD and associated depression, in specific cases and especially when SSRI monotherapy proves ineffective.

Large studies have shown that these medications at least slightly benefit nearly 80% of patients, and in more than half of cases, the medication relieves OCD symptoms by decreasing the frequency and intensity of OCD symptoms. obsessions and compulsions. Improvement usually takes two weeks or more.

If a patient does not respond well to one of these drugs, or has unacceptable side effects, another SSRI may give a better response. Research is being done on the use of an SSRI as the main drug and one of a variety of other drugs as an augmenter for patients who are only partially sensitive to SSRIs. Medication is helpful in controlling OCD symptoms, but often a relapse occurs if the medication is stopped. In fact, even when symptoms have subsided, most people will need to take the medication indefinitely, perhaps at a lower dose.

SSRIs have improved efficacy in 40 to 60% of patients, but their side effects, intensified by the high doses usually required for treatment, lead to high dropout rates. One of the most common is its effect on sexuality, because it causes inhibition and difficulty reaching orgasm. In fact, SSRIs are among the drugs that can most interfere with sexual relations, since they work by increasing serotonin levels and, consequently, reducing impulsiveness, anxiety and, also, desire. Studies show that 80% of healthy young people who take paroxetine (a serotonergic) suffer from sexual dysfunction. Because of this, dopaminergic drugs are sometimes used—which do not have the negative effect on sexuality of serotonergic drugs—such such as agomelatine (Valdoxan).

For its part, the "natural treatment" of the TOC, based on the serotonin precursor L-5-Hydroxytryptophan, despite having been shown to be more effective than tryptophan, there is currently a lack of clinical evidence to prove the efficacy of its use.

Behavioral Psychotherapy (Exposure Response Prevention, RPE)

The specific technique used in cognitive behavioral therapy is called Exposure and Response Prevention (ERP) which involves teaching the person to deliberately come into contact with the situations that trigger obsessive thoughts and fears ("exposure"), without carrying out the habitual compulsive acts associated with the obsession ("response prevention"), and thus gradually learn to tolerate the discomfort and anxiety associated with the obsession. non-performance of ritualistic behavior.

For example, a patient who compulsively washes their hands may be encouraged to touch an object they believe to be contaminated, and then the person is told to avoid washing for several hours until the anxiety caused has been greatly reduced (the anxiety decreases with the passage of time, even if the patient believes otherwise). The treatment begins with a compulsion that causes little anxiety in the patient, and once this is overcome, the next one is passed, and so on, step by step, guided by the patient's ability to tolerate anxiety and control the rituals. As treatment progresses, most patients gradually feel less anxious about obsessive thoughts and are able to resist compulsive urges.

Studies and daily practice show that EPR is a very successful therapy for the majority of patients who complete it. For the treatment to be successful, it is important that the therapist is fully trained to direct this specific type of therapy. It is also helpful if the patient is highly motivated and has a positive and determined attitude.

The positive effects of EPR last long after treatment has ended. A 1996 study indicated that of more than 300 OCD patients who were treated with EPR, 76% still showed significant lightening between 3 months and 6 years after treatment.Foa, Edna B.; Kozak, Michael J. (1996). «Psychological treatment for obsessive-compulsive disorder». In M. R. Mavissakalian; R.F. Prien, eds. Long-term treatments of anxiety disorders. American Psychiatric Association. pp. 285-309. Another study found that incorporating relapse prevention components into the treatment program, together with follow-up sessions after intensive therapy, contributes to the maintenance of improvement.

The continued search for causes, along with research into treatment, promises to bring even more hope for people with OCD and their families.

Cognitive psychotherapy

Obsessions are intrusive thoughts, fantasies, or urges that have to do with being in danger or being aggressive. Other times they are feelings that something "bad" is going to happen or that the discomfort will never end. In any case, when they appear in the mind, the patient tries to explain them, avoid them, or cancel them by following some procedure that calms them down (what we call compulsions).

Cognitive therapy is based on the idea that thoughts, fantasies or impulses that invade the mind are not the problem in themselves, since everyone experiences them at some point, especially when they are tense for some reason. The problem appears when the patient values the appearance of these phenomena in his mind as dangerous and feels responsible for what happens, at which point he tries to do something that allows him to feel safe and not responsible for what happens.

Through experiments that the therapist designs for the patient, destructive ideas about the power of thoughts, guilt, the search for absolute security, the tendency to catastrophize, perfectionism, self-punishment and intolerance of discomfort are put to the test. This allows the patient not to react with the anguish of before, getting the obsessions and compulsions to gradually disappear.

Psychoanalysis

Other forms of psychotherapy, such as psychodynamics and psychoanalysis, can help manage some aspects of the disorder, but in 2007 the American Psychiatric Association (APA) noted a lack of controlled studies showing their effectiveness "in treating the core symptoms of OCD".

The psychoanalytic approach is one of the options that exist to treat OCD. For this kind of therapy, the emphasis is placed on investigating the origin of obsessive ideas and compulsive repetitions through the patient's own associations, to then interpret the unconscious psychic mechanisms that are involved in the formation of symptoms, ideas obsessive and compulsive repetitions.

Freud analyzed an emblematic case of a patient who presented a picture that he called «obsessive neurosis», called The Rat Man. In this case, it was seen that his compulsions and obsessions had elements that were repeated at an unconscious level from the homophony of words or situations related to the individual's family history. In the famous case of Freud published as About a case of obsessive neurosis is the analysis and solution of a series of obsessive symptoms of a serious nature.

At the time of its founding, the position of psychoanalysis towards neurotic pathologies in general and obsessive neurosis in particular constituted an important innovation. Freudian theory installed for the first time the basic assumption of the "psychic causality" of the unconscious conflict, where the subject, in this case an obsessive neurotic, generates symptoms as substitute satisfactions for repressed desires.

The ego of the neurotic is overwhelmed by the unconscious conflict between the commands and regulations of the superego and the unconscious desires coming from the id. In this way, unconscious desire motions can only emerge through compromise formations, which are those that are expressed in obsessive symptoms. However, there are cases of successful treatment of obsessional neurosis with psychoanalytic therapy.

Prevalence

Recent studies have estimated an overall prevalence of 2.5% and an annual prevalence of 0.5 to 2.1%. However, the methodological problems existing in the assessment system suggest the possibility that the true prevalence rates are much lower. Studies in the general population carried out in children and adolescents have estimated an overall prevalence of 1 to 2.3% and an annual prevalence of 0.7%. It is unusual for symptoms to start after the age of thirty-five, and half of people have problems before the age of twenty. Men and women are affected equally. Research shows that the prevalence of OCD is similar in many cultures around the world.

Additional bibliography

• Freeston, M.H; Ladouceur, R. (1997). "Analysis and treatment of obsessions." In V.E. Horse (Dir.), ed. Manual for cognitive-behavioral treatment of psychological disorders 1 (Madrid: 21st Century). pp. 137-169. ISBN 978-84-7927-553-2.
• Cruzado, Juan Antonio et al. (1993). Conductive treatment of obsessive-compulsive disorder. Madrid: De. University-Empresa Foundation.
• Silva, P. and Rachman, S. (1995). Obsessive-Compulsive disorder. The facts. Bilbao: Descleé De Brouwer. p. 113. ISBN 8433011316.
• Vallejo, J; Berrios, G.E (2006). Obsessive States (3rd Ed.). Barcelona: Masson S.A. p. 816. ISBN 9788445816110.
• Rapoport, Judith L (1989). «Biology of obsessions and compulsions». Rapaport L.J. Research and science books. Brain function: 142-150.
• Jakes, Ian (2001). Theoretical approaches to obsessive-compulsive disorder. Bilbao: Ed. Take off. ISBN 9788433016065.
• Tallis, Frank (1999). Compulsive obsessive disorder (a neurological cognitive perspective). Desclee. p. 232. ISBN 9788433014153.
• Olivares Rodríguez, Jose; Alcázar, Ana Isabel Rosa (2010). Compulsive obsessive disorder in children and adolescents. Pyramid. p. 288. ISBN 9788436823608.
• Cia, Alfredo H; Authors Several (2006). Compulsive obsessive disorder and spectrum. Editori Polemos. p. 407. ISBN 9789879165768.
• Belloch, Amparo; Cabedo, Elena; Carrió, Carmen (2011). Knock. Obsessions and compulsions. Cognitive treatment. Madrid: Alianza. p. 404.
• J. Chapa, Herbert (2010). Integrative Treatment of Compulsive Obsessive Disorder: Practical Manual. Bogotá, Colombia: Akadia Editorial Library. Distributes Medical Editorial. p. 380. ISBN 9789875701250.